Hello. I had a Type 2 Diabetes diagnosis a couple of years ago, and in this issue I’m going to talk through the various effects it - and the medications I have for it - has had on my thinking and feeling about food. Some of it has been very strange.

There are a variety of medications I’m on to deal with the diabetes itself, some of its knock-on effects, and then some to deal with side effects of the main meds. If you’re over 40, you probably know how it goes. If you’re under 40, you too will get to roll on the Random Ailments Table soon - the best of luck.

Most of those are not problematic. And then there are the two variations of what are called GLP-1 agonists; Trulicity and Ozempic. I was put on Trulicity first, because it’s somewhat more available than Ozempic, which is being used as a weight loss drug by millions of people who don’t have diabetes. Unfortunately, Trulicity did not agree with my digestive processes. I spent about 16 months having something wrong with my guts pretty much all the time. Rarely nausea, thankfully, because that’s something I don’t deal well with, but almost everything else you can imagine. There were a few stomach bugs that did the rounds while I was on this, and I honestly don’t know if I got them or not - their effects were basically my day-to-day baseline.

Trulicity really hated some foods, and it wasn’t always possible to predict what it would react badly with. And unfortunately, when you’re travelling, you sometimes have to eat what’s available rather than what would suit you, and that’s not a good time for the drug to decide it disagrees with what you ate. There were two instances of this; one on the way to an SCA event in the UK, which gave me four days of fairly painful issues, and one on a plane to Finland, wherein the pressure changes conspired with the general effects to give me the most painful experience I’ve ever had short of a particularly bad toothache, and caused me to throw up from the pain. Not fun.

On a day to day basis, though, and very ironically, the effects of Trulicity could be reduced by eating something with sugar in it. So I was, against all good sense, eating a biscuit or the like three times a day to keep my diabetes medicine from chewing me to bits.

It did do what it was supposed to; the diabetes numbers went in the right direction pretty rapidly alongside general diet changes. It didn’t really result in any changes in appetite or what foods I wanted, except for an absolute aversion to anything that even looked like it had been deep fried in anything but the hottest oil for the shortest time.

I lost a fair bit of weight, dropping three belt notches in a few months, and having some slight not-recognising-my-own-body oddities. I hesitate to call this dysphoria, really, because I don’t dislike the new shape, per se; I just don’t really recognise it. I’ve always been perfectly comfortable with my well-rounded shape, and tend to take the view that being fat is unhealthy with a decent dose of scepticism, given that I have been able to run 5km while being fat (although never enjoying it; I just don’t get exercise endorphins), and I have more endurance for walking or physical work than many nominally fit folk. But the bit where I threw back the covers one morning and went “whose legs are those?” was weird, as was the bit where I recoiled from my own torso in the shower because it felt wrong. And one of the very oddest things was looking down at my hands while I was chopping carrots one day, and thinking they were not my hands, but my father’s. Most of that faded after the first few months, though.

But to start avoiding those digestive side effects, I switched over to Ozempic. First up, the digestive issues almost completely vanished, which was a relief beyond measure. Second, some of the other knock-on effects (acid reflux, mainly) reduced to the point of almost disappearing; I no longer consume Gaviscon like coffee. And then there was the effect on appetite.

I have always - well, since my early 20s anyway, and I’m pretty sure before that - been someone who thought about food. As I finished lunch, my thoughts would drift toward what dinner was going to be, and I spent a lot of time thinking about what to cook, what to shop for, what to eat when travelling, and so on. The thought of breakfast would get me out of bed before most of my contemporaries were even awake, and I would walk considerable distances from whatever office I was working in at lunchtime to get specific foods I’d decided were The Exact Thing that day.

Ozempic hasn’t stopped that. But for the first time in my life, my thinking about food is disconnected from the physical want to eat. I can now forget to eat if I’m not careful, which has absolutely never happened before, outside of very high-stress work days. And I sometimes come down in the morning, feed the dog, look in the fridge, and have no plan for what breakfast will be. Sometimes I think I might skip it, but my morning meds do need to be taken with food, so some toast and a boiled egg have to happen. I have found that unless I eat some carbs, I’ll be physically tired by lunchtime, and unless I eat some protein, I won’t be able to concentrate. This has presumably been true my whole life, but I’ve never known it before, because there was never the remotest possibility before that I’d miss breakfast.

I can now absolutely miss lunch unless I’m paying attention. It’s not as though I get hungry later, either; it’s entirely possible for me to arrive at the end of the working day with no real recollection of whether I ate since breakfast. And on days where I’m not cooking for anyone else, dinner may happen quite a bit later than it otherwise would.

I still think a lot about food, because it’s still my major Special Interest, as is the way of my people, but having that not be physical is deeply, deeply weird. I haven’t had a food craving, as such, in months. I have wants for texture, alright; the crunch of crisps or crackers or wafers, the melt of chocolate, the thick sensation of a milkshake - but that’s disconnected to some degree from the taste, and there’s no want for it at the belly level.

Another two notches have gone on the belt - and indeed, I had to make new holes with a leather punch - and I’m going to have to reduce it a bit more soon. I’m getting toward the belt size I had when I was 19, although there’s still some belly there, which I think will probably be the last bit to disappear. I still have the occasional bit where I don’t recognise some part of my body, but presumably I’ll get used to that. I am not, however, used to not having the padding to hold off cold temperatures (and my thermoregulation has been shot since the very start of the diabetes medications anyway). And I think the cat is finding me a bit less comfortable to sit on these days.

So yeah. Medications can do weird stuff, and my whole visceral experience of food has changed. I miss it, sometimes, maybe even often, but there’s not much that can really be done about it, since the meds are doing what they need to do.

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