Interesting project, Danny! Hmm…
1992 – Finished Master’s degree, defending and writing thesis in “record time”, moved out of apartment and into a dorm to start PhD at big-time U. Started noticing increasing tiredness and thirst.
1993 – Tiredness increasing, frequent urination, coffee cup filled with water glued to palm of hand. Diabetes diagnosis 3/22/1993, age 26 w/10.0 A1c and 466 random bg. Fasting is 195, so is below 200 and “don’t need insulin – isn’t that great?” Ask which type, told by endocrinologist with student health center, “Type 1, but you don’t need insulin” despite loss of 40 lbs over 6 weeks without trying. Down to 98 lbs. Left big-time U, since the months of undiagnosed diabetes and weeks of poorly treated diabetes left me unable to think clearly.
1994 – Weight (somewhat) stable at 94 lbs, diabetes still being managed with 1500 calorie diet (60% carb, 20% fat, 20% protein) and exercise, still no insulin. Told by family physician am type 2, despite on-going post-prandial bgs in the 200s. Told not to test after eating, because “Why punish yourself?”
1995 – Weight drops down to 88 lbs. Ask family dr about gaining weight, advice: “Just eat more!” Given 1800 calorie diet (50% carb, 30% fat, 20% protein) and told to follow. When ask if should test more frequently, told, “You can, but I don’t see how it will do any good. Waste of time and money.” Will take 10 years to get up to 100 lbs. Food and weight start becoming an issue and start occassionally withholding food.
1998 – Noticing that bgs are not responding to exercise as well as before and fastings are slowly creeping up. Weight at 95 lbs. Doctor unconcerned, as A1c is within target.
2001 – Start working with family business, up to 18 hrs/day. Diabetes plays a secondary role.
2005 – Decide to try to go back to graduate school, take GRE (General: 1150; Psych: 720). Interview, apply and am accepted at yet another big time U PhD program.
2006/2007 – Weight: 104 lbs. Start school, start having sinus infections and have fellow student ask frequently “Are you sure you’re ok?” When fall asleep and miss class, schedule appointment with “diabetes doc” at student health center. A1c: 8%, fasting bg: 170. Doc decides to start metformin, despite request that I want no drug that will cause weight loss. When ask why metformin, told, “You’re a type 2 and you’re insulin resistant.” When ask how he knew since an A1c could not possibly tell him that information, told “Everyone is insulin resistant!!! Don’t argue with me or I will send you to expensive specialist and he will tell you the same thing!!!” Request for c-peptide denied and made to feel guilty for not deliberately exercising for 1 hr/day everyday, though because of lack of car, must walk everywhere, including to the grocery store. Start metformin ER, causes immediate gastrointestinal upset and appetite loss. Quickly drop 10+ lbs (most of which I still have not regained). Fasting bgs improve, but post-prandials can go as high as 300+ for 3 or more hours after a meal. CDE claims all this is a sign of insulin resistance and will probably be prescribed a TZD next. Met with dietitian, who encourages change in diet and to drop some carbs, replacing them with either fat or protein.
2008 – Despite compliance with medication and getting more exercise, bgs stubbornly will not come down. Find new doctor, who, unlike previous doctor, trusts the computer-generated bg data (all downloaded from my meter) and agrees that a standard deviation of 50 mg/dl is not good. Adds Lantus to metformin, which does nothing for post-prandials (go figure!), but does give nearly daily fasting lows – even when only taking 2 units/day instead of the 10 units was told to take. Finally get c-peptide and, lo and behold, insulin production is below normal. Sent to CDE for Humalog induction, but CDE would not create an insulin regimen for me because, “I can’t figure out an insulin:carb ratio that would work for you beyond 1:50”, so CDE’s boss insists – yells – that I need (yes, believe it) Byetta and a low-carb diet (for someone who barely weighs 94 lbs on a good day??). When won’t give in, CDE makes appointment with endo, who, upon looking at my chart and listening to my tale, says, “Why the H*** didn’t they start you on insulin back in 1993? Even at that time, that was the common practice, and there really isn’t any difference between a 195 and a 200, even with a lab test.” Changes diagnosis to type 1, sees evidence of extreme insulin sensitivity, so am told to stop taking metformin immediately and to start injecting Humalog that night at a ratio of 1:50 with a correction of 1:200 if necessary. I watch bgs carefully over the next month as the metformin leaves my system and gradually change the ratio from 1:50 to 1:15. Have lows, but the post-prandial highs are no longer an issue. Found some evidence of very mild peripherial neuropathy in feet.
2010 – Still having lows, especially at breakfast. Finally start getting some fine-tuning on my self-determined insulin:carb ratios. Have changed to 1:19-1:20 for breakfast and 1:19 for lunches. Smile every time I think about the student health center doc and how very wrong he was – hmm, guess a PhD student can be as smart as an MD. Peripheral neuropathy is still present, but not as much as it was earlier. Last A1c: 5.8. Weight: 91 lbs on my scale at home.