Balancing college and diabetes

By LOVASHNI KHALKIAPRASAD

For most of his childhood, Aanas Mohamed played basketball, a sport he would give up anything  to play.  He was the most active and outgoing child among his eight siblings—until he was diagnosed two weeks after his 15th birthday with Type 1 diabetes.

Seven years later, Mohamed is one of many college students trying to balance his studies with the demands of coping with the disease, formerly known as juvenile diabetes.

The disease Mohamed is living with, diabetic ketoacidosis, is a complication of diabetes that has become increasingly common. It is far more likely to strike people under 45 years old than those older, and it is life-threatening. It normally develops from Type 1 diabetes, which Mohamed has, and needs to be monitored constantly—not an easy task for him as he tries to juggle school with the demands of his diabetes and, also, hemophilia.

“Having diabetes is almost like adding another course to your schedule,” Dr. Lori Laffel, chief of the Pediatric, Adolescent, and Young Adult Section at Joslin Diabetes Center in Boston, told the magazine Diabetes Forecast.

As a science student at Kingsborough Community College in Brooklyn, Mohamed, 21, said that he wants to be a physician’s assistant. He hopes to do a job that will help people to appreciate life’s brighter moments.

Students with diabetes were not given much leeway in the past, but that changed in 2009 with an amendment to Americans with Disabilities Act aimed at protecting diabetics. If a student misses class often due to a doctor’s appointment, he or she would not be penalized, but could be required to submit the missing course work at a later time.

Colleges have Disability Services offices that provide help for Type 1 diabetics, according to the American Diabetes Association. The upside of registering with a school’s service is that in the event of the event of a diabetes-related emergency, a student will be able to make up work if he or she misses a class or test, and must be given fair treatment.

“The student would need to register with the center for disability to present the professor with an accommodation form,” said Valerie Stewart-Lovell, director at the Center for Student Disabilities at Brooklyn College.

“On that form it would state the student is able to eat and drink in the classroom and may be excused for breaks,” Stewart-Lovell said. The form is signed by the student and given to the professor. “Students could be allowed for excused absences so long the student does their part by registering with us and getting the form to their professor.”

Mohamed knows that when his sugar is low, he needs to eat something quickly. Or he may need bathroom breaks.

“You can’t eat or leave in some classrooms, and I’ll be the only guy eating and drinking,” said Mohamed, who signed the accommodation form. For the most part, “I just tend to keep my disability to myself.”

Mohamed, who went to Intermediate School 303 Herbert S. Eisenberg in Brooklyn, recalled how he loved to play basketball everyday after school.  And some nights, he would rush home in Brighton Beach, grab a quick bite and then head off to the basketball court nearby.

“I used to be an active person,” he said, tossing his empty right hand into the air.

Basketball  was not the only non-academic activity he enjoyed. “I also used to be a little tech savvy working with phones, laptops and all,” he said. But, today, being tech savvy is not so much a hobby for Mohamed.

“When I used to play a lot of basketball, I used to always get tired, I drank a lot of Gatorade, a lot of water and used the bathroom a lot,” Mohamed recalled.

“So for me, these symptoms of diabetes were seen as normal.” Mohamed thought so because  he felt his energy was used up during his long hours spent in the gym. “I’m a middle-school athlete playing basketball, of course I’m going to be tired, I’m going to be thirsty and of course I’m going to be using the bathroom a lot,” he said pounding his hand lightly on a round black table during an interview in the cafeteria at Brooklyn College.

According to the American Diabetes Association, some symptoms of Type 1 diabetes include: urinating often, feeling very thirsty, feeling very hungry even though you are eating, extreme fatigue, blurry vision, cut or bruises that are slow to heal, and weight loss even though you are eating more.

“I had those symptoms besides throwing up, but, I thought I played basketball, I’m an athlete, I go to school, I learn, I play basketball there, then I come home and then go to the courts in the night to play,” Mohamed said.

But then, the ugly truth came out when he fell sick and ended up in the emergency room at Coney Island Hospital in the nighttime. He was not eating properly in the previous weeks and had lost significant weight in just about two weeks. “I went from 157 to 105 pounds,” he said, nodding his head. “It was a lot,” Mohamed said.

He was suffering from diabetic ketoacidosis. “The step before falling off the table,” he said in a fading voice.

According to the American Family Physician, a clinical review journal, diabetic ketoacidosis is caused by reduced insulin levels, glucose use and increased gluconeogenesis, a metabolic pathway used to keep blood glucose from dropping too low, from elevated counter regulatory hormones.

“When the acid is high and the pH is low, that is called ketoacidosis,” said Dr. Vinuta Marigouda of Interfaith Medical Center.

Diabetic ketoacidosis is a serious condition that could put the patient into a coma or lead to death, Marigouda added.

“From the way I looked and the smell of my breath, the nurse knew I had diabetes,” Mohamed said. “I never expected that I would have diabetes.”

According to the American Diabetes Association, patients with Type 1 diabetes do not produce insulin, a hormone that is needed to convert sugar, starches and other food into energy vital for daily life. The illness, which was referred to as juvenile diabetes, is usually diagnosed in children and young adults. The association stated on it website that only 5 percent of people with diabetes have Type 1 diabetes.

“I was in the ICU for four days,” Mohamed said. His A1C test, known as the glycated hemoglobin test, gave a result of 16 percent. Once a person’s A1C test is higher than 6.5 percent, he or she is diagnosed with diabetes. Mohamed’s blood sugar for the past two to three months was escalating to the point where he reached the dangerous stage of diabetic ketoacidosis.

Shockingly, the Centers for Disease Control and Prevention reported that from 1988 to 2009, the most recent data available, the number of hospital discharges for people with with diabetic ketoacidosis as the first-listed diagnosis increased from about 80,000 to about 140,000.

The agency also noted that the disease hit mainly people under 45 years old.

Marigouda said that if a patient does not go to the hospital, the sugar level will be very high. The patient will end up drinking a lot of water and urinating a lot. Because of excessive thirst, the patient will show signs of dry mucous membrane and hypotension.

Hence, patients who show symptoms of diabetes should consult their healthcare provider immediately to not only prevent complication but also death.

Mohamed grew up in a large family. He and his family migrated from Yemen and settled in Brooklyn in 1996. He has three older brothers and four older sisters.

On the day Mohamed fell sick, his panic-stricken sister and brother rushed him to the emergency room at Coney Island Hospital.

“It was devastating to hear Aanas got diabetes at a young age but he is the type of person who would always accept it and fight back,” said his brother, Saned Mohamed, 25. “Everyone was just trying to help him understand his new lifestyle and the changes he had to make and we are here to help him.”

His mom could not be interviewed because she went back to Yemen to spend some time with her family there. But, Mohamed said, “she was sad, and she told me the same thing my father told me, ‘Don’t be stupid with your health.’” She also warned him that no one else in the family had diabetes at such a young age, and therefore, he needed to take on more responsibilities to preserve his health.

“We could have prevented some of the symptoms of diabetes and I would have not ended up in the ICU,” Mohamed said about not detecting the autoimmune disease earlier.

“I used to go for a yearly check at the doctor’s office,” he said. But that was not enough because, diabetes is quite a tricky disease to detect. Mohamed did a physical test at the doctor’s office during his summer vacation in 2006 so he could be a part of the basketball team at his middle school. His blood and physical were checked off as good.

“When I was younger, insulin would get used up,” Mohamed said, but there was no way to tell. “It would show up as normal in my report. And, one day it was just gone, just gone.”

Another turn in Mohamed’s life was the death of his father in 2011 from pancreatic cancer. It was a trying time for Mohamed but he pulled through.

“Everyone in my family was depressed,” said Mohamed. “I, personally wasn’t depressed, but I had to live my life with hemophilia. I thought this wouldn’t be a huge thing. I took it the good way.”

He added: “Hemophilia is going to stay with me for the rest of my life just like diabetes.”

Growing up, Mohamed spent most of his childhood indoors and watched his friends run and goof around. But because of his hemophilia, his parents were cautious of him bruising himself.

Hemophilia is an inherited genetic disorder in which the blood does not clot normally because it lacks the vital blood-clotting proteins. Small cuts are not a problem, nor are daily injections. But, injuries to the knees, ankles are elbows are of greater concern because deep bleeding could occur in the without the patient realizing it.

Mohamed limps on his left leg because he broke his ankle. “I was playing basketball and I broke my ankle and was rushed to Coney Island Hospital,” Mohamed said. For him, it is impossible to do surgery because he is a hemophilic and diabetic, so he took physical therapy to heal the ankle. “I’m a special patient,” Mohamed said.  Although he took physical therapy, Mohamed limps when he walks.

He uses an insulin pump that he attaches to his stomach every day. He takes it off only when he takes a bath or exercising. Wearing the pump at all times prevents hyperglycemia, abnormally high blood glucose level. For Mohamed, the pump is his life saver.

“The pump is mostly for people who are adventurous, or have no time or people whose blood sugar is not controlled,” said Mohamed. “It’s like a little tubing that goes into my skin.”

If Mohamed’s sugar is too low or too high, the pump supplies him with the insulin he needs to bring it back to the normal level.

An estimated 350,000 people in the United States use insulin pumps, according to the website Diabetes Self-Management. Not everyone prefers the pump though.

Aliza Tessler was diagnosed with Type 1 diabetes at 12 years old. Upon finding out she was diagnosed with diabetes, she shed some tears, but her mother cried for almost two months. “I think she is still upset by it sometimes,” said Tessler, now 20 and a student at Brooklyn College.

“My father didn’t really react as strongly as my mother did. And my twin sister actually got jealous, because I got a lot of attention when I was diagnosed,” she added.

But when it comes to choosing between injecting yourself twice a day and attaching a pump on your stomach to supply insulin to the body, Tessler chose the injections for several reasons.

“I got the pump about 10 days after I was initially diagnosed,” said Tessler, who opposed the idea of wearing a pump.  “I didn’t know where those tubes were leading to, and I thought injections were the best option. My 12-year-old mind was wrong, and I’m very happy my doctor and mother encouraged me to try the pump.”

Tessler said, her mindset has always been, “Okay, so I’m diabetic. Who cares?”

Likewise, Mohamed accepts  the disease. “I took it the good way,” he said. “You can’t let something control you, you have to control it.” He added:  “We were the chosen ones.”

Photo: College student Aanas Mohamed says of his Type 1 diabetes: “You have to control it.” (Saned Mohamed Photo.)