Hey, Diabetes Community! Welcome back to our weekly Saturday advice column, Ask D'Mine!, which offers real-world wisdom from veteran type 1, diabetes author and educator Wil Dubois.

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This week, Wil examines the emotional and psychological aspects of living AND working with diabetes. He also looks at when exactly our bodies begin the diabetes process... even before an official diagnosis.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Janet, type 1 from Wisconsin, asks: What's it like working professionally in diabetes and also living with it? Do you suffer from diabetes overload?

Innovation 2015

Wil@Ask D'Mine answers: Ninety percent of the time, I find it invigorating. Everything I do, read, hear, and experience is connected for me. I'm fully networked. All the dots connect. Almost every moment of every day is diabetes, diabetes, diabetes. I'm swimming in it. Breathing it.

Do I get overloaded? Personally, I do not, but that may just be me. My diabetes isn't going anywhere anytime soon, so I'm stuck with it 24-7-365 anyway. I might as well have fun with it and put it to good use.

And I find that my many diabetes jobs overlap and help each other. As a reminder: I work at a diabetes clinic 30 hours a week, write about diabetes for several publications, teach community health workers about diabetes for the University of New Mexico's School of Medicine, and am both figuratively and literally married to diabetes (as my wife is living with type 2). So, yeah, that's a lot of diabetes, but there's some cross-pollination going on. Sometimes research on a question from a reader at D'Mine will help shed light on a prBrain Workoutoblem a patient at the clinic is having. Or the other way around. Sometimes a personal diabetes experience will help someone else, and sometimes someone else's experience will help me.

Living with 300 people's diabetes is, frankly, a lot more comforting than just living with my own. At least when it comes to diabetes, I don't get lonely.

Does that mean I'm Mr. Happy Diabetic all the time? Not at all. The disease occasionally gets me down, slows me down, runs me down. But truth be told, it's not diabetes that causes me most of my trouble so much as what comes with it. Especially the issues around insurance. What's covered. What's not covered. The constant struggle and never-ending battle to get the basic supplies I need to stay healthy is what will shorten my life. Not the frickin' diabetes. Those issues are what keeps me awake nights staring at the ceiling (or punching my pillow to vent my frustrations).

That's the only awful part. Not the sea of diabetes that surrounds me, but that the ground under my feet is always shifting. The rules change all the time. There's never any rest. If I'm not fighting my own insurance, I'm fighting someone else's. So that part gets old.

Oh, and then there's another awful part. Patients die. Sometimes directly related to their diabetes. Sometimes they're people I didn't get to in time. Sometimes they're people who just didn't want my help. Those are the hard ones. I always second-guess myself. What if I had talked to them differently? Said something differently? Why wasn't I able to get through to this person? Help them understand? Help them take ownership? Help them get control? Why couldn't I convince her to take her medicine?

I know these things aren't really my fault, and I try to let it go. Long ago I had to mentally accept that I cannot save everybody, that I have to concentrate on my victories instead. But the heart does not always do what the mind commands. I hate to lose to diabetes, but well... it happens. And sometimes my email is full of letters that make me want to cry. Stories of pain and suffering and fear. I write back to everyone, but sometimes it takes me a stiff drink to dull the empathic pain I feel reading them, and it takes time to try to figure out what to write back.

But other times I get letters telling me how in some small way I've made someone's life better—and that's a powerful antidote to the blues.

So diabetes overload doesn't give me much trouble. Where I have trouble is when I'm doing something non-diabetes. It feels... wrong? Off? Out of place? I'm probably a workaholic, but I have a hard time relaxing and doing something I enjoy that has nothing to do with diabetes. It makes me feel a bit adrift. It's something I'm working on because it seems there's no reason to be that focused on anything. Still, I can't help myself. I guess I'm trying to save the world, even though I know I can't.

 

Stephanie, type 1 from Massachusetts, asks: I have a question for you—when exactly did I become a type 1? I know the onset of type 1 is more acute than type 2 but when I look back over the five years prior to my diagnosis, I feel like there were definite signs. I remember signs and symptoms of both hyper and hypoglycemia (severe lethargy and dehydration in the early afternoon as well as increased hunger and tremors prior to lunch) in the four years prior to my diagnosis.

Wil@Ask D'Mine answers: Ohmygosh. What a great question! And I have no frickin' idea whatsoever what the answer is. You just penned the ultimate diabetes chicken and egg question.

But let's speculate.

First we need to ask: Are we type 1s born or made? No one knows for sure, but the evidence is beginning to point towards there being a Chicken and Egggenetic component to type 1, just as there is for type 2. Under this scenario, you'd be born ready, as it were, and the autoimmune malfunction would slap you upside the head once you encountered the trigger, whatever the friggin' trigger turns out to be. If that's the case, you "became" a type 1 about nine months before you were born. Of course, that isn't really true either, is it? I mean, most of us type 1s lived for a decade or two as sugar normals before becoming type 1s. Right?

A great many PWDs celebrate their diaversary, but this is the annual holiday that marks the moment of the bad news: the diagnosis, not the onset of the disease. So while that's an important milestone, having a white coat tell you that you have diabetes isn't really when you became one—although for legal and insurance purposes the official diagnosis date is the moment you became type 1. But in reality, it had to have happened earlier. How much earlier? Well, at least when it comes to kiddos, most type 1 diagnoses happen after a fairly brief and dangerous time period of crazy-high sugars that land them in the ER. So they probably "became" type 1 a month or two before the diagnosis crisis.

Or... maybe not. Recent data from the Trial Net project shows us that early indicators of type 1 can be detected a year or two out. At that point the pot is on the stove, but the water isn't boiling yet.

If we could pinpoint the very moment the first immune cell made a picnic out of a beta cell, would that be when we became type 1s? Or would it be when the critical mass of beta cells was lost, tipping us just over the brink of normal glycemia? Or was it later, when we became genuinely hyperglycemic?

There really is no answer. All can be correct. All can be wrong.

All of that said, however, I don't think that the symptoms you were having for four years before your diagnosis were from high blood sugars. That's a very long time to be high, and the length of hyperglycemia prior to type 1 "onset" seems to be very short in most people. The destruction of the beta cells happens at a pretty rapid pace once it starts. Unless, of course, you had that whole Double Diabetes thing that I don't believe in, with type 2 striking before the type 1...

I guess we all get to choose. We get to decide for ourselves when we became type 1. For me what makes most sense is... let me think about this...  Well, given all that has transpired in my life since joining this family, it sort of seems like it was my destiny to be type 1. Why it took four decades to happen, I can't say, but I choose to believe I was born type 1.

 
This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.