Dr Poonam Jadhav was diagnosed to have Type 1 Diabetes at the age of 6. But instead of despairing, she continues to display a resilience of spirit that encourages people with Diabetes to also expand their wings and fly towards their goals. She has successfully reduced Diabetes to a medical condition instead of allowing it to dictate her life.
I am Dr Poonam Jadhav, Dental Surgeon at Dr Poonam's Dental Clinic and Assistant Professor in Management Institute, Indore. I am also a certified Diabetes educator and a person living with Type 1 Diabetes for more than 29 years.
My life was just like any other child - no worries, no responsibilities, only playing and fun all the time. I was diagnosed at the age of 6 years, on 04th August 1993.
Diagnosis with Type 1 Diabetes was not an overnight happening and prior to diagnosis, it was over a fortnight that my health started deteriorating. I had unusual symptoms like sudden weight loss, despite eating all the time. I was lethargic whole day unlike any other kid of my age. I used to keep mum at times, irritable at others and wake up to a wet bed daily. I showed all other symptoms relatable to Diabetes (as narrated by my mother). This was alarming for my parents and they went to see our family doctor.
After some required lab investigations, I was diagnosed with Type1 Diabetes. My family doctor advised to admit me to the hospital immediately, as my blood glucose levels were more than 500 mg/dL with Diabetic Ketoacidosis (DKA). After a long examination and history taking, it was
found that I had an episode of viral fever a couple of weeks ago and as a result, I had an autoimmune reaction in my body, that destroyed beta cells in my pancreas. After that, series of drug trials were done to revive my pancreas (Cyclosporin therapy) and after a month long stay in hospital, I was finally discharged with a set of insulin vials and syringes.
Those were the most difficult days for my parents, their life turned upside down as Type 1 Diabetes was rarely found at that time and treatment was also not that advanced as present times. There was no awareness about Type 1 Diabetes, no social media and peer support groups, so as to get help from fellow Type 1 Diabetes.
As a child, insulin injections were my biggest fear. I hated the food restrictions of my favourite items like chocolates, biscuits, wafers, ice creams, etc. But as years passed we were very used to the Type 1 life, the only thing that depressed us was the people surrounding us. They kept poking me all the time about my Diabetes and my family decided not to disclose my Type1 life to anyone, until and unless very much required. Obviously, my relatives, family friends, school friends, staff were aware, as my parents were very concerned for me and wanted to always keep an eye on me, while I was in school.
On the other hand, some people were very helpful and concerned, that I do not have words to thank them. One of most important person in my life, after my family is my doctor, my Endocrinologist, I feel like worshipping him as God, he was full time support for me right from my childhood, just like my father. May it be counselling on regular intervals, annual check-ups, midyear check-ups or any other queries, he was always ready to help me and I won't forget to mention that he didn't took a single penny from me for 29 years.
During all these years, my family was my biggest strength and they continued to push me up whenever I was low and I would love to mention that I have a loving father, mother and a younger brother, three pillars of my life.
After the diagnosis, I did my schooling, graduation and post-graduation. There was nothing that held me back. It was just that I had to be more careful about my food habits and taking care of hypos, otherwise there was nothing, my friends could do that I could not.
I feel, after living with diabetes for 29 years, my life has become more disciplined. I have a routine to follow, my meal timings, my work time, my exercise time, sleep time etc. Earlier, it felt like a burden to me, but over a period, it turned out to be a boon and I feel that I follow my routine more religiously as compared to people without diabetes.
There were certain things during childhood, like sleepovers at friend's place, outdoor trips, career plans which were restricted initially. But now, I guess nothing stops me, I do all of my house chores, drive on my own to work, manage my Diabetes I would say I'm very much independent.
I discuss my diagnosis not only friends, but everyone who wishes to know about Diabetes. As I am working for Diabetes awareness for many years, talking about Diabetes does not scare me, rather I love talking about it.
My friends help when it comes to taking care of hypos or when I'm feeling low on some days because of high blood glucose or any other health reason, my friends and colleagues definitely help me.
For years, I have followed the same meal plan as formulated by my Endocrinologist, except for the changes in quantity of food items as I grew in age. I eat 2 chapatis/ rotis, 1 bowl sabzi/vegetable (More of green leafy vegetables), salad (more of cucumber along with peanuts), 1 bowl rice, not regularly (boiled and strained) and 1 bowl dal.
This is the meal plan I follow regularly, but there are days when my mom cooks some seasonal delicacies like, kheer, gajar halwa, mango shake then I adjust bolus accordingly ( refined sugar is not added in any of these food items). Additionally, if there is any festival/ celebration/outing/ birthday party, my meal plan definitely changes and I will have to take extra bolus units or correction doses.
I will again say discipline is the key to Diabetes management.
Regarding exercise, time may differ but somehow I manage to do any type of physical activity daily for 45 minutes to 1 hour, whether cycling,walking, aerobics, yoga etc. It is obviously difficult to manage both of these when you're working, still, health has to be first priority for everyone.
Devices I use are:
Allstar Pen - I use this for taking my long acting insulin.
Novopen 4 - This is for short acting insulin.
Glucometer - for blood glucose monitoring
LibrePro sensor - This is an FGM device for BG monitoring.
Libre sensor - for real time glucose readings
Freestyle Libre Reader - For blood glucose monitoring
MiaoMiao2 Smart Libre Reader - Sometimes, I use it with my LibrePro reader to convert it to CGM, when I feel I need more of monitoring.
Glimp - This is a third party app used for monitoring BGs with Abbott's LibrePro sensor
Tomato - This is an app used with MiaoMiao2 Smart Libre Reader to monitor BGs
Health App - This app tracks all of my activities during whole day
Strava - This app is very useful on the days I do cycling.
MyFitnessPal - This is the best app I have ever used to know how much carb, protein and fat any food item has.
Flo - I use this app to track my Menstrual Cycle, as this phase needs more of monitoring and changes in Bolus.
Before departing on a longer trek, people with Diabetes have to first see the effect of hiking or trekking on their blood glucose by doing small treks first or by simply walking/jogging.
Another thing to consider is how the surrounding temperatures affects your blood glucose levels. Most people with Diabetes have high insulin sensitivity in winters or low temperatures and experience more incidences of hypoglycaemia (low blood glucose). However, there are also people with Diabetes who have low insulin sensitivity. Therefore, you have to understand your body variations, as it varies from person to person.
It is important to monitor blood glucose levels with the help of glucometer as my MiaoMiao2 reader failed to give correct reading and I had to rely on my glucometer for whole of my 22 days trip.
Note: Any of your devices may fail at high altitudes and those who are on insulin pump should carry Insulin pens or vials in case the insulin pump fails or tubing is clogged or the insulin freezes.
Always carry extra supplies with you like:
Hypo supplies (glucose and sugary drinks)
Chargers for Libre Reader and MiaoMiao2 Smart Libre Reader
Extra insulin pens
Cooling cases in case you're traveling in low temperature areas
In high altitude areas, temperature is usually low and if you are traveling in winter season when there is snowfall and temperature is usually zero degrees or below zero degrees, then you need to carry insulation flask, which will protect your insulin from freezing. Anything that is stored inside any insulated flask remains isolated from outside temperature. This is important because once frozen; insulin is denatured even after melting and is not suitable for use.
In case you are going to a place where there is high temperature, then you need to carry cooling cases with you (cooling cases are best for use). I carried
both insulation flask and a cooling case along with Diacool which has ice packs, because you never know when weather will change and you need to protect your extra insulin supply from atmospheric temperature as there may be no electric supply on a high-altitude trek like Pangong Tso Lake and Nubra Valley.
It is important to be physically prepared for any high altitude expedition, at least a month prior and as my parents had also accompanied me, I had to be extra-cautious. I sought help from my family doctor and cardiologist because at very high altitudes, there are chances of getting breathing issues, cyanosis, increased pressure in brain, high blood pressure; bleeding from nose, etc. It is important to get a routine check-up done from their doctor, to take approval that you are medically fit before starting for the trek.
A first aid kid is necessary with various medications. I personally carried medicines which we take on regular basis, apart from this, Diamox (For increased intracranial pressure, dispirin, aspirin, medicines for fever, diarrhoea, nausea, vomiting, motion sickness, blood pressure, common cold etc.
As we travelled by road, we were gradually acclimatised to the atmospheric pressure at high altitude. In case you are traveling by air, you may get mountain sickness symptoms, so try to travel gradually.
We purchased oxygen pumps from local shops and kept taking oxygen puffs regularly whether required or not, especially at Kardung La Pass, Chang La Pass and Pangong Tso Lake.
Before any trekking or hiking expedition, any person with Diabetes has to be prepared beforehand. The person should regularly undertake activities at least a month prior to the scheduled trip, like walking, cycling, jogging, running, treadmill sessions etc. It is necessary to be physically prepared for the exertion and one should not randomly go these places without any preparation.
Breathing exercises (pranayamas) is another important practice that has to be done to increase the lung capacity, because whenever you travel in high altitudes, there is less oxygen in these areas and people suffer from altitude/mountain sickness more often.
There's simple rule during any mountain travel or trek “stay hydrated, drink lot of water and fluids, this will protect you from mountain sickness”
For any mountain travel, always carry lot of snacks and water with you, along with medicines, reason being you never know which road may get blocked due to landslide, avalanche or heavy snowfall and you may get stuck at a place for hours or days. We personally carried lot of snacks especially peanuts and dry fruits, so that we can eat fistful of these while moving at regular intervals.
It was difficult for me at times, because the food items available at these places are mostly high-carb like instant noodles, aloo paratha, sandwich, roti made with maida (refined flour), which could not be avoided during meal time.
Carry extra supplies Insulin/ Oral medications
Carry ample snacks and hypo treats
Do regular monitoring with Glucometer; do not rely on CGM/FGM devices completely.
Pulse oximeter and blood pressure instrument should be carried to check oxygen level in blood and BP at regular intervals.
When my annual Diabetes monitoring and three monthly HbA1c, when it shows that I'm as healthy an any Non-diabetic individual, it's a driving force for me and I keep on working more and more on my Diabetes Management.
People who get inspired from me especially the caregivers to Type 1 Diabetes children, when they say that 'We want our kid to be like you, someday', that is something that keeps me going and I feel that it's my bit towards Type 1 Community.