Nothing is more satisfying in medical school than learning about a disease you know you will see every day once you are practicing. Let’s be honest, how many of us are truly going to see a Naegleria fowleri infection or familial dysautonomia on a regular basis once we finally enter the clinics? But diabetes, yes we will all see diabetes. No matter what specialty or part of this country we choose to practice in, our patients will have diabetes mellitus. Spending days on learning the physiology, the morbidity, the complications, the treatment options, and the counseling techniques, while tiresome and frustrating to some, was fascinating and engaging to me. I drank in all I could, tried to store it away and keep it, instead of brain dumping and moving on after the exam.
So when a diabetes immersion course was offered to five volunteers in our class, I jumped at the chance. We would live as type 2 insulin dependent diabetics. We were given a crash course on carbohydrate counting, portion sizes, and healthy eating. We were given a glucose monitor, syringes, and a vial of saline to act as insulin. It took about two hours after classes to get this crash course, longer I suspect than patients get with their doctors the first time they are diagnosed.
We practiced giving ourselves the first shot together, all five of us in the same room. We all handled it quite differently. Some went in with no fear, a quick in and out, like ripping off a band aid. I stared at my pinched belly fat for quite awhile, heart pounding in my ears before I worked up the courage to finally stick myself. I was pleasantly surprised at how little I felt. Not bad, not bad at all.
When I went home I stared at my pantry. What of these cheap, easy, med student foods could I eat on this new diet? None of it was the answer, none of this food. I pulled out a bag of frozen vegetables and had a very unsatisfactory dinner thinking only of the box of pasta I had in my pantry. This was going to take some very conscious planning of my meals. No longer could I just wake up and grab whatever I could see for breakfast, no longer could I just make pasta or have a sandwich. I sat down and planned my meals and “insulin” shots ahead of time. How much forethought it took, I wondered how many patients could put this much time and effort into planning their meals.
The first day went well, I followed my plan, gave myself my shots, and was pleasantly surprised at how consistently low my blood sugars were. The second day also went well until the evening. It was the week of Halloween, I had bought candy, and it was eight at night. I stared intently at the peanut butter cups. All I had to do really was give myself a unit or two of “insulin” and I could eat one, or maybe two. I ate three that night. I imagine many others make the same decision I did.
At the end of the third day I was more than just relieved to be done with my course. So much of my day was spent thinking about my “condition,” planning my meals, planning what to bring with me to class, figuring out when and where I would give myself my shot. I was so relieved to be done, to eat pasta and cake and peanut butter cups. Patients though can’t just give back their insulin and blood sugar monitors. They can’t give back their disease.