I think it was February or March that I started noticing just how thirsty I was all the time. I could tell my body wasn't doing anything useful with the extra fluid, because I waking up at least once every night to let it out again. Then one morning I nearly blacked out after skipping breakfast and running for the bus. I was often grumpy and a few of my friends commented that I'd lost a lot of weight. For a while, there seemed to be reasonable explanations: the warmer weather, the extra exercise of walking around campus instead of sitting in front of a computer all day, the exam stress. By the middle of May, I realized that these were pretty clear symptoms, so I saw a doctor and asked to be tested for diabetes.

I have a very healthy diet and don't have any family history of diabetes as far as I know, but I hadn't been getting much exercise for a few years. The doctor was skeptical, but agreed that it was best to get checked out either way. On the morning of May 21, after fasting since dinner the night before, I left the lab enough fluids to check my blood glucose and a list of other chemicals in the hopes of finding some other problem instead. The doctor called me back before I got around to making an appointment to follow up. She didn't say anything specific in her message on the aswering machine, but I could tell what was up. When I saw her, the prognosis was pretty clear. Normal people have 3-6 mmol/L of glucose in their blood. My results showed 12.7 , more than double the acceptable limit. And that was after not eating anything for over 12 hours. She gave me some credit for my self-diagnosis.

Now, there are two main types of diabetes mellitus. Type 1 diabetes, also known as juvenile, early-onset, or insulin-dependent diabetes, is the result of a non-functional pancreas. The pancreas normally produces insulin, which is needed to get sugar from the blood into the cells which convert it into energy through a convoluted process typical of biological systems and incredibly frustrating to students trying to remember it. In some people, however, the pancreas stops producing enough (or any) insulin because the beta cells die off for some unknown reason. If there's a genetic link, it's extremely small. Most of the theories seem to involve weird viruses or misguided auto-immune responses. Type 1 diabetes occurs without warning and takes hold very quickly. Type 2 diabetes is the one you hear more about. There's a type 2 epidemic sweeping North America because people eat too much crap and don't get enough exercise. In type 2 diabetes, the pancreas produces normal or even elevated amounts of insulin, but the cells build up a resistance to it, and the effects are the same as if the pancreas wasn't producing enough. Type 2 diabetes usually occurs later in life, is associated with lifestyle choices and genetics, and sets in over a longer period of time. Type 2 diabetics outnumber type 1 diabetics by about 9 to 1, though I've heard there are plenty of cases that fall somewhere between the two.

Enough of a biology lesson. The doctor didn't want to diagnose the type until I saw a specialist, but decided to proceed under the assumption that it was type 2 and treat it with metformin. The reasoning is pretty simple: type 2 is more common and metformin, while only useful to type 2 diabetics, doesn't cause any damage to type 1 diabetics provided they have healthy kidneys. Metformin makes the cells more sensitive to insulin, countering the effects of insulin resistance. It doesn't do any good if your pancreas isn't producing any insulin, though. The only way to treat that is to inject insulin, but that can cause serious problems. Having too much sugar in one's blood can lead to all kinds of long-term complications like blindness and nerve damage, but having too little sugar can lead to immediate complications like coma and death. The doctor referred me to the diabetes clinic for lifestyle training and to see a specialist. I don't have a scale at home, so I asked if they had one. With all the compliments about my physique lately, I was curious to see just how much weight I'd lost since I left my desk job last summer. Turns out it was about 16 kg (~35 lbs), putting me near the bottom of a healthy BMI.

Due to some clerical errors, it was about a month before I got into the clinic. In the mean time, I had my blood glucose checked once a week and checked in with the doctor a few times. The metformin didn't seem to have a noticeable effect, and I was more or less resigned to the idea that I actually had type 1. Finally I got into the clinic. The two-day training session went well. It mostly reinforced stuff I knew already - eat lots of vegetables, don't eat candy, exercise regularly. They also made a big deal about foot care with a slide show that looked like it hadn't been updated since the 1970s. As part of the fun, they tested everyone's blood sugar at the end of the second day. I was the last to be tested and was over 15. The dietician and nurse running the show seemed very concerned and I was quickly tested for ketones and taken to the nurse's office to sit while she got in touch with the head endocrinologist to see about giving me some insulin. She later said that if I hadn't received insulin that day, I would have been in the hospital within a week for ketoacidosis. Good timing. I can't say enough good things about the diabetes clinic. Everyone there is incredibly helpful.

My diabetes routine involves two main things: glucose testing and insulin injecting. There are about a million glucometers on the market with all kinds of fancy features, but I just have the one they gave me for free at the clinic. It glows in the dark, which I guess would be useful if I lived in a cave. There's an optional USB cable and some Windows-only (grrr) software available for an extra fee, but I'm happy enough with the low-tech pen and logbook approach. The insulin injecting isn't as bad as I expected. Instead of the needles you normally see at the doctor's office, it's a cartridge-based thing with a dial to set the dose. Being so lean these days, I get to use the smallest needles available and don't have to pinch my stomach to get through the fat.

I've felt a lot better since the insulin started. Like a lot of things in medicine these days, the main downside is the cost. Diabetes is a big industry and I'm sure it's cheaper and more convenient to treat than ever, but all the consumables still add up.

I can think of much better uses for that kind of money. Posted by tim at July 11, 2004 04:23 PM