When my doctor slipped back into the examination room sheepishly, with her lips pursed and eyes averted, I knew that it was bad news. I knew she was about to tell me that I had type 2 diabetes.
I was about to learn I was only half right. I did have diabetes — but it was type 1 diabetes.
I’d made my erroneous self-diagnosis just a couple days earlier, with the help of the internet. I knew this wasn’t the most reliable technique, but my symptoms were unmistakable: blurry vision, extreme thirst, absurdly frequent urination. They even seemed to wax and wane along with my sugar intake, reaching an undeniable peak on a family vacation filled with sweet treats. What doubt could there be? At the time, I was only dimly aware of type 1 – a rare childhood disease, perhaps? – and the possibility that I might have it never previously entered my mind.
To be sure, I didn’t seem an obvious candidate for type 2: mid-30s, moderately active, average weight. But my research taught me that the condition affects millions who don’t fit the stereotype. Visions of past sugary excesses floated through my mind, pints of ice cream and boxes of cookies polished off in one sitting. Slowly, my conviction that I’d done this to myself grew.
I also knew that type 2 diabetes could be reversed, or at least beaten into a kind of remission, through lifestyle changes: weight loss, exercise, carbohydrate restriction. If I had done this damage to my body, I thought, at least I could fix it.
In the days between my self-diagnosis and my fateful doctor’s appointment, I swore off added sugars. I started researching ketogenic diet plans, and I began counting calories. I even took a photo of myself in the mirror, stripped down to my underwear, so that I could flatter myself by tracking the changes in my body. I determined that this would be the life-changing event that inspired me to take my health seriously.
So when the doctor finally raised her eyes and said, “You have diabetes…”, I knew this was my moment. It was the chance to cinematically declare that I would quickly and decisively conquer the disease.
I never got the chance:
“… and I believe it’s type 1.”
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Shock, and then fear. My ignorance of type 1 was complete enough that I couldn’t yet even guess at what this would mean for my life. A flood of vital details soon followed, which began to dispel the mystery. I had diabetes all right, just as predicted, but everything else I thought that I knew – the pathology, the prognosis, the treatment – was dead wrong.
In a day of grim revelations, perhaps the most disheartening was learning that my escape hatch had been shut. All of my passionate plans to fix my condition through healthy living had been laid to waste. No matter what I might try, my disease would be with me until the day that I died. Healthy living, apparently, could not help me.
Accepting a new reality
This was difficult to accept. I was still inflamed by the healthful fervor of the previous few days. I still wanted this event to be the inspiration for a new me. And so there followed some curious exchanges with my doctor, in which I tried to argue that I should live a healthier life, and she continually insisted that I need not do any such thing.
“Do I have to stop eating sugar?”
“No,” she replied, “you’ll just need to be careful about taking your insulin. But you can eat anything you want.”
“Do I have to lose weight?”
“No, your weight is fine.”
“Is it better if I lose weight?”
“Not really. Type 1 isn’t affected much by weight.”
Her message was clear: with prudent insulin usage, my lifestyle and diet wouldn’t need to change. She must have been surprised to learn that this was the last thing that I wanted to hear.
Moving forward with diabetes
It’s now been about a year since my diagnosis, and I still haven’t accepted the idea that I should live my life, as much as possible, exactly as I had before. And I have found ample justification for further improving my health.
Carbohydrate and sugar restriction can be an essential element of tight glucose control, my single most important health goal. Exercise can markedly improve insulin resistance, to say nothing of the myriad benefits that it offers those both with and without able pancreases.
Perhaps most critically, type 1 diabetes remains a hugely significant risk factor for cardiovascular disease. While trials such as the landmark EDIC study have demonstrated a significant reduction in risk of macrovascular complications with intensive blood sugar control, nobody has yet identified a glycemic threshold below which the risk returns to normal. The mechanism by which T1D increases CVD risk “is not well understood,” and it is possible that the risk of heart attack and stroke remains elevated no matter how good one’s glucose control is. The American Diabetes Association continues to recommend that virtually all adult diabetics be prescribed a statin.
Simply put, the very real threat of early sickness — or worse — makes it just that much more important to improve the risk factors that I do have some control over.
It’s funny to think that my newfound passion for health was originally inspired by a mistaken belief in how diabetes works. But that error ultimately put me in the right mindset to thrive with type 1.