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.”