You don't have to let a chronic disease control your life. Janice Taylor (not real name) did not wallow in self-pity or denial, when diagnosed with diabetes at the age of 22. She tells Gwen Lee of HealthAnswers how she controls the disease instead.

Staying Cool About Diabetes
If you see Janice walking briskly or skipping rope deftly in the neighbourhood park, you'd probably think she is another young woman in the pink of health trying to stay slim. The truth is, Janice is living with the silent killer -- diabetes, and she is doing her routine exercises to strengthen her immune system and reduce the risks of complications.

Five months ago, Janice was diagnosed as suffering from diabetes (Type I). Next, the pretty IT officer learnt there is no cure for the disease, and that once she's hunted down by the killer, it will shadow her for as long as she lives. One would expect her to feel shocked or saddened by the verdict, but her initial reaction was nothing of the kind.

"I was very cool about it," says Janice, "It never crossed my mind that I'm too young to get diabetes nor did I ever ask 'why me?'. I just accepted it." Janice attributes her positive thinking to her strong Christian faith. "Feeling upset or depressed is not going to solve my problem, I see no point wallowing in it. I believe the only way to get my life back is to follow medical advice."

Translated into action, it means she has to modify her lifestyle to include a low-intensity exercise programme, comprising brisk walking and skipping rope at least three times a week, which she tries to adhere to despite a hectic five-and-a-half day work week. And precautions have to be taken too. Each time before she exercises, Janice has to perform a blood test to ensure there is enough blood sugar for the body.

"Drastic swings in blood sugar levels is one thing that all diabetics have to watch out for during strenuous physical activities," says Janice. To that extent, brisk walking is a much safer exercise compared to jogging, a favourite activity of many young people, which burns off blood sugar rapidly and may cause hypoglycaemia. "If the blood sugar levels dip too low, one may collapse and become unconscious."

Talk to her and you will be struck by Janice's depth of knowledge of diabetes. Indeed, she has been reading all she can about diabetes since her diagnosis, as she believes familiarity with the disease is the key to control the disease itself.

Controlling The Diet
For years, diabetics have to observe the "no sugar" rule. But today, researchers have discovered that if the blood sugar level is well-controlled, diabetics can also indulge in small amounts of sugar, provided it is within the carbohydrate allowance for the meal. Still, as a rule of thumb, diabetics have to go easy on sugar and sweet foods. And diet control, which has to last a lifetime, is that part of diabetes management that many diabetics fail miserably, often with dire consequences.

While a diet high in fibre and low in sugars may be boring for many, Janice has no problem making the switch. "I'm a vegetable and fruit lover, so eating foods like brown rice or wholemeal bread is something I enjoy, " says Janice.

But Janice is only human. She admits there are many occasions when she craves for her favourite sugary snacks like chocolates, ice-creams and preserved mango slices. So how does she ward off the craving attacks?

"Self-discipline," replies Janice. "I'd tell myself 'If I eat this I'd be risking infections and complications, it's dangerous.' I just need a few minutes to cool down and the urge will subside."

Enduring The Pain
What Janice is suffering from is Type 1, or insulin-dependent diabetes mellitus, the less common form of diabetes. Of the total diabetic population, it is estimated that less than 10 percent have Type 1 diabetes.

A chronic and debilitating disease, Type 1 diabetes occurs when the pancreas produces little or no insulin, a hormone which regulates blood sugar levels in the body. When this happens, sugar does not leave the blood to enter the cells but remain in the bloodstream, causing blood sugar levels to rise beyond normal range. If blood sugar remains persistently high over a long period of time, many tissues of the body will be damaged, leading to various complications or even death.

To lower the blood sugar levels, people with Type 1 diabetes have to be given insulin, which unfortunately is not available in oral form, but can only be injected. Thus, Janice has to come to terms with syringes and needles in her daily life. On top of the two insulin jabs, which Janice takes religiously everyday to survive, she has to prick her fingers two to three times a day to monitor her blood sugar levels as part of diabetes self-care.

"Of course the pain bothers me at times. Who would enjoy it anyway?" she says, but when "self-discipline" moves over to take charge of the situation "I look ahead and tell myself that those fingerpricks are necessary to avoid more suffering in the long run."

Another thing that Janice has to be careful about is her foot health, as diabetics are prone to foot problems. As part of foot care, Janice checks her feet for sores and signs of infection every day and make sure they are always clean and dry.

"I try my best to look after my body by going for regular check-ups and so on, but there's only so much I can do."

Keeping Complications At Bay
That diabetes can lead to severe, and sometimes fatal complications, like renal failure, blindness, diabetic foot requiring amputation, stroke or heart disease - one reason it has been labelled "the silent killer".

The truth is that although good control of blood sugar levels cuts the risks of complications, there is no guarantee that all the patients' efforts and care will protect her. In some cases, complications result, even if all the golden rules of diabetes management -- medication, exercises, diet control -- are observed. And the potential for developing complications is greater among people who live with Type 1 diabetes mellitus.

"You just have to take it as it comes," says Janice philosophically. "I don't want to be paranoid about it"

So far, Janice has been able to carry on her daily routine just like any other healthy individual. She is quick to add that if diabetes has changed her life at all, it has increased her awareness of the disease. .

To cope with diabetes all of her life, Janice says, it takes more than just courage. And looking beyond the disease is that life force which keeps her going.

"I have my friends, my family, my commitments, and my whole life ahead of me. Having diabetes is not the end of the world," says Janice. "Diabetes is part of my life, there are many limitations as to what I can do or eat, but I don't want to be held back by these limitations. Diabetes shouldn't be my God, I shouldn't fear it. I should control it more than it controls me."

Date reviewed: 30 June 2000