Diabetes Forecast July 2005

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FOR TYPE 1/TYPE 2

Back From Iraq: A Soldier's Story

Staff Sergeant Mark Thompson convinced the Army that having type 1 diabetes shouldn't keep him from serving in Iraq.
by Laurie Meyers

The soldiers set off in their Humvee. Sandbags were wedged against their doors, stuffed behind them, even resting under them, as seats. The bags wouldn't offer much protection if they hit a land mine or faced a roadside attack, but they were better than nothing. Even garbage in the road was a threat—a possible hiding place for explosive devices.

They passed children with hands outstretched, begging for food, and men carrying AK-47s. Were the men hostile or friendly? No way to know: Just keep the weapons pointed outward and shoot to kill if approached.

They drove for 2 days, stopping only once, for the convoy to refuel. Stopping was like putting on a big red bull's-eye. Insurgents could and would appear out of nowhere. They had to keep moving until they reached base.

That drive—from Kuwait to Tikrit, Iraq—is not one most of us would want to make. But Staff Sergeant Mark Thompson fought his own personal war to be part of it.

This Soldier's Story

Thompson, 28, is an Iowa native. He's been married for 9 years and has a son, Kyle, who's 2. He's always had something of a travel bug, and it was this desire to see the world that inspired Thompson to join the Army.

That, and the stories he heard from his college roommate—an older student who had served in the Vietnam War. As Thompson listened, the Army started to sound like an adventure. Thompson also needed money for college, so in 1996, he signed on for 4 years, expecting to do his time and then finish his education.

But Thompson never went back to campus. He had found his place, and it was in the Army. He was a "lifer."

Then in 2000, Thompson began losing a lot of weight. He felt thirsty and tired all the time. One morning he collapsed during a run. When Thompson made it to the hospital, his glucose level was over 600. The doctors told him he had type 1 diabetes.

This diagnosis could have meant the end of his career. Plenty of soldiers who are diagnosed with serious medical conditions must leave because they can't prove they're healthy enough to do the Army's work. Thompson was bound and determined to not end up like one of those soldiers.

He went from having an A1C of 12.5 percent at the time of diagnosis to 6.2 by the time the Army's medical board reviewed his case in 2002. Because he was able to control the disease so well, the board found him "fit for duty."

Thompson's victory wasn't absolute. He was told that while he could continue serving, he would not be allowed to do it from combat zones where refrigeration and medical supplies are hard to come by.

The Battle At Home

But Thompson wanted to go where he was needed most, and by 2002, war had broken out in Afghanistan. A year later, American soldiers also were moving into Iraq. Thompson is a career counselor, which means that he helps soldiers choose career paths within the Army and asks them to reenlist.

"I'd be sitting across from a soldier with a [combat] patch, counseling him, and I wouldn't have the combat experience," Thompson said. "It just didn't seem right."

In the spring of 2003, Thompson's division, the 1st Infantry, received word that it would be deploying to Iraq in January 2004. Thompson was assigned to the "rear detachment," which meant staying at the 1st Infantry's home base in Germany.

"Rear detachment has an important job," Thompson said. "But it's not where I wanted to be. It's not why I joined the Army."

So Thompson did some homework.

He called to make sure the military base hospital in Tikrit could stock a 5-month emergency supply of the insulin he uses—fast-acting for his pump, and some NPH to mix with it if he needed to use syringes. He bought a camping refrigerator that he had converted so that it could be plugged into a Humvee.

Thompson wears an insulin pump, and his main challenge would be keeping the insulin at 86°F or less, all while on the go in a place where temperatures can soar well over 100°F. He discovered reusable Frio pouches, which are made of a special material that is activated when the pouches are immersed in water. They keep contents cool for well over a day in such temperatures. If the pouches failed or if the pump broke, he could get insulin from the hospital and switch to the backup syringes he would be carrying.

Thompson's research paid off. Lieutenant Colonel Michael Brumage, MD, division surgeon, 1st Infantry Division, initially thought it was too risky. But Thompson "showed me that he had a comprehensive knowledge of his body, his diet, his insulin needs, and that he also had an in-depth trouble-shooting plan," Brumage said.

Thompson had the permission he needed, but with a few conditions: He would carry an 8-month supply of insulin, catheters, spare blood glucose meters, and syringes everywhere he went. And if his glucose levels fluctuated too much, or if his health was in danger, he would be on the next plane back to Germany.

In Iraq

After that initial 2-day drive into the heart of Iraq, Thompson traveled around the country, visiting the 1st Infantry's various units. "I kept multiple baggies of food with me all the time—Nutri-Grain bars, power bars, any quick source of food I could pick up at the dining hall."

When things were relatively calm, soldiers could just wear bulletproof vests. But most of the time they had to wear full combat gear: vests, body armor, eye protection, helmet, ammunition, and supplies.

The whole ensemble weighs at least 60 pounds, and it was too much for Thompson's pump. In April 2004, the pump broke under the pressure. It was the worst possible time. Thompson and his peers were subsisting on prepackaged, nonperishable meals that feed soldiers when regular food supplies are for some reason cut off. These meals made it hard for Thompson to calculate carbohydrates, and without his pump, it was hard to keep a steady supply of insulin.

But Thompson told himself he was not going to be sent home. He checked his levels 10 times a day for the next 4 weeks until his replacement pump arrived, and he put the new pump in a lower pocket to protect it.

The checking and emergency planning paid off: Thompson's A1C during his time in Iraq stayed at about 6.5 percent.

Home Again

Summer came, bringing a blast of unimaginable heat. By June the whole division had stopped wearing full body armor because it was simply unbearable. Temperatures hit upwards of 130°F; even the rock candy Thompson's mother had sent from home melted.

The desert air, especially if there was any wind, "felt like sticking your head in the oven while cooking the Thanksgiving turkey," Thompson said.

But Thompson was holding his own, and so were his pouches. He never even needed the refrigerator. And by February of this year, Thompson had completed his tour of duty in Iraq.

Thompson thinks often of his time there, of that harrowing drive to Tikrit, of the sinking feeling he had the day he realized his pump was broken.

He also feels proud, because while the final chapter of the war in Iraq has yet to be written, Thompson waged his own war, of sorts, to be part of the experience there.

And he won.

Laurie Meyers is an associate editor of Diabetes Forecast.

Fit For Duty: Diabetes And The Military

Under the Americans with Disabilities Act, the Rehabilitation Act of 1973, and many state anti-discrimination laws, it is unlawful for an employer to have a blanket ban that prohibits anyone with diabetes from holding a given job. Rather, an employer must look at each case individually. The exception is when another federal law or regulation "trumps" those laws. This happens very rarely. One place it does happen, however, is in the military, where people with diabetes are prohibited from serving. However, as Staff Sergeant Mark Thompson's story shows, the military has made some exceptions.

The keys to staying in the military following a diabetes diagnosis are having:

• Excellent management of your diabetes
• Health care professionals on your side who can explain to military review panels how diabetes affects you and why it will not prevent you from doing your job

For more information, call the American Diabetes Association at 1-800-342-2383. You can request a free packet on employment discrimination. You can also ask to speak with the legal advocate about your situation.