This past summer, I made the bold decision to leave my full-time (and awesome!) job as Assistant Editor here at the 'Mine to pursue a lifelong dream of becoming a Certified Diabetes Educator.
That meant going back to school to get some kind of medical degree (I chose nursing), working in that field for two years, then finding a diabetes educator job and accumulating 1,000 hours of with patients before finally passing an exam with the National Certification Board of Diabetes Educators. Whew!
Before even starting my first semester in September, I knew I'd have my work cut out for me!
Just a few weeks after making the decision, I was enrolled in my first round of classes at my local community college. Although I already have a Bachelor of Arts degree, there are several prerequisites needed before I can attend nursing school. Classes on tap were: Anatomy & Physiology, Chemistry, and Algebra. If you're wondering where the Algebra fits in, it's a pre-req for Statistics, which is the actual pre-req for many nursing schools (and isn't diabetes a huge D-Math algebra problem, anyhow?!).
Honestly, so far I'm just taking a lot of background and intro stuff that's needed for nursing school but doesn't hone in on diabetes care in particular. Still, there's a fair amount of "remedial education" on diabetes included, and this is the thing that surprised many people when I first announced that I was going back to school: Wouldn't I be able to skip 'Diabetes 101'? Didn't my 19 years as a PWD (person with diabetes) count for anything?
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While I do think my nearly two decades of living with type 1 diabetes deserve some credit, I knew there was a lot about the disease that I still didn't understand. I also knew, from having reported on nearly two dozen diabetes complications, that blood sugar affects nearly every system in the body and there are a lot of medical nuances you wouldn't necessarily know just from the experiences of your own diabetes.
Needless to say, the class I was looking forward to the most -- Anatomy & Physiology -- definitely taught me a thing or two! Some of these things I find I sort of inherently knew already, but they weren't necessarily things I fully understood or could explain to someone else (which is pretty important for a career in education!). Let me try to explain a few lessons now, for practice, if you will.
Three Things Anatomy & Physiology Taught Me:
1. Don't Blame the Calories
A common theory is that "calories make you gain weight," and that's why people focus on counting calories. But I learned that isn't correct.
When you eat anything with carbohydrates, whether it's a whole wheat bagel or the last of the Christmas cookies, your body breaks it down into glucose. This is Diabetes 101. Your body uses this glucose to power your muscle cells so that they can contract and relax. So what if you eat too many carbs? Does the right amount of insulin "cancel out" all that sugar (i.e. glucose) going into your cells?
Not exactly. Excess glucose is processed into fat by your insulin. So it's not calories that make you fat; it's glucose, which is primarily made from carbohydrates. But protein and fat can also be converted to glucose by the liver. Calories are just a unit of measurement, like a meter (no, not a glucometer but the kind that measures length!). Your body doesn't actually use calories, but you use the measurement of calories to monitor your diet made up of carbs, protein and fat. What counting calories can help with is portion control: too-high calorie count means you're probably just taking in too much food overall.
2. Cortisol & Our Stressed-Out Livers
I always knew that stress raises your blood sugar. But I assumed that meant that the stress hormone, cortisol, somehow inhibits insulin from working. And that's true — cortisol causes insulin resistance in cells. But it's not the whole story. Cortisol also increases the production of glucose in your liver, using gluconeogenesis. That's the scientific term for creating glucose out of non-carbohydrate sources, and it's something the liver likes to do a lot. It's also the process that metformin targets, which is what helps keep blood sugar lower.
The cortisol initiates the flight-or-fight response, so the body registers that it might need more glucose soon. It dumps glucose into the system to get ready. Of course, because we have diabetes, this glucose response is not counteracted automatically by the pancreas, which is why you see your blood sugar spike during stressful times. So when you're stressed, not only is your system hit with sugar it wasn't expecting, but the insulin you do have in your system isn't as efficient.
3. High Blood Sugar Begets High Blood Sugar
When we finally got to the section on diabetes in our Endocrine System unit, I was pretty convinced that I would have this down pat. I mean, sure, how glucose affects non-PWDs might be a complete mystery, but not the disease itself that I've been living with since childhood. I was all smug, sitting in my seat, waiting for my professor to make an egregious error. But my professor actually did quite well — he even emphasized that juvenile diabetes and adult-onset diabetes are now called Type 1 and Type 2!
What I learned was that when your blood sugar is increasingly high, it triggers a "sympathetic response" in your nervous system to actually make more sugar (using that oh-so-annoying-for-PWDs glyconeogensis). Seriously?! When I thought about that, it made complete sense! How many of you have clocked in with a blood sugar of 350 or 400 mg/dL -- or something way higher than a "normal" high — and watched as your blood sugar took its sweet time (pun intended!) dropping lower, despite your best efforts, as compared to treating a high when you're 200 mg/dL.
In fact, I've often noticed that when I'm super-high, I won't even make it back to normal, but instead will halt in the upper 100s or low 200s, nowhere near my target of 100 mg/dL. You may need even more correction insulin to treat a higher high because your body could actually be fighting your very attempt.
So, those were my top three nuggets taken from this first semester.
As it happens, I got a B+ in Anatomy & Physiology, with an A- in Algebra and a B in Chemistry. Overall, I'm pleased with my grades. Considering many people fail Anatomy & Physiology the first time around, I'm excited I did so well! I start classes again on January 22 and I'm registered to take the second half of Anatomy & Physiology, Microbiology and Statistics.
Now I'm beginning the emotionally taxing process of applying to nursing schools. I have sent in my application and requested transcripts to my first choice school, so now I just have to wait and see. It's a bit of a reach, since my undergrad GPA doesn't meet their minimum requirements.
I hope they like me anyway. After all, I've got a 19-year track record as an actual PWD under my belt!