Diabetes ‘epidemic’ — a mum’s ordeal
because of the effects of diabetes.
Over time, poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys that filter waste from your blood. This can lead to kidney damage and cause high blood pressure.
High blood pressure can cause further kidney damage by increasing the pressure in the delicate filtering system of the kidneys.
The cost of it all? Bay of Plenty District Health Board acting chief operating officer Bronwyn Anstis says $5,845,089 was spent on renal related services in the 2019/2020 financial year.
It’s just a small dent in the $2.1 billion spent a year on diabetes nationwide. The trouble is keeping that number down.
About 8000 people in the Western Bay of Plenty region have type 2 diabetes, including 1400 Ma¯ori and 200 Pasifika. About 4500 are men.
The number of Kiwis with type 2 diabetes is projected to rise by 70 to 90 per cent by 2040 if nothing is done, according to a recent PWC report.
There are currently about 228,000 with the disease. This could rise to 390,000 to 430,000, or up to 7.4 per cent of the population.
The report said New Zealand was headed for “epidemic proportions” of diabetes in the next 20 years.
People will develop the disease younger and there will be worse health outcomes for minorities if “no action is taken now”, the report found.
It means more people could be like Geri — or worse. As we sit and chat I take notice of those around her, some missing their feet or legs due to amputation resulting from diabetes.
None of them are smiling and in a hot room they are all wearing beanies, layers on top of layers and tucked in with blankets.
Geri wears a beanie trying to hide her hair she forgot to do before I came. As a hairdresser by trade she doesn’t want a photo advertising her bad-hair day, she says with a laugh.
A bright purple sleeping bag lies across her lap and as with others around her, headphones connected to the television above are close by, allowing them to zone out for the five hours.
Geri tells me all the layers and heat are because once the blood goes back into the body, it’s colder after the machine has worked to clear the waste from her blood.
And she means literal waste. Geri cannot use the bathroom and limits her liquid intake to 750ml a day. That includes a yoghurt. And for the time she has sat today, three litres of waste has been extracted from her blood.
It was her inability to go to the bathroom in the first place that led her to where she sits today.
“In actual fact, my kidneys were failing on me.”
When she was pregnant with her son in 2003, Geri had to start taking medication. For close to 20 years, she hasn’t missed a day of taking it.
Now she is on a different type of insulin which is working okay, she says, but medication isn’t enough.
“You have to change your whole mindset.”
Eight years after her daughter was born, Geri went to the doctor multiple times with a severely bloated stomach, asking “what is wrong with me?”
It was a specialist that told Geri her kidney was functioning at 7 per cent.
“I started getting cold all the time. I would sleep all night, all day. My husband would want to take me out and all I’d do was sleep. All I could do was think, ‘get me home to bed’.
“I actually thought I was dying, really dying, with only a couple of weeks left.”
With that in mind, she decided to take her children on a holiday to Auckland, giving them memories with her for what she believed was the last time.
When she returned home, Geri went to her doctor who said she needed a pre-assessment for dialysis. Wanting nothing to do with it, Geri asked if exercising more and eating better would help her diabetes.
“The doctor turned and said to me, ‘It’s too late’. That’s the worst words you want to hear.
“I just sat there with my mouth wide open, absolutely shocked at the diagnosis. I guess I was so selfish, within myself, thinking that I was all good . . . So lots of things have changed for me, apart from the sitting here three days a week.”
While that is her reality, Geri admits that at the start she wasn’t so positive.
“I bawled my eyes out, I was so upset because I thought, ‘Do I want to live like that or am I prepared to carry on until I die?’
“I couldn’t believe people were sitting there for five hours, and thought it was such a waste of time. I was an active mum, we had dancing and all these things and I wondered, how would I be able to do these things with my girl?
“I wanted to give up, to be honest, I didn’t want to do dialysis. I thought there was no point in doing it. I’m just waiting here till I die.”
But there is always hope — technology can change and Geri is happy to hold on for her children. However, she is also too high a risk to have a kidney transplant.
As she adjusts her chair, making sure the tubes transporting blood from the fistula in her arm are all intact, Geri says the harsh reality of dialysis is she could arrive tomorrow and there will be someone missing that used to sit in the chair next door. Or it could be her.
“It changes just like that, it’s really fast. I don’t know from day to day, if I’m gonna have a good day; Whether I’m going home or going to the hospital.”
Geri may bear the brunt of her disease but having diabetes affects the whole family, she says.
“My kids are the ones that suffer as much as I do and my husband because there’s a lot more he has to do now.
“But he’s a beautiful patient man, that just picks up the pieces for me and goes along with what needs to be done.”
Renal service clinical nurse manager Katie Johanson says the Tauranga unit had 28 patients who attend three times a week. There were also eight patients who do home haemodialysis and around 40 who do peritoneal dialysis at home.
At Whakata¯ne Hospital, there are 24 patients who attend three times a week, 13 patients who do home haemodialysis and around 35 patients who do peritoneal dialysis at home.
“We have patients that travel from all around the Bay of Plenty to undertake dialysis in Whakata¯ne and Tauranga. We have some patients in the Te Kaha area that travel to Whakata¯ne three times a week.
“Both the units are full, so we have on average 12 patients that travel from Tauranga to Waikato three times a week, and in Whakata¯ne we have five patients that are either travelling from Whakata¯ne three times a week or they stay in Waikato as the travelling time is too long.”
It’s the same story in Rotorua. Lakes District Health Board clinical nurse manager Tracy Boyd says the hospital currently treated 24 haemodialysis patients over six days per week and 36 peritoneal dialysis home-based patients.
However, some six to eight patients have been travelling to Waikato District Health Board for treatment three times per week, she says.
“The numbers treated in the unit have remained steady up until approximately the last six to 12 months, when there was an increase in numbers. However, the increase did not see the number of permanent patients increase sufficiently to have a second shift here.
“They will be able to be treated in Rotorua from early July when an afternoon shift will start here.”
In the past, patients have travelled from as far as Taupo¯ and Tu¯rangi to have dialysis in Rotorua.
“The increasing number of people requiring dialysis is a concern. Needing dialysis has huge personal costs, for example being unable to work and disruption to family life. It is also a large cost to the health system.”
Johanson, of the Bay of Plenty District Health Board, says the number of people needing dialysis was increasing due to the high prevalence of diabetes, the ageing population and more complex health needs.
While it was a privilege to be part of each patient’s journey, it came at a cost, she says.
“For dialysis patients, it is ongoing, time-consuming and it is a life-sustaining treatment that can create a big burden on them and their wha¯nau’s lives. These patients often have a lot of other health conditions, so it is often a challenge to address all their health needs.”
She says it is unfortunate for those patients who had to travel to Waikato for treatment, but the number continued to grow.
“It is very hard to tell them that they will need to travel to Waikato for haemodialysis.
“Ideally, we would like to have a facility of sufficient capacity to allow us to provide care for all of our renal patients.”
Geri agrees. She would like to see a renal ward with more seats plus an emergency area independent of the help from Waikato Hospital.
“I also feel there should be more done in the community about this, we could be educating people more than we are.
“I would like to see renal failure where cancer is, it might seem like a big jump but it’s not.
“I feel like we are alone.” But for now, Geri sits and waits, with layers on top of layers, while a machine acts as her kidneys to ensure she can go home and be with her children.
“I’m staying healthy enough to be there for them, to say good morning to them, to see them smile.
“Those are things that I look forward to with my children.”