Background
I have suffered from depression since I was 14 but was only diagnosed when I was 16. I am currently trying to get my diagnosis changed to treatment-resistent recurrent depressive disorder as my reading of ICD-11 before it came into effect suggested two of my ICD-10 diagnoses could be coded as a single diagnosis under ICD-11.
In February 2025 I contacted my GP for the first time in years (outside of vaccinations) for a referral to the mental health team as my mental health was starting to effect my physical health. I also went to Specsavers over concerns about my eyesight and hearing degrading, but other than a change in astigmatism and a slight change in sight neither an OCT scan or audiology test found anything wrong.
Not happy with the lack of specificity in the audiology tests which only focussed on a small number of frequencies of human speech, and realising I didn't have a contingency plan for sight loss, I ordered the RNIB's dot-to-dot Braille course (the "by touch" material/method), with an aim to learn contracted Braille, Math Braille, and Music Braille before the possibility of sight loss (I have yet to start learning uncontracted Braille despite having the material), and I also started to try to memorise the deaf-blind manual alphabet (I've probably forgotten some of it in the last year).
Also in February I saw an emergency dentist for a cracked tooth that was later extracted, and in March 2025 I saw a physiotherapist for pain in my right arm where I was diagnosed with carpal tunnel syndrome and tennis elbow, was seen in the urgent care centre 9 months after a cracked/broken rib hadn't healed (they didn't do an x-ray, just said to take paracetemol/ibuprofen), and saw the mental health team and restarted antidepressants after discussing which ones to retry (followed up with a dose increase the same month and the following month).
In May 2025 my blood pressure was recorded as 138/90, heart rate in the 90s with regular sinus rhythm, and was prescribed anti-dizziness medication.
In September a second anti-depressant was added, followed by a dose increase at the end of the month.
In October I self-diagnosed myself with Vitamin D deficiency and possible osteomalacia due to the arm/rib pain persisting and having needed to have a tooth extracted, and started to take Vitamin D3 at 1,000 IU per day.
I brought up the supplementation and my theory at my next GP appointment and had blood tests in early November, where insufficient Vitamin D was confirmed (34 nmol/L) and was prescribed a booster dose of Vitamin D3 (20,000 IU tablet three times a week for 5 weeks) after which I was to restart taking 1,000 IU per day OTC for life (including in summer). At the same appointment my weight was recorded at 144 kg which was noted as a 6% gain from previous reading (136.4 kg in June 2022).
Multiple blood tests were done at the same time as the Vitamin D test in early November (references to billions/trillions use the short scale):
- T4 was slightly low (11.6 pmol/L) but TSH was fine (2.17 mU/L).
- Ferritin was fine (200 μg/L) but folate (5.8 μg/L) and Vitamin B12 (491 ng/L) were at the low end of normal.
- Ionised calcium (2.36 mmol/L), adjusted calcium (2.32 mmol/L), inorganic phosphates (1.42 mmol/L), ALP (115 U/L), and albumin (44 g/L) were within reference ranges.
- ALT (119 U/L) and GGT (495 U/L) were very high, with bilirubin (9 μmol/L), protein (77 g/L), and globulin (33 g/L) within reference ranges.
- Sodium (142 mmol/L), potassium (4.5 mmol/L), urea (4.6 mmol/L), and creatinine (73 μmol/L) were within reference ranges.
- Cholesterol (6.5 mmol/L) and triglycerides (4.58 mmol/L) were high, with HDL at the low end of normal (1.35 mmol/L).
- HbA1c was very high at 60.3 mmol/mol.
- Neutrophils (6.18 billion per litre), monocytes (0.86 billion per litre), eosinophils (0.33 billion per litre), and basophils (0.08 billion per litre) were within reference ranges, with lymphocytes (3.16 billion per litre) slightly above the top of the range.
- White cells were just above the reference range at 10.61 billion per litre, but the rest of the full blood panel had everything within range - 5.07 trillion red blood cells per litre, 146 grams per litre estimated haemoglobin, 0.46 haematocrit, mean cell volume of 90.9 femtolitres, mean cell haemoglobin of 29.0 picograms, and 338 billion platelets per litre.
As well as Vitamin D insufficiency, the blood tests suggested possible Non-Alcoholic Fatty Liver Disease (NAFLD) with my GP preferring an ultrasound scan to confirm a diagnosis, poor HDL/non-HDL ratio, and possible type 2 diabetes (a second HbA1c blood test within about 2 weeks is required for a confirmatory diagnosis). There was also a slight sign of a recent COVID and influenza (probably subclade K) infection.
Pre-Diagnosis
A high HbA1c level means that red blood cells are bigger than normal. When it comes to sight loss, high blood sugar over prolonged periods can rupture blood vessels in the eyes, and blindness can occur from diabetic retinopathy. My first HbA1c test was on 6 November 2025; I enabled activity monitoring in Samsung Health on 12 November 2025, presumably after I realised I could access the blood test results in the NHS App and had analysed the data.
I swapped some foods, although being averse to food waste I didn't switch to olive oil spread until I'd used the last of my salted butter. I tried to start walking despite my short October walk requiring 2-3 weeks to recover from.
Early Walking and The Walking Plan
On 12 November 2025 I walked 1.82 km (first walk in about a month), and on 17 November I walked 2.25 km. On 22 November I located my old Garmin fitness watches and started wearing my Vivoactive 4 again. On 25 November I told my GP I planned to lose 5-10% of my body weight in 2-3 months, and was then sent with paperwork to the blood clinic for my second HbA1c.
I walked 2.25 km on 25 November (three Move IQ walks - home to the GP, GP to blood clinic, blood clinic to home).
On 27 November I went on my first Garmin-tracked walk since 3 June 2021, with the route planned to be 'around the block' at a distance of 1.34 kilometres in 17 minutes 13 seconds (moving pace of 4.7 km/h or 12:52/km). Unfortunately, I snapped the wrong key in a lock when I returned from the walk and got defrauded by a rogue locksmith, with my blood pressure recorded at 143/100 (85 bpm) after regaining entry to my room but before the fraud had been completed.
For comparison, my blood pressure on the 25th after returning from the blood clinic was 146/103 (85 bpm) and that was after having to sit in two crowded waiting rooms with my social phobia. My blood pressure on the 26th was 146/97 (86 bpm) and on the morning of the 27th 123/90 (80 bpm).
On 28 November I walked 1.11 km to the library to print copies of a Letter Before Claim, and Move IQ automatically logged the 15 minute walk to the Post Office and the 17 minute walk home from a Master Locksmiths Association member who I stopped in on for an informal consultation.
The next week I had my walking progression spreadsheet ready (albeit forgetting to add rest days) and walked 1.74 km on 1 December, 1.76 km on 2 December, 1.76 km on 3 December, 1.75 km on 4 December, and my first long walk was 3.27 km on 5 December.
The plan was to quickly ramp up distance over several weeks whilst attempting to avoid injury, at which point progression would slow to a safe 10% distance increase per week.
Diet
Also on 5 December I downloaded MyFitnessPal and created a new account (hadn't logged in to my old account since before their data breach), and realised I wasn't eating enough.
Based on regular Bod Pod assessments from December 2012 to February 2014 where I went from 255.5 lb to 174 lb [TODO: Double-check exact value] whilst my lean mass hovered at 135-140 lb throughout, I had to now look at what was feasible and what was improbable.
In 2014 there were days I'd go on a 5 hour walk and do a 1 hour run, but in order to have a 1,000 kcal deficit when expending 6,000 calories a day I was eating a fair amount of ice cream and walks tended to be fueled with Snickers bars. The first refinement from 2012-2014: I need to do things differently at the calorie, macronutrient, and micronutrient level. I also can't grill turkey breast steaks and steam broccoli - eating clean is improbable with my depression.
After looking at my 2008-2009 spreadsheet, where I went from 237.5 lb to 176 lb with both waist circumference and BMI-based body fat calculations suggesting my lean mass also hovered in the 135-140 lb, I decided that unlike 2012-14 I would not be eating for a 'high' caloric deficit of 1% body weight per week but would instead eat for my basal metabolic rate (Katch-McArdle) with perhaps a few hundred extra calories if hungry or exercising.
Thus, without even knowing how much lean mass I had, I calculated the BMR for someone with 140 lb of lean mass starting by converting 135 lb and 140 lb to kilograms (61.29 kg; 63.56 kg) and then rounded both (61.3 kg; 64.0 kg). With Katch-McArdle giving a BMR range of 1,694-1,752 kcal/day, I set a minimum average calorie consumption of 1,700 to 1,750 kcal/day.
The first macronutrient to follow from that was grams of protein per day to maintain lean mass. I started from 1.25 grams protein for 64 kilograms of lean mass (80 grams per day) to 1.75 grams protein per kilo (112 grams per day), and then tried to work that into MyFitnessPal macros whilst taking into account MFP was setting a calorie target of 1,950 kcal/day. At 4 kilocalories per gram of protein, 25% of calories coming from protein (487.5 kcal or 121.875 grams) when scaled down to 1,700 kcal seemed OK (425 kcal or 106.25 grams).
That was followed by setting a carbohydrate target of 40% daily calories (4 calories per gram) and fats target of 35% daily calories (9 calories per gram).
The first micronutrient to be looked at were saturated fats, where I set a ceiling of 22 grams per day. That was based on 1,850 kcal being 74% of 2,500 kcal (men's recommended intake) and the advice to keep saturated fats to no more than 30 grams per day for men. 74% of 30 is 22.2 grams per day. Alternatively, 10% of 1750 is 175 kcal, or 19.4 grams per day.
All other macros were ignored (sugars is 73 grams per day) with the exception of iron: MFP uses some weird iron RDA that isn't suitable for men, so I changed my iron target to 45% of US RDA (there was some maths involved but I can't recall it).
Red meat was dropped, saturated fats were cut, most fruit was cut, fruit juices were cut, and I spent a couple of weeks trying to find a milk replacement. After much exprimentation, I switched back to semi-skimmed cows milk for my tea and use no-sugar soya milk in my porridge. Sodium is less of a problem than getting my potassium intake up.
Dietary Modifications
Glycemic index and muscle glycogen replenishment also play a part in terms of sugar control.
Taking my porridge as an example, it used to be oats, semi-skimmed milk, cinnamon, raisins, pecans, and a banana. It is now oats, sugar-free soya milk, cocoa powder, vanilla whey protein powder, chia seeds, frozen blueberries, and pecans. The 'used to be' was in November - it had been a long time since I'd last had porridge. The ingredients for the modified recipe were purchased on the morning of 27 November for home delivery.
Sugars are less of an issue if they are combined with fats or protein, or taken after a long walk. If the porridge doesn't satisfy chocolate cravings there is 85% dark chocolate. There are sub-optimal times to have a fish finger sandwich slathered in ketchup. After several refinements due to stock issues, when I get a Tesco or Sainsbury's meal deal these days it tends to provide 48-51 grams of protein.
Early Walking Progression and Diagnosis
My walking plan continued, but then abruptly stopped:
- For week two of the plan I did four 2.75 km walks and a 5.8 km long walk, or 16.8 kilometres in total for a 23.89% increase over week 1.
- For week three it was four 3.6 km walks and a 5.8 km long walk, or 20.2 kilometres in total for a 20.24% increase over week 2.
- For week four it was four 4.4 km walks and an 8.6 km long walk, or 26.2 kilometres in total for a 29.7% increase over week 3.
- For week five, due to the weather (and the bank refusing a chargeback), it was a single 5.8 kilometre walk for a 77.86% decrease compared to week 4.
- My next walk would be in week 15 - conducting one's own fraud investigation takes time.
In week two I was hospitalised from an irregular heart beat caused by the stress of the bank's illogical decision to classify obvious fraud as a pricing dispute.
In week 5 I got confused between in-person and telephone appointments, so missed an appointment with a pharmacist. In my absence, the second HbA1c result (60.1 mmol/mol) meant I now met the diagnostic threshold for a Type 2 diabetes diagnosis, and the closest you can get to being cured is the 'remission' label. Also that week: the bank's legal team stood by the bank's final decision.
Two weeks later I had my next GP appointment where they wanted to start metformin, but I had several concerns over existing untreated insomnia (of the previous 28 days I had 0 minutes sleep on 6 of them and less than 6 hours sleep on 20 of them), persistently high stress levels (Garmin was always reporting high stress indicative of low heart rate variability), that my liver pumping glucose into my blood is not something I wanted to interfere with if it was keeping me functioning, and that I wanted at least one more HbA1c data point before I'd consider metformin as I believed I would be in the normal range at that point.
I had, after all, said "I plan to lose five to ten percent of my body weight in the next two to three months" six weeks prior, and as of that morning I weighed 128.9 kg - a 10.5% reduction in body weight. Continued weight loss on top of my other metformin concerns raised the risk of EDKA, and I also hoped my next HbA1c would give an indication of whether my blood glucose can be controlled without medication despite the lack of sleep and high stress levels.
The Third HbA1c Result and Eye Tests
Two weeks after telling my GP I wanted another data point I had a triple appointment at the GP surgery. First was an ECG following the hospitalisation because apparently ECG printouts aren't shared - unlike when in hospital 6 weeks earlier I had a regular sinus rhythm and nothing abnormal. That was followed by my first diabetic review, which was followed by a GP appointment to discuss the ECG results.
I weighed 127 kg - a reduction of 17 kilograms (37 pounds; 2 stone 9 pounds; 11.8%). My blood pressure was 121/89 (76 bpm) - diastolic was still an issue at times.
Before getting those results, though, I had my first diabetic eye clinic appointment the next day. They told me to wear my prescription distance lenses so I did, and when it came to the eye chart I had trouble focussing - I could only read the fourth line on one eye and the letter 'A' in the other. With my pupils then dilated and them using 2D photography for my eyes (where I had to hold my eyelids open due to photophobia), I was left feeling my eyesight had massively degraded.
I left the eye clinic with blurry vision and headed towards Specsavers, stopping at the dentist on the way to book my first checkup since the Vitamin D booster. Holding my phone calendar up they wrote an appointment time on a post-it so I could read it a few hours later, and popped in to Specsavers.
Specsavers warned about the cost of an eye test after only 11 months and that the NHS recommends 24 months minimum and won't pay towards things if my prescription hadn't changed, but I had literally just had an eyesight exam whilst wearing my current prescription and could only read the first line in one eye - it was literally impossible for my eyesight to have not changed. They wrote an appointment for the next day on the post-it note. When I got home I looked towards the box with Braille dot-to-dot in with my blurred vision and thought "it would've been useful to have learn Braille before now".
The next day I visited the dentist, a white filling was starting to have issues, and not wanting to go through another cracked tooth we discussed the options and agreed to replace it with an amalgam filling rather than hope it wouldn't get worse. Upon arriving at the receptionist to book an appointment they said someone had just cancelled and an appointment was available immediately - back to the same dentist's chair. With filling drilled out and replaced, I went to Specsavers without being able to eat or drink anything for a while.
The result of the eye tests revealed my eyesight had only slightly degraded with the biggest issue being my astigmatism changing again (much like the year before). I paid for an OCT scan and there was no real change from the year before - my hyperglycaemia had not caused eye problems yet.
When the results of those blood tests came, they would be data points to see if I needed to tweak anything. All references to billions/trillions use the short scale:
- ALT (66 U/L) and GGT (77 U/L) were high, with ALP (77 U/L), albumin (41 g/L), bilirubin (6 μmol/L), protein (68 g/L), and globulin (33 g/L) within reference ranges.
- Sodium (144 mmol/L), potassium (4.0 mmol/L), urea (4.4 mmol/L), and creatinine (91 μmol/L) were within reference ranges.
- Triglycerides (1.76 mmol/L) were still elevated, but cholesterol (3.8 mmol/L) was in the normal range. HDL had dropped under the low end of normal (0.95 mmol/L), with my LDL at 2.05 mmol/L, non-HDL at 2.9 mmol/L, and cholesterol/HDL ratio at 4.0.
- HbA1c was a hair within the normal range at 41.8 mmol/mol or 6.0%.
Two weeks earlier my ALT was 130 U/L (up 9.2%) and GGT 162 U/L (down 67.3%). In terms of my liver, in 12 weeks I had got ALT down by 44.5% and GGT down by 84.4%. I was still waiting on an abdominal ultrasound appointment. In terms of lipids, I had already switched from the olive oil spread to ProActive (with plant sterols), and I wasn't yet sure what to do about my dropping HDL levels.
In terms of my blood sugar and insulin sensitivity, in 12 weeks my HbA1c was down 30.7% and barely within the reference range. That result still included about a month of pre-November red blood cells, so another data point was needed to fully determine what the changes had done, however the result did say I knew what I was doing. 3 weeks later I was starting the diabetes online education course I was referred to.
The early walking helped, but as my next walk wouldn't be until 5 March 2026 (5 weeks later) the change in HbA1c was mostly due to dietary changes, caloric deficit, and visceral fat reduction.
I have still got to get around to learning Braille.