As a medical reporter who has been writing about diabetes for more than 20 years and living with the disease myself since 1973, covering JAMA’s diabetes “theme issue” press briefing on Tuesday was familiar territory.
Four papers were presented. Frans J. Th. Wackers, M.D., Ph.D., of Yale University reported that routine screening for cardiovascular disease in asymptomatic patients with type 2 diabetes did not impact CVD outcomes. Rachel A. Whitmer, Ph.D., of Kaiser Permanente presented her group’s finding that severe hypoglycemia resulting in a trip to the hospital was associated with an increased risk for dementia in older adults with type 2 diabetes. The impact of milder episodes needs to be studied, she said.
Dr. Richard K. Burt, of Northwestern University, then discussed his success in the use of autologous nonmyeloablative hematopoietic stem cell transplantation to reverse type 1 diabetes in newly-diagnosed patients. Might this treatment work in type 1s with longstanding disease, I asked him, given that recent evidence suggests that some of us might still retain some residual beta-cell function? “Hmm…maybe,” he answered. The final talk, by medical student John S. Kaddis, of City of Hope National Medical Center, summarized the current state of research in pancreatic islet cells for the treatment of diabetes, a field that has grown tremendously in the last decade.
I’d had a hypoglycemic reaction on my way to the briefing that morning. This, despite the fact that I had cut back both my breakfast insulin bolus dose and had programmed my pump to deliver just one-third of my normal basal infusion during the three-quarter mile walk from my apartment to the subway. The clammy, shaky, confused feeling began to set in just as I stepped on the train. There were no free seats, so I had to hang on to the pole with one hand while using the other to temporarily suspend my pump, grab a couple of glucose tablets from my pocket, and pop them into my mouth as the train lurched forward. Happily, I made it to the press club in one piece.
By the time the briefing started, my blood glucose level had rebounded to 189 mg/dL (normal is about 70-140). But I didn’t give myself more insulin because I didn’t want to risk overcorrecting and dropping low again during the two-hour briefing. My sugar was up to 214 mg/dL at 12:30 p.m. when I finally gave myself more insulin for lunch. How much damage had been done to my eyes, kidneys, nerves, and heart during that time? I try not to think about it. For people with firsthand knowledge of type 1 diabetes, this roller-coaster scenario is painfully familiar.
I suspect that my approach to covering diabetes as a journalist is similar to that of a physician who must deliver bad (or even good) news to a favorite patient: You put your personal feelings aside in order to do your job. The feelings are still there, but you don’t let them cloud your objectivity. In both cases, the “delivery” is heartfelt while remaining professional. The fact that I was given a very short time window to file all four stories certainly assisted me in that regard.
–Miriam E. Tucker
(On Twitter: @MiriamETucker)