"There's a problem with your blood test," she said. "You have to come in to see the doctor."
"Ok," I said hesitantly. She recited the office hours. "Is there a problem with my blood test, like I need to take another one?" I asked. "Or is this about results?"
"Um, the doctor will tell you about that when you come in."
I thought I'd finish my shift and hit the doctor on the way home, but the nervous nausea of anticipation overwhelmed me. I left work early.
I had finally agreed to see a doctor at the urging of my mother. For months, I'd been losing weight, which my loved ones and I were initially willing to write off as the result of diet, or the caprice of metabolism. (Several friends first wanted to rule out an abuse of illicit substances.) But after I'd dropped close to 60 pounds in nine months, like some kind of reverse megapregnancy, and my new pants—several inches smaller around the waist than my old ones—were starting to fall off even when I was wearing a belt—in which I'd had to awl new notches—and my ribs were poking out of my skin, and my back had become so fatless that it stung my spine to sit back on the subway, the weight loss could no longer be easily ignored. I looked gaunt, my eyes sunk into my face. Friends and I cracked jokes about The Machinist, Steve McQueen's Hunger, Stephen King's Thinner: What role was I preparing for? What was I protesting? What gypsy had I wronged?
My wasting away wasn't the only cause for alarm: against the scrawnification, I was hungry all the time, eating whatever I wanted, in whatever quantities I wished, whenever I felt like it. Twelve Reese's Peanut Butter Cups? For a snack between my afternoon snacks? Don't mind if I do. Furthermore, I could guzzle all the Adam's ale in the Ashokan and not sate my thirst. Consequently, I had to rush to the restroom every 45 minutes; I woke up several times a night to pee. I couldn't sit through a movie without running to the lobby halfway through.
In the mornings, my feet and calves cramped: the pain wasn't "stabbing," but like major muscles and tendons had been snipped with cruel surgical precision. During waking hours, my legs throbbed with a deep, dull ache. Not so long ago, I had walked so briskly that I'd pass everyone on a sidewalk or set of subway station stairs. Now, I was the last one to get up to the F train at 9th Street, lagging behind the old Chinese women with orange shopping bags. Just climbing my front stoop proved a challenge.
One day, it popped into my head: a single, terrifying word, as though my subconscious had known the problem all along.
I googled the symptoms and was dismayed to discover that I had almost every one: the hunger, the thirst, the frequent urination, the weight loss. It was classic, the sort of thing a medical student could diagnose in a chat room. I didn't share my fears, only letting my suspicions slip occasionally as a joke. Then, one day, I googled "diabetes leg cramps" and, without even having to click a link, I read "The symptom of having leg muscle cramps, particularly at night, is a classic sign of undiagnosed diabetes." That was the kicker. Still, I held out hope that a doctor would prove me wrong, and reprimand my hypochondriatic self-diagnosis—the irresponsibility of my WebMDing.
So I agreed to make an appointment. The doctor asked me why I'd come and I described the pain, the insatiability, the waist reduction. "How much weight have you lost?" he asked.
"About fifty pounds."
"Fifty?" he said. "Five-zero?"
Later, my parents asked me how it went. "He said it sounds like diabetes," I said. "But we already knew that."
Diabetics can't convert sugar into energy; instead, glucose collects in their blood. Essentially, they're starving, even when they're eating. The name was coined by Aretaeus of Cappadocia, an ancient Greek physician, and it translates into something like "siphon," after the excessive urination that is the disease's most common symptom. "Mellitus" was added in the 17th century; meaning "honey," it refers to the sugary character of the urine, in which passes some of the unprocessed glucose. Ancient Indians (of the subcontinent, not the buffalo-roaming plains) called it "sweet urine disease"; in order to diagnose it, a patient would piddle on a rock and see if the micturition attracted ants. Asiatic peoples called it "sugar urine disease."
The pancreas produces insulin, a hormone that allows the body to process glucose; its name comes from the Latin for "island," after the Islets of Langerhans, a region of the pancreas, that produce it. Insulin functions like a key that unlocks cells and allows them to convert sugar into energy; for reasons not entirely known--the body often attacks the pancreas, but why?--diabetics stop producing or stop processing the hormone. There are, essentially, two forms of the disease: Type 1, or "juvenile diabetes," in which a person produces no insulin (or, negligible amounts) on their own and must inject a synthesized version daily; and Type 2, or "adult onset," in which afflicted persons produce some insulin (though usually less than normal) but their cells have developed a resistance to it. This is usually treatable through oral medication in combination with diet and exercise. (The nicknames refer to the period of life in which the sufferer usually develops the disease, though they are going out of style as more older people develop Type 1 and younger people, Type 2.) If insulin is like a key, then it's like Type 1 diabetics have lost their only set. For those with Type 2, it's like someone changed the locks. (Another type, "gestational," occasionally affects pregnant women, and usually disappears once the baby has been delivered.)
Doctors didn't recognize the role insulin plays in diabetes until the 1920s (Banting and Best, the researchers who developed injectable insulin, produced from pig pancreases, won a Nobel Prize); up until then, a diagnosis of diabetes was effectively a death sentence. Aretaeus described the diabetic's life as "short, disgusting and painful." Now, through a combination of treatments, the disease is manageable, though mercurial. It requires constant attention; a diabetic on NPR recently described it as "like a baby that won't stop crying." But as long as they take care of themselves, "diabetics can live into their seventies and eighties without any complications," a nurse told me. "Well, maybe not their eighties."
The doctor had ordered a spat of blood tests, which I'd taken on a Wednesday morning. By Thursday afternoon I'd been called back.
My regular doctor wasn't on call that day. Another doctor entered the room where I waited nervously, looked uneasily at my information on the clinic's computer system, and then left. A nurse came in and asked me to change rooms.
Eventually, a Chinese doctor with a heavy accent entered briskly, her attention divided. She looked quickly at my electronic records and began bullying me with questions I'd already answered last week. How was I feeling? Why was I there?
I mentioned the weight loss. "Fifty?" she asked. "Five-zero?" She clicked a few buttons. "Oh yeah, you have diabetes."
I had been daydreaming about what sort of tact the doctor would use in this worst-case scenario, what kind of care and delicacy would be applied; I tried to imagine the gentleness I would use to deliver such traumatic news. She spoke as though to tell me I had a bit of spinach in my teeth.
"Yeah, look at you sugar, it's 300," she said.
"Is that high?"
"Three hundred?" she snorted. "Yeah, how much higher you want it?"
"I don't know?"
It was difficult to speak because I was devoting all my strength to holding back tears.
"Is it Type 1 or Type 2?" I miraculously thought to ask.
"Uh, I think it's Type 2." There was a pause. "So just, uh, stay away from carbohydrates and eat vegetables and lean protein, like chicken."
"I'm a vegetarian," I muttered.
"Oh! So you eat tofu," which, though structured as a description, she inflected as permission.
She ordered a few more tests, told me to come back in a month, and wrote me prescriptions to combat my insulin resistance and high cholesterol, the latter, most likely, an insult-to-injury result of the former.
I cried all the way down 56th Street.
The increasing rates of diabetes in America, which many professionals have taken to calling an "epidemic," are of Type 2, the one associated with obesity, poor diet and an inactive lifestyle. (These are risk factors, not causes per se.) The vast majority of diabetes cases in the United States are Type 2, like mine. Or so I thought.
Part two of Henry Stewart's story appears tomorrow.