Life and death balancing act
For Zoe Sole, living with diabetes has been a blessing and curse in equal measures. Despite recently discovering her kidneys were failing, Sole still views the disease as a positive part of her life.
Type-1 diabetes does not seem to have a whole lot going for it.
It is a disease that affects small numbers of people in big ways.
People with it go through life tethered to needles and synthetic insulin, without which they cannot survive.
Their every snack, drink and exercise session must be carefully calibrated to a reading on a blood-glucose meter. Too high, they inject. Too low, they scoff some lollies.
Even the most diligent managers of their disease live in the shadow of grave complications. Blindness, kidney failure and losing a limb are possibilities.
But Dunedin medical student Zoe Sole, 23, has lived with type-1 diabetes for 14 years and says it is, in some ways, the best thing to ever happen to her.
Diabetes is the main motivator for everything she does, she says.
"When someone tells me 'no, you can’t do that', I’m like, 'well, watch me'.
"It shouldn’t hold anybody back from doing anything they want to do."
Sole was 9 when she developed the disease. On a family ski holiday she was unquenchably thirsty. It wasn’t until she got home to Wellington she discovered she had lost 12 kilograms in three weeks, prompting a trip to her doctor.
Her blood sugar was soaring, and she was rushed to hospital where she received her life-altering diagnosis.
Her memories of that day are of her mum in tears.
Sole swiftly adapted. Even at 9 years old, she took charge. Within a week, she had learned to test her own blood sugar using a handheld digital meter, and inject herself with insulin.
"If anyone was going to stick a needle into me, it was going to be me," she says.
"I just got on with it."
From that point, Sole’s life was a balancing act.
She tests her blood sugar up to 15 times a day: before and after meals, before, during and after sport, and often once during the night.
Though the prospect is gruelling, she says the nocturnal tests are better than the alternative: hypoglycaemic episodes have killed many diabetics in their sleep.
Her health has been relatively stable since her diagnosis but she has had close calls.
"I’ve had scary hypos [low blood sugar] overnight, where I’ve woken up drenched in sweat and not with it," she recounts.
"I’ve woken up in morning and there’s been jelly beans all over the bed."
Depending on her meter’s readings, Sole injects insulin into her stomach and legs about eight times a day. At school balls, this meant removing her gown in the bathroom.
On occasions when she has injected in public, she has had strangers accuse her of taking illicit drugs.
Sole is pragmatic about such encounters.
"It’s just an awareness thing," she says. "But I’m not going to change what I’m doing."
Managing her diabetes has taught her discipline and control, virtues that have translated into other spheres of her life, she says.
Sport has always been an incentive to keep on top of her condition. And this diligence has paid off.
Last year, Sole completed her first half Iron Man – a 2-kilometre swim, a 90km cycle, topped off with a 21.1km run.
The Otago University medical student believes her experiences will make her a better doctor.
"Diabetes has given me the biggest advantage I could ever ask for," she says.
"I understand what it’s like to live with a chronic condition, and what it’s like to be told by a doctor that your control’s not good enough. They don’t understand how much time and effort it takes do your best."
Sole has for seven years supported others with diabetes at youth camps.
She is passionate about helping those with body image struggles, which she says go hand in hand with having type-1.
A hyperawareness of calorie counts, combined with the "near impossibility" of losing weight on insulin therapy, can be a calamitous combination for image-conscious teens, she says.
Some diabetics stop taking insulin in an effort to lose weight, playing Russian roulette with their health.
While they can lose about 5kg in one week, the practice can put someone in a coma within days.
Unlike some of her peers, Sole has never been tempted – the risks are too great.
She has had struggles with disordered eating, which she has conquered only since becoming a self-described Crossfit addict a year ago.
"I remember walking into the gym and all I wanted to do was lose weight," she says. "Within two months, everything changed."
For the first time, she was pushing herself to test her physical limits, not to lose weight.
Sole hasn’t stepped on the scales since.
Despite her best efforts, Sole recently discovered she was entering stage-2 kidney failure.
"That was quite a rough day," she says.
"Diabetes has always been my No 1 priority. I’ve known others who haven’t taken as good care of themselves and been fine.
"I felt like saying, 'well, this isn’t fair'. But life isn’t fair."
Sole’s kidney function will decline as long as she has diabetes: a transplant or a cure are her only options.
But she is cautiously optimistic: "I don’t follow the research as closely as some people, but in 20 years there’ll be a cure, if we’re lucky."
And if that day comes?
"I can’t imagine my life without it. It’s going to be a very weird day. I’ve got mixed feelings about it."
WHAT IS TYPE-1 DIABETES?
Type-1 diabetes affects about 10 per cent of diabetics. Unlike type-2, which is caused largely by obesity and diet, type-1 results from the immune system attacking insulin-producing cells in the pancreas.
Though the symptoms are the same for both types – increased thirst and hunger, frequent urination, weight loss – type-2s can go into remission by changing their diet or having gastric bypass surgery.
Type-1s must manage their condition with synthetic insulin, and will have the disease for life.