Sunday, 6 October 2013

The 4Ts - After diagnosis

The 4Ts campaign was launched by Diabetes UK in order to make people aware of the signs of undiagnosed Diabetes. Knowing these signs could prevent a person from going into diabetic ketoacidosis, which can be fatal.  

The signs to look out for are; 

  • Thirst
  • Toilet
  • Thinner
  • Tired

You can read more on this campaign here 

However it's important for people to recognise that the symptoms that present at diagnosis don't always end there. 11 years after being diagnosed I still experience these symptoms.

I can only share my personal reasons for why this has happened in the past and occasionally now, and hopefully by sharing them it may give a little insight into how we can help and support others who are displaying the 4Ts.

Here are a few of mine:


A lack of diabetes education can lead to all sorts of difficulties and, for some, complications. Diabetes is a life long learning process and educations needs to start from the very beginning. Structured education is incredibly helpful as the next step from basic education, and it allows us to think of strategies to adapt to our own lives... Being given a leaflet some insulin pens and a blood glucose meter, then being sent on your merry way... Not so helpful. 

Here are a few educational tools that would have made a big difference to my diabetes management:

Carb counting - Is everyone taught how to carb count from the start? Well no, they aren't, but how long is it before people are informed of this amazing self management tool? 

For me... 9 years. 

It wasn't long until I was put on a basal bolus regime, and for 9 years I was told to take exactly the same amount of insulin 4 times a day and to avoid sugary food and drinks - that was all. I didn't use the internet or social media to educate myself about diabetes until 2 years ago; otherwise I'm sure I would have discovered carb counting for myself. I relied on my health professionals to give me the information I needed to control my blood sugars, but from the start it wasn't delivered. 

And then one day I was told about a wonderful educational programme (JIGSAW) that not only taught me how to carb count, but almost everything else I needed to know about my diabetes. As insightful and helpful as this was I couldn't help but feel a little sad and disappointed that I hadn't been offered it sooner. I understand that staff are stretched, money is tight and time is precious... but for 9 years...

Corrective doses - I had no idea that I could take a little more insulin, without food, if my blood sugars were too high. On being told this 2 years ago I was shocked... Can I really take insulin without food? It was like I was being exposed to a whole new world... My blood sugars improved dramatically after this discovery. Combined with being able to carb count, I felt like a whole new person.

Rotate injection sites - Again, I didn't know this until 2 years ago! 9 years of injecting into my legs caused hard lumps and extra fat deposits to develop. These lumps change the way insulin is absorbed, making it more difficult to keep your blood sugars within target. For me this also contributed to high blood sugars, I just didn't know it at the time. 

Needle Phobia

Pre-diagnosis I disliked needles, but post-diagnosis I feared them, to the point that stopped injecting. A phobia is an irrational fear of a particular situation or object and I avoided both in any way I could. 

I was labelled as 'non compliant' even though I had admitted my fear of needles on a number of occasions in appointments. I made no secret of why I didn't get my hba1c done, but never was there a suggestion made to help me around this problem. To this day none of my health professionals have even approached the subject and I was even told by one only a few months ago; "You do not have a fear of needles".

I accepted that I wasn't going to be given help on this one, so I found my own way around it... I studied a psychology module about phobias in patients - I chose to concentrate on needle phobia and from this I found my own self help strategies.


This one's a pain in the pancreas. Stress can make a person do some strange things, but it can also make blood sugars do some equally strange things. 

When we're stressed (physically or emotionally) our stress hormones kick and raise our blood sugars in order to help us deal with the situation. However for those of us who have diabetes, bringing those blood sugars down can be tricky. 

Recent prolonged stress has left me with the 4Ts - I couldn't remove the stressor, therefore I was/am tired, thirsty, thinner and going to the toilet more often. Whilst it was happening no matter what I did to try to bring my blood sugars down they would not budge.

Stress can also affect appetites, causing blood sugars to go off target. I lost my appetite for weeks, it came back with a vengeance (comfort eating) and then off it went again. 

On seeing my consultant last week I realised that I should have gone to him much sooner than I did. I tried my best to adjust my regime and combat the high blood sugars, but being unsuccessful only added to the problem. A few comforting words, an understanding wink and a review of my sugars has helped immensely. 

Control and Rebellion

Control - This is a strange one for me - Being in good control of blood sugars, diet, exercise, and overall diabetes management can be incredibly empowering and rewarding. 

However control can also be a form of protection from hurt and pain that may have been experienced - usually it's reinforcing the problem that has caused it, and therefore not protecting us from it. Not testing blood sugars and not injecting can be forms of control in people's lives.

This leads me to...

Rebellion - Not a cry for help as some would think. I was once described as a covert rebel. I would sit and smile sweetly in appointments, but secretly I was thinking of different directions to take, escape routes and ways to cheat my clever health professionals. I didn't want to submit to their authority. In the past I'd only experienced rushed appointments with little or no change in their structure, leaving me with little or no change in myself. I wasn't given any reason to feel wanted... I felt I was simply there as a hospital number.

And today...

Today things are different... I can see the mistakes that I made and the mistakes that were made with regards to my treatment. I can see the different options that are available to me if I open my eyes and ears. I can see that if I want something I have to go out there and get it for myself... but I can also see others who are still struggling to get what they need for many reasons, and as I said before; hopefully by sharing our experiences and showing understanding we can help and support them through those 4Ts.

Please feel free to add any of your own reasons for why you still experience the 4Ts and how you have been helped/helped yourself in overcoming them.

Ninja x

© Ninjabetic

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