In 1981 I was diagnosed with type 1 diabetes. The following day I started on insulin injections, which I soon learned (and indeed already knew) would be needed for the rest of my life. I was 16 years old.

In 1984 I was diagnosed with an overactive thyroid (Graves’ disease). This has recurred a couple of times since. Each time, it was treated with a two-year course of medication to suppress the overactivity of the thyroid gland.

In 2004 I was diagnosed with rheumatoid arthritis. This is a type of inflammatory arthritis, in which the membranes of the joints become inflamed. It usually starts in small joints in the hands and feet, though many other joints can be affected. There are drugs which can suppress the inflammation, but they don’t work for everyone. Permanent joint damage from the inflammatory process can occur if the right drug combination is not found, or not found quickly enough.

All the conditions I have are auto-immune diseases, in which the body attacks and destroys its own cells, resulting in some part of the body no longer working correctly.

If you met me at a party, it would not be obvious straight away that I had any of these conditions. An astute observer (perhaps a rheumatologist) might notice that some of my knuckle joints are swollen, and my right wrist is knobbly and does not bend.

You might suspect something when I start asking lots of questions about food – what food is to be served; does it contain a lot of carbohydrate or sugar; etc? I need that information to plan how much insulin I need before I eat.

If at a party I got into conversation with you about my “conditions”, I wonder how long your attention span might be? Talking about illness is often considered taboo. Did I go into too much detail about the conditions I have? Is it overwhelming to the listener hearing that I have three auto-immune conditions? On a practical basis, what does living with these conditions mean for me day to day? How do they affect my ability to work? What about other areas of life they might affect?

Sometimes I meet people who are really interested to know and understand more, and I do my best to explain.

In the media, it often seems to me that news reports over-simplify things when doing a feature on someone who has a particular chronic condition. We might be told that so-and-so has type 1 diabetes and has to give insulin injections several times a day and test their blood glucose level regularly. Perhaps less easy to get across is the particular burden of daily behaviours that are needed to control type 1 diabetes well. In my experience, it is difficult for most people to grasp this. I see I’ve drifted into explaining more about one of my conditions…

Another area that can be challenging when you have more than one condition is health care. I am under two hospital specialists – a diabetes/endocrine specialist and a rheumatologist. What if treatment offered for one condition upsets another condition? For example, steroids are sometimes used to reduce inflammation in my joints. Steroids, as many will be aware, upset blood glucose control. I regularly have to remind the rheumatologist that I have diabetes when I am being offered a steroid injection for my joints.

In January 2021 I was hospitalised with COVID-19 pneumonia. I was immediately started on the steroid Dexamethasone, which in my case definitely helped me recover. However, it upset my blood sugars (as I knew it would). I find it is certainly the case that I have to be my own doctor to some extent. That can mean making health professionals aware that I am living with more than one condition, and that treatments for one condition may affect another condition, and that one condition may affect another!

We all need to understand better what it is like to live with a chronic condition, and even more so when one person has several such conditions.

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