I was diagnosed with type 1 diabetes mellitus in September 1998 after a two year illness. In the beginning of my illness, I felt fine and was just losing weight slowly. I really didn’t notice the weight loss as I was not in the habit of stepping onto a scale. I was told by another physician that I was losing weight. I asked how he knew that as I had just met him that moment. He said he could tell from looking at my picture on my hospital ID badge. I think I just ignored his comment. I did notice after 6-9 months that my stomach was shrinking and being 37 years old, that was a good thing. However, after a year I developed diarrhea, occasionally at first, then over the next few months, more frequent, especially after meals. I assumed I had become intolerant of something I was eating and began eliminating foods one at a time, but to no avail. By 18 months into my illness, it was getting more and more difficult to deny that I had a problem and I started noticing feeling tired more easily and some increase in thirst and urination. With no family history of diabetes or any serious medical problems, I didn’t think I could develop a serious medical problem myself. After all, I did not have any bad habits: no tobacco, no alcohol, exercised when I could (not much), ate a pretty healthy diet (more on that later). As the two year mark approached, I had eliminated every food I ate, one at a time, without any change in the diarrhea. I felt lousy, looked thin, finally got on a scale and was about 40 lbs. below my usual weight. Clearly past time to go see a doctor. Blood tests were ordered prior to seeing the doctor (I chose a gastroenterologist because the diarrhea was my biggest concern) which made it easy for him to make the diagnosis, DIABETES, as my random blood glucose was 489 mg/dl. Fortunately, I was not in diabetic ketoacidosis (DKA) i.e. did not need to be hospitalized, so I started on insulin that same afternoon. The unfortunate part is that my delay in diagnosis essentially destroyed my beta cells (the cells in the pancreas that make insulin). Had I sought help sooner, starting on insulin therapy may have preserved my beta cell function for several years longer. This was especially in light of the fact that my beta cell destruction had to have been slow to have symptoms of diabetes for two years without developing DKA. My doctor was not sure of the cause of the diarrhea, but a quick check in a standard medical textbook made it clear that I had diabetic diarrhea. This is a longterm complication of diabetes due to the effects of hyperglycemia on the autonomic nervous system, specifically the nerves that innervate the intestines and colon. It results in diarrhea often precipitated by eating a meal. I won’t do into great detail, but you can likely image that diarrhea 10-20 times a day is pretty miserable.
By September 1998, at least I had a diagnosis for my problems, that it had a treatment, and that it was something I could live with. I had a brief bout of reactive depression as I contemplated the fact that I would have to live with this for the rest of my life, and worse, that I may have to suffer from further complications of the disease and a shortened lifespan. I did not dwell too much on it as I had to quickly learn how to manage this disease to minimize any adverse consequences. In the next post, I’ll describe what happened after starting insulin and how things got worse before they got better.
Keith Runyan, MD