Two Pediatricians And A T1D Diagnosis

Two Pediatricians And A T1D Diagnosis | The LOOP Blog

Like many other families, Dr. Stephen W. Russell and his wife, Dr. Gretel Russell, had no family connection to diabetes. They are also both pediatricians, though that didn’t prepare them for two new jobs in a new city – and a new diagnosis of diabetes for their daughter – all in the same summer. Not unlike many other families in the diabetes community, they show an impressive amount of courage, love and tenacity as they continue along the ongoing journey of learning about diabetes and what works best for their family.

Real estate, it seems, is all about location. So, too, is the management of diabetes.

Eight summers ago, my wife and I strapped our two toddlers and a newborn into the back of a dusty Ford Explorer and moved south to start our professional lives. She joined a pediatric private practice, teaming up with a doctor from Georgia. I joined other physicians in an academic group, following my desire to teach medicine as well as practice it. During our real estate search that year, we crafted check lists for neighborhoods with good schools and sidewalks. Three months after the moving trucks left, even as we were still exhuming our belongings from corrugated cardboard, we unpacked a new diagnosis of diabetes.

As we’ve told our story of a new city, a new home, a new job, and a new diagnosis to other veterans of the diabetes journey, we’ve heard familiar echoes in their own stories. “But we don’t have a family history of diabetes,” we initially complained, as if that offered a protective salve that could rub out the reality of giving a four-year-old shots. We tried to hide the emotional rawness behind the line, “We’re doctors. We’re supposed to be offering treatments, not receiving them,” but that did little to assuage our pain and nothing to help our situation.

With eight years behind us, we now look back and can see the denial inherent in our grief. We can see the arrogance of thinking that education or station could protect us from a genetic card that we dealt to our daughter as randomly as we gave her blue eyes and freckles. We can also more clearly see the missteps.

One scene continues to haunt us, mocking the notion that pediatricians must make great parents. Having just completed our first Halloween “A.D.” — after diagnosis — I found our pre-school princess straining against my bear hug as we sat at the kitchen table, forcing her to eat. “Too much insulin onboard,” I concluded when she didn’t eat her meal, so we did what we thought would be the next best thing: we forced her mouth open and shoved food in. We quickly saw it again as she got sick and soiled her sparkling Cinderella shoes.

Really? What day of diabetes education taught us that?

Fortunately, she didn’t go low that early November day. But we did.

Looking for a better way, we enrolled her in a study that fast-tracked young kids onto insulin pumps. Most of the kids with diabetes in our community waited a least a year before being considered for a pump. By our first Christmas, though, we had a pleasant plastic insulin pump stuck to her thigh. Decorated in pink and programed to give micro-doses of insulin, this first pump gave us more control. In looking for a better way to deliver insulin, we traded the certainty of a stiff needle for the flexibility of a pump, only later learning that kinked catheters and dead batteries could also lead to the vomiting that comes from high blood sugars.

The realities of real estate on her offered other challenges. She was already smaller than her classmates, so where would we hide a life-saving device the size of a deck of cards? We tried the thigh, but often found the plastic casing on the playroom floor if it snagged on the sofa or clipped the wall as she ran past. We tried the back of the hips, but pre-school chairs are perfectly curved to catch a case at belt-level. We stopped trying on the abdomen. A few choice pinches during catheter insertion effectively dissuaded her from re-exploring that site. We needed some new real estate, and after the study’s completion, we changed pumps to find it.

Late one weekday night after the kids had gone to bed, a Medtronic rep sat at the same kitchen table, demonstrating the insertion of an infusion set into his own abdomen. My wife gave me a practiced glance that said, “she’d never go for that.” We signed up for the pump anyway. We soon forged new paths with that two-inch adhesive, annexing pump sites from the real estate on the back of her arms. Some sites now work better for self-insertion, other sites for us to do. Some sites allow the tubing to snake beneath clothes and discreetly clip to her belt. Others are better for a pump pouch. In an unexpected frontier that comes with the independence of age, sometimes in the summer, it’s just easier to unplug, preferring the freedom that comes from shots at the beach rather than having to leave the surf to administer insulin.

Real estate, we now know, is not just about location. It’s also about forgiveness. Even good schools and sidewalks crack, but those in the neighborhood adjust, reset expectations, and work to improve. So too, we’ve learned, with the management of diabetes. Even following the rules of ratios and corrections can result in dangerous blood levels. But our family has adjusted, forgiven, and tried to improve. Eight summers into diabetes, we’re still growing, but now from a great location.

IMPORTANT SAFETY INFORMATION

– Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems.
– Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms.

Medtronic Diabetes Insulin Infusion Pumps

– Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day.
– Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately.

Please visit http://www.medtronicdiabetes.com/important-safety-information for complete safety information.

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