Confused about my future

This post is a mix of general life questions, but also about my diabetes.

I’ve currently reached what somewhat of a crossroads in my life. Firstly, in regards to my diabetes; For the past 17 or so years of living with this condition I would say I’ve been approaching my control with somewhat of a complacent attitude. That’s not to say I have never tried, but rather I never really looked into how to achieve better control. In fact, until recently I thought that I was a very well controlled Type 1 Diabetic. Being diagnosed at the age of 7, in 1998, like many young children with diabetes, my A1cs for the preceding 10 years were by no means ideal. Having recently requested a list of these, I discovered them to be ranging from 7 to the high 9s throughout this period. Since I was 18, or roughly since I finished secondary school, my A1cs have ranged in between the lower 6s to the mid 7s, numbers that my diabetes care team were always very pleased with. In fact, I rarely ever had a checkup where they would say here is what you can do better, as they thought I was controlling my condition extremely well. I thought I was controlling my condition quite well, and would often come home quite proud of how I was managing to keep good control, without letting diabetes limit my life. I don’t know whether it was a failure on my behalf, on my doctor’s or a combination, but reflecting on the past I can’t say I even really knew what the ‘ideal’ blood sugar reading was. I knew I wanted to stay under 10 mmol/ml, but certainly if I was around 7-8 mmol/ml I didn’t see that as a negative.

I was always quite happy with this approach, from what I’d been told I was controlling my diabetes very well. I had never let it interrupt my life, and as such have and continue to live a very full life. In my later teens and early twenties I was often out at bars once or twice a month, drinking too much beer with my friends, like many I spent my early twenties in an undergraduate degree, I’ve spent quite a bit of my early twenties travelling, despite my diabetes, and in my mind I still kept good control. Retrospectively, I realise this control was probably not as good as I had thought.

Things started to change for me around this time last year when a begun to experience a number of alarming symptoms. Firstly, I started getting pins and needles, numbness, tingling and burning in both my feet and my left hand. Both my endocrinologist, a number of general practitioner’s and a number of other health professionals seriously doubted this was diabetic neuropathy, for a number of reasons but largely because I have had such well controlled diabetes, at least for the past 8 years. On top of this, I also begun experiencing chest pain in the left of my chest. Again this was never properly diagnosed as anything, but was quite alarming.

Around the same time, I also had a yearly checkup at my optometrist where he found a small dot of lipid at the back of one of my eyes, early signs of non-proliferative retinopathy. According to my optometrist, nothing to worry about as it stands. Further to this, I also begun to experience some notable gastric discomfort. Stomach aches, vomiting sometimes in the middle of the night, all symptoms that seemed to point to mild Gastroparesis.

The following months became I began to struggle with my own mental health. I felt depressed, I felt angry that I had made decisions that may have impacted my life negatively, but I also felt scared. I was, for the first time possibly since my diagnosis, scared for my future. I was uncertain of what might happen, and for the first time ever I started asking whether diabetes would and should limit what I can do.

It was at this point that I really decided I needed to be far more engaged with more control. Since then, I have adopted a low-carbohydrate diet and have spent far more time scrutinising and working towards better blood glucose control. In the last year I have managed to reduce my standard deviation and A1c dramatically. My last 3 A1cs being in between 5.3-5.6 and my standard deviations being around 1.2-1.3 across 90 days of blood sugar readings. Since these improvements my chest pain, tingling and numbness in my left hand and feet, and even gastric discomfort seems to have either disapeared or drastically improved, only very occasionally rearing its ugly head.

This really leads me to where I am currently.

I have for awhile been working for a software company. But have reached a point in my life where I am ready to move on to new things professionally. Partially due to my experiences, particularly recently, but more in general, and partially due to my genuine interest in the area I have started contemplating the prospect of applying for a position in a Graduate Medicine (MD) degree. Due to my recent experiences though, I have become concerned and have started questioning whether this is possible, or smart. Not due to my own capacities as a human being, but solely because of my diabetes. I know there are some MDs floating around on this forum, and I know there are other people who work in high paced, stressful jobs so I would love to hear from anyone who can share their own experiences.

I also understand that each person is an individual, so it is almost impossible to alleviate my fears. More than anything I just needed to post about this, somewhere that people who may actually be able to empathise with my concerns can read it.

I really have developed great concerns that I will have to resign myself to a job I dislike, simply because it provides good conditions for me to control my diabetes. I am scared if I go down the path of Medicine, that the stress and anxiety will make my bloods sugars impossible to control, that the night shifts will impact me, that all the hard work I’ve put in over the last year and a bit will be lost. I am scared that the minor complications I’ve started to experience will get worse because of this. I have managed such strict control now due to my adherence to my diet, I am scared I would not be able to put the time and effort into eating that I need to now to keep my bloods sugars good, I am scared I would have to many hypos whilst trying to work in fragile environments.

I had, never in the past asked myself the question of whether I should take my diabetes into consideration when making my life decisions. I went backpacking for 6 months, I know now if I wanted perfect control of my diabetes technically that probably wasn’t the right decision, but it was in my opinion the right decision for me as a person. I am struggling now to find this medium between what I want as a person, and what I know is right for my diabetes. Should I even be taking that into consideration when thinking about my career?

I would also like to take the chance to say I love this forum, the time people put into responding to people, the amazing stories I’ve read, the acceptance everyone shows to each other regardless of their backgrounds and experiences with Diabetes. It’s great. So thank you all in advance.

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My heart goes out to you! I am too overwhelmed by life myself right now to say much more than you will be in my thoughts. D is evil and somehow manages to throw such an unfairly huge monkey wrench into the works of our lives, doesn’t it?..

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I’m not an MD, though I’ve thought about that route from time to time, so I can’t give the advice you seek.
What I can say is that D. Richard Bernstein became a doctor as a second career after his diabetes had started to cause complication (and after he’d started managing it better). From his story, he did it not only in spite of his diabetes, but because of it. Was is stressful and challenging? Most assuredly, but he’s 82, healthy and still practicing medicine.

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I know it can be done! In fact Bernstein was what originally got me down the track of the low-carbohydrate life style, as I’m sure he did for a lot here. It’s hard sometimes to placate ones fears though. Granted, that is life. If I didn’t have diabetes something else would possibly come out of the cracks to cause me great anxiety.

I should say as well, whilst I’m specifically interested in any MD’s opinions on practicing medicine with diabetes, I by no means don’t want to hear from others. Life is varied and full of challenges in all areas so all experiences to me are valuable!

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Thanks rg! It certainly can, though largely I am grateful for the things in my life. I certainly have had an easier life than many people, which I will forever be grateful for. But diabetes can indeed by a massive monkey wrench.

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My families thoughts are with you and we know in the end, you’ll do the right thing…it’s really true about life, many times we spin our wheels worrying and stressing, but in the end things fall together somehow and most of the time, better…or different but still equal or better…than we anticipated before ever worrying.

I’d grab a cold one, sit back and relax and try to think of other things and let “life” happen the way it happens…that’s what I generally do. Take one day at a time, one decision at a time.

Regards.

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You can do it, go to med school! we have a member here who is currently in med school in Switzerland, @swisschocolate

we’ve had other MDs and medical professionals here w type1.

I’m also thinking of Dr Jason Baker, an endo in NYC who does lots of good work helping PWD in Africa get access to insulin
http://www.tudiabetes.org/video/tudiabetes-live-interview-with-dr-jason-baker-founder-of-marjories-fund/

Go for it!!

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Further on Bernstein . . . in the midst of a succesful engineering career, his Type 1 symptoms kept getting worse no matter what he did. So he started measuring his blood sugar several times a day and gradually developed a diet and medication protocol that gave him extremely tight control. Many of his symptoms lessened or disappeared. (Sound familiar?) This was in the era when home blood glucose meters didn’t exist; he was only able to do it because his wife, a doctor, was able to order a fairly expensive machine for him.

He tried to spread the knowledge about what he had done, controlwise. No one would listen. He wrote articles that were returned unpublished because “You aren’t a doctor.” So somewhere in the general neighborhood of age 40, he went to medical school, became a board certified endocronologist, and has spent the years since teaching patients (and through his writing, others) how to achieve tight control. And he’s still T1.

Point being, if you’re sufficiently determined to go the route you are contemplating, nothing’s going to stop you. If you want to do it, do it!

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If your interest in the Medical profession is primarily towards working with people with diabetes, you may want to consider someone like Gary Scheiner, MS CDE and the Integrated Diabetes website. There are many other options than the traditional office practice for medical professionals.
Many health insurance companies also have dedicated diabetes care resources. The internet and ‘remote’ health care visits are increasing.
With your software background, is that an option you would be interested in ?

Bottom line, find your passion and go for it. But a little bit of precaution and ‘reality check’ helps too.

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Some people find that their diabetes gives them a “calling.” There is no reason you can’t aspire and work towards a career in Medicine. There are many doctors who have diabetes and become doctors because they felt called. Dr. Steven Edelman and Dr. Irl Hirsh are just two. But you don’t have to become a doctor to work in the space, there are many different jobs in healthcare and diabetes advocacy that don’t require the grueling path of becoming an MD. Just look at some of the people at weareonediabetes.org.

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Thanks everyone for some great replies.

My background is actually as a secondary school teacher, before I moved into the Software industry. I actually work for a medical software company as well. I am certainly interested in how technology can be used to assist with the management of chronic conditions (not just diabetes, but obviously this is what sparked this interest). I have thought about being a diabetes educator as well, but it’s more than just managing diabetes that interests me with medicine.

My diabetes was certainly the catalyst in a drive to want to pursue it, but I am much more broadly interested in the field. Also, that is an intriguing website Brian, thanks for the link!

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I think this is a complicated question, but I will say that if you want to do this, I would not let diabetes stop you. If it’s the field in general that you are hesitant about, it might be worth seeing if you can get some volunteer experience in the healthcare field or even shadow a doctor or interview one to get more information.

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Certainly, as with any big change there are some reservations I have specifically for medicine, but I guess the main concerns I have are things everyone here has probably questioned at some time. Which really is, will this pathway have too much of a negative impact on my diabetes control? That question is by no means limited to medicine, though medicine likely has challenges specific to that career.

I’ve been reflecting on this question myself since I posted this yesterday, and one thing I’ve asked is how would I feel if I decided against it, still ended up with complications in the future. Would I regret my decision then to not pursue a pathway because I felt it may be bad for my diabetes?

But then again, is it irresponsible to not consider the impact on my diabetes control at all?

Does going into medicine automatically mean that your diabetes control will deteriorate? I think the answer to that question depends on what you decide. I don’t think the two have to be mutually exclusive. However, if you want both, it does mean that you’ll have to put in a lot of extra time and effort into diabetes that your classmates and colleagues don’t have to.

I’m legally blind (from birth) and ten years ago went into teaching. My family and close friends were supportive, but that’s where the support ended, and even they occassionally let slip a comment of doubt. So many people told me that I couldn’t do it. How would I teach a kid to read when I myself could hardly read print (I can read large print held extremely close, but also read braille)? How would I keep 22 young students safe? How would I write on the board? How would I access classroom materials? How would I mark student work when I couldn’t read it? What if parents had a problem with my blindness? What if my students had a problem with my blindness? What if, what if… Right after I was accepted into a teaching program I got called in for an interview (no other students had to do interviews) where I was grilled with these types of questions. I finally said, “I don’t have answers to all of these because I’ve never taught before. But I wouldn’t have applied to this program if I didn’t think I could do it. At least let me try, and if I can’t do it, we’ll know soon enough.” It was a very hard program for me, and there did come a point when I almost quit, but friends and family talked me out of it. In the end I finished all the requirements any other student had to meet in the same amount of time with a decent GPA and letters of recommendation, went out and got a job almost immediately, went on to get a master’s degree that would have been unavailable to me had I not held a teaching certificate, and am currently taking a graduate certificate in a field that, similarly, is traditionally very hands-on and dependent on vision and has those who would claim someone who is severely visually impaired cannot do it. I have plans for a Ph.D. in an education-related field in the not too distant future. I have no idea what my life would be like if I had decided initially to not even attempt to become a teacher just because of my visual impairment (or diabetes, which was also challenging but which is usually overshadowed by challenges my vision presents), although in the year before I started the teaching program I did have many doubts and fears. A big part of why I applied is because I knew if I didn’t even apply I’d never know whether I should have tried or not, and I’d regret it forever; but, if I applied and attempted and failed, I could live with that. Certainly, the course of my life would be very different than it’s been had I not even attempted the program or had I quit midway through.

Before I began my teaching program (and the program I’m doing now), I knew in advance that I would face challenges that other students wouldn’t encounter. I worked in advance to mitigate any of those that I could, and I resigned myself to the fact that I would be putting in many extra hours above and beyond what anyone else would have to do. I sought accommodations through my university if I thought they would help. I spent nights up late brailling material as it was read aloud to me so that I’d be able to read it to students the next day. I went out to schools before my practicum began so that I could learn the bus routes there as well as my way around the school well enough that I would be able to focus on students and not mobility as I moved through the halls with a class. I found ways to make tactile seating plans and creative solutions to knowing when a student was putting up their hand. I spent many more nights up late thinking over how I could do this or that task when most people relied on vision to complete it. For you, I think there’s no reason you couldn’t approach medical school the same way in regards to diabetes. You know in advance what some of your challenges will be, such as eating a low-carbohydrate diet. Some of that can be overcome by preparing food in advance and making up a plan of easily prepared meals and snacks that you can have available. You may have to request some accommodations through medical school, if you need to have supplies or food with you or test and treat where such things are normally not allowed. Maybe obtaining and learning to use a CGM by the program start date could be part of your strategy, if you don’t already have one. Throughout the program you may encounter other things that present challenges to your blood sugar controlt hat you’ll have to find ways to compensate for. You’ll have to be prepared to put in even more time and effort than the average student, but as others have mentioned Dr. Bernstein, that’s certainly been done before.

Best of luck with whatever route you decide to take.

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Hey! I went in some of the same directions in my career. Worked as a programmer in and out of the “software industry” (business) for about a dozen years, then worked as an IT Director/Administrator in the healthcare field for the next 12-or-so years. Did some part-time secondary school teaching for around 10 years (concurrently with the last several position). After that, though I’m still working in software and/or system administration (no no longer on the business end of things, thankfully), I decided to make a change. I’m probably older than you, so medical school was definitely not appealing to me, though. Instead, building on the healthcare experience, I went to school for a Masters degree in Healthcare Informatics. Wanted to go into research, but the university discouraged me from that track, however. I’m not sure I’m happy about that – I’m only sorta using that degree at the moment.

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I’m not a doctor, but I am a professional nurse currently working on my Master’s degree. I think you can do anything you set your mind to doing. Is it easy, no long hours and the commitment to studying is rough on anyone, but you can certainly do it if you want to do it. Are you on an insulin pump? That would be something if you aren’t I’d look into for numerous reasons…mainly though the ability to customize basal patterns to meet your needs. Face it, as a health care professional you cannot tell your patient. hold off on that heart attack you are in the middle of while I go eat. A pump however lets you suspend your dose if needed in an extreme situation, and also lets you reduce your basal rates too. This is really ideal in professions eating at a certain time isn’t always guaranteed and life and death situations come up that have to be dealt with and dealt with now. But that being said, I certainly believe if you want it bad enough you should go for it. Don’t let diabetes hold you back from achieving your drams and living your life.

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Wow.

I’m admiring your strength in your resolve. I wish I had such control over the 40+ years of my T1.

Don’t be too focused on other problems than your own. Diabetes is just one of many factors that guide us in our lives. EVERYONE is guided by their own issues, problems, good, bad, otherwise. That your diabetes guides yours should not be a problem, but rather a force in your resolve.

A quote from the internet “do something every day at that scares you…” Sounds like you are on the verge of a major scare that might be good for you an others. Don’t be afraid. Of either your personal self, or of the task that intrigues you. If it interests you, there is peace in resolve. Go! have fun. smile. and be happy in your choices, no matter how scary they are at first. :slight_smile:

Thanks for your insight, it was helpful for me too.

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Thank you once more everyone for your great responses.

A particular thanks to all who have shared some of their own personal experiences with me. It’s really inspiring to read about everyone’s own journeys through life, and to hear how you have all balanced your diabetes, and in some cases much more. I can’t express how much I appreciate that insight, as I know it can be difficult to share that kind of personal information.

Certainly, a pump is something I’m looking into for a number of reasons, regardless of whether I go down the path of Medicine or not, and I imagine it would make it a little easier to deal with some of the challenges that would arise.

I’m still struggling with what I personally want my path to be for the coming years, external to my diabetes, so I have a bit to contemplate in the next few months. I’m actually going on a road trip around Iceland for 3 weeks in a month, so I’m hoping that will provide some clarity of thought.

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Hey Donman90,
Man, can I relate to this post! Im 27 years old, been living with type 1 since I was 3. I, too, recently went through a bout of complications (retinopathy in both eyes and subsequent horrific treatment for it) that really kicked me in the ■■■ to get serious about taking care of myself. I drank a lot in college and ate whatever I wanted. Didn’t care to deal with my diabetes, because life is hard enough without managing a chronic condition on top of it. I think my highest a1c was 14% and I got up to 180 lbs at 5’3". Never had great control before I gave up entirely. The last 5 years or so have been a journey of self discovery and learning how to take care of myself. I started following a ketogenic diet at the beginning of this year. I’m the healthiest I’ve ever been since making that choice! I can totally understand the fear of “am I making the right choice for myself or am I limiting myself because of my condition?”

I work in the lighting and production industry. It’s a high stress environment that’s constantly changing, heavy physical activity (think unloading trucks and building stages), and really odd hours that are unpredictable. Not to toot my own horn too hard, but I’m good at what I do, so I’ve gotten many offers to go out on tour with companies. I’ve turned down every offer because, at the end of the day, I fear that the stress of touring would make me ill and bring back those complications I’ve worked so hard to manage. I want to be able to have that experience and to just go out and do it to see what happens! But there’s always a voice in the back of my mind telling me that my health is not worth that job. So yeah, I get that fear. I really do. But I also know that it’s possible, with a little more effort, to stay on top of it and manage your numbers in such a crazy enviroment. Lighting and production is not medicine, to be sure, but the stress, long hours and inability to stop and take care of yourself because there’s something that needs to be done right now is similar. You can’t stop to check blood sugar or treat a low when you’re 40 feet up in the air, wearing a harness and hauling lights up with a rope!

My solution has been a CGM. I despise wearing a pump (critics be damned) for many reasons, so I get by on MDI and being strict about diet. I find with the keto diet, I can go 12, 18, sometimes 24+ hours without eating or dropping low, so that’s been a huuuge help. I guess what I’m saying is don’t let your diabetes control your life. If you want that medical degree, then go get it! Sure, it’ll be a little harder to manage your blood sugars, but if you’re working towards a goal and it makes you happy, then why not? I have similar conversations with myself on a daily basis. Am I letting my own fear get in the way of what I want and being happy? Can I really do this? But better to try and fail than to never try at all! If you want it, then you can do it.

Everyone’s got their own path through life, but I hope sharing here helps you make that decision. Keep us posted on how you’re doing!

Much love,
Alex

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Hey Alex20,

Thank you for sharing your own story with me! I certainly relate to a lot of it! It’s great to hear you’ve got your diabetes control back on track!

I guess questioning your ability, whether it be because of diabetes or otherwise, is a natural human compulsion. I can imagine the lighting and production industry would be a difficult job to keep stable bloods guars with. I know some people who are also in this industry, not diabetics, but I know often it’s a lot of travel, erratic hours and a lot of physical and stressful work. So good on you for keeping at what you love and keeping your control stable still!

Seems like everyone on Tu absolutely loves their CGM’s, I only wish they were a bit more affordable!

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