Even a thin person can get diabetes

Sugar shocked
I'm not the only one whose A1C score has led to serious head scratching of late.

In February, the National Heart, Lung, and Blood Institute halted part of a large study because too many diabetic patients at high risk for heart attacks and strokes were actually dying of them while they were being treated aggressively — in some cases with multiple drugs and insulin injections — to lower their glucose.

The goal was to bring them into line with normal, as measured by the A1C. Fifty years of conventional wisdom regarding diabetes says this group should have had the best outcome, not the worst.

It may be the wild ups and downs — replayed several times a day for years or decades — that takes the biggest toll on the body. Yet rather than seeing high and low blood sugar as two sides of the same insulin resistance, most of the diabetes organizations I contacted don't even think about the low side where type-2 diabetes is concerned.

The CDC does acknowledge that reactive hypoglycemia exists, but it has no data for hypoglycemia among men in the United States with diabetes, according to a spokesman. But he goes on to say this: "No data provide sufficient evidence that reactive hypoglycemic leads to diabetes."

"I think reactive hypoglycemia is a big problem," says Dr. Berkowitz. "No, I take that back. It's a huge problem." He tells me what's at stake for me in this battle. "If you don't do what we've been talking about, you will, over time, become diabetic. There's absolutely no question about it." After seeing my father minus his entire right leg, I have no reason to doubt the good doctor.

Dr. Berkowitz says that for a glucose-intolerant person, when to eat is nearly as important as what to eat. It only makes sense: If you want that seesaw to move gently through a small range of motion instead of swooping, you need to tap it more than three times a day, right? So in addition to sticking with my reduced-carb diet, I need to eat before I become hungry and finish my third small meal of the day before most men sit down to lunch. Sure, it's inconvenient at times, but then, not as inconvenient as losing your limbs.

Breaking the chain
My father was once a formidable man. He should have wiped out type-2 diabetes like one of the giants he knocked off in that basketball tournament. But how could he? Unless he lives long enough to read this article, he'll die not knowing the name of the metabolic disorder — reactive hypoglycemia — that made him diabetic. Coincidentally, my second and final visit with him coincides with his evening meal, wheeled into the room by two orderlies. I watch as they gently prick his finger to measure his blood sugar — and then leave behind a meal that includes mashed potatoes and fruit juice. I wonder if they've ever measured him an hour after such a carb-laden meal. Not that it matters now. The damage is done.

Near the end of my research, I'm stunned to learn that my grandfather, Thomas Joseph O'Connell Sr., another thin man, died from type-2 diabetes. One reason my father got blindsided was that his father had moved on, and one reason I didn't see diabetes coming was that my father and I had parted ways.

Consider it one of the unexpected costs of fathers and sons disconnecting: missing what should be obvious signs of family illnesses. Ironically, this disease also reunited us in the end and provided us with our one final bond. As I leave, I realize this isn't just the first time I've seen my father in 20 years. This is probably our last goodbye as well.

The night before my last blood draw for the lab work for this story, I begin my fast at 7 o'clock but still trudge off to the gym at 10 for a cardio blast. I also decide to rise at 6 the next morning; I want to hit the treadmill again for a few minutes of sugar burning before the nurse plunges a needle into my arm. For a year and a half, I've been determined to push that number under 100, no matter what it takes.

The alarm on my cellphone beeps. I roll over, gaze at the ceiling, and change my mind about the gym. What matters are the measurements I've already taken myself. In a year and a half, this disease has made me stronger, fitter, more determined, and more optimistic than I ever was before. In trying to lay claim to my body, diabetes unwittingly gave me a new lease on life instead.

When the lab results come back the following week, along with dramatic improvements in cholesterol and blood pressure, my fasting glucose registers 99. Those two digits say that my blood sugar is normal again. But I know better. Like millions of American men, my body can no longer handle processed carbs in anywhere near the quantities included in the typical American diet.

Type-2 diabetes still lies waiting for me. It just needs me to drop my guard and eat junk food, put sugar in my coffee, skip meals, fall out of shape, and forget for even a brief stretch that this metabolic fire needs only its oxygen to roar again.

That's all the breathing room this deadly disease needs to take me down — and maybe you, too.

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