1. The Beginnning It was 1988, I was a 3years old little girl. A kindergarden playful kid in Nagayo Kindergarden. Who would wonder that I will be diagnosed with Type I diabetis Mellitus , well, that's what really happened. I called it takdir from Allah SWT. I cant really remembered how, or why or when I was diagnosed. Being pushed into the alleyway of the hospital ( it was in Japan), with the ceiling light soo bright I used both my hands to cover my eyes. I was hurried into, somewhere emergency. Maybe the Emergency Department? People in white coats and stetescope hanging at their neck, mumbling and talking in Japanese language about me? Or was it my condition? It was a total darkness afterwards. I opened both of my eyes. A blink of once and twice, and I noticed I was a white room. Beds were arranged perfectly in each corner. I'm warded, definitely. My days were filled with visiting interns and medical students, doing round, diagnosing me. Long cases, Short cases, u named it. I was their guinea pig and subject of their classes. The endocrinologyst and his team were really a helpful team. It was Dr .Papa and mama was taught about the disease and its complications and the needs to take care of me. We were surrounded by beautiful smiles everyday , friendly nurses and supportive team in the hospital . Finally , I was discharged home with my insulin stocks and etc. My life as a kindergarden little girl was occupied by being a Type I diabetic. No ice cream, chocholates or sweet beverages and dessert as frequent as the rest of the other childrens. It dont really bother me much. I prefer fruits and mama's cooking, more delicious. Primary school I was at 2 years of my diagnosis when I entered primary school. Mama has been always, and never failed to provide me with my lunch, pack like the Japanese Obento. Pretty cute looking, covered in those Japanese handkerchief. My friends being curious, always came and asked, What's inside there, Athirah? Whats for lunch today, Etty'? And some, does wonder why I never or very seldom bought foods/ snacks from the canteen. Probably, Mama already taught me that it is healthier to eat home-cook-food, thus not favoring the outside food. Sometimes, mama bought nasi lemak from the stalls, or bihun goreng. I hardly remember the type of insulin I am using back then , and did I injected any insulin during school hours? At 7years old, i'm allowed to inject myself, or was it 8years old. Nevertheless its an achievement! No Ramadhan fasting for sure. Mama says its a No No . Ada diabetik, tidak boleh puasa You are diabetic, u cant fast.

2. Probably, Mama was too worried if her daughter developed hypoglycemia or my blood sugars went haywire or went into coma at school. I just follow her order. LOL! Very obidient little girl am I? My parents did not allow me to go for any of the out-of-school activites such as camping/ etc. Too worried probably. It was once in a bluemoon that my Pandu Puteri teacher asked me if I want to go to the district camp. I asked mama and she agreed and allowed it, of course with much concern. Overtly concern. I was a standard 5 pupil that year. Mama prepacked me with sugary juice in boxes and sweets. My camping bag was hugely filled with my hypokit. She even came everyday to look at how I am doing . It was at an event at SS11 or SS14 Subang Jaya. Clinic has been a routine visit for me, every 4 to 6 monthly. Prof Fatimah was the one who patiently handle me-with-care as my dad is very protective of me. I always heard of arguments been made inside the room or even outside, not just with Prof but the diabetic nurse and the rest of the team. I was too nave to join the conversation, well, i'm just a kid , remember? Papa do a lot of reading on diabetic. That's why he can argue and made suggestions. Journals and online website. He theoritically can be at the same level with the medical practitioner I guess. He is the one without failed went to the PDM Selangor branch to buy the things needed; lancets, needles and so on. I never went out-of-stock, and I can just ask Papa myself if the things are nearing finish. He never allow me to attend any of the diabetic children's camp. You can learn about diabetic through life, and reading, and learn and keep learning by mistakes I agreed. I do learn by self-experience. Deep down I know papa just wanted the best for me. The Highschool years Entering high school, a prefect, and I participated in a lot of activities. I was among the top student in class. Weekend will be a busy scheduled for me. I joined the karate team after I get soo inluenced by The Karate Kid movie. Obsessed. Martial arts needs a lot of discipline. And practise requires energy and proper food intake before each clases. And I always have my hypokit inside my bag. Twice, did we practise for the district karate tournament. One of it was during the fasting month! I do had my hypoglycemia and hyperglycemia moments but it is very seldom. Training was tough but it was very much enjoyable. What interest me next was the traditional dance. Zapin was my favorite. That too, needs a lot of focus. And proper diabetic care. Foot care, good glucose control, and food intake. 3. I rarely check when I had the activites, I only based it on symptoms. Palpitations, fatigue and trembling are the most occurred symptoms of my hypoglycemia events. I hurriedly drink juices, as that spikes my BG fast. If I am at home, the fastest that I can make is Milo. 3 spoonful or more and I will be OK. Sweets to me doesnt really work. I will checked my BG aterwards. In the event of my hyperglycemia, I feel the coldnesss. I kept urinating. And feel amazingly thristy. That just makes me give a bolus jap and another BG after 30minutes. The routine follow up in the paediatric diabetic clinic was still University Malaya. Mama was the person who accompanied me to the clinic visit while papa sent us to the University Hospital. Masuk seorang Go in alone Mama said. Maybe she's training me to become an adult. To think like adult. I had the oppurtunity to discuss my problems with the attending doctor, yet the management is still on their shoulder. Finishing high scool, and it was the 10th year of my diabeticversary. What do I master? I was allowed to make changes to the basal/bolus regime of mine. Too many in and out of school activites, and sessions with friends and events, I really have to make my own decision and not to ponder both of my parents. Reaching the HBAic goal was my most problematic issue, as it never went down to 8mmol/l. Being a teenager, I have more freedom. Or me, being myself. To explore the surrounding and experience life. Everywhere I went, never I forgot to bring insulin and my glucometer in my bag. Have u ever missed your japs? one of my friend asked. Truly, lots of people asked me that question. No and never ! I answered. Why do I want to miss it? It is all about self-discipline and knowing the consequences that may arises in the event of not taking the japs. I have been living my life with diabetic through all these years, and if it be taken from me, I will miss the everyday injections and the checking of BG. Only the diabetic will feel excited looking at Bgs and only diabetic will feel the exitement of a perfect Bgs level. To have a good HBAic is the highest achievement. The college years Welcoming college years, I for once requested my insulin to be changed to Novorapid and Lantus. I I 4. browsed the internet and by far these are the best insulin types as per reviewed by diebetic himself or herself. Who can handle a 30minutes wait before meal after the bolus jap? Teenage life is a drama. Action-packed, ruined plans, with meadow moment at times. It was unpredictable. When I woke up late for classes, I miss my breakfast and had brunch instead. The weekend birthday celebrations, the meals after classes, coffee sessions and midnight snacks. Movies and popcorns! If I stay up late to revise and study, I will take snacks definitely I mentioned during one of the doctor's visit You have to limit your snacks, it is not good the doctor advised. But I will be sleepy he noticed my eyes rolling. Check you BG then he knew i'm being rebellious. Ridiculous. To follow the advices and rules is not easy. Teenagers are not robot. We are not programmed. Life is a moving game. We need to adapt. It's the survival of the fittest. The Islamic Prophet Muhammad (pbuh) pronounced: "Seek knowledge even as far as China" We need experiences. We are learning. The University years Thus it was the year 2005 that I continued my study to Ukraine. By far and foremost, the farthest country I have ever been in my life. Where on earth is Ukraine anyway? one of my friend asked. Do you know Turkey? The black sea? Or Rusia? Poland? They're just neighbours! The East Europe region, the ex Soviet. It's not as popular as the UK or Australia or India, perhaps? I feel a little offended by such questions. Not all students are granted the oppurtunity to study in among the best universities for medicine. It's the individual and attitude that counts You're gonna miss the Malaysian Maggie Mee she giggled. My annual luggage back composed of a year stock of dry spices, to flavorings, and unbelievablingly, insulins and its needles, glucometer lancets and strips. I entered medical school. It was 6 years in duration. And I gained a lot of experiences by living far and apart from my family. Most of my friends know I have diabetic. I'm not hiding it for if emergency happens, they wouldnt get panicked. Don't forgot to put sweets and chocs and juices in you handbag!, remind Mama The first 2 years of medical student, I still went for University Malaya endocrinology clinic appoinments. It was each during my summer holiday, including ophthalmology eye check and boods . The most common question I received was Does your parents have diabetic too? 5. I'm Type 1 , its different People always thought of diabetic patients are fobidden to eat like normal people does. We require discipline, a good carbohydrate count and a healthy lifestyle. After classes, I went for aerobic classes or gym. I do jog everyday too. Really, it was influenced by seeing those beautiful bodies of the Ukrainian ladies. They are like dolls, perfect with no flaws. Very stylish. Every year, I made eurotrips. It was planned before our final year exam. Once you are a doctor, you are married to your work. True enough How I do miss travelling ! Backpacking in the Europe! I always prepared a letter for the imegresen checkpoint, provided by my endocrinologyst. Stating about me a diabetic type I on insulin, and the diabetic bracelet is another proof it. Always bring extra vial, insulin needles, and glucometer lancets and strips Mama will remind me via phonecalls. I had an episode of getting sick during one of the trip . It was in Barcelona. I had fever, and felt very weak to go out , enjoying the city. . you guys just go out and enjoy yourself! I will be fine here, trust me and I felt into a deep slumber sleep. 3 hours later, my friends were back with dinner and food packed for me. They bought for me a porridge, vegetarian. Halal. That is most important when choosing food on a trip. And I had a hot milk with me. How refreshing. I felt relive by the goodness of the taste when I tried to take it into my mouth , slowly at first and when they started sharing the scenaries and lookabout, I felt much more alive and just can't wait for tomorrow to come. I am back to my normal me, no fever the next day. I should thank each and everyone of you. Shahida, now a wife and happily married to Acheh. Ainaa, a cardiologyst medical officer in Sarawak Cardiology Hospital Kota Samarahan Hanisah , an ENT medical officer in Queen Elizabeth Hospital Kota Kinabalu Aibaq, a medical officer in Klinik Kesihatan Rompin There were others too, especially the Egypt trip. The most amazing trip ever! A note ; Go out and experience life. Being diabetic is not a major issue. The housemanship years The most troubled ever years of my diabetic are during the housemanship. What is a houseman? According to Wikipedia.com a junior doctor , but Ho are the male worker who works in a home, and follow the guide. That was not far from the truth. Who doesnt? Even the non diabetic doctors had stress that could just cracked up the head, less sleep 6. than they ever had in life, unproper diet, missed meals, feeling tired and the anxiety and changes in life that could all raise up the stress hormone. All of these will effect the blood sugar. Once work become an enjoyable thing in life, even the stress could be handle with care. Nothing does stop me for living a normal lifestyle. I have to adapt with the changing life schedule. I can't be too strict with my mealtime, I cant realy hope that everyday will be perfect. I can't blame diabetic for not letting me be the best that I can be. By being able to control these, it slightly makes me feel independent and not putting diabetic as the reason for not getting what I want to do or achieve in life. Of course, with the support of the my family , bestfriends and friend and loved one. Loved one. Past tense. A broken relationship. Ouch! It does happened. A history. The best experience was during the Emergency Department posting. I called it the Adrenaline-push department. Work is always fast and furious, colleagues are fun, witty, and the feeling of togetherness makes us a whole big family. Have u eat? have u check your dxt blood glucose That's some of the usual questions been asked. Sometimes I do have one of those days where my blood glucose went haywires. Either its a hypoglycemia event, or hyperglycemia event. In any hypos event, I hurriedly grabbed a small dextrose 50% 50ml slurped it. Tasted really sweet, I nealry vomitted. Hyperglycemia is far the most occurred events. Can I just blame the hormone? The one beautifully called, the cortisol, the growth hormone all due to the workstress and workloads. Even anxiety and eagerness plays a big factors in contributing to the changes of blood glucose. Do I have to remind that housemens never or very seldom get enough sleep? Well, that could be a factor too. My Hbaic never went up to 10mmol/l, nevertheless never been lower than 8mmol/l. Really , I miss ED Selayang Hospital. It was second to Medical Department. I was under Hospital Selayang follow, Dr Foo was the head of the endocrine team there. She once offered me if I want to try the insulin pump, a 1 month trial programme for diabetic patients, but of course the cost that she explained later just pull off my interest in it. RM 20,000 for a pump? that amount just beyond my economy capability. Really, it is that expensive? I gave the look with both eyebrows raised up, a look of surprised. As a houseman we were paid approximately RM3000-4000 a month, and with all the money used to pay for bills, cars and you just name it, life in the big city does need one to utilise almost 80-90% of the monthly salary. I can get broke by just buying the pump. I could easily get broke by the end of the month too. 7. I've live this long with insulin japs, so why would I change ? But maybe I will, once my economy is more stable. Young Leaders in Diabetic The greatest thing that ever happened being a part 1 diabetic is when I was chosen to represent Malaysia as one of their young leaders in the IDF Young Leaders programme year 2013. It was really an eye opener. It was a priceless experience. People from all over the world from almost 83 countries and almost 127 adolescents with Type 1 diabetic are gathered in Melbourne, Australia. A one week programme was scheduled for us including outdoor activites, morning exercises, learning about diabetic and its discrimination worldwide, plans and what we think about the negative and positive impact of being a diabetic as adolescent, the power of advocacy , ways to create plans to let the public knows about what Type 1 DM, in differentiate from Type 2. The public always blame the sugary and carbohydrate food, less physical exercise and overweight, family history as the cause of diabetic. These are not far from the truth, but it was far away from the truth for Type I People should be educated about the difference between these common 2 types of diabetic. There are other types, lest to be discussed now. The most percentage of type 1 DM are due to the antibodies inside their body, attacking the pancreatic Beta Langerhans cell, causing the organ unable to produce the hormone insulin. Insulin is an important hormone in the carbhydrate metabolism in the breakdown of carbohydrate into its simple form. During the whole week programme, I got to meet different people from all over the world. Some already used insulin pump for almost 15 years, some less than 5 years. I got to know about CGM - continous glucose monitoring. An amazing device which could showed to us in real-time how is the blood glucose currently is. By pumping , it was so much easier as we can key in the blood glucose and the pump will calculate the amount of insulin needed for the exact amount of food. First thing first, you need to be good at carbohydrate counting. I roughly can estimate the carbohydrate amount as I have been living with diabetic for more than 10 years I generally avoid temptation unless I can't resist it. A diabetic. A doctor Currently working as a Medical Officer in Sabah, who ever thought working in Sabah could be soo much fun and interesting. A new place, different ethnics and cultures, learning the Sabahan slang, expereince the wonders of nature, The Land Below the Wind should be given a salute for its uniquecity. I handle most of the NCD ( non communicable disease ) patients in my clinic. That includes diabetic patient. All are type 2 diabetic patient. None of them are type 1. Treating diabetic patients are my interest. I will spend more time explaining and educate them the best I can. Sometimes, I do need a translator as they couldnt understand either Malay language or English. Not being choosy , but I feel 8. good when I see they came back on the next appoinnt looking better than previously . And better Hbaic. And the most important is theyre happy with their life, and with diabetic. Nowdays, my life is more adjusted. I seldom miss my coffee. Coffee is my morning drug. I will miss lunch if clinics are busy but definitely dinner will be at home. A gift for myself 2014. I am a diabetic for 27years. And i'm on insulin pump now! That was like a dream come true. The rest of the dreams are still not accomplished, yet. I had trouble choosing the color for my pump casing. Of course my favorite color is always been purple but the pink casing looks soo cute. I had asked my friend around to give me ideas on choosing which color suits me best, and what I received is a different answer. That makes me more undecisive. Pink suites you, its a sweet color. But maybe purple is the best choice. You are a one of a kind girlfriend, with a mysterious self, at times, so choose purple. But its all up to you. Its a gift to yourself what a statement he gave me that day when I asked for his opinion. Finally , I chose purple. Pink will get stain easily , and it will be soo obvious. It is almost a year since I started pumping. To give myself an insulin bolus nowdays are much easier. There are few buttons on the pump which is soo easy to master. What I have to do are to key in the approximate amount of carbodyrate of the food and the insulin will calculate it for me. It just need a simple click of confirmation before the bolus could be given. A needle connects the pump with our skin. Hygeine is a very important aspect when changing the resorvier. I am using Paradigm 522 by Medtronic. Being a diabetic on pump, I dont have to bring my insulin pen as I used to do. Memories of having to jap myself in public and receive all the awe seeing me with the injection and then came all the questions of what is that? or are you a diabetic?. Sometimes I feel very irritated with all those questions. Maybe because I have to keep telling people around me the same answer since I was a small kid. At times, I do go to toilet or by the corner just to give myself a bolus. Tell me about checking my blood sugar in public. People always gave that weird eyeeing look. Eyeball. You are sleeping with it? my boyfriend once asked. I just take it off during the bath, or when changing the resorvier and infusion set I explained that It will be as slightly similar to a functioning pancreas but without the glucagon function. A Robocop! we both laughed! New experience I gained, new world I see. I learned how to dive after my houseman, and the underwater sea is a whole new world. Medtronic is not a waterproof device. Animas are, but yet to enter the Malaysian market. So does dexcom and johnson and johnson. 9. I do put on the pump with me and when it is about time that we jump underwater, only then that I suspend and take it off. Once I get back unto the boat, I will put it back on , start mode. The 27th year Diabetic Anniversary Work nowdays are not as busy as when I was a houseman. Stress came from different factors in life. Being an adolescent I have more freedom to choose my own food. And by living own my own, I can decide on what food I want to cook and prepare for each meals. I will chose healthy over delicious, definitely. And my carbohydrate counting skills has been much improve since I used pump. My Hbaic for the first time ever, is 6.0mmol/l. It has been below 7.5mmol/l after 3 months of starting the insulin pump. I never regretted changing the japs to pump. I was a bit suspicious initially. As we get older, we look through the life experiences and it is because of problems that we grow mentally, spiritually and emotionally. You only live once, but if you do it right, once is enough Dr Nurul Athirah Naserrudin Type 1 Diabetis Mellitus Malaysia. 10. I do put on the pump with me and when it is about time that we jump underwater, only then that I suspend and take it off. Once I get back unto the boat, I will put it back on , start mode. The 27th year Diabetic Anniversary Work nowdays are not as busy as when I was a houseman. Stress came from different factors in life. Being an adolescent I have more freedom to choose my own food. And by living own my own, I can decide on what food I want to cook and prepare for each meals. I will chose healthy over delicious, definitely. And my carbohydrate counting skills has been much improve since I used pump. My Hbaic for the first time ever, is 6.0mmol/l. It has been below 7.5mmol/l after 3 months of starting the insulin pump. I never regretted changing the japs to pump. I was a bit suspicious initially. As we get older, we look through the life experiences and it is because of problems that we grow mentally, spiritually and emotionally. You only live once, but if you do it right, once is enough Dr Nurul Athirah Naserrudin Type 1 Diabetis Mellitus Malaysia.