Education: Hard Lessons

Firsthand Knowledge About Diabetes

By Rosalind S. Fournier

For many School of Medicine residents, diabetes training lasts for one rotation. For Mary Lauren Scott, M.D., it has taken years, with a new assignment every day. She has been learning about diabetes since she was 12 years old, when she was diagnosed with the disease.

Even then, Scott was a quick study. She recalls that soon after she was admitted to the hospital for a week of diabetes education, a nurse entered her room with a needle. “I was sitting in bed with a friend watching TV, and the nurse said, ‘Are you ready to give yourself a shot?’ So I did it, because I realized that either I do it and feel better, or I don’t do it and get sick. And once I started, it was fine.”

Of course, the teenaged Scott also learned that diabetes care was more complicated than getting over the “ick” factor of insulin shots—she had to stick to rigid mealtimes as well, even when it was inconvenient. But she adjusted quickly—to the point that she was soon giving herself insulin shots at the school lunch table and barely giving it a thought.

Still, the long and unpredictable schedule that comes with being a medical resident poses its own challenges. One of Scott’s fellow residents, Stephanie Berger, M.D., also has diabetes, having been diagnosed at age 13. Like Scott, Berger took the diagnosis in stride, crediting her parents’ positive attitude and the “unbelievable job they did in not freaking me out.” But she concedes that residency has made diabetes control more difficult. “Truthfully, it is hard and frustrating at times,” she says. “One of the secrets to good control for me is a schedule—figuring out my body’s needs and then anticipating and reacting to its responses. Right now my schedule is never regular, and with the frequent 30-hour shifts, switching from days to nights, it does have a negative effect on my overall control.”

Sharing Strength
In her residency, Scott has looked for electives that relate to diabetes, and she has enjoyed learning about current thinking and research in a clinical setting. Her rotations have also introduced her to aspects of the disease she hasn’t experienced herself.

One such aspect involves working with patients who lack a positive outlook about their long-term prognoses. In treating adults, for instance, Scott often has encountered scenarios that baffle her—diabetes patients suffering complications they may have avoided by managing their disease better and others who have already relegated themselves to a life of poor health and limited options even though they have no complications.

Straight from the Source

The new NIH-designated Diabetes Research and Training Center will further UAB’s efforts to provide medical professionals with the latest insights on the disease. Principal investigator and UAB nutrition sciences chair Timothy Garvey, M.D., says the new center—part of the UAB Comprehensive Diabetes Center—will combine potentially groundbreaking research with outstanding training opportunities. “That usually happens naturally,” he adds. “By bringing together clinician scientists and basic scientists to study diabetes, we will learn more about the disease; then the clinician scientists will pass on their knowledge to health professionals across the board who care for diabetic patients.”

“I’ve had patients in their early 20s ask to be put on disability for their diabetes,” Scott says. “Because I’m working over 80 hours a week, it’s hard for me to understand why they think diabetes is such a bad thing. They may be in bad control, but they don’t have renal failure or other problems—they just feel that having diabetes means they can’t do anything else with their lives.”

Conversely, Scott—who is considering a career in pediatric endocrinology—finds great satisfaction in working with children because it gives her the opportunity to educate and reassure them that diabetes is not a death sentence. “From the beginning, you can tell them your experience and emphasize that they can still do whatever they want to do and have a normal life,” she says. “I love that part of it—seeing them from day one and trying to influence how they feel about themselves.”

For her part, Berger also is considering a specialty in endocrinology, though she hasn’t ruled out emergency medicine or general pediatrics. She says that having diabetes herself has taught her far more than she ever could learn in school about the disease. And she, too, has found it a constructive icebreaker with individuals and their families who are facing a new diagnosis. “I did my endocrinology rotation last year and really enjoyed it,” she says. “And depending on the interaction I have had with families, I have often disclosed that I have diabetes. Often they are very relieved to find someone living and working with the disease.”