We don’t always realize it, but each one of us had come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years, you’ve done something outstanding diabetes-wise. So today let’s share the greatest accomplishment you've made in terms of dealing with your (or your loved one’s) diabetes. No accomplishment is too big or too small - think about self-acceptance, something you’ve mastered (pump / exercise / diet / etc.), making a tough care decision (finding a new endo or support group / choosing to use or not use a technology / etc.). (Thanks to Hilary of Rainie and Me for this topic suggestion.)
I would not be writing this blog today if it weren't for my decision to finally start seeing a counselor for my very deep dark Diabetes denial. I was a perfectionist in every aspect of my life - especially school. I was incredibly hard on myself in order to achieve my best possible results. Except with diabetes. And because I wasn't conquering it, I started ignoring it entirely. Guessing insulin doses, not testing for weeks on end...this went on for almost a decade.
During this time I was on a horrible 3 month cycle -- diabetes appointment with horrible A1C, ugly cry with empty promises, repeat. Each time I convinced myself that I didn't need anyone else to help me. Every other goal I had set out to conquer I was able to accomplish all by my lonesome. Diabetes was supposed to be no different, but it was.
Something clicked inside of me during one of my subsequent ugly cries in front of my Endocrinologist. The words "I need help" came creeping ever so quietly around the lump into my throat and into the open air. Exposed, vulnerable, desperate words.
I was given the number to a counselor who only treated people with diabetes. She was a godsend, and I credit her with saving my life. She didn't just save it, she gave it back to me all shiny and new.
Through counseling I realized that suppressing my fears and anxieties about diabetes was incredibly exhausting all those years. It was even more exhausting to expel them, to open myself up to a stranger about a topic I couldn't even talk to myself about. But after each session I would float out of that office, lighter than helium. I was free floating into happiness and health and a normalcy I didn't know could exist alongside diabetes.
I started talking to other people through support groups. I got introduced to the DOC, and the DOC blogosphere. I now have the best A1Cs of my 20 years of this disease and I look forward to (hopefully) tackling a scary thing like pregnancy in the future. I never thought I could do it, but I am.
I am.
Click for the Accomplishments Big and Small -Thursday 5/16 Link List
Thursday, May 16, 2013
Memories - DBlog Week, Day #3
Today we’re going to share our most memorable diabetes day. You can take this anywhere.... your or your loved one's diagnosis, a bad low, a bad high, a big success, any day that you’d like to share. (Thanks to Jasmine of Silver-Lined for this topic suggestion.)
It was 2 months after my 9th birthday. Only 6 weeks after my diagnosis.
I sat in my parents' bathroom. My skinny, bare legs pressed against the cold marble step leading up to the bathtub. I noticed how the orange plastic cap of the syringe in my right hand perfectly matched the skin of the orange I was holding in my left. My eyes darted from the syringe to the orange, the orange to the syringe, but otherwise I was paralyzed by fear.
I had practiced injecting the orange and now my left thigh was slated to be the next target.
My father was right next to me, but he sounded so far away as he whispered words of encouragement. "You can do this, it won't hurt. It doesn't hurt when we give you your shots."
I was frozen. A fat, salty tear rolled down my cheek and several more followed suit. They threatened to melt me into a puddle on the bathroom floor.
I sat on that step in the bathroom for over an hour. I did not question why I had to learn to self-inject that day, instead of the next day, or instead of years from then. My third grade brain did not process that it was just too young to take on such a responsibility because it was just that - too young. I could see the worry furrowing my father's brow and kind, patient eyes as I refused again and again. I didn't like for my parents to worry, so I tried to stifle my sobs. It only served to make them louder.
As I proceed through my Pediatric Endocrine training I sometimes look back on that day. I've asked my parents about it and they explained that they were instructed by the medical team to make me as self-sufficient as possible. They were told that the earlier I learned to do things like injections myself, the more successful I would ultimately be.
That belief has been shattered across the years, with study after study showing that the earlier the diabetes independence, the poorer the outcome. We encourage parents to continue to inject their children for as long as the child allows it. Hopefully, this memory remains just a memory for me and never a reality for future newly-diagnosed little ones.
It was 2 months after my 9th birthday. Only 6 weeks after my diagnosis.
I sat in my parents' bathroom. My skinny, bare legs pressed against the cold marble step leading up to the bathtub. I noticed how the orange plastic cap of the syringe in my right hand perfectly matched the skin of the orange I was holding in my left. My eyes darted from the syringe to the orange, the orange to the syringe, but otherwise I was paralyzed by fear.
I had practiced injecting the orange and now my left thigh was slated to be the next target.
My father was right next to me, but he sounded so far away as he whispered words of encouragement. "You can do this, it won't hurt. It doesn't hurt when we give you your shots."
I was frozen. A fat, salty tear rolled down my cheek and several more followed suit. They threatened to melt me into a puddle on the bathroom floor.
I sat on that step in the bathroom for over an hour. I did not question why I had to learn to self-inject that day, instead of the next day, or instead of years from then. My third grade brain did not process that it was just too young to take on such a responsibility because it was just that - too young. I could see the worry furrowing my father's brow and kind, patient eyes as I refused again and again. I didn't like for my parents to worry, so I tried to stifle my sobs. It only served to make them louder.
As I proceed through my Pediatric Endocrine training I sometimes look back on that day. I've asked my parents about it and they explained that they were instructed by the medical team to make me as self-sufficient as possible. They were told that the earlier I learned to do things like injections myself, the more successful I would ultimately be.
That belief has been shattered across the years, with study after study showing that the earlier the diabetes independence, the poorer the outcome. We encourage parents to continue to inject their children for as long as the child allows it. Hopefully, this memory remains just a memory for me and never a reality for future newly-diagnosed little ones.
Tuesday, May 14, 2013
We, The Undersigned - DBlog Week, Day #2
Recently various petitions have been circulating the Diabetes Online Community, so today let’s pretend to write our own. Tell us who you would write the petition to – a person, an organization, even an object (animate or inanimate) - get creative!! What are you trying to change and what have you experienced that makes you want this change? (Thanks to Briley of inDpendence for this topic suggestion.)
We, the teeth in mouths of Type 1 Diabetics everywhere, petition to end hypoglycemic reactions that occur immediately after we have been brushed.
I mean seriously, diabetes, seriously?! Right after a good brushing and Listerine-ing? It seems as though you sit quietly, rubbing your scheming diabetes-hand together until we have finished our bedtime cleansing routine. That is the only period in a 24 hour day when we DO NOT want something sweet and delicious swirling around us. Have you ever tried orange juice after minty toothpaste? Not a delightful combo, which is impressive considering almost everything is palatable when feeling low.
What that, diabetes? Glucose tabs, you say? Like we really want to mash and grind SUGAR into our pearly white selves after undergoing vigorous scrubbing and flossing? That seems like a good recipe for insanity.
Being teeth, we are all privy to the fact that poorly controlled diabetes increases plaque formation and cavities. This is supposed to be from increased sugar in saliva when blood sugars are out of range. The head in which we rest is trying real hard to keep those numbers under control, but sometimes out-of-range stuff is inevitable. But you know what doesn't help AT ALL? Forcing us to chomp and get rinsed in pure, sticky sugar when we're at our very cleanest.
So give hypos after night-time brushing a rest, diabetes. Cause we could really use some rest, too.
To read other blog posts on this topic, click for the We, The Undersigned - Tuesday 5/14 Link List
We, the teeth in mouths of Type 1 Diabetics everywhere, petition to end hypoglycemic reactions that occur immediately after we have been brushed.
I mean seriously, diabetes, seriously?! Right after a good brushing and Listerine-ing? It seems as though you sit quietly, rubbing your scheming diabetes-hand together until we have finished our bedtime cleansing routine. That is the only period in a 24 hour day when we DO NOT want something sweet and delicious swirling around us. Have you ever tried orange juice after minty toothpaste? Not a delightful combo, which is impressive considering almost everything is palatable when feeling low.
What that, diabetes? Glucose tabs, you say? Like we really want to mash and grind SUGAR into our pearly white selves after undergoing vigorous scrubbing and flossing? That seems like a good recipe for insanity.
Being teeth, we are all privy to the fact that poorly controlled diabetes increases plaque formation and cavities. This is supposed to be from increased sugar in saliva when blood sugars are out of range. The head in which we rest is trying real hard to keep those numbers under control, but sometimes out-of-range stuff is inevitable. But you know what doesn't help AT ALL? Forcing us to chomp and get rinsed in pure, sticky sugar when we're at our very cleanest.
So give hypos after night-time brushing a rest, diabetes. Cause we could really use some rest, too.
To read other blog posts on this topic, click for the We, The Undersigned - Tuesday 5/14 Link List
Monday, May 13, 2013
Share and Don't Share - DBlog Week
Hurray for DBlog Week! Here's today's prompt:
Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one's daily life with diabetes? On the other hand, what do you hope they don't see?
This topic is especially interesting to me, considering that I am a Pediatric Endocrinologist in training and that my Endocrinologist also happens to have Type 1. What are the odds?
That fact that we are both in medicine and both have the disease we treat makes for a peculiar clinic visit. On one hand, it's great because he completely understands the struggle. Not just what it is like to live with Type 1, but what it is like to live with the disease while juggling an insane medical training schedule. I enjoy discussing the differences between how my office runs compared to his, and the colleagues we have in common. When it comes to my diabetes, he talks to me professionally in terminology that is not watered down. I appreciate that.
With other providers, I worried deeply that I would be judged for numbers and A1C's that would not meet the expectation one would have for a physician with diabetes. With him, I can be completely honest about how I know that carb-heavy meals screw up by numbers but that I choose to eat them anyway, and that I still really, really suck at guesstimating the carb count in restaurant food. There really isn't anything I feel I cannot share. I feel much more at ease with this doctor, and although I still get the traditional pre-checkup palpitations, I find that I am harder on myself than he is on me. That wasn't always the case with previous Endos.
On the other hand, I wonder if this unique situation makes things too lax. He is definitely available if I were to need him, but he has verbalized that he trusts I can manage changes on my own. I worry that he puts too much trust in my judgement and my decisions because I am an Endocrinologist as well. The freedom is flattering and quite nice, but I wonder if I'd be better off if he insisted on keeping a closer eye on things himself.
If he was reading this, I'd want him to know that I love the candor and professional courtesy, but to not forget that I am in the patient role during my appointment, not the doctor role. But all things told, I feel incredibly lucky to have such an amazing Endo on my side :)
Click for the Share and Don’t Share - Monday 5/13 Link List.
Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one's daily life with diabetes? On the other hand, what do you hope they don't see?
This topic is especially interesting to me, considering that I am a Pediatric Endocrinologist in training and that my Endocrinologist also happens to have Type 1. What are the odds?
That fact that we are both in medicine and both have the disease we treat makes for a peculiar clinic visit. On one hand, it's great because he completely understands the struggle. Not just what it is like to live with Type 1, but what it is like to live with the disease while juggling an insane medical training schedule. I enjoy discussing the differences between how my office runs compared to his, and the colleagues we have in common. When it comes to my diabetes, he talks to me professionally in terminology that is not watered down. I appreciate that.
With other providers, I worried deeply that I would be judged for numbers and A1C's that would not meet the expectation one would have for a physician with diabetes. With him, I can be completely honest about how I know that carb-heavy meals screw up by numbers but that I choose to eat them anyway, and that I still really, really suck at guesstimating the carb count in restaurant food. There really isn't anything I feel I cannot share. I feel much more at ease with this doctor, and although I still get the traditional pre-checkup palpitations, I find that I am harder on myself than he is on me. That wasn't always the case with previous Endos.
On the other hand, I wonder if this unique situation makes things too lax. He is definitely available if I were to need him, but he has verbalized that he trusts I can manage changes on my own. I worry that he puts too much trust in my judgement and my decisions because I am an Endocrinologist as well. The freedom is flattering and quite nice, but I wonder if I'd be better off if he insisted on keeping a closer eye on things himself.
If he was reading this, I'd want him to know that I love the candor and professional courtesy, but to not forget that I am in the patient role during my appointment, not the doctor role. But all things told, I feel incredibly lucky to have such an amazing Endo on my side :)
Click for the Share and Don’t Share - Monday 5/13 Link List.
Sunday, May 5, 2013
Journeys
20 years ago today I was over 2,000 miles away in Mexico City and my parents were unable to wake me up from a nap. My 9 year old self was rushed into the hospital and I was discharged as a little adult, forced to mature overnight for Type 1 Diabetes.
I have never commemorated the anniversary of my diagnosis. Diabetes, or conquering another year with it, did not cross my mind as cause for celebration. It was just something I lived with and, for many years, ignored.
Oddly, I find myself insisting that my patients remember and celebrate their diagnosis date ever since I began my Pediatric Endocrinology training. Seeing the struggle from the outside has given me stronger convictions about focusing on the positive.
One of my most favorite patients in diabetes clinic is a middle-school aged girl who was diagnosed almost one year ago. Her journey with Type 1 has been particularly grueling, as it is laced with anxiety and fear that stems from seeking perfection from an imperfect disease. She has avoided social activities and outings because she can only assure tight glucose ranges in the controlled environment at home.
Recently, she told me her family had plans to go on spring vacation to a beach across the country. She was so nervous about the thought of traveling and eating out at restaurants every night that she refused to go on the trip, and her family was so torn over her anxiety that they canceled it.
In a heart to heart conversation, I told her that I most definitely want her to learn how to do things like calculate carbohydrate ratios and inject insulin by herself, but that if she learns only one thing from me, it is that she cannot let diabetes hold her back from living her life to its fullest. She promised me she would try.
Despite our exchange, I was sadly convinced she would not take that beach trip or any other for a long, long time. Work kept me busy for the weeks that followed, and so I was surprised to get a call from the clinic secretary announcing that my special patient was there to see me.
I quickly walked over to the clinic. I was so curious to know what prompted her visit, as she was not due for an appointment for 2 more months. She was waiting for me outside of the clinic doors with something hiding behind her back. With a beaming smile, she handed me a tote bag emblazoned with the name of the beach she had spent the last week visiting! She excitedly told me to look inside, and I pulled out a beautiful photo album.
It was full of pictures from their beach vacation, along with hand-written captions. One depicted her on the beach, treating low blood sugars with juice and crackers. In another, she was swimming in the ocean, because “exercise helps keep blood sugars stable." The most touching picture of all showed her with an a bowl of ice cream the size of her head, with the caption reading, “My first time eating out since diabetes.”
Standing there next to me, she was pride personified. With misty eyes and a full heart, I hugged her and the gift that so beautifully represents the journey on which we Type 1’s are forced to embark.
So in honor of her, I will proudly acknowledge the anniversary of my diagnosis this year and each year to come. My 20th Diaversary is today, her first is tomorrow, and we both have so much to celebrate.
I have never commemorated the anniversary of my diagnosis. Diabetes, or conquering another year with it, did not cross my mind as cause for celebration. It was just something I lived with and, for many years, ignored.
Oddly, I find myself insisting that my patients remember and celebrate their diagnosis date ever since I began my Pediatric Endocrinology training. Seeing the struggle from the outside has given me stronger convictions about focusing on the positive.
One of my most favorite patients in diabetes clinic is a middle-school aged girl who was diagnosed almost one year ago. Her journey with Type 1 has been particularly grueling, as it is laced with anxiety and fear that stems from seeking perfection from an imperfect disease. She has avoided social activities and outings because she can only assure tight glucose ranges in the controlled environment at home.
Recently, she told me her family had plans to go on spring vacation to a beach across the country. She was so nervous about the thought of traveling and eating out at restaurants every night that she refused to go on the trip, and her family was so torn over her anxiety that they canceled it.
In a heart to heart conversation, I told her that I most definitely want her to learn how to do things like calculate carbohydrate ratios and inject insulin by herself, but that if she learns only one thing from me, it is that she cannot let diabetes hold her back from living her life to its fullest. She promised me she would try.
Despite our exchange, I was sadly convinced she would not take that beach trip or any other for a long, long time. Work kept me busy for the weeks that followed, and so I was surprised to get a call from the clinic secretary announcing that my special patient was there to see me.
I quickly walked over to the clinic. I was so curious to know what prompted her visit, as she was not due for an appointment for 2 more months. She was waiting for me outside of the clinic doors with something hiding behind her back. With a beaming smile, she handed me a tote bag emblazoned with the name of the beach she had spent the last week visiting! She excitedly told me to look inside, and I pulled out a beautiful photo album.
It was full of pictures from their beach vacation, along with hand-written captions. One depicted her on the beach, treating low blood sugars with juice and crackers. In another, she was swimming in the ocean, because “exercise helps keep blood sugars stable." The most touching picture of all showed her with an a bowl of ice cream the size of her head, with the caption reading, “My first time eating out since diabetes.”
Standing there next to me, she was pride personified. With misty eyes and a full heart, I hugged her and the gift that so beautifully represents the journey on which we Type 1’s are forced to embark.
So in honor of her, I will proudly acknowledge the anniversary of my diagnosis this year and each year to come. My 20th Diaversary is today, her first is tomorrow, and we both have so much to celebrate.
Sunday, March 17, 2013
Community
Yesterday, I had the honor and pleasure of leading a discussion with Kerri at our local JDRF Expo entitled "Living Well with Type 1 Diabetes". The event was bustling with children and their families, many of whom I recognized from the outpatient clinic where I work. I expected it to be a fun and informative day -- one that would motivate or inspire those that were so new to the crazy game of diabetes. I wasn't counting on counting myself among them.
After our first session, several people approached the front of the room to ask questions or exchange pleasantries. I noticed an older, smiling woman waiting in the mix of them. She waited patiently while I finished up a conversation with a very nervous, newly-diagnosed family and then held out her hand and said, "I think I know who you are."
I shook her wrinkled hand, soft like paper, and smiled while I conducted a frantic brain-scan to locate the familiarity of her face or the name on her JDRF name tag, but it yielded zero results.
She smiled back and said with playful mystery, "You moved to Providence this past summer."
I nodded, figuring she was recalling that tidbit from the introduction of me provided prior to the presentation.
"I bet your husband also works at the local hospital," she continued.
I opened my mouth to speak but only shocked silence emerged. How did she know that?
"And I bet," she continued with a twinkle in her eye, "That you live on __ Street."
"How...who...how did you know that?" I stammered.
She smiled and paused for dramatic effect, "Nice to meet you! I am your neighbor!"
I was blown away! She went on to explain that she lived a few houses down, and that she had been so curious to see who had moved in. She heard through the grapevine that a young married couple had moved from Florida and they both worked at the hospital, and that one was training in Pediatric Endocrinology. She told me that she chose to sit in on the "Living Well with T1D" session and when I was introduced, she put two and two together!
I was amazed that our paths had not crossed on our street, but at a JDRF Expo! I asked her what her connection was to diabetes, and she straightened her stooped shoulders with pride before she said, "I have had Type 1 Diabetes for 60 years."
She blew me away again. Sixty years with diabetes. I couldn't even begin to fathom her life, her struggle, her perseverance.
"I'm not supposed to be here!" she quipped, and we both knew she wasn't talking about the JDRF event.
She shared old stories of the neighborhood and of her life with diabetes. It was touching and inspiring, and she filled me with the hope and motivation that I had been hoping to provide others that day. With misty eyes and a full heart, I shook her hand and promised that our paths would cross again.
She may not be the neighbor to borrow a cup of sugar from, but she sweetened my day in so many ways. Diabetes really does foster a beautiful community.
After our first session, several people approached the front of the room to ask questions or exchange pleasantries. I noticed an older, smiling woman waiting in the mix of them. She waited patiently while I finished up a conversation with a very nervous, newly-diagnosed family and then held out her hand and said, "I think I know who you are."
I shook her wrinkled hand, soft like paper, and smiled while I conducted a frantic brain-scan to locate the familiarity of her face or the name on her JDRF name tag, but it yielded zero results.
She smiled back and said with playful mystery, "You moved to Providence this past summer."
I nodded, figuring she was recalling that tidbit from the introduction of me provided prior to the presentation.
"I bet your husband also works at the local hospital," she continued.
I opened my mouth to speak but only shocked silence emerged. How did she know that?
"And I bet," she continued with a twinkle in her eye, "That you live on __ Street."
"How...who...how did you know that?" I stammered.
She smiled and paused for dramatic effect, "Nice to meet you! I am your neighbor!"
I was blown away! She went on to explain that she lived a few houses down, and that she had been so curious to see who had moved in. She heard through the grapevine that a young married couple had moved from Florida and they both worked at the hospital, and that one was training in Pediatric Endocrinology. She told me that she chose to sit in on the "Living Well with T1D" session and when I was introduced, she put two and two together!
I was amazed that our paths had not crossed on our street, but at a JDRF Expo! I asked her what her connection was to diabetes, and she straightened her stooped shoulders with pride before she said, "I have had Type 1 Diabetes for 60 years."
She blew me away again. Sixty years with diabetes. I couldn't even begin to fathom her life, her struggle, her perseverance.
"I'm not supposed to be here!" she quipped, and we both knew she wasn't talking about the JDRF event.
She shared old stories of the neighborhood and of her life with diabetes. It was touching and inspiring, and she filled me with the hope and motivation that I had been hoping to provide others that day. With misty eyes and a full heart, I shook her hand and promised that our paths would cross again.
She may not be the neighbor to borrow a cup of sugar from, but she sweetened my day in so many ways. Diabetes really does foster a beautiful community.
Tuesday, February 19, 2013
Guest Post: 17 Years
I met Rose this past year via the DOC. We clicked quickly -- not only because we both have Type 1, but because we are both knee-deep in medical training as well! Rose is almost half-way through medical school and is working out how diabetes shapes her and her medical experience, so her post fits here perfectly. If you'd also like to connect with her, she is @diabud on Twitter!
17 years ago tomorrow I was told that I could do anything
I wanted to (except be a commercial airline pilot), but I was going to have to
be more careful. Because of this
idea that I was not limited, I did not realize how much having diabetes has
shaped me. I really had no idea when I applied to medical school, how much my
personal experiences with health care shaped my ideas of medicine and how I
want to practice. The time around
my diaversary is always a time of reflection and this year is no exception.
It was not until one of my medical school interviews that
I was asked, “what is the hardest part of having diabetes?” that I began
thinking about it. I was
completely stumped. I had not
thought about it before. I had spent so much time convincing people around me
that it wasn’t a bit deal, that I never acknowledged that it was. It probably
took me over a year to figure out the answer to the interviewer. Now I know my
answer is that, no matter what I do and how things go, I’ve got to do it
again. I can have a really rough
exhausting week, where nothing goes well, I feel crummy way to often and I do
not know why. But there is no
vacation from diabetes.
For me the barriers to my health are not knowledge or
access. For that I am very grateful. For me the barriers are time, mental
space and an inconsistent lifestyle.
The barriers are daily management. I do not need help interpreting my
A1C or handling a sick day. I need
help when I sleep through my alarm and need to rush out of the house so I can
get parking, I skip testing (my blood sugar) because it doesn’t seem as important
as getting to school faster.
The problem is, on those mornings where I am in a rush or
distracted for some other reason, I want to trust the CGM and postpone testing. Sometimes the CGM is very accurate and
so it is easier to ignore my dry mouth and other symptoms of high blood sugar
and get on with my day. The problem is it takes more than the 30 seconds to
test. It takes time to interpret
the result, figure out an action plan, not judge, not get distracted by an
inaccurate continuous glucose monitor (CGM) that looks perfect, but is off by
150points. This is the part of my health that I need more help with. The part
where I realize that taking care of myself is part of my homework. I need help figuring out how to fit D
in to everything else.
I have never been that big on resolutions but with the
boards coming up, it seems like some goals were in order. I have always had
academic goals to keep me motivated. Last year I set my first ever A1C goal
(which I met!). This year I
decided to set one complete goal that includes my school, home and diabetes
lives. In June I hope to be
happily married, with a Step 1 score I like and my best A1C since high school.
I hope that considering my total life, and not just my
academic achievement will help me with “work life balance” in a setting where that
sometimes seems impossible. I also hope that my effort to figure out something
that works for me will give me new ideas about how to help other people manage the
daily practical challenges of their chronic illnesses and
own health in the future.
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