A medical student becomes a diabetic and finds public disapproval

Recently, 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. (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.  For those who’ve never used a diabetic lancet (especially the cheap, plastic ones we were given to practice with), they 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.  “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(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 hotel in town on the weekend and we had a fabulous time talking business and economics.  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.  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.)

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 guesswork of eating out.

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

“Atalanta” is a medical student who blogs at Atalanta’s Antics.

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  • http://www.facebook.com/TheGirlsGuidetoDiabetes Sysy Carolina Morales

    Very interesting.  I’m a type 1 and appreciate you writing this.  There is a difficult psychological dance we go through.  We have to stay alive, or rather, stay healthy and to do this we often must do things in public with needles and syringes, blood, and gadgets.  It’s not helpful to get physical cues of disapproval because we already don’t want to do all the things we have to do.  

    You did this for a very short time.  The insulin shots eventually hurt if scar tissue forms. This happens to many people if they don’t rotate properly.  Certain insulin like Lantus sting really bad sometimes.  Many type 1 diabetics with tight control test their fingers 8-12 times a day (when I was pregnant I tested almost every hour during the day and every 2 hours during the night-I set alarms).  So by then cumulative damage is incurred.  And that’s the damage we don’t care about.  We care and are much more annoyed by the damage to our kidneys, eyes, cardiovascular system, etc.

    This article hints at one aspect of some of the most painful damage that happens-the mental stress of dealing with something like this when it isn’t understood in society.  Not to mention there is a stigma out there that we type 1 diabetics gave ourselves this disease.  

    Anyway, I hope many medical students/doctors read this and take with them your message and this one:  Anyone can do anything difficult for a certain period of time but after a while, a toll does come down on the person.  Can you imagine being in medical school your entire life?  Do you think you might eventually crack under that kind of intense schedule and pressure? That’s kind of what type 1 diabetes is like.  It never ends and there is never a break.  I think if doctors understand this and are sympathetic to this, they can really connect with patients and provide them the compassionate ear they often need before being able to really soak in any medical advice.  It’s a win, win.  Again, thanks for writing this :)

    • unicorn_of_balinor

      Thank you so much for reading!  I wrote this partially for other med students so they knew what goes into the day-to-day trudge, not just the pathophysiology and treatment.  I also wrote it partially for people like you – blogging is a fantastic way to connect, especially when it comes to things like this.  I want to make sure I never lose sight of the human side of things and this experience certainly reminded me of that.

      And thanks for clarifying, it’s good to know that the injections can get painful with time.  And you’re right, I only experienced this for a week, which only magnifies my respect and thankfulness for people who can manage to keep tight glucose control.  Because life doesn’t always work out according to plan, but the diabetic is expected to adhere to it 24/7.  I understand now just how unrealistic that can be sometimes.

    • http://www.healthcare-information-guide.com 2dougmac

      I guess that after almost 50 yrs. of Type 1 I’ve missed what the public thinks (or maybe I’ve reached an age in which I can’t bother to notice), but you’re right; the about having to deal with the psych. aspect also. Diabetes is the shadow that doesn’t go away, and is always there whatever you may be doing. And there is always the “what if?”

      It’s a challenge to handle the metabolic aspect which changes over your lifetime, the changes in form and function of your body and the constant “I’m different because I have to do things that others don’t”. Oh, and trying to reign in fluctuating blood glucose so that you don’t stand out, with work and recreation activities.

      It’s good to know that you got a taste of what a diabetic has to go through, and hope that this memory will be there when treating a diabetic. Thanks for letting us know of your perceptions.

  • http://makethislookawesome.blogspot.com/ PamC

    You’re not reading into it at all. You should see some of the stares I get should someone new happen to see an orange medication bottle in my purse. Doesn’t matter if it’s blood pressure medication. You’re suddenly seen as broken, contagious, weird, etc. etc. 

    Out in the “real” world… it’s a BIG deal. 

  • http://profiles.google.com/harnessg Glen Harness

    Sorry, but I never would have even consider injecting myself in a public place if I were diabetic, unless it was some sort of emergency. I would excuse myself and go to the restroom and do it in private.

    • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

      Restrooms are about the filthiest, germ-ridden places in the restaurant. I’m now on a pump, but when I’m out and need to test or take insulin, I just warn the people around me, so they can turn their faces away if they’re squeamish. I’m not going to go into hiding just because OTHER people have phobias. I try to be respectful of their needs, but they need to be respectful of mine, too.

    • http://www.facebook.com/profile.php?id=704293717 Rachel Bogdan

      You say that because you aren’t diabetic first off public bathrooms are insanely unsanitary and secondly  if you have to inject as much as 15 times a day that is enough of an inconvenience to then add having to find a place to hide every time to it why would you do that because it makes others uncomfortable -.-

    • http://www.facebook.com/profile.php?id=100002934866034 PJ Dew

      Glen, the bathroom is a disgusting place to do a sterile injection.  You do realize when people flush toilets, that the bacteria actually goes airborne?  I hope that someday you get some compassion and realize that we do this to save our lives and it’s not your concern.  I wonder, would you take your food into the bathroom???  No?  Is it too dirty???  Do you understand that we need to test NOW sometimes and inject NOW sometimes b/c we are low or high and don’t have time to find a private place so your sensitive little psyche doesn’t have to see the evil little needle?  You’re so totally wrong on this.

  • http://twitter.com/diabeticallymn SuFu, Ph.D., MS1

    I was diagnosed with type 1 diabetes at 26 years old and am now in medical school. I can completely vouch for everything that she has said. The stigma surrounding diabetes is depressing for those of us who are type 1′s. With greater than 90% of the diabetic population being type 2 and the association with being obese and not caring for yourself it’s a challenge to accept the looks you get. There have been dozens of times where I am checking my blood sugar or giving myself an injection in public that I get the head shake or the disdainful glare. I’m sorry, but when you’re giving yourself 6-10 shots per day, you are going to have to give some of them in public, that’s just the nature of the disease. Unless you have it and have to deal with it, there is no possible way you can understand. 

    • unicorn_of_balinor

      I’m sorry to hear mine wasn’t an isolated incident… to be completely honest, I’d hoped that I would get a flurry of comments telling me how most people are more understanding than I make them out to be.  Consider me a bit disappointed.  But thanks for reading, and keep truckin’!

      • http://twitter.com/diabeticallymn SuFu, Ph.D., MS1

        Anymore a lot of people don’t care or don’t notice. However the ones who do try to make a big stink about it. Hope school is going well! Back to biochem!

      • http://twitter.com/diabeticallymn SuFu, Ph.D., MS1

        PS. This ended up on the blog as soon as I read it. Hopefully we’ll get a ton of people to read it and think about what they are doing when they see people in public who are diabetic and are just trying to manage their disease the best they can.

  • Earl Ware

    Type 2 here, so don’t have to worry about insulin injections yet.  One comment about testing on fingers. I was taught that since finger tips are loaded with nerves, I should test on the sides of the fingers.

  • Erin Moore

    As a Type I Diabetic for more than 20 years (I’m 26 now), I find this post completely insulting. The worst thing about having and living with diabetes is that IT NEVER GOES AWAY. So, glad you got your “little peek,” medical student. I pity your future patients.

    • unicorn_of_balinor

      Sorry to hear that – I do understand that I only got a very superficial look at diabetes, but it was an interesting incident that opened my eyes to a part of diabetes that I never would have experienced otherwise.  Please don’t presume my candid tone translates to patronizing my future patients.

  • http://pulse.yahoo.com/_XG6RWDT77KAFOW5WTX57YHXYVQ Sarah

    The first thing that struck me, apart from the points raised by the other commenters, about the sheer unrelentingness of diabetes, is that, if you were really a diabetic, the lack of sugar-free syrup means that the “diabetic option” isn’t an option at all, and you’d have to choose another meal.  Food becomes an obsession.  You can’t skip a meal, you have to be aware of when you ate last if you don’t want to have a hypoglycemic attack, for example, when driving, Heaven forbid.  As a CNM, when delivering a baby, or when scrubbed in the OR for a C/S, I’ve had to call for assistance because when I first begin to get the symptoms of a hypo attack, I’m already severely hypoglycemic.

    Traveling and managing to keep your insulin supplies properly refrigerated.  Being stopped at airport security and made to explain why you are carrying “unusual” medical supplies.  Wearing a swim suit when you have a pump [you can disconnect it for only two hours at a time].  The effect diabetes can have, if you are a man, on your potency; if a woman, on how your partner perceives you with your pump at intimate moments. And diabetes is 24/7 for the rest of your life – I remember a patient of mine whose type 1 daughter died in her sleep from insulin coma; a brittle diabetic can actually fear sleeping;  the relative of such a diabetic can actually feel required to stand vigil.  A diabetic child who cannot engage in sports or peer activities freely without knowing how to adjust his insulin regime [and of course, if he's very young he has to be protected from noshing indiscriminately when friends offer him some sweet, as well]  It’s no wonder many diabetics also suffer from depression.

    It’s good you got a peek at living with diabetes.  But unless you kept up the charade for a long period, I don’t think you can really appreciate just how all-encompassing this disease really is — especially since the sufferer doesn’t usually feel ill and people around him don’t see him as a “really sick” person.

  • http://www.facebook.com/profile.php?id=26702329 Kari Kuhar

    I greatly appreciate that you and your colleagues were willing to do this.  It took courage, quite frankly.  Thank you for sharing your experience.  Honestly, what you experienced in terms of disapproval are the things all diabetics have to deal with.  We are treated with derision and disapproval on a daily basis from misinformed and ignorant people who assume we either a)did this to ourselves (so they treat us like we’re dirty or something) or b)should keep ourselves alive where others don’t have to see us doing it.  As a child I didn’t realize this (I was diagnosed at age 6). As a teen I felt shame and told very few people about my diabetes, and even those who knew didn’t see me doing anything about it.  As a young adult I was so ashamed that I even stopped caring for myself the way I should have.  It’s only recently I realized that I have nothing at all to be ashamed off, and that other people’s disapproval, ignorance, etc. has no place in my life if I’m going to care for myself the way I should.  I don’t inject in public now, only because I do use an insulin pump.  However, I do test my blood sugar in public and I do still get looks (or downright stares).  I usually just stare back :)

  • Anonymous

    Thanks for your post. I married a type 1 almost 20 years ago. He’s now been diabetic over 40 yrs. I’ve experienced all the stares and judgmental looks, the need to run to find a bathroom when sugars rise, the scrambling for candy when they drop. He also lost his sense of smell due years ago.  Not good if our home ever burns down, really helpful those afternoons I come home from the gym.
    I’m also congenital heart pt with 2 St Jude valves, pacer dependent (Lloyd’s of London wouldn’t insure us.) I was also widowed when my first husband died of cancer at 43. A few folks suggested I not marry a diabetic but I have learned that life works best when we see it as the true gift it is. Giving ourselves permission to face challenges with humor also helps. Don’t loose the humor or the compassion and you’ll make a great doc one day!

    • Anonymous

      May I make a suggestion as a Certified Diabetes Educator?  In our Diabetes Self Management Education  (DSME) program, we teach the Rule of 15 to treat a low blood sugar, one that is <70.  Take 15 grams of quick-acting sugar, i.e., 3 of the square BD brand or 4 of the round Dex glucose tablets.  The blood sugar should rise by 30-45 points.  Wait 15 minutes and test again.  If the blood sugar is rising, good–follow with a meal or a substantial carb snack within the hour.  If the sugar is the same or dropping, treat again.

      DSME programs are available at many hospitals, and they are covered by most health plans. Check with your local hospital and/or your health insurance.

  • John Holland

    For some reason they never tell you to stick the side of your fingertip, not the pad. There are far fewer nerve endings in the side, next to the nail, than in the fleshy pad that you type with.

    • unicorn_of_balinor

      They did teach us that, funny enough.  The lancets were just that bad, that they bruised my fingers for days!

  • http://www.facebook.com/people/Sven-Houndoom-Demonica/100001857530422 Sven Houndoom Demonica

    I’m interested now in what the public thought. Did you get any other comments or looks?

    • unicorn_of_balinor

      No, this was the only time I injected in public (and not in class where everybody was doing it!) – we didn’t have that many needles to use so I was pretty limited in what I could experiment with.  Given some more time, I would have been interested to try it out in other settings like in a mall or around campus.  Maybe other populations would have been more understanding than a fussy restaurant?

  • Anonymous

    I’ve been a diabetic for over 20 yrs and unlike some of your other commentors, I think youv’e done a good thing.  Many doctors (and other medical professionals) have NO idea what it’s like to have to deal with this crap.

    As others said, never use a lancet on the pads of your fingertips. It’s easy to get more blood there, but there are more nerve endings.  Always use the sides of your fingers. And never, ever use a lancet without a spring-loaded device.  They make things a lot easier and less painful.  When you jab by hand it really hurts!  Well, more than normal.

    The mess of using a syringe in public is mind numbing. Nobody thinks twice about taking pills, even handfuls of them, in public, but pull out a syringe and you’re suddenly a junkie in people’s minds.  Even my family flips out on me  (“Go do that in the bathroom!”   Ew, not a chance, it’s disgusting and filthy in there. Just what I need, some poop in my injection site!).  For a while I used insulin “pens” that look like giant Sharpies and got less reaction. But they’re expensive and you need really good drug coverage (which I don’t have anymore) to afford them.  I’ve read tales of diabetics having the cops called on them for “shooting up” in a restaurant. 

    My favorite tale of injecting in public was when I was with my best friend and her family. I was using a pen, and as the needle slid into my tummy her brother, who was watching with a look of horror on his face, blurted, “What the hell IS that?!”.  Without batting an eye I replied, “Heroin.”  He went white as a sheet and started panicking.  I thought his sisters and mother were going to hurt something, they were laughing so hard.

    On the other side is when I travel. If I’m flying I always tell anyone searching my bag that “there are syringes in there, they should be all capped or clipped (I clip the needle of a syringe after use) but please be careful anyway.”  Occasionally an agent has paused and thanked me for thinking of their safety. 

    There’s a crapload more to the disease that it’s not possible for you to experience: The fun of surprise hypoglycemia that always hits at the worst times [while driving, at 3 am when your nearest emergency sugar is in the other room (you dumbass), in the middle of a job interview] — while you can try to be as careful as possible, simple things like stress or a cold can throw things out of whack trivially.  Or the sudden fun of a reading of 500 for no apparent reason – and then the next day you come down with an infection.   Pre-menstrual women also can find their cycles make things difficult, too.  Diabetes can also aggravate other conditions, including depression, which in turn aggravates your blood sugars. 

    It’s such a fun disease, it just keeps on giving!  (<- yes, this is sarcasm)

  • Anonymous

    A couple of suggestions from a certified diabetes educator:

    Diabetes Self-Management Education (DSME) programs are comprehensive classes that cover many aspects of diabetes care:  physiology, meds, monitoring, complications, meal planning, sick days, exercise, foot care, resources, etc.  They are available at many hospitals, and they are covered
    by most health plans. Check with your local hospital and/or your health
    insurance.

    Those who use insulin can do so discreetly with an insulin pen, which resembles a fountain pen.  You can inject into the abdomen while sitting in a restaurant.  Some people inject through their clothing, for instance, into the thigh.  An insulin pumps is an option too.

  • Anonymous

    Disability is not a choice.  Exposure of the young MD to the social perception of disability is necessary in order to avoid victimization, prejudice and stigmatization of disabled individuals

  • Anonymous

    Thank you for sharing your experience. Personally, i inject anywhere and everywhere. it makes no difference to me what so ever how anyone reacts. It’s no different then a non diabetics pancreas working whilst they eat, only difference is I am doing the job for my pancreas. I think every single diabetic is different and the most important thing is to listen to how that indivdual feels about it and their psychology of it. Mine for example is meh, stuff it. I’ll do my best to control it and the rest is up to fate. Other’s feel much more strongly about their diabetes and treat it much mroe seriously. I hate doctors who tell me how I feel about it. For example one doctor said to me after 13 yrs diagnosis that i ‘has obviously never come to terms with diabetes’ which is utter rubbish.
    In repsonse to earlier post, why would you go to the toilet to inject!! It’s up to other people to look away if they want, not for me to withdraw myself as I am doing something which may upset some people.