I am a registered nurse and have enjoyed working in medicine for over 20 years. At the age of 50, I developed type 1 diabetes, and entered a world I was completely unprepared for in spite of all my experience in health care. The people at work all know I have diabetes but they are clueless as to what that means in practical or personal terms. I haven’t hidden the diagnosis, but I do conceal many of the details of what I have to put up with. There is no help at the hospital for people who have to maintain high standards of professionalism while living with a chronic disease.

Here’s an example of my predicament. I have been in the habit of letting my numbers run a little high because if I go at all low in the O.R., it’s a big problem. My brain gets fuzzy. There are lots of times when a nurse can’t drop what she’s doing to fiddle with pumps or take a sugar pill. So the short-term needs of my profession conflict with my long-term need to keep the numbers as low as possible without going so low that I lose my ability to concentrate. For the uninitiated, it may be hard to understand why it’s so tricky managing blood-sugar levels. There are so many different variables confounding the decision of how much insulin to take. Eating carbs raises the dose, so now I have a PhD in the carb content of every mouthful of food. Exercise – even walking – lowers the dose. The volume of the food on my plate raises the need for insulin even if the carb content is low. I didn’t know about that before. It explains some past experiences I had after eating large but low-carb meals and ending up with high blood sugar since I did not take enough insulin to deal with the issue of volume. Stimulants like the caffeine in coffee spike my sugars too, even if I have no carbs. And too much stress messes everything up and makes it hard to know what to do, especially since my first reaction to stress is to look for chocolate. In general, stress also raises my need for insulin.

I wouldn’t wish type 1 diabetes on anyone (although there are a few people at the hospital who I wish could have it for just one day). Even when I follow the directions, my blood sugar numbers are all over the place. So hearing other type 1 diabetics talk at the Suppers table about how they resolve their issues prompts me to try new approaches. For one thing, we are all becoming skeptical of the party line that says go ahead and eat 45 carbs at a meal and cover it with insulin. The one person at our meeting who got her A1C (a three-month measure of blood sugar regulation) below the cut-off for diabetes doesn’t eat that many carbs in a whole day! The new pumps and monitors make it easier to track the consequences of my behavior. It’s fascinating to eat a low-carb meal at the Suppers table and watch the graph line on the continuous blood glucose monitor stay flat as we enjoy our blanched asparagus, fresh garden salad, and grilled salmon.