Diagnosis

Monday, 22 July, 2007. Everything changes. The doctor says, "Hmm, the test," and there's something in his voice that tells me before he finishes on the computer keys, before the results of the glucose tolerance test come up on his screen. About five years ago, I did the same test and it came up with impaired glucose tolerance. Nowadays, I learn, that's called pre-diabetes. Maybe to rightfully scare you better. I didn't get scared enough, so here I am, and the doctor looks me in the eye and says, "You have Type 2 diabetes. You're diabetic." He repeats it, maybe as he watches my face crumple and wonders if I've properly heard. "You're diabetic."

So. Everything changes. I can't expect my body to cope any more. Without changes, I am heading to a hell of blindness and amputation and heart disease and kidney disease and a shortened life span.

I'm in my mid-forties and have been overweight for years.

It took me a little while to write that last sentence. Instead, I went hunting for an online converter to see if figures make it any better. (Delusional procrastination would be one label for it).

Here are the numbers.

I'm 167cm tall (or 5'6").
I currently weigh 115kg (253lb).
My BMI is 40.8 (obese is over 30). Calculated here.

My ideal weight is between 58 and 65kg (130 and 144lb). A long way away. The doctor says that even if I lose 20kg (44lb) it's unlikely to be enough to make medication unnecessary, or do as much as needs to be done.

For now, maybe my initial target should be 99kg (218lb). Double figures.

The test results were high enough to have the doctor put me on medication straight away, a version of metformin, which I gather is a common and effective medication for type 2 diabetes. I've never before had a script with such bulk or longevity. It makes this all hit home, when you see the big box, know you have five repeats and that this is longterm. I don't know if I can lose enough weight and achieve good enough blood sugar readings to make medication unnecessary. I have to remember to take one every night with dinner, every night, every night of my life for the indefinite future.

I don't know is a wall I find myself up against in many ways. I'm a well-educated, well-read person, but I'm suddenly in a whole new world, at sea and trying to make sense of it all, not generically but in specific reference to me, to this body I inhabit.

The doctor gives me a double-sided sheet of patient information about type 2 diabetes. It has the things I sort of know already. Insulin is important. It's not working properly in your body. Lose weight. Exercise. Watch your diet.

I've been on diets before - a fad here and there, but mostly proper, considered ones. For three different time periods I've visited a dietitian, a wonderful woman and my failure to lose and keep off weight is my own, nothing to do with what she might have done or could have done. I refined what I ate to some excellent choices: but where I've fallen down is mostly chocolate, the fat and sugar hit that can kybosh a sensible breakfast, a nutritious lunch and a wise dinner. Chocolate is peace. And sanity. And time out. And a mouthfeel that greets you every time. It's a medication for stress and a reward for exhausting effort.

And now, it's poison.

After getting the biggest prescription of my life filled at the pharmacy, I head down to the supermarket. It's dinnertime, and although I have reasonable food choices at home, I feel as though I have to start the changes NOW, with the next meal.

One of the food options I developed from the dietitian's input was my personal salad. Like most people, there are salad ingredients that work for me (eg. carrot, tomato, lettuce, mushroom, capsicum, shallots, cucumber) and those that don't (never avocado; celery cooked but not raw). I trundle my basket around the supermarket and buy for the new life. The salad ingredients I like. Small portions of lean beef. A couple of salad dressings.

And I'm reading labels, and I'm still at sea. I can understand what I need to do to lose weight, but if you add in the complication of whatever it is I need to do in terms of carbs/blood sugar, I don't know. It's not just about the calories or fat content.

The doctor is organising referrals to the dietitian and to a diabetes nurse educator, but in the meantime I'm on my own.

My breakfast choice since they came on the market is All-bran bars. The dietitian originally suggested Fruity-bix bars, and I ate them for breakfast for a while. I usually eat breakfast while driving to work - it's a long drive, and this way I savour breakfast. All-bran bars are higher in fibre and from memory came up well on the comparison, so I went with them. For now, they seem like an OK choice, along with a banana. That's breakfast sorted.

Morning tea and lunch - it seems right to do these, I haven't always been having them. Harris Farm Markets have a wonderful plain yoghurt, while bananas I like and apples (Royal Gala) I like too.

Dinner: the big salad, with lean meat and should I be factoring in a serve of carbs? I remember the dietitian talking about one rice being particularly low GI. Mahatma brand, I think. Maybe I'll just use up the long grain I have in the cupboard first, then switch to brown rice (I'll miss jasmine rice, such a wonderful fragrance).

I haven't been eating a lot of takeaway food. Occasional Thai, pizza maybe four times a year? For all the reading I'm doing and the blame that's being laid on preprepared meals and takeaway, it's not been how I eat. I'm more likely to go for a tin of soup, although I'm aware that they can have issues with sodium. For fast work lunches, though, there must be some reasonable options among the better-quality ones. I come away with some tetra-bricks of mostly vegetable soups.

And so I come home, and cook a midget lean steak and make two big salads, one for dinner and one for tomorrow's lunch, and try not to cry. But I do. It's fear and anger and despair and anger and the fact that everything's changed. Some test results on a page mean that any excuse fades away. Unless I change, and aim to be wise, I sail off the map where there be dragons.