For people with type 1 diabetes, this chronic disease can be a personal burden, one we reckon with every day of our lives. For doctors, it can be a complex condition to help patients manage.
To Dr. Michael Heile of Cincinnati, it’s both. Through his practice with The Family Medical Group-Cincinnati, Dr. Heile has treated more than 500 patients with type 1 diabetes. His personal career with diabetes began just before his medical journey, as he was diagnosed with type 1 diabetes in his senior year of college at Hanover College in Indiana and was about to head to the University Of Cincinnati College Of Medicine.
“I was walking home from the swimming pool, and I saw two moons in the sky,” he told us. “I went to get blood work done, and my blood sugar was over 800 (mg/dL).”
Learning about diabetes – and how to live with it
In the early 1990s, when Dr. Heile received his diagnosis, the clinical approach and available technology differed dramatically from today’s more sophisticated options for diabetes technology.
“The doctor put me on NPH and Regular insulin, and I asked him about everything I needed to do and if I was still going to be OK If I did it,” said Dr. Heile. “‘I don’t know if you’ll be ok,’ the doctor told me. ‘But you’ve got to do this stuff.’”
For Dr. Heile, managing blood sugar with the tools available while trying to study and do clinical hours proved to be a significant challenge. “No matter how good I was, my sugars were either 30 or 300 (mg/dL)!”
Dr. Heile told T1D Exchange Glu about some of the critical issues he faced while receiving his medical education and training, including misunderstandings and skepticism from doctors and instructors.
“I went to my endo and asked, ‘Doctor, is there anything you can do to help me with these horrible inconsistent sugars? I can’t be all that consistent with my meals as a med student,’” Dr. Heile told us. The endocrinologist simply told him to go see a dietician and learn to eat better
Another lecturer at the university told a class of med students that “all diabetics are liars” about their blood sugars and diets.
What it means to be a doctor and a diabetic
Though he didn’t initially intend to specialize his practice in type 1 diabetes – and indeed, he still sees a broad range of patients regularly – Dr. Heile found that his personal experiences with the disease helps him provide better treatment. It also has meant that both patients and other doctors have respected his advice and knowledge over the years.
One of his goals from a clinical perspective is to collaborate with other physicians and people with type 1 diabetes to leverage their expertise and knowledge to provide more meaningful and helpful care.
Dr. Heile has also observed some intriguing dynamics within his patient population, such as the prevalence of people with type 2 diabetes using insulin pumps and CGMs. While originally very rare, these treatment options have become more popular as people experience some of the advantages of adjustable basal rates, easy boluses, constant glucose awareness, and more.
Many of these “type 2’s” are “LADAs” – Latent autoimmune diabetes of adulthood, he said. As there has been an increasing number of diagnoses of adults over the age of 20 or 30 with type 1 diabetes, some physicians struggle to issue the correct diagnosis. Some of the telltale symptoms of type 1 diabetes may initially appear to be those of type 2 diabetes, which can throw clinicians onto the wrong track. Dr. Heile has found that his experience with type 1 diabetes helps him address these cases.
Diabetes brings different challenges – and corresponding insights – to each of us who struggle with it. For a family medicine practitioner, it can be an especially valuable, albeit far from easy, shared experience.
“My goal is to help make this disease the least of your troubles and to help you manage it well so that it doesn’t become the most of your problems,” said Dr. Heile. “Your job is to use these tools to get your diabetes controlled. My job is to help you get there safely and with good quality of life.”
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