Unforeseen Complications: Diagnosed With T1D in the Army
Claire Paterson knew something wasn’t right when she suddenly weighed less than she did in middle school for what seemed to be no apparent reason. It was August 2018 and the 31-year-old was at the end of a pediatric rotation. She had a few other tell-tale type 1 symptoms, but labs came back normal. No stranger to diabetes what with her work as a pediatrician, Claire sought out another physician, tested once more, and with an actual blood glucose (BG) of 495 and an A1c of 16.5, she was admitted in diabetic ketoacidosis (DKA).
“I think my initial response quite frankly was just shock. It seems like something I should have been able to figure out on my own a lot earlier. I was sitting in the ER being treated by residents that I work with every day and just could not connect the two, and it really wasn’t until I had been admitted and all the lights were off and the nurses had finally left the room that it really hit me that I had type 1 diabetes and everything was about to change,” she says.
Initially, Claire worried about how she would do everything she loves which, for someone who grew up in Utah, includes a lot of camping and adventure sports: “I started googling climbers with type 1 diabetes. How do I run with type 1 diabetes? It wasn’t going to be the first step, but it was the most important thing to me, understanding how to get back to being active with the diagnosis and seeing if it was possible.”
Claire says a major game-changer was being able to start using a Dexcom G6 about a month and a half after she was diagnosed: “Being able to actually see how my body was reacting to different things gave me a lot more control.” A few months after that, she was able to get the Tandem t:slim X2, which she says, “made a huge difference with my hypoglycemic events, both when I was working in the hospital on long call shifts and on runs. I was still having pretty severe hypos, and that helped change my entire management from that standpoint and really make things a lot safer both for me and for my patients.”
A new approach
The pediatrician’s take on DKA and diagnosis also changed as a result of her own type 1 diabetes (T1D) diagnosis. When she’d worked in the pediatric ICU in the past and saw children admitted in DKA, she always wondered about the ones who had been previously diagnosed—where did they go wrong? She felt their bouts with DKA were probably the result of issues with management, but quickly realized after her own diagnosis that poor management isn’t always to blame. Claire herself has been in DKA twice since diagnosis and now knows that even if you do everything to the letter, problems can still arise.
Having more insight into managing the disease, she started approaching her T1D patients differently: “I was working in the ICU again and I admitted probably five new patients with diabetes. With each one, I would make sure I had time to go back and sit with the family for an hour or more every night and say, ‘Here’s my pump. Here’s my continuous glucose monitor (CGM). Here’s my insulin. This is how I do these things. These are a few resources that I’ve found so far. Your life can be normal.’ [My diagnosis] really gave me a whole new level of empathy for my patients and a whole new level of understanding.”
Claire explains that in medical school, she was conditioned to see diabetes as just glucose corrections and carb counting, a life of straightforward calculations when all is said and done. She’s since learned that there are so many variables to living with this disease and without enduring it firsthand, most people will never understand or have the awareness of what people with diabetes have to think about day in and day out.
“I honestly don’t know how parents and kids who don’t have a medical background learn this so quickly and manage it so thoroughly because it’s just overwhelming even with the knowledge that I do have.”
A unique situation
It’s important to note that Claire doesn’t have the same situation as most pediatricians—she is also currently an active duty member of the United States Army and is finishing up training. As a result of her type 1 diagnosis, she had to submit her case to a medical review board. This evaluation will ultimately decide if she can remain in the Army, though she will not be eligible for deployment as someone with T1D.
“While it is possible to do many things with type 1, the Army currently has regulations against joining if you have been diagnosed with T1D. This is largely due to the potential risks it would place on a deployed soldier and their unit. An untimely hypoglycemic event while deployed can not only risk the life of the soldier by also put the unit in a precarious position. Additionally, not having access to insulin and maintaining it at its required temperature is not a guarantee in many deployed environments,” Claire says.
She assumed when signing up for the military in 2011 that at some point, she would be deployed and serve her country as an Army physician. This diagnosis has proved a mental adjustment for Claire, especially knowing that many of her peers will be deployed within these next few months. Though the future is now a little uncertain, she respects the process, regardless of the decision reached. Her priority is being able to safely perform her duties and fulfill her commitment, and if it is decided she cannot, she will find other ways to move forward. (Update: As of August 2019, Claire received clearance to continue as a member of the Army with her type 1 diagnosis!)
In the spirit of moving forward, when Claire heard about Beyond Type Run’s marathon team, she figured applying would be a step in the right direction.
“I thought, ‘Maybe if I do this, I can push my boundaries even further. I can be connected to this new group of people that are training for the same thing and really learn from a group that probably has a lot more experience with type 1 diabetes and with running than I do.’ That’s what pushed me to apply—that and all the patients with diabetes I’ve taken care of since I’ve been diagnosed, being able to tell them, ‘Look, I was able to do this thing, which means you can do anything.’ I think being able to give them proof that their life can go back to normal is one of my biggest motivators,” she says.
Claire’s immediate future sees her taking a trip to the French Alps to visit the beautiful hiking and climbing destination Chamonix. She awaits the Army’s decision on her status, but knows that whatever the outcome, she’s got a whole lot to look forward to. When she gets back from France, she’ll continue training to be ready for marathon in November. In the midst of the questions about her future, putting effort into running and having the camaraderie of the team has been a source of stress relief.
“Honestly, hearing that I was selected for the marathon team was probably one of the best, if not the best thing that has happened to me since I was diagnosed —I was tearing up about it. It made me feel so empowered and so lucky and just really excited to be a part of something bigger and to see other people are doing this, which means I have no excuse. I can do it too.”
Claire Paterson is raising money for Beyond Type 1 through Beyond Type Run—her fundraising will make a real difference in the lives of those living with T1D.