Conventional wisdom is that adults who start developing symptoms of diabetes in their 20s and beyond, and especially in their 40s or 50s, have Type 2 Diabetes. Traditionally, Type 1 is referred to as "juvenile diabetes," because most cases of T1D, traditionally, develop in childhood, for reasons that are still not fully understood.
       In fact, when my glucose numbers jumped from the lower 100s suddenly into the 300s (and my a1C flew from 6.3% to 19%), my internist told me with a confident nod (but no testing) that I had Type 2 Diabetes, especially because I had no (known) family history of the disease.
       But, it turns out that recent studies show that 62% of T1D cases develop in patients who are older than 20 years now, and that misdiagnosis occurs in nearly 40% of adults with T1D, according to a 2021 study by the National Institutes of Health. I was one of those people who was initially mis-diagnosed, and probably unknowingly had T1D for more than a decade before it was discovered.
      In reading this study online, I believe I may have had LADA or "latent autoimmune diabetes in adults, a progressive autoimmunity that was slowly attacking my pancreas, but not enough to bring on the extreme symptoms I experienced (see Hack 6) until the past year. In fact, it may have been my 20-year-long Zone Diet and Muscle Hack (low carb) diets that help keep symptoms at bay because my body didn't require as much insulin to break down the limited carbs I was eating at each meal. Ironically, I had started relaxing on carb intake the past couple of years, which may have prompted the extreme symptoms that "suddenly" occurred last summer. 
        Anyway, I cover the details in other Hacks, but here I want to make the case, and build awareness, that one should not just accept "conventional" wisdom, even among health professionals, that adult-onset diabetes is automatically Type 2, especially if one already manages their weight, eats well and exercises. 

As I mentioned in my Day 1 visit in Hack #6, because the Mayo Clinic treats primarily out-of-town patients, and is in a relatively remote (2 hours outside of Minneapolis) location, the facility does an amazing job of scheduling last-minute tests, trainings, prescriptions and other necessities into a short period of time, to help people maximize their time there. And follow-ups are very easy to schedule and efficiently executed via the Mayo portal, along with many other digitally driven features including Zoom meetings, medical records, prescriptions, care team messages, billing, etc. to facilitate pre- and post-visit needs. I don't take this for granted, given the routine difficulties I face with navigating and connecting local medical resources related scheduling appointments and lab work, messaging and meeting with care providers, following up and getting prescriptions filled, etc. 
        So while Day 1 at the Mayo was met with some anticipation because I was "finally" going to get some answers and begin my journey, Day 2 was met with some trepidation because, now that I knew for sure that I had incurable diabetes and would need insulin injections and other lifestyle adjustments, I was preparing myself for all the sacrifices, new learnings and habits I would have to succumb to for the rest of my life, presumably.
        First stop was the diabetes nurse, where I received one-on-one schooling, quizzing and practice with insulin, needles, and dosing. This was only a one-hour session because it involved only learning how to self-administer long-acting insulin once a day, given that my pancreas was still producing a little insulin and my new endocrinologist had probably decided I could get by for awhile before having to introduce more complexity -- via rapid-acting insulin and possibly a Borg-style insulin pump attached to me -- into my life. My starting dose was to be 10 units a day, while my nurse said that some patients require 70 units a day, given their insulin resistance.
​       I was relieved to learn that there are these wonderful insulin "pens" now that allow you to turn a dial to get the right dosage of units before simply sticking it into a random area around the abdomen and pushing the button. This seems much easier than the old days, where insulin had to be drawn into a syringe from a vial and then injected after inserting the needle into the skin - all of which took more time and skill by oneself. And the needles are much smaller and finer than days of old. But still, I was feeling overwhelmed by the fact I would have to do this to myself several times a day, every day, the rest of my life. Oh, and until I could get a prescription for a continuous glucose monitor (which is ANOTHER thing you have to attach to your body with a needle), I would also need to prick and bleed one of my fingers several times a day before meals and at night to help me determine how eating and insulin were affecting my blood sugar levels.  
       I was also dreading and anticipating the Mayo dietitian counseling session I opted for, because I already believed I had a good diet and exercise program, and was curious - and afraid - what I might learn that I wasn't already doing. And while I wasn't prepared to answer the question "what are you hoping to achieve today," I was thrilled to be told that "there is no such thing as a diabetes diet" in response to my expressing interest in learning about a diabetes diet. Of course, this means that my Mayo dietitian obviously had never read or given credence to Dr. Bernstein's "The Diabetes Diet" that had been in publication for more than 25 years, which I was not to discover for a few months hence (see Rant #33 on trendwolf.org's home page). 
       But even as the Mayo dietitian told me that sweets were still on the menu for me if I wanted them, she also told me that although I had lost weight in recent months due to a failing pancreas, I could expect to gain weight back (read: unwanted weight) now that I would be taking insulin. As if to suggest that a diabetic can pretty much expect to be overweight because that's just what happens, even with a 'normal' diet and exercise. She didn't SAY that, but it's still the impression I was left with: that "good enough" was my life now. In fact, she DID say that I needed to add MORE CARBOHYDRATES to my diet, including potatoes, to get my macro-nutrients more in balance with a normal, 'healthy' diet. Her eyes went wide when I told her how much protein I was eating a day (a gram per pound of my weight - which is at least 2-3 times the standard recommendations.  
       After some additional visits to the on-site pharmacy to get loaded up with insulin and needles, and a final visit with my endocrinologist to summarize all the next steps, tests and appointments on the horizon, I bee-lined out of Rochester feeling like I had just been swept up by a tornado and life was going to be the same again.