Why I Gave Up Peanut Butter Cups Forever
From Healthy Living on HuffingtonPost.com
September 20, 2013 - 5:56pm
At six weeks, doctors removed most of my pancreas. Then, at six months, they removed most of what was left.
It was an ordeal. I was born with a genetic condition that caused my pancreas to pump way more insulin than I needed, causing dangerously low blood sugars. In 1989, when I was born, this was called nesidioblastosis, and today it's called congenital hyperinsulinism. The medical records show that I was cute and happy (and huge), but not yet healthy.
This all happened before my first memories. My parents raised me to think that everything was all right. The scars across my midsection -- the train tracks -- are nothing to worry about. That attitude basically defines my worldview today.
So once I finally came home from the hospital, I grew up like any other lucky kid. The challenges I faced throughout my childhood had nothing to do with my nearly catastrophic medical beginnings. That my life was so "normal," that I could focus on studying baseball, becoming cool, and protesting violin lessons, was to the immense credit of my parents and Dr. John Crawford (deceased, 2005) and Dr. Samuel H. Kim (retired) at Massachusetts General Hospital.
The remnant of my pancreas today doesn't produce enough insulin to regulate carbohydrate metabolism and, as a result, my blood sugar level. That's not too surprising, considering that my pancreas is little more than a nub. Its paltry insulin production seems to have lagged through adolescence, though we don't have longitudinal evidence to show that explicitly, and I was diagnosed with diabetes at the age of 19. I showed all the telltale symptoms: weight loss, physical weakness, frequent urination, thirst, and, as it turned out, a blood glucose level of around 600 mg/dL. (That's really high.) I was working on a family farm at the time, and the other strapping, vigorous college students on the crew thought I was a lazy weakling. I was starting to think so, too.
The doctors and I set about reining in my blood sugar. No one, including the American Diabetes Association, suggested that I should try to log levels expected of a non-diabetic. They set moderate goals that would be achievable with moderate effort. The endocrinologist furnished me with insulin shots. The nutritionist reassured me that I wouldn't have to make uncomfortable dietary changes.
This plan was apparently designed to manufacture success and build positive relationships with my doctors and my diabetes. And I see the rationale. It's true that patients are better off when inclined to visit the doctor at all, so the doctor wants to foster cooperation. I suggest that cooperation could be fostered through respect and honesty rather than leniency.
Somewhere here lies a line between accommodating a patient's comfort level and withholding information that could extend or improve that patient's quality of life. Settling for mediocre results would not kill me immediately, but it would quicken the onset of diabetic complications (a comically mild term) such as blindness, nerve damage, high blood pressure, depression, heart failure, and death.
This sort of doctor-patient relationship reminds me of the perverse incentives that drive grade inflation in academia. Need an extension? I'll give you that extension, that B+. I'll make your life easy if you rate me highly on course evaluations, because that's how I get tenure.
So I was prescribed insulin pens, which I used to administer injections several times daily. After a couple of years, I switched to an insulin pump, with its promise of flexibility and effectiveness. All the while, I tested my blood sugar compulsively and limited my carbohydrate intake.
This all worked to regulate my blood sugar levels. Using these tools, I exceeded the doctors' expectations.
But success came at a price. More than once, I messed up. I miscounted my carbs and injected the wrong amount of insulin. I was caught without glucose tablets. I got frustrated with a persistent high blood sugar and overdosed. That's called a rage bolus. My blood sugar hit 50, then 40, then 30. I lost consciousness. They found me having a seizure in the quad, and I woke up in the hospital.
This perpetual roller coaster left me angry, confused, and apparently unable to go about my business without stumbling into the ground. (That's what happens when your blood sugar plummets. You get all shaky, the world spins, you lose track of reason, you try to pretend that everything is fine, you get ornery, you gobble down whatever Continue reading this article »