Roberto da Silva's passion for healthy living keeps his type 1 diabetes in check

"Back in 2020, I'd lost about 14kg in the space of three months - and I didn't have much weight to lose to begin with," says Roberto da Silva (35).

"I wasn't that concerned about the weight loss, but my wife was concerned about my health. During that time, I was also extremely thirsty and urinating a lot more than usual." "In August 2020, I eventually went to the doctor to put my wife's mind at ease and prove to her that I was okay. But it turns out that I wasn't okay at all."

Roberto's blood sugar levels found to be dangerously high

"My blood sugar level was dangerously high at 24.1mmol/L. A healthy level is between 4 and 7mmol/L."

• Mmol/L stands for millimoles per litre. It is the international standard unit for measuring the concentration of glucose (sugar) in the blood.

"Blood tests also showed that my HbA1c levels had averaged at 17.4% over the three months prior to visiting the doctor. That meant I had persistent, high blood sugar levels which was extremely dangerous and put me at high risk of serious health complications."

• HbA1c refers to glycated haemoglobin which is a measure of the percentage of red blood cells that have haemoglobin that is coated with glucose. This is because glucose sticks to a protein in the red blood cells called haemoglobin (it carries oxygen in our blood). As the blood glucose levels increase, more of the haemoglobin gets coated with glucose. The amount of glucose that attaches to haemoglobin is proportional to how much sugar is in your blood at the time. As red blood cells survive in the body for up to 12 weeks, a measure of HbA1c can show average glucose levels for this amount of time, giving doctors a good long-term measure of blood glucose control.

"My doctor told me I had diabetes, and I was initially put on medicine for type 2 diabetes. But we quickly realised that the medicine wasn't helping. Then, an anti-GAD test picked up that I had glutamic acid decarboxylase (GAD) antibodies, which meant I actually had type 1 diabetes. The pancreas needs the enzyme glutamic acid decarboxylase (GAD) to function normally. Antibodies that target this enzyme are called GAD antibodies. It's rare to be diagnosed with type 1 diabetes as an adult as this is usually diagnosed in younger people. What I have is known as 'latent autoimmune diabetes in adults', or 'LADA' - a form of type 1 diabetes that starts in adulthood."

"I decided to manage the condition as best I could"

"Leading up to my diagnosis I had felt great, physically and energy-wise. I had always relied on how I felt as an indication of how healthy I was. But that approach let me down. This has made me realise why going for regular health checks is so important."
"Initially I was in denial about my diagnosis. But when I was told that I had type 1 diabetes, I knew that I was dealing with a lifelong condition and that there was nothing I could do to change the diagnosis. I'm not an emotional person and I like being in control, so I decided to manage my condition as best I could."

"I got my blood sugar levels under control very quickly by changing my diet and starting insulin therapy. In the beginning, I had to prick my finger regularly to draw blood to measure my blood sugar levels, and then to know how much insulin - the medicine I was using to help me to control the condition - to inject into myself."

"I am also using a Continuous Glucose Monitor sensor (attached to my upper arm) and an insulin pump (attached to my abdomen). These devices assist me to monitor my glucose levels and to ensure that I inject the correct amount of insulin in my body."

"The way I eat and exercise is critical"

"When I received my diagnosis, I went home and threw all my fizzy drinks away and immediately stopped eating or drinking anything that contained sugar."

"Managing my diet has been a learning curve. Initially I cut out all carbohydrates, which meant my diet was very bland. So, I incorporated more fatty foods like cheese and eggs but that caused high cholesterol. I then incorporated more acidic foods like pineapple and tomato which increased my uric acid. Eventually I realised that an extreme diet isn't the solution and had to learn how to balance all the food groups instead."

After his diagnosis, Roberto and his wife also started going for daily walks with their dogs. "We gravitated towards an outdoors lifestyle because I was diagnosed during the COVID-19 pandemic, so training outdoors made more sense. On the weekends we would go hiking or cycling."

"Now that I've been living with diabetes for a few years, I'm working to ensure that the condition does not run my life. So, I've been trying to exercise more and venture into different sports. Previously I'd held back because there were so many unknowns around how my body would react when I started a new sport. But now I go for it!"

"I also started weight training in the gym three times a week. I've found that this has really helped to improve my blood sugar control. When I weight train, my system seems to process sugars better giving me a more predictable, less reactive response to sugars. And in general, I feel a lot better, stronger and fitter. I have also managed to pick up most of the weight that I lost leading up to my diagnosis."

"My doctor told me that my lifestyle - the way I eat and exercise - is critical for managing diabetes. Managing type 1 diabetes takes work but the price that you pay if you don't put in the effort, is your health and wellbeing, your quality of life and possibly even your life itself." Roberto uses insulin (medicine) to manage his diabetes and has also found the use of a continuous glucose monitoring device very useful in managing his condition.

• - Scheme members registered for type 1 diabetes on the Chronic Illness Benefit have cover for continuous glucose monitoring (CGM) according to their health plan's benefits.

"Find a doctor who is knowledgeable about diabetes"

"I see my GP and a diabetes educator twice a year for an overall health check, to test my blood sugar levels, and to check my kidney and liver function, and so on."

"My GP specialises in diabetes treatment. I really encourage other people living with diabetes to find a doctor who is knowledgeable about diabetes, understands your condition, and takes the time to explain everything to you. You don't need to necessarily see a specialist. There are many GPs who specialise in diabetes care and who offer truly holistic and excellent care."

"As part of my ongoing diabetes management, I also see an ophthalmologist and podiatrist once a year. All of this is covered in full within the DHMS Diabetes Care Programme, which I have access to through my DHMS benefits."

• - Find a doctor in the Premier Plus Discovery Care Coordination (DCC) Network to register you on the Diabetes Care Programme and become your Premier Plus doctor for all your chronic conditions. This doctor works with a dedicated care team focused on diabetes. If you use your Premier Plus DCC doctor, you will have full cover for: Consultations with this doctor, related blood tests, diabetes education, and education and support around your condition.

"Take small steps to achieve your goals"

"I am really pleased with how I've managed my diabetes. I'm an engineer and I approach my diabetes like an engineering problem rather than something I'm suffering from. If you look at the graph of my blood sugar levels over any 24-hour period, there is very little variation in it, with no extreme blood sugar highs or lows. I have an A-type personality, so controlling my blood sugar levels plays to my strengths."

"My mindset is the biggest factor around managing my diabetes. I know what I need, to thrive. So I make short term decisions - like living healthily- which yield long term returns for me, like a better quality of life and living a longer life in good health for all my years."

Getting this right means a lot to Roberto. He and his wife had their first child, a son, Atley in October 2023.

"At the end of the day if you live with type 1 diabetes and neglect your health and wellbeing, you and your loved ones pay a very high price as the healthcare complications are significant. That's why I advise other people who live with this condition, or with type 2 diabetes, to just start where they are and take small steps forward toward achieving their goals. You don't have to do everything in one big step. Sustained, daily steps are the key to better health. It's a health journey and it's made of living a healthy lifestyle every day."