On Monday two things happened to me:
1. I had an appointment with my endocrinologist.
2. I found out that I received a grant to live in Estonia for a year starting in September (!)
They had more to do with each other than one might think.
Part of this was the timing: I was leaving my house for the appointment just as a postman was walking up to my door, so I took the letter right from his hands. The thrill of the good news overshadowed my anxiety about the doctor’s appointment, at least for the duration of the car ride there. (My blood sugar readings have been erratic recently, and I was afraid that my A1C results wouldn’t be so fantastic.) Still, the juxtaposition of the appointment and the letter prompted me start to thinking about the reality of living abroad with diabetes sooner than I might have otherwise.
And once I started thinking, I was overwhelmed my the amount of things I’d have to figure out before leaving the U.S. It’s true that I have some experience of managing diabetes in a foreign country–I travelled in Estonia and Latvia for two weeks this summer. But that trip was short enough for me to bring all my supplies with me, plus extra prescriptions from my doctor at home in case I ran out. Actually living in a foreign country will present a whole new set of challenges. What kinds of insulin and supplies will be available in Estonia? How will I find a good doctor? What will I do if there is an emergency?
At my doctor’s appointment, I also learned that I will have to deal with a new challenge from now on: eating gluten-free. In previous posts, I’ve mentioned that my brother is one of the many people who has both type 1 diabetes and another autoimmune disease, celiac disease. The only way to treat celiac disease is by eliminating all gluten–a protein found in wheat, barely, and rye–from your diet. Long before I was diagnosed with diabetes, I was tested for celiac disease. The doctors told me that the results were inconclusive.
I was more than happy to take advantage of this ambiguous diagnosis to continue eating gluten. On this visit to the endocrinologist, though, I had decided I would clear up matters once and for all: Should I go on the gluten-free diet or not?
My endocrinologist explained that the tests had shown that I had antibodies for celiac disease in my bloodstream, but they didn’t show the “gold standard” for diagnosis–damage to the intestines. Her suggestion was that I try to avoid eating wheat, barley, and rye as much as possible. Still, she said, it probably wouldn’t hurt for me to eat foods containing gluten every now and then.
For me, eating gluten-free at home is annoying, but feasible. After years of living with a brother who has celiac disease, I know where to buy gluten-free flour, and which brands of gluten-free crackers and bread taste the best. But trying to maintain a gluten-free diet in a foreign country will be more tricky. To begin with, I currently know a total of two words in Estonian (“hello” and “thanks”), so reading a list of ingredients on a package won’t be easy. To make matters worse, bread is an integral part of the Estonian cuisine–so much so that in previous times, “bread” was a synonym for “food.” There is even an Estonian saying: “have respect for bread; bread is older than we are” which conveys the reverence with which Estonian peasants regarded the food. Not exactly auspicious for someone on a gluten-free diet…or someone with diabetes.