I have had type 1 diabetes for 14 years. Every time I think about complications and the natural history of my disease, I worry about the future even though I am in relative control. I always wonder if my life will be normal when I get older. If I were to marry, would my children have diabetes? If this were to happen, I would blame myself.

Whenever I exert even a minimal effort, I feel very tired. How can I prevent this? I am concerned about being tired during my exams since I am in the faculty of medicine and have many long, tiring days.

If your fatigue were related to excessive hypoglycemia or hyperglycemia, then, improving control of glucose levels would be key. This, of course, is also the key to maintaining good health and preventing the long-term complications of diabetes. In simple terms, this means following a meal plan (timing and amounts, carbohydrate counting) and adjusting insulin doses frequently based upon multiple daily blood glucose measurements. To make sure that you are optimally educated about such matters, you might want to read manuals such as Type 1 Diabetes in Children, Adolescents and Young Adults, Second Edition by Ragnar Hanas, M.D. and Type 1 Diabetes for Dummies by Alan Rubin, M.D. and staying in close contact with your diabetes team will help. You should have A1c tests done at least every three or four months to give you some feedback on how you are doing and help you establish treatment goals (i.e., safely maintaining an A1c below 7% without excessive hypoglycemia).

Whether or not your future children were to have diabetes is not under your control since this would randomly occur from environmental issues totally out of any of our control, as well as random genetic passage of risk factors. So, you should know that the risks for a future child with diabetes are in the 2 to 6% range. If this would be too high for you to consider, then you should not have any children. For most of us, this positively means that you have a 94 to 98% chance of NOT having a child with diabetes. This is an individual decision, of course, and one which you should discuss with your family and significant others.

There is plenty of reason to be optimistic that good control is possible with an intensive diabetes management plan and that you can be a good doctor despite your having diabetes. Maybe you will be even a better than average doctor if you understand some of the difficulties of a chronic medical condition like diabetes.

SB