Type 1 vs. Type 2 Diabetes Medical Course
Managing Type 1 Diabetes: How a Physician Assistant Takes Care of Herself — and Her Patients
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Hannah Kirk works as a physician assistant at an outpatient internal medicine clinic in Greeneville, Tennessee. She was first diagnosed with type 1 diabetes when she was 11 years old. She was eating like a horse (her words!) but still losing a significant amount of weight. Concerned about a possible eating disorder, her gymnastic coach approached Kirk’s mother. A visit with a pediatrician revealed the child’s blood sugar to be 403 mg/dl. A healthy range is between 80 to 130 mg/dl before eating and less than 180 mg/dl two hours after a meal, according to the American Diabetes Association (ADA). So Kirk’s family rushed her to the local children’s hospital, where she was diagnosed with type 1 diabetes.
Starting Each Day Off Right
Now 28, Kirk has been living with diabetes for most of her life, and she has her diabetes management routine down pat. She begins her day by testing her blood sugar and usually tests four or five more times throughout the day with a glucose meter or monitoring system.
Kirk’s routine is fairly typical, according to Joshua D. Miller, MD, MPH, medical director of diabetes care at Stony Brook University Hospital in East Setauket, New York, who has also been living with type 1 diabetes for more than 20 years. “Glucose monitoring is vital to daily life for people with type 1 diabetes. At minimum, most people with type 1 diabetes should check their blood sugar before each meal and at bedtime,” he says. Occasionally, Dr. Miller will ask patients to also check their sugars at other times to determine the effects of certain foods, activities, or medication adjustments on blood sugar control.
Consistency is key for Kirk when it comes to managing her condition. “I wake up at close to the same time every morning, and I have the same thing for breakfast — a granola bar, one cup of skim milk, and one cup of coffee with cream and sugar.”
Caring for Her Patients — and Herself
Kirk’s medical office has a catered lunch delivered every day, so she never knows what’s on the menu until it’s actually time to eat. Carb counting has become second nature to her in the last 18 years, so the “unknown” factor doesn’t get in the way of eating what she wants and adjusting insulin accordingly. “Most of the office is on a low-carb diet. Healthy options are usually available, and I can choose what I want,” she says.
Her packed schedule of seeing patients can be stressful at times. “At this point I’ve become accustomed to that; it’s my new normal,” she says, but she’s also mindful of how extra stress can impact her health. “In stressful times, your body produces cortisol, which does increase your insulin level,” she says. “When I feel stressed, I check my blood sugar a little more frequently than usual just to make sure I’m okay.”
Kirk says her own diagnosis played a large part in why she chose a career in medicine. And her insight as a healthcare provider living with type 1 diabetes draws many patients managing the condition to her. “Diabetes — both type 1 and type 2 — is something that really interests me as a healthcare provider,” she says. “I love to treat it and help people who have diabetes get on the right track.”
Hitting the Stables After Work
After seeing patients all day, Kirk takes off to the barn. “Taking care of my horses and riding my horses are my main forms of exercise,” she says. Each day she needs to strip out the horse stalls, clean them, and make sure the horses have enough hay and water. “It’s not a ton of aerobic activity, but it requires a lot of upper-body strength,” she says.
The ADA recommends that people who have diabetes do strength training exercises at least two days a week and aim for 30 minutes of moderate to vigorous intensity aerobic exercise at least five days a week, though this can be difficult to achieve, says Miller. “I recommend that people make small changes in their daily lives to incorporate more physical activity,” he says. An active hobby like Kirk’s can be one way to do that. Miller also suggests small steps like parking in the farthest spot in the lot or always taking the stairs in an effort to burn more calories.
Riding and caring for her horses are part of the daily preparation for weekends when Kirk competes in a sport known as “barrel racing,” in which a rider and horse race around barrels placed in a cloverleaf pattern to compete for who can put up the fastest time without overturning barrels.
Staying Healthy and in Control
“Type 1 diabetes is a chronic condition — it’s never going away, you’re going to have it forever,” says Kirk. “The consequences of uncontrolled diabetes are scary — blindness, renal failure, or loss of a limb. I’ve unfortunately seen those consequences very frequently at my medical practice,” she says.
Managing the condition is all about having a plan that you consistently follow, says Kirk. “Once you get you get your game plan on how you’re going to manage to check your blood sugar, take your insulin, and count your carbs — then you have to make up your mind to follow it,” she says. “The way I see it, diabetes is either going to control me or I’m going to control it.”
Self-care for Kirk includes making dinner at night for herself and her fiancé, Chris. That usually involves preparing some variation of grilled meat and vegetables. “Carb counting is so much easier when you cook and eat at home,” she says. “I know exactly what goes into what I’m making; when you eat out, you never completely know what you’re eating.” Sugar can be added to a lot of things you wouldn’t expect simply because it makes things taste better, she says.
Kirk also tries to get at least eight hours of sleep every night. “Sometimes that isn’t possible, but that’s what I shoot for, otherwise I can feel bogged down and drained,” she says. Stress relief comes in the form of taking care of her horses, where she can be engaged in physical activity while being around the animals.
“I’ve found the key to successfully living with the condition is to not let the day-to-day of diabetes management get the better of you,” says Miller. “Diabetes is a second (or third) full-time job. The time, energy, and emotional capacity needed to successfully manage the disease can seem overwhelming. My most successful patients find simple solutions to deal with ‘everyday living’ associated with diabetes,” he says.
Managing Through Highs and Lows
In case of low blood sugar, Kirk keeps a can of soda in her car at all times, and her fiancé keeps one in his truck as well. “I also carry glucose tablets, though I rarely need them; they’re important to have just in case.” She keeps a pack of gummy bears on hand, too.
“When I feel low blood sugar coming on, I get sweaty and shaky, and feel really weak,” says Kirk. “I start yawning frequently, which is a little strange, but that’s the way my body handles it,” she says. If her blood sugar gets really low, Kirk sometimes experiences double vision and becomes unable to speak or walk.
Although high blood sugar isn’t the same medical emergency that low blood sugar can be, it still doesn’t feel great. “It can make me really thirsty,” she says. “Sometimes I’ll get a headache and it can make me irritable,” she says.
Kirk is always prepared to manage her diabetes, even when she travels out of town, whether for a beach vacation or a horse race. “When I’m traveling I always make sure I have two sets of insulin — some in my purse, and extra in my suitcase in case I lose my purse, or my luggage gets lost. The same for test strips — I keep two sets just in case,” she says.
“Managing diabetes can be a daily struggle for some people, but it’s worth it to stay healthy and be able to enjoy your family and do the things you love,” Kirk says. “Everybody slips up sometimes, and that’s alright.
Video: Managing type 1 diabetes
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