Surprisingly, I Didn’t Know Everything About Diabetes Before Medical School (Here’s a List Of Enlightenments)

We like to consider ourselves experts. On the spot, we can spew carb counts for all things edible. We alter our insulin rates and corrections on intuition.  Always a step ahead of our endocrinologists, we people with type 1 diabetes appear to have a superiority complex, the by-product of years of acting as the human, oftentimes inaccurate form of a beta cell.

Coming from this background as I started medical school, I was shocked by many things subsequently presented over the last two years–more or less on a daily basis–that were completely off my limited radar. Really though, almost every day I found out something new about diabetes. There was no waiting until the endocrinology class started. Diabetes complicates every disease process. Diabetes knows no bounds: immunology, genetics, neurology, nephrology, dermatology, cardiology, and any other -ology (sorry, forgot ophthalmology).

During our first few weeks of class, when diabetes was mentioned as a complication on a slide, friends in class would look my way as to say with a glance, “Hey man, you have that disease. What do you think?” This soon wore off. There were just too many mentions of diabetes.

Of these daily mentions, a few really stuck. This is not a comprehensive list but more a list of interesting facts. Maybe you can spring a couple of these on your fellow friends with diabetes as a pop quiz.

 The Tidbits From Two Years Of Medical School

• Type 2 diabetes has a stronger genetic link than type 1 diabetes
  • In identical twins, there’s a 50% shot that both will have type 1 diabetes if one has a diagnosis. But, in type 2 diabetes, that rate is 90%.
• If a person with diabetes has nephropathy (kidney disease), they are highly likely to also have retinopathy (retina disease). But, if a person has a retinopathy, there’s not as strong a link with nephropathy.
• Alcohol lowers blood sugar, over long periods of consumption. But how? Finally, an answer. One of the by-products of alcohol metabolism in the liver is a metabolite called (NADH). Having too much of this around signals the liver to stop making new glucose. Pair the stoppage of gluconeogenesis along with our inability to functionally use glucagon, and you’ve got insulin working solo. This is the recipe for hypoglycemia.
• Ketoacidosis is dangerous. This we all knew. But did you know that being in ketoacidosis allows certain kinds of bacteria to do some pretty horrible stuff to your face (Google Image Mucor and Rhizopus photos, if you dare). Lesson: try to avoid going into ketoacidosis (I know, when you’re sick, this isn’t quite as straight-forward).
• Another ketoacidosis note: rarely do people with type 2 diabetes develop ketones, because their bodies are kicking out just enough insulin to prevent ketone synthesis. (Remember, the issue with type 2 diabetes is insulin resistance, usually.)
• Being low, while trying to be intimate, is challenging. Many know this from experience. It’s not just you. You know that anxiousness that happens when low? That anxiousness can be caused by a variety of neurotransmitters but it seems that norepinephrine actually shuts down the parasympathetic nervous system in a way. That parasympathetic nervous system is the one operating the machinery. Nothing a glass of orange juice can’t fix. Sugar helps turn off norepinephrine, in an overly simplistic explanation.
• Heart disease is the leading cause of death for people with type 1 diabetes. Why you may ask, when you’ve avoided sugar your whole life? Well, that extra sugar in our blood makes our blood vessels leaky, allowing proteins to sneak through and build up, effectively accelerating atherosclerosis. That atherosclerosis is also the main cause of diabetes foot ulcers.
• Having quality diabetes management can prevent many things. Almost all of these dreaded complications can be avoided. But, it appears that nephropathy (kidney disease) can happen in folks who’ve had great control, too. I know, bummer.
• On the kidney front, diabetes is the leading cause of dialysis.
• People with down syndrome are more likely to develop type 1 diabetes. Good company.

Coming in, I was aware of the three horseman of the diabetes apocalypse: retinopathy, nepropathy, and neuropathy. Those were big words and they seemed years away from consideration. Having now been presented with the barrage of diabetes complications as a daily ritual, there’s no way to plead ignorance.

Overall, it’s been liberating, forcing me to evaluate my daily choices with more consequence, yet not a burden at all. More a nudging reminder, I am mortal and will die. Might as well get down and dance right here, right now, be thankful, and enjoy the heck out of life. Because, if it were a 100 years ago, I wouldn’t be here (no insulin yet).

(Note: Ryan is a second year medical student who generally cannot be trusted with any form of medical advice. These were general observations from a guy with type 1 diabetes. If you’d like to learn more about any of the points above, leave a comment and will steer you toward a more qualified source.)