The system of tag teaming parents managing my routine worked well until college, when I forgot my first injection. By then we had disposable syringes and I didn’t have to reuse the needle until it became dull, plus it was a smaller needle.

Today’s needles are 31g compared to the 25g monsters I used. Gauge is a measure of thickness of girth of the needle. The larger the gauge, the thinner the needle.

Anyway, getting back to the story, I ran out of insulin on a Saturday and pharmacies were not open on Sunday in those days. I thought it would be alright to wait until Monday. Well, I learned a hard lesson that day when I became nauseated and started vomiting nonstop. I had fallen into diabetic ketoacidosis (DKA) that Sunday evening and spent the next 3 days in the university infirmary. At first I thought it was food poisoning, but no one had ever taught me how to recognize the early stages of DKA or the consequences of a missed injection. The two lessons I learned from that experience were:

1) PLAN ahead; and,

2) NEVER omit an insulin dose!

My parents had insulated me from this outcome since they had been so meticulous in my care. I’ve never forgotten that lesson.

Well, fast forward to medical school in 1980 and I met a wonderful adult endocrinologist with a passion for diabetes similar to my own. He was a role model for what I would eventually become. He convinced me (after several weeks) that a single injection was not best for me. I was stubborn and set in my ways by this time so I tried every argument I could think of to maintain the status quo of one insulin injection a day. I finally relented and made the switch to a two injection per day insulin regimen. Furthermore, I had a new blood test called the hemoglobin A1C. It gave an overall estimate of my blood sugar control for the past 3 months. My result was 10.5% (not good). Immediately, I started doing better and my A1C result began to fall. I also was given my first blood sugar testing equipment. Like the old syringes, by today’s standards blood sugar checks took minutes to do, plus access to water. Now of course this is done in seconds.

In 1980 I also saw an ophthalmologist (eye doctor) for the first time, who discovered early diabetic retinopathy (eye disease). It was a shock. Thoughts of going blind consumed me. Fortunately, after a few laser burns to the affected area, plus achieving better control over my diabetes, I have kept this in check for 27 years with no progression. I still see the same eye doctor too.

Later that first year in medical school, I attended my first diabetes camp as a volunteer medical staff. I’ve been going back ever since (26 years), and now run the diabetes camping program there. It’s one of the largest residential camps in the country (serving 440 children each year) and it has always been offered free to the children. Camp is another way I can express my passion for caring for those with diabetes (children and their parents). Another year later, in 1982, I started using the insulin pump. I’ve been using it (with a couple of vacations) ever since. Like many of us with type 1 diabetes, it offers a chance to live a near-normal life, but with more diabetes self care responsibilities folded in.

As I’ve now said many times, I have a passion for diabetes. My passion led me to become a pediatric endocrinologist. I’m certainly not the first person with type 1 diabetes to do this, and definitely not the last. I’m actively involved with the national process for attaining certification in diabetes education (the certified diabetes educator or CDE credential) and have been involved in this since 1993. Since 1998, I’ve operated a children’s diabetes center in south Texas. Lately, I’ve been an eyewitness to the rapid transformation of the face of pediatric diabetes due to the epidemic of child obesity and type 2 diabetes (formerly called “adult-onset” but nothing could be farther from reality here). I see more children with new-onset type 2 diabetes (formerly called “adult-onset”), than with the traditional type 1 diabetes (“formerly called “juvenile-onset”).

I’m now married 21 years and have 3 children. None have diabetes. They’ve been tested once with standard antibody tests for possible risk. Problem is that these tests ought to be done every year or so to have any long term value as possible predictors. Fortunately, my wife has a genetic makeup that actually lowers the kid’s risk of getting type 1 diabetes. I have the classic immunogenetic makeup for type 1 diabetes. Still, if they do develop it, we know how to pick it up early.

My philosophy of care is a reflection of my past, but serves well to carry me forward. Simply stated, I aim to provide a normal life to children with diabetes and their families. The focus is on the person, not the numbers. We are overrun with numbers in our world. We get tagged with a number (the Apgar score) by the time we are 1 minute old. It seems to go downhill from there. Diabetes care is about teaching children, adults and families how to live full and productive lives with this condition and not allow it to dominate their existence. Dr. Elliott P Joslin, the father of modern diabetes care, said almost a century ago “the person with diabetes who knows the most, lives the longest”. Nothing is truer today.

Future posting will follow many of the themes above. I’m looking forward to sharing my views and I welcome yours. As the name of this site implies, diabetes IS a challenge, but it’s a challenge that can be conquered. In fact I see it conquered in very many different ways on a daily basis. Nevertheless, most success stories do have common themes and I’ve already mentioned three of them in my own case. I’m excited by the opportunity to share some of thoughts and observations with you. Not just my own, but also those situations I see every day in my busy children’s diabetes practice. I’ll also share some of the heartaches that we see every day and the challenges many face in attempting to master this potentially deadly disease. Finally, I will be posting my thoughts on new and emerging technologies for improving diabetes care for all forms of the disease, but always with the perspective of the patient having the final word on his or her own fate.

Last 5 posts by Steve

• Day 15 - Sixtieth Camp Blog Entry - August 3rd, 2008
• Day 13 - Fifty-Ninth Camp Blog Entry - August 1st, 2008
• Day 12 - Fifty-Eighth Camp Blog Entry - July 31st, 2008
• Day 11 - Fifty-Seventh Camp Blog Entry - July 30th, 2008
• Day 11 - Fifty-Sixth Camp Blog Entry - July 30th, 2008

This entry was posted on Thursday, June 21st, 2007 at 9:51 pm and is filed under Experiences. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.