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Living with diabetes: Walking a mile in my patients' shoes

Health is a privilege.  Health is luck.  Health is genetic.  Health is life.  After completing my diabetes rotation at Sunnybrook Hospital in the outpatient diabetes education centre, I have realized how lucky and thankful I am to be healthy.  It is truly a miracle how all the systems in one’s body work cohesively to sustain a healthy body.

In the final week of my placement, I participated in a program called, “Living with Diabetes.”  Essentially, I was supposed to live for a week mimicking the life of someone with type 2 diabetes.  Participants in this program included four family practice residents, a family practice physician and myself.  We met every morning and were presented with the progression of our diabetes, which would likely have taken years, but for this simulation, it only took a few days. 
We were given hypothetical lab values, food records, and self-monitored blood glucose values.  Medication was provided in the form of Skittles®, which I had to take daily at allocated times.  I had to check my blood glucose four times a day at a minimum and record the values. 
As our conditions progressed, we had to inject ourselves with an insulin pen before each meal and before sleeping. I was hesitant to try injecting myself, but we all tried together and it was not as bad as I had anticipated.  I was told that resident doctors have been so scared to inject themselves in the past, that they close their eyes, squirm, and hesitantly count to three before doing it. 

We had to learn to count carbohydrate servings based on portions we ate. As I was in my diabetes placement, I knew how to do this, yet I never had to actually pay much attention and be cognizant about my specific numbers.  Many of the participants in this program had never counted carbohydrates before. They found it difficult to measure and quantify their foods.  In addition, at any point in the day or evening, we could receive a text message saying we were having a low blood sugar and needed to treat it immediately.  I was actually driving once when this happened!
How this experience changed my practice
This program not only opened my eyes to living a life with diabetes, it made me reflect upon my counselling practice as a whole.  Experiencing this program and having group reflections each day was so powerful.  Hearing the medical team speak about their perspectives from the side of a patient, how their practice will change, and how they developed more empathy and respect towards those living with diabetes and for the diabetes education team was incredible. 
I shared many similar views about this experience changing one’s life, witnessing the daily struggles, and how a newfound level of empathy was formed. Yet, from the dietetic intern perspective (having exposure to these concepts on a daily basis), my experience was perhaps different from that of the family practice residents. 
I learned about living with diabetes in class, but only after experiencing it first-hand did I truly understand the daily struggles.  If patients’ tells me they forgot to take their insulin with them when going out for dinner, or forgot to take evening insulin after an exhausting workday, I can now relate. When patients tell me they are embarrassed to pull up their shirt and inject themselves with insulin in public, I can now relate. I understand how easy it is to forget to check your blood sugars exactly two hours after eating, and have great respect for the dedication and commitment required to manage this disease.

This experience enhanced my feeling of empathy toward patients, and helped me better understand the struggles that may influence their lifestyle choices.  Going through this made me appreciate the (seemingly) small things in life, such as having the freedom to enjoy a birthday party, without focusing on the carbohydrate load or my insulin dose.
Last year, my family experienced some horrible losses and sicknesses, some of which took place at Sunnybrook Hospital.  My personal losses and recent professional simulation made me reflect upon how lucky I am that every system in my body is working effectively.  Whether personal or professional, I now have a better understanding of the role of the health care team in health management and the importance of empathy. 
As a dietetic intern’s small note of advice, take all opportunities given to you in placements.  They may push you out of your comfort zone, but this is how you will grow. Being able to genuinely understand what a patient may be going through will make all the difference when building rapport and providing patient-centered care.
The learning I acquired from this program will be invaluable towards improving my patient care, which at the end of the day, is what really counts.
Editor’s note: What a fantastic opportunity to have as a soon-to-be dietitian! This sounds like a very challenging and eye-opening experience. If you’re a preceptor, have you been able to provide interns with a similar opportunity to live in a patient’s shoes?
Please share your stories and comments below. 
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