When the model Roxy Horner married the comedian Jack Whitehall last month there was a moment before she walked down the aisle when, she says, she felt as if “I was going to bawl my eyes out”. But on seeing all the people she loved — and hearing their daughter, Elsie, aged two, shout, “Daddy! Daddy!” — she couldn’t stop smiling. In fact it was Whitehall who was overcome with emotion. “He was crying and it was so sweet,” she says.
Horner, 34, had a little more to contend with than the average bride, having been diagnosed with type 1 diabetes five years ago. “I was very anxious about managing my diabetes on my wedding day because I was thinking, what if my glucose levels go really low while I’m walking down the aisle?” she says. Fundamentally, though, she knew she didn’t have to worry. The tech she uses to manage her condition, “I trust with all my heart”.
“I’ve got these two devices managing my diabetes for me,” she says. She wears a Dexcom G7, a continuous glucose monitor (CGM) that sends accurate glucose readings to its app on her smartphone every five minutes, no finger pricks required. It’s a little flat disc (for her wedding she had it “blinged up” with little stick-on pearls). “I put it on my arm or my tummy and it reads my glucose levels for me, it talks to my phone,” she says. Consequently she can see her levels at a glance.
She also has a tiny device, the Omnipod 5, which works in what’s called a hybrid closed-loop system with her CGM and injects insulin into her body as needed. “I’ve got mine on my leg,” she says. “I’m getting insulin injected into me while I’m talking to you. I don’t have to do it myself.”
Roxy Horner with her CGMInstagram
Nearly half a million people in the UK have type 1 diabetes and over the past two years tens of thousands of them have benefited from an NHS rollout of hybrid closed-loop systems, which are also known as an “artificial pancreas” (the Dexcom and Omnipod system is just one of several prescribed by the NHS; they’re also available privately). Although such systems automatically adjust the delivery of insulin to keep glucose in range, Horner says you still need to tell them whenever you’re about to eat.
“There really is no kind of break,” she says. “Everything you eat, everything you do, you’re thinking about your glucose levels.”
No one wants to count carbs before tucking into their wedding cake but Horner had no choice. “I tell my hybrid closed-loop the rough amount of grams of carbohydrates I’m going to have and it will inject me automatically,” she says. Then she waits five to ten minutes for the insulin to be absorbed. “I eat my cake and go about my day, as long as I get it right. You do have to take into account, ‘Am I going to be dancing or going for a walk or to the gym?’ All these things change the amount of insulin you’re going to need for that cake.”
That essential pause before every meal doesn’t always suit Whitehall. “Sometimes we’re at a restaurant and Jack’s eating and I’m like, ‘Hmm. Can you wait?’” Horner says.
She now has the experience (and the tech) to manage her condition effectively but Horner knows how dangerous and terrifying it can be. Before she was diagnosed in her late twenties, she was busy, happy and successful, and didn’t understand why she felt so acutely unwell.
“I was so thirsty that no matter how much water I drank I would be gasping,” she says. “I was drinking excessive amounts. I bought a four-litre bottle off Amazon because I was drinking jugs of it.” She was constantly hungry and eating — “I felt like I needed energy” — yet was losing weight. She knew it was bizarre — she was barely moving. “Even walking round the block I felt like I was going to pass out,” she says. “I was really, really exhausted. I was crying, I was sad, really depressed, because I didn’t feel like myself. I gaslit myself. I don’t know why I didn’t believe myself that there was something wrong.”
Yet she had sought medical advice several times. “The doctors were telling me I was fine,” she says. “They didn’t look at me and assume ‘diabetes’. Type 1 used to be known as ‘juvenile diabetes’, which is not the case at all. You can get it at any age. It’s an autoimmune disease. We don’t really know what causes it.” While it can be hereditary, no one in her family has it. “It can just happen to anyone,” she says.
The couple at the Grand Prix in Monaco last year Daniele Venturelli/Getty Images for Grand Prix De La Haute Joaillerie
Horner became so desperate that she sought advice on social media. Replies told her to check for diabetes. “I went into a pharmacy and bought myself a finger-prick monitor. My glucose levels were 32.8 — ridiculously high.” She took herself to A&E. She told them: “I’m sorry, I can’t go on like this. I feel like I’m dying.”
Instantly diagnosed, Horner says she was actually relieved to know that there was something wrong with her. However, she still didn’t realise how serious it was. “I thought I’d be in and out — I was there for days,” she says. Then she discharged herself. “I had a terrible hypo, where your sugar goes so low that you can pass out. I panicked and I took myself back to hospital that same day.”
It was traumatic and a big learning curve, she says, noting that while undiagnosed type 1 diabetes can be fatal (“If you don’t have your insulin, it will kill you”), it can also be slow onset. “I felt like I had symptoms for, honestly, about a year and it gradually got worse and worse and worse.”
Memory loss was another symptom. “I still suffer with that, actually,” she says. “Memory loss is really bad for me. I forget the simplest things. Jack and I will watch something and I will sometimes forget what we’ve just watched.”
Now she is experienced in controlling her condition. “But you do have to learn quite a lot about managing diabetes, type 1 especially, because it’s a dangerous thing to manage,” she says. “You’re playing with your life every day. Injecting insulin into your body is so dangerous. I was pricking my finger up to 20 times a day to check my glucose levels. That was quite consuming. I couldn’t focus on anything else.” She was also manually injecting herself.
For the first three months she was too scared to go to the gym. “I kept having these hypos. I was terrified, your whole body goes shaky, you can pass out — and I have passed out before.” A few times, she says, “I was so terrified, I called the ambulance”.
Then a friend gave her a CGM to try and, a year in, Horner discovered Dexcom “and never looked back”. She’s had the Omnipod for a year. The devices have been transformative. So much of her headspace had been taken up by the logistics and stress. “I can be with my family and friends again, and not worry as much,” she says.
If her glucose levels go out of range, her Dexcom sends an alert to her phone. It can also send alerts to people she trusts. “So my mum and dad, for instance, have this alarm going off on their phone sometimes, which,” she says wryly, “may or may not be great for them. They have turned up at my house at a ridiculous time in the morning: ‘Oh my gosh!’ — Jack was away — ‘You’re alone with Elsie, we panicked, we saw you were having a hypo in your sleep!’”
Horner is Essex-born but her parents lived in Australia for 12 years. “And then, when I fell pregnant, they very sweetly moved back to the UK so they could be close by and help with childcare,” she says. “They live in Oxford now, which is really lovely.”
Horner hadn’t realised that pregnancy with type 1 diabetes needs careful management. “It is a terrifying thing being pregnant with type 1 diabetes,” she says. “Your glucose levels do crazy things. My glucose levels were going really, really high, really, really low, all over the place. I had to go in every week either to have a scan or make sure baby was OK or I was OK.”
Fortunately her local hospital took great care of her. And Horner was fully focused on controlling her diabetes throughout her pregnancy — again, her Dexcom was invaluable as she watched everything she ate. (Managing glucose levels reduces any risk to the baby’s health.) As it was, she was advised to have an early birth and Elsie was delivered two weeks short of nine months.
According to Diabetes UK, the risk to the general population of developing type 1 diabetes is low (about 0.4 per cent), but for the child of a mother with the condition, it is slightly higher: they have roughly a 1-4 per cent chance of developing it. Elsie is healthy and doesn’t have it but, Horner says, “it’s an anxiety I have that one day she could have it”.
It’s tempting to say that Horner looks a picture of health but the difficulties and dangers of type 1 diabetes aren’t always apparent, which is one of the reasons why she wants to raise awareness of the condition. Her devices have been a “game-changer” and she marvels at how far tech has come for people living with type 1 diabetes. But, she says, “It took me a long while to feel OK and normal. And I don’t feel normal ever, I guess, because it’s always there.”