Atalanta: The diabetic medical student

For those who don’t know, this past week our whole class was asked to “become” a diabetic to try and really understand what it is we’re diagnosing people with.  Fantastic idea.  Fantastic opportunity.

Not so fantastic to carry out.  I opted for the insulin-dependent, type I option, which meant I had to keep a diary of what I ate (including counting carbohydrates), regularly check my glucose level, and inject myself before meals. (Note: we didn’t actually inject insulin or saline, it was just so we get the feel for it.)

The meals were usually a cinch.  For those who know me, you’ll recall I’m a creature of habit.  I make one dinner for 4 days and generally have the same sorts of things for breakfast and lunch.  Easy to count carbs that way.  However, spreading out carbs and snacks through the day is a real pain, especially when you’re in school and they don’t generally allow food or drinks in the cadaver lab.  All that ghrelin does give you the munchies, though.

Oh, and those meter checks.  ZAM.  For those who’ve never used a diabetic lancet (especially the cheap, plastic ones we were given to practice with), they HURT.  Hot damn, do they ever hurt.  Imagine stabbing the end of your finger with a dull clothes pin.  Now imagine doing that at least twice a day, trying to rotate fingers so you can still manage to type.  Several days later, my fingers are still bruised.  I can imagine my diabetic readers nodding sagely right about now.  “Mmmm hmmm.  Been doin’ it for years, sweet cakes.”

The interesting part of the experience was the injections.  What a ridiculous idea.  Inject myself?  With a REAL NEEDLE?  Into MY GUT?  Ew.  (Insert more sage nodding here.)

But they don’t hurt.  Seriously.  Not at all.  Unless you get a bad needle with a barb in it, you can hardly feel them, the guage is so teeny.  You can even inject with your shirt on.  Hell, I injected through my dress at a fundraiser.

Don’t misunderstand, that’s not the interesting part.  The real doozy was the perception of other people.  Now usually I was injecting and stabbing and whatnot amongst my fellow med kiddies.  And they were doing it, too.  No big deal.  But at one point, I wanted to experiment with injecting in public.  See how people reacted.

They didn’t disappoint.

I went to brunch with a relative at a hoity-toity hotel in town on the weekend (God, did that mess up my meal schedule) and we had a fabulous time talking business and economics and the business-y, economic-ness of medicine.  The restaurant was nice enough to have a specifically labelled diabetic option so I didn’t have to guess what I was eating.  I got my injecting supplies out just before our waitress came around to drop off my pancakes.  I got my needle ready.  Hell, I even set the injection pen to 15 units.

Then she came back.  She set down my plate and noticed the pen in my hand, needle all ready to go.  I smiled, thanked her, and busied myself with trying to find the right spot to pinch for the injection.  I looked up quickly to see her face, and what I saw was nothing but thinly-veiled disapproval.  It was written all over her face, from her eyes that narrowed ever so slightly, to the corners of her mouth that were stretched just a bit too tight.  I could almost see the thought bubble floating above her head: “Good grief, is that a needle?!  Oh.  Right, diabetic meal.  Well.  What a perfectly inappropriate place to use that… thing.  This is a public eating place, for heaven’s sake.  Is that even sanitary?”

I felt surprisingly affronted.  I’d ordered the diabetic option.  What did she think I was going to do with that needle?  I’m sorry, would you like me to go hyperglycemic somewhere else?  Or can I enjoy my dry pancakes and corn syrup in peace? (Oh yes, they’d run out of the sugar-free syrup.  So corn syrup it was.  Huzzah.)

Maybe I’m reading into things a bit.  Maybe she was just a bit confused by the pen injector.  Lots of people have a regular syringe still, maybe she’d never seen this style.

But still.

At the very least, I can say I’ve had a small peek into the day-to-day trudge of the diabetic lifestyle.  The endless finger pokes, the frustrating guess-work of eating out…

And now I know.  When it comes to diagnoses like this, it’s certainly better to give than to receive.

 – Atalanta

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9 Comments

Filed under Medicine, Personal & Blogs

9 responses to “Atalanta: The diabetic medical student

  1. Matt Evans

    Loved the post, i’m a type 1 diabetic and medical student rocking both my profession and my illness in Phoenix AZ (though I prefer being called a diabadass, not a diabetic, by my friends). I also loved the post about Facebook censorship for medical students. You rock.

  2. PJ

    Hi! I really admire that you tried to walk a week in my shoes as a T1. That’s so totally awesome!! And, yes, the general public can get very annoying when I test/inject in public. The only thing I would say, is if there were some way that you could feel the lows or highs and all of a sudden have them for no reason, that would make it more realistic. One lesson I learned early-make sure to take the wrapping off of all of my “fast sugar” treatments, b/c if I’m low, I won’t have the dexterity or presence of mind to be able to do it. Tubes of cake icing are wonderful for lows, by the by. Easy to open and pure sugar. We T1s now do carb ratios for Novolog and I have to take it with every bit of food I eat except my HS snack. There are days that I eat the exact same thing, inject the same amount, do the same thing, and end up with a BS of 40 or 190. A lot of us also split our Lantus/Levemir dose b/c it works better and it doesn’t last 24 hours in most people like it says. I’ve been as low as 18 and completely conscious and retested b/c I thought my meter was wrong and tested on a different meter and got 21. So, yeah. Drank some juice. Also, exercise is so freakin’ scary. I walk and I have to eat before I walk or i bottom out. Heavy activity like snow shoveling will affect my sugars for 24 hours or more, dropping them considerably. I have hypoglycemic unawareness (obviously since I can be at 18 and not know!) so I wear a continuous glucose monitor now. It checks every 5 minutes and alerts me to highs, lows, how fast I’m going up or down, etc. The worst experience is “waking up in a swimming pool”. That’s when you’ve been so low, so long all night, that your sheets, pajamas, comforter, everything is soaked with sweat. You feel like you got hit with a mack truck and are so tired. Then, our good friend, Mr.Liver, starts kicking out butt loads of glycogen and you end up having to use a crap load more novolog to stay in range. We can’t take prednisone. We can’t take birth control pills. Both jack your sugars up and make you really insulin resistant. I’d love to know your thoughts and how did it go the rest of the week? Oh, and most of us T1s test 4-6 times per day. The T2s do BID or twice a week BID. I personally test at least 5 times per day. Last A1C: 5.6%!! I OWN DIABETES. IT DOES NOT OWN ME!!! 🙂 Paula Dewey

    • Woot, nice A1C, missy! And yeah, we only tested glucose twice a day since that’s all the lancets they could spare for free. (Cheap and nasty as they were…) All I can say is I would be first in line for a pump. It sucks pricking finger after finger, even if you do it on the sides like they teach you. Maybe I just have sensitive little fingers, hah.

      • PJ

        You should have your school check out the Accu Chek Multi-clix lancing device. It comes in a drum and has 6 lancets, and I very rarely feel it-it’s the best one out there. I used it on my charge nurse to show her that you don’t feel it at all, and she was totally amazed. (I’m a nurse working in a Vet’s Facility) I hate when I’m at work and I have to check with their lancets b/c my sensor goes off. The lancets they have there are so vicious and leave bruises on my fingers for a couple of days!! I bleed forever from those and actually have to put a band-aid on my finger!!! I would like to go on a pump again someday, (you still have to do all the work of checking your blood sugar, figuring your carbs, bolusing for meals, etc.) and I actually was on the Omni Pod for a bit, but I’m (a lot of us are) a bit of a control freak over my numbers and after the thing clogged on me several times and I had to change it out each time, I couldn’t stand worrying all day whether or not I was getting insulin. I was almost dead with a blood sugar of 382 (ph of 7.03, 17 liters behind in fluid, labs totally whack! DKA SUCKS!), so I can’t afford for the thing to kink up at night and not get insulin for several hours. Some other fun diabetic things that have happened to me: I’ve actually experienced workplace discrimination-I had an assistant director of nursing tell me that I had to leave my testing supplies and food in my car or the break room-clear at the other end of the facility-bad idea to go wandering about with a blood sugar of 45! Had to bring in the American’s With Disabilities Act Law to show them and that changed their tune. My last facility, I actually passed out from a low, and right after that, they were harassing me so badly with stupid crap and writing me up for anything and everything, (I never had any write ups before that!) and I KNEW it was because they saw me as a liability and wanted me gone. I always run into people in restaurants that give me “the look” of disapproval and have even had people say things to me. It’s really amazing how heartless and condemning people can be towards others. The other thing you get all the time is people telling you what you can and cannot eat. Or, my absolute favorite-“You can eat as much of this as you want!! It’s sugar-free!!” I then explain that it has just as many carbs as regular stuff, if not more, and it’s the carbs that make my blood sugars go up. I have found that people are fairly ignorant when it comes to diabetes. I really often want to slap the crap out of my attending at work. He’s 75 y/o and he puts my people on 2 long-acting insulins a lot. Humulin N and Levemir. I’m just like, “PICK ONE!!!” Of course, I can’t say anything to him. It took me an entire year to get him to switch my one brittle person off of straight dosing. She was supposed to get 11 units of novolog regardless of what she ate, so long as her BS was above 150. Guess how many times she bottomed out!? It then took another 4 months for me to get him to stop giving her novolog at night. She’ll drop from like 500 to 200 all on her own with no insulin whatsoever, so she doesn’t need any sliding scale at night. Now, she hasn’t had any serious lows since I finally got him to do that. Perseverance and patient advocacy pay off. 🙂

      • Patient advocacy ftw. Good for you for sticking up for her – I know how tough it can be, especially as a med student, to feel like you could correct your preceptor but it’s not “your place.” And sometimes the patient suffers for that, unfortunately.

  3. William Stueve

    Great blog entry. I found it on KevinMD.com. (I’m way behind). I have been a practicing physician for almost fifteen years and treat A LOT of diabetics. Your insightful report on your experience has opened my eyes considerably in regards to the real life experience of people with diabetes. Thank you for contributing to my ongoing education as a physician. Keep up the good work.

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