When I was diagnosed with diabetes in the autumn of 1998, my first impulse was to ignore it. It didn't hurt, and it was not going kill me any time before the Super Bowl. Hardly a disease at all.

My doctor told me I should watch my diet and exercise more. Doctors have been telling me that for a quarter of a century. I agreed that lifestyle changes were important; I have always agreed with that. I lost 250 pounds between 1990 and 1998. To put it another way, I lost the same 50 pounds five times.

Then I began hearing more about diabetes. Words like "blindness" and "amputation" and "impotence" and "kidney failure" began creeping into the conversation. I began thinking about my daughters, and how I might like to see my grandchildren some day, and how it might be nice to spend quality time with my wife with both legs attached all the way down to the toes.

So I actually joined a gym and watched my calories, which is fine but not sufficient. I also attended a three-day class in How To Be A Person With Diabetes. For some reason, the word "diabetic" as a noun is considered uncool. Being a person with diabetes and a person with a normal life span -- that's the tricky part. Death is diabetes' most troubling symptom.

You may have heard the Centers for Disease Control and Prevention recently announced that diabetes had achieved official epidemic status. 14.6 million Americans have it; about 6.2 million more are undiagnosed. It is a condition without symptoms until the late stages; I found out I had it only because I got a blood test for other reasons.

After I was diagnosed, I had trouble using the "D" word. I told people I had a little blood sugar problem. Some little problem. I was already on medication. In truth, I'd had the symptoms of diabetes before I was diagnosed. If you've ever said to yourself, "Of course I pee more than most people. I drink more fluids than most people," it might be time to get that blood sugar checked. Likewise if you have temporarily blurred vision. It is a sad truth that many family doctors do not know as much about diabetes as they should. So I became a gold-star student of the subject. There are two kinds of diabetes, usefully called Type 1 and Type 2. Type 1 used to be called juvenile diabetes; Type 2 used to be called adult-onset diabetes. Ninety to 95 percent of the diabetes patients in this country have Type 2, including me.

Diabetes, either type, is characterized by an unhealthy increase in the amount of glucose in the blood. Glucose is a type of sugar. Insulin is the substance in the body that controls the utilization of sugar. It is produced in the pancreas, an unattractive pancreas-shaped organ that adheres to the outside of the stomach.

Type 1 diabetes is an autoimmune disease in which the body produces little or no insulin. People diagnosed with Type 1 diabetes have, from early in their lives, injected insulin to regulate their glucose levels.

Type 2 diabetes is a condition of "insulin resistance." There's much we don't know, but we do know that people with Type 2 diabetes have less insulin than other people. The insulin they do have has trouble binding to the insulin receptor of the cells. Once insulin's in the cell, enzyme defects prevent it from working as well as it should. Theories abound: Maybe the pancreas is producing the wrong kind of insulin; maybe the beta cells that make insulin are slowly dying off; maybe the liver is releasing the glucose it stores in inappropriate ways.

There is strong correlation between the rise in reported cases of diabetes (a 54 percent jump for adults from 1997 through 2004, almost unheard of in non-infectious diseases) and the rise of obesity in Americans. We have known for a while that obese adults were more likely to get diabetes than their slimmer compatriots. Now it turns out that obesity increases insulin resistance in all patients, even those without diabetes.

Which brings me back to my story. As a newly diagnosed person with diabetes, I learned that I had to be on two kinds of diets: a regular old low-calorie diet, for weight loss and a low carb diet. Carbohydrates (sources include milk, fruit, pasta, bread, rice, and sugar itself) are what produce glucose in the body; "counting carbs" is the daily task of the person with diabetes. A glucose meter can provide instant feedback about your choice of meal. People with diabetes live in a world of arcane numbers. It can be very, very tedious. It is better than death, however.

So I got religion. From December of 1998 to November of 1999, I lost 65 pounds. I walked for an hour a day and began a weight training program. By increasing my muscle mass, I was told, I could change my metabolism and process calories better. I changed my screen saver to "Year of the Body." I got a personal trainer. I came to call my gym "Hiroko's House of Pain." I did not always want to be there. But the name made me laugh enough to show up for every appointment.

Hiroko (my trainer) taught me stretching exercises and asked me to mimic her movements. Sometimes I could not do it. But I became acquainted with my body. It was as though my body had many rooms that I had never visited before. I watched my diet carefully. I estimated the grams of carbohydrate in every meal. Counting carbs automatically creates eating in moderation. Sometimes I had steak and potatoes and salad. I ate butter -- God's gift to the human mouth. I felt good. I slept well. I could see my feet.

A year after my diagnosis, I reached my goal weight. I had hoped to get off my medication (a common drug called metformin, whose trade name is Glucophage) by losing weight while watching my carbs. I was being such a good boy, I was sure that God would reward me.

Alas. My glucose numbers got a little worse. My doctor suggested I start taking a small amount of a second kind of medication. It appears that my beta cells are dying and that somewhere down the road I will have to start injecting insulin.

After I came out in my newspaper column as a CWD (Columnist With Diabetes), people began to take me aside and ask, in funereal tones, "How ARE you?" Sometimes they would follow with, "Really, now, how are you?" There's a certain deathbed hush they bring to the question, as though my appearing in public in street clothes and laughing with every appearance of enjoyment was some sort of brave sham. My interlocutors are well meaning. I know. I've done it to others myself. I just wish they would stop.

In truth, by any standard, I am healthier now than I have been at any time since the Carter administration. And yet there's no way to say, "I'm fine," without having the other person say earnestly, "That's the spirit. That's the way to handle it."

No, damn it. I am literally fine. Wanna see my damn charts?

I am stronger and faster, and strangers wink at me. How bad can that be? My Hemoglobin A1c number is the envy of my peers. My blood pressure is lower than it's been in 30 years. And I look fabulous .

-- Jon Carroll is a daily columnist for the San Francisco Chronicle.

References

First published February 13, 2001
Last updated January 18, 2007
Copyright © 2001 Consumer Health Interactive

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