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From Germantown, Maryland, USA:

I was just diagnosed with Type 1 at 25 years of age. Hopefully I'll be starting medical school this fall. I'm interested in any information or advice on handling my diabetes while in school. I know the curriculum can get rough, even rougher during residency. I'm on two injections (R and NPH) a day but will soon switch to the intensive therapy of 4 per day. Any information would be welcome.


Congratulations on your acceptance to medical school. Yes, medical school and residency can be "physically challenging" with frequent nights on call and irregular schedules even for people without diabetes. I think it is a good idea that you are trying a more intensive insulin regimen before starting school as it will give you more flexibility trying to match your insulin to your activity. You might also want to consider trying out an insulin pump as it may give you even more flexibility.

A few practical suggestions:

  1. Test your blood sugar frequently. The stress of being on call for 24 hours or more can either increase your blood sugar or decrease it.

  2. Always be prepared and carry around emergency food. Keep in mind that when you are rotating through an acute care hospital ward or emergency room, you may be called to literally run to emergencies and not have time to stop, test your blood sugar, and go somewhere to get extra food. If you are always carrying some cookies or other starch, you can literally eat it while running to an emergency. You can't take care of a medical emergency while having a low blood sugar.

  3. Don't count on taking breaks for meals at the proper times. If you are busy with a sick patient, you may not be able to leave the ward. You should always bring food for meals and snacks in case you can't go to the cafeteria (You may be very popular if you have food and can cover for other doctors during meal times. Make sure you take a break some other time during the day if you don't make it to meals.)

  4. The hardest rotation (or profession) is surgery. You may be "scrubbed" (dressed in sterile gowns and gloves) for hours at a time and not be able to test your own blood sugar or eat food. Surgeons do drink liquids through a straw during surgery held by someone who is not "scrubbed", but when you are a medical student and "low on the totem pole" you may have trouble finding someone before surgery to agree to feed you. If you are using the pump, you may be able to figure out a basal rate so you can go hours without eating. Before relying on this, you should try it out yourself. Again, you can't have a low blood sugar during surgery. You may have to settle for blood sugars higher than you would normally prefer in order to avoid lows.


Original posting 15 Apr 1998
Posted to Daily Care


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