An Introduction to Dependence

     Insulin dependence: before April 2009 I had no idea what that meant. Of course I had heard of diabetes, but was blessed with no family history of the sort, no friends I knew of who had it, no experience or knowledge of it. I was active, even athletic, but in a decidedly lazy way. I surfed, swam, body boarded, backpacked, gardened, mountain-biked, free dived, and taught partner dance, though rarely exercised for exercise sake. To actually swim laps at a pace, or cycle for distance, that was a different story. I never saw the point. I was healthy—or so I thought.

     But, at age 41, something strange happened. On a molecular level it had probably been progressing for a few years before I hit the tipping point. Then, over a period of six weeks, I started feeling a deep and sticky lethargy. In my dance classes, more than once, I tripped over my own feet. I was really thirsty—all the time. At night I would dream of crawling over parched and cracked plates of sun-baked desert sand. The Argentine ants which perpetually roamed our house suddenly invaded the toilet bowl, a mystery which was really a clue, but not one I could interpret at that time.

     My wife noticed something different about me as well. “Are you okay,” she asked. “I've never seen you lie on the couch for three hours reading in the middle of the day.” I hadn't thought about it, but it was actually quite nice—to just relax with a book. A few years later she told me that I had smelled different then as well. A friend mentioned something more alarming: “Chad, you're looking pretty gaunt these days. Is everything all right?”

     At that point I decided that weighing myself might not be a bad idea. I didn't do this often, but was pretty sure that, for many years running, I had weighed between 185 and 190. I had always sported a little roll just above my belt, but that was gone. I looked down and saw ribs poking out. At the health club the next morning, I tipped the scale at 162. A great unease swept me, tensing my stomach and making my blood race. To lose 15% of my body weight in less than two months could not be good. At home that night, I spent hours investigating on the internet, and came to the conclusion that I either had

cancer, a major thyroid issue, or diabetes. None

sounded desirable. None seemed the preferable

option.

     My general practitioner had a cancellation

the next day, so he was able to fit me in on short

notice. He pricked my finger, squeezed a little

blood out, and dipped a test strip into the drop.

The meter beeped. We both looked at the num-

ber 335. His eyes got wide. “Well,” he said, “I

rarely diagnose anything on just one test, but I'd

say you have diabetes.” He sent me across the

street for a blood draw, made another appoint-

ment for the next day. My results came back at

11.8 a1c, definitely diabetic, and they started me

on insulin immediately. The diabetes educator

taught me how to inject, how to test, how to

carb count, what the possible symptoms are of

a hypoglycemic event coming on. Before I went

home that day, my GP told me he “wasn't in the

business of diagnosing people who looked like

me with diabetes.” Not knowing what else to

think, I took it as a compliment, though later

I would have second thoughts about this.

     I was referred to an endocrinologist who was

a nice guy... but seemed particularly uninformed.

He was a year away from retirement and clearly

not up on the latest research. It took him four

weeks before he told me he wasn't sure what

kind of diabetes I had. He said maybe it was

LADA, Latent Autoimmune Diabetes in Adults,

but that it didn't matter, I'd probably be injecting

insulin for the rest of my life, many times a day.

     And he was right. For about a year I just used                     Mather Pass: 92 mg/dl at 12,100'

syringes. Then I got pens, still with little needles

but much more user-friendly than syringes. Later, I had an insulin pump, but my infusion sites were

always getting irritated, even infected, so I gave that up. I now use two kinds of insulin, long-acting Lantus and short-acting Apidra, delivered in 6 to 12 shots a day. I am dependent on insulin for my continued survival.

     I am much more active now than before my diagnosis. My wife and I hiked the John Muir Trail in 2012 and mountain-biked 9 days across the Atlas Mountains of Morocco in 2013. I ran a half marathon. I have done three triathlons and ridden thousands of miles of roads and trails. I am in better shape than ever before, though I have a number of chronic and related conditions, requiring numerous prescription meds. Suspiciously, just after my diagnosis, I started getting headaches, the worst of which would last for months. For a while I thought perhaps I was allergic to something in the insulin solution. I became gluten intolerant.     

     The amount of stress and the constant challenge posed by type 1 diabetes and these other complications is beyond easy explanation. Sometimes it is too much to think about, too much to deal with. Occasionally, in the thrall of hypoglycemia, with a bad migraine to boot, I look at my insulin pen in frustration and think how easy it would be to just give myself 30 units. Without assistance my blood sugar would plunge to zero and I would be dead in the space of a couple of hours. But that's not me, nor is it most insulin dependent people. We have suicide at our fingertips, every time we dose, but we don't make that choice. I personally have too much joy in my life, too many things left to do, and too many people who love and depend on me.

     I started this blog for a few reasons. I want to share the adventures an insulin dependent human can have, mostly but not entirely on a bike. I want to deal with my emotions surrounding this journey by putting it into cyberspace and sending it out to the world. And I hope others who are struggling with similar issues can find camaraderie, humor, and perhaps some strategies to help with their own struggles.