When I Decided to Live With Diabetes...

Dannenfelser's Complete Manuscript

For a year or two prior to this recognition of diabetes I had always felt tired and despondent and had on numerous occasions pondered the merits of suicide for no particular reason that I can now recall. I had never been as active physically as most children in my age group. I was an only child and could never get interested in group games although I liked checkers and strictly individual contests of a non-physical nature. My unusually good scholastic record and childish snobbishness that my parents never discouraged properly confirmed my feeling of isolation and frustration. Instead of running with a gang of boys as early adolescents are inclined to do I preferred the company of girls and books and only gradually developed a sort of reserved sociability. For three years I was president of my high school class and took an active interest in school affairs -- chiefly by stirring up controversies on politics, student government, religion, and numerous other subjects that intrigue adolescents and scare teachers. I always thought the athletic events were silly and persuaded a vociferous minority of the students that this viewpoint was sound -- thereby meriting the wrath of right thinkers. In fact things were at times so unpleasant over this, that, or the other that I sometimes found it physically expedient to keep close to my fellow thinkers who composed a slight majority in my own class and an unpopular minority in the other classes. When my cousin was president of the senior class and I was president of the juniors the traditional joint picnic had to be abandoned because we were not on speaking terms and our respective political followers were not socially inclined. In 1924 I was almost the only La Follette partisan in the county until a few of my fellow students were properly indoctrinated, and my conservative parents were alarmed by this peculiarity. They were even more alarmed when about the same time I discovered that God was not giving proper attention to my advice and forthwith decided to shun all verbal contact with the deity. I remained an active Methodist through adolescence and did not withdraw fro the church till my early twenties but my attitude was essentially critical and my "faith" which was never very strong any how left me about the time diabetes was discovered and I have since then lived right comfortably with a humanistic philosophy developed through the influence of Nietzche, Bertrand Russell, Coce, John Dewey, Karl Marx and other strangers with whom my fellow students and their parents weren't acquainted. In high school my scholastic records continued to improve. I withdrew from bible class as a result of theological indiscretions. My interests were Latin, English, Geography, and history. Mathematics came easy but except for geometry such subjects were not especially interesting. My peculiar viewpoints and my childish readiness to enlighten the general public on the slightest provocation added to adolescent social difficulties and physical and emotional maturity were retarded by intellectual ambition and the naive motion that I could with diligent application get all the answers to all the questions out of books.

I have described the foregoing psychological facts in some detail in the belief that diabetes was an active factor in shaping my viewpoint and encouraging my social limitations. I was a high school freshman when the disease was discovered. I started taking insulin in 1927 when I was a senior and never returned to school. I translated six books of the Aenid at home in bed and did the other necessary work to get my credits and graduate with my class.

The diabetic viewpoint advanced in the books my mother read recommended that the use of carbohydrates be eliminated from the diet as much as possible. We promptly followed the recommendations and for nearly three years I lived on a diet of meat, butter, gluten bread and five percent vegetables. All sorts of special diabetic foods were tried but I wasn't enthusiastic about any of them. In fact, I was never a food fancier and the problem of being tempted to eat foods that were not prescribed has never in 18 years of diabetes occurred to me. The new diet very promptly eliminated the sugar in the urine and the physician decided that maybe I didn't have diabetes after all. In fact, my parents were so anxious for me not to have diabetes that for three years they carefully limited my condition to a "diabetic tendency."

I became increasingly hungry regardless of the quantity of cabbage and sauerkraut I ate and was thirsty all the time. When the disease was discovered I was nearly six feet tall and weighed 150 pounds. In the next three years my height increased to slightly over six feet and my weight gradually declined to a low of 120 in the fall of 1927. In spite of the restricted diet sugar soon returned to the urine and control continued to become more difficult as my physical condition declined. We went to all four of the local physicians for medical advice. They all insisted that we should under no circumstances use insulin and that they could not do anything to greatly postpone my imminent demise. My parents then took me to physicians in New Albany and Louisville who prescribed "Fulton's Compound" and certain pink medicines with sweetish tastes which I drank in large quantities. Christian science and various religious short-cuts were seriously suggested to my parents in the treatment of the disease but my increasingly critical attitude toward any brand of piety prevented my ever giving such cures a chance. I had refused to go to a chiropractor and was continuing to go to doctors principally to avoid unpleasant scenes with my parents. The high fat diet recommended by the doctors permitted the unlimited use of honey as a sweetener and another prescribed glycerine instead of saccharin. For a long time I walked four to six miles a day on orders of various doctors. Walking in the country was usually pleasant but even in cold and rainy weather I often put on the necessary clothing and did my daily walking. The air and sunshine were perhaps helpful but by the time I gave up forced exercise I was getting pretty tired. Numerous well meaning people with all sorts of sure cures for diabetes called on us. Mail order doctors with special water cures and all sorts of odd nostrums found out about my diabetes and tried to do a selling job. But I became a tougher prospect all the time. Farmers who knew of sure cures with exclusive diets of cider, sauerkraut, milk, cheese or other foods offered their advice without charge but I continued to grow worse and no doubt developed an increasingly disagreeable disposition.

By the fall of 1927 I felt too tired to go to school and decided that I was going to die very presently anyhow. My parents who had always done their best to make my life pleasant and improve my condition decided that a trip to visit my mother's brother in Texas might be helpful. My physician thought this might be a good idea, so in October 1927 my mother took me to Texas. We immediately went to my uncle's doctor who thought my diet was exactly right when followed in connection with a new kind of tonic he had heard about. He felt that the use of insulin would be fatal. It is difficult now to understand why so many physicians in the 1920's were afraid of insulin, but I can only say that this was the attitude of every doctor I ever knew until I went to the Santa Rosa Hospital in San Antonio about two o'clock one morning in diabetic coma. The doctor who had treated me decided that I was going to die anyhow and being very tired, he left.

In this critical situation one of the senior internes at the hospital heard about my condition and induced my mother to let him try the use of insulin. With the use of saline solution, glucose, and some 300 units of insulin I was out of the coma the next day. My father arrived in Texas very shortly and the hospital authorities permitted Dr. Boen Swinny, the interne to accompany me to a Louisville hospital as soon as I was able to travel by Pullman.

My improvement seemed very rapid. For two or three months I got by with three daily doses of insulin totaling some 50 units. For the first time I was on a carefully weighed diet. I felt much better and my disposition improved. I now came into contact with people who could discuss literature and philosophy objectively and I decided that life could be worth living after all. In a couple of weeks I returned to my home some thirty miles from Louisville where my mother continued careful attention to my diet. By the time I was able to sit up I began to worry about failure to finish school and began to develop other symptoms partly physical and partly nervous that made necessary a rapid increase in my insulin. I had to return to the hospital for further attention. My diet was changed and my insulin increased beyond 70 units a day. My condition continued to deteriorate until it was found necessary to take insulin four times a day -- before each meal and at midnight. Even with this and with carefully measured diet and later a regular system of exercise the size of doses had to be varied daily to meet insulin reaction and excessive sugar which occurred at almost any time. High sugar usually occurred after breakfast and insulin reaction generally after supper and this problem has continued unsolved up to the present time.

From 1928 until I began the use of protamine insulin in January 1936 I continued to take insulin at midnight -- with orange juice if the test was negative and without orange juice if the test was positive. For another period of some two years I took both kinds of insulin before breakfast and supper. With the development of insulin zinc crystals I discontinued the use of unmodified insulin and have since taken from 65 to 70 units of Protamine insulin and about 10 units of insulin zinc crystals before breakfast and about ten units of insulin zinc crystals before supper. For periods of several weeks it has been possible to eliminate the supper insulin altogether but I always find it necessary to return to its use. When other complications such as boils develop I have taken over a hundred units daily for short periods. My diet during this period has averaged some 2,000 calories daily and since 1938 I have generally eaten my noon and evening meals in restaurants and have continued to have a weighed breakfast. Restaurant eating has apparently been just as satisfactory as the weighed meals. When I have sugar I eat less and when I have reaction I eat more. Reactions have been more severe and less predictable since the use of the newer types of insulin but the danger of diabetic coma seems also to have been greatly reduced.

My second diabetic coma occurred in my home in 1931 and was more difficult than the first. My physician, Dr. R. Hayes Davis of Louisville spent several days at my home and in less than 24 hours administered over 1200 units of insulin. The coma was preceded by a bad cold and indigestion but came with little warning.

My last diabetic coma occurred in 1934 when I was living in Louisville. At noon I was unconscious with insulin reaction and before evening I was in the hospital in coma. It was less serious this time, however, and I was out in a few days.

When I was completing my studies at home after I began taking insulin I first verified the fact that mental fatigue, eyestrain, and emotional disturbances increase the blood sugar. To combat this I deliberately developed a tranquil disposition.

After finishing high school I attended business college in the belief that I wanted to be an accountant. After limited office experience I changed my mind on this subject and went to work for a newspaper. In writing for newspapers I failed to develop tact and discretion and the other necessary virtues. I have done some writing for magazines but my work has to be carefully edited and for the past few years I have given most of my attention to the problems connected with making money. In early 1936 I went to work as a salesman for Remington Rand and was shortly promoted to branch manager. In September 1936 I married a nurse who has continued to work since marriage. My work at Remington Rand was pleasant but I was not satisfied with my income so in 1940 my wife and I bought a half interest in an office appliance business in New Albany. Our income is greatly improved and we now own a home. I travel out of town almost every day and often stay out over night. Insulin reaction has almost caused several accidents but I've had a lot of luck. Reaction is rare except in the evening and I rarely drive in the evening. A late breakfast almost invariably brings reaction but this is easy to correct with a little fruit juice. I have made trips to Chicago, New York and other points without any apparent complications and since 1936 have not averaged more than two or three days illness a year.

In 1929 one of my toenails became black and was removed by a surgeon. Healing was very slow and I was crippled for several months. A very thick hard nail has returned but if it is properly trimmed it causes no trouble.

In 1932 I survived a very serious attack of typhoid fever without any apparent ill effects and have had rheumatic fever and other illnesses.

My physical condition has been better and more stable since my main work has been selling than it was when I was doing various kinds of clerical work. I now work very long hours and average about seven hours sleep at night. The condition of my eyes is checked regularly but the glasses have not been changed for some five years and there has been no evidence of deterioration since the discovery of diabetes. My teeth have not required dental attention since 1922 but are now threatened by pyorrhea. The skin specialist to whom I went some ten years ago thought I would soon lose my hair but I am still not nearly bald.

My disposition is stable and I do not have moody spells, despondency and elation as diabetics are reputed to. When I decided to live with diabetes in 1927 I deliberately decided to make life as pleasant as possible for myself and went about overhauling my disposition. I never use liquor, and I rarely use beer as its effects are too easily mistaken for reaction. I never learned to smoke and have outgrown any urge to smoke for sociability. The usual emotional experiences of adolescents occurred in my late teens and early twenties -- somewhat retarded for various reasons.

My basic viewpoint on philosophic questions has never changed radically but such matters do not seem as important as they formerly did and the urge to enlighten the public has greatly subsided. I still read extensively along the lines of special interest to me and have taken a number of university courses -- night school, independent study and correspondence -- but adolescent notions about the virtues of success and the desirability of being a big shot no longer intrigue me. When I was in Louisville I attended the Unitarian church and participated in left-wing intellectual and political movements, and I now greatly miss these contacts and find luncheon clubs a very poor substitute. I don't know how much of my social and emotional make up is connected with diabetes but perhaps all of it is.

As to my heredity background, my father and uncle have diabetes and take insulin and another of their brothers died of diabetes in 1927. My father's father was a German immigrant of apparently Nordic ancestry, and longevity characterized the entire family. My mother's ancestry is remotely Welsh. Kidney diseases were common in her family and few of her immediate relatives lived past seventy. Insanity and organic diseases other than diabetes seem to have characterized some of her relatives.

Courtesy of Selma Dannenfelser Brigham