The College Guide for Secret Diabetics


Blurb


Diabetes will bankrupt you and it will kill you. While you have it, it’s time-consuming, restrictive, and painful. You wish it didn’t exist—or at least that you didn’t have it.

You’ve decided to hide your diabetes as a form of deep personal denial, great! I have, and you can, too, with this nifty guide to keeping your condition undetected.


A Brief History


Somewhere in India, sometime in the 5th century BCE, a doctor tastes your pee. Excited, the doctor jots down sweet, sticky, and attracts ants. Sure enough, an ant colony gathers to feed on your evaporating pool of urine. This is one of the first records of a type 1 diabetes diagnosis. Sushruta, the doctor discovering the tasting notes in your piss, called it madhumeha. (1) Madhumeha killed you in weeks, months if you were lucky, and madhumeha continued to be lethal until 1922.


§


Two years before winning the Nobel Prize, Dr. Frederick Banting bought thousands of discarded cow embryos. He used to tinker with dogs, causing their pancreases to fail, extracting their atrophied organs to make a serum, and then reinjecting the serum into those same dogs. A dose of his serum, momentarily, lowered a dog’s blood sugar. Banting was thrilled. Lowering blood sugar is crucial for type 1 diabetics whose pancreases cease to produce enough insulin.

Extracted cow embryos lowered blood sugar more effectively than dog pancreases, and with further refinement, they became the first man-made insulin. Dr. Banting sold his insulin patent for $1 to the University of Toronto, stating, “Insulin does not belong to me, it belongs to the world.” His selfless act—which allowed US pharmaceutical companies to patent lightly altered analogs for themselves—was the worst mistake Banting ever made.


Food

The meal is a load-bearing column of social life. Get familiar with the phrase, “Let’s get a meal.” It can mean: I would like to spend individual time with you, or—and much more likely—let’s keep a friendly demeanor while never actually meeting. On the rare occasions that platitudes become plans, follow these rules for a safe experience.

In dining halls, use the bathroom to your advantage. (2) Here, you can enter your meal’s carbohydrates into your insulin pump. (3) If you forget this step and sit down without dosing, don’t fret! Kindly excuse yourself to wash your hands. This will keep your dinner guest waiting (likely idling on their phone), so try hard to remember the bathroom step. If you realize your error mid-meal, it’s best to wait until the meal’s end to bolus (4).

Pizza, that saucy cheese wench. At college, there are boxes of available pizza. (5) Hot, bubbling cheese, the smell of synthetic garlic, and butter designed to make you drool. Club meetings, class council events, formals, and house parties order pizza because of its popularity and early a.m. availability. You are probably familiar with the pizza wave (6). If you have good health insurance, which is an oxymoron, your insulin device has a dual-wave function that releases insulin at delayed intervals. (7) However, each pizza has a unique rise time (8) so there’s still a good deal of guesswork. No matter your equipment, expect high blood sugars.

Spontaneous food. There will be unscheduled times when you are offered food. This could be a professor bringing in dessert as an end-of-semester reward/bribe (9), like a guava cake for an Aboriginal Mythology course. Or maybe a classmate brings hot cookies on a greasy parchment-lined dish. In these cases, where the number of carbohydrates per piece is mysterious, it’s best to politely decline. Fight the societal custom to accept food and have a communal tasting experience. I made this mistake many times.


§


To combat the rising number of suicidal students, my college spends fistfuls of money to keep us happy. Sometimes, they rent poutine trucks that serve one pint of mashed Belgian fries topped with chicken gravy and locally sourced cheese curds, free with a student ID.

I ask a friend whose depression syncs up to get a bite. We get in line, and I tell my friend to hold our place while I go pee. When my back is turned, I program a large insulin load for this carbohydrate banquet. I guess a pound of fries will be eighty carbs. I order. After one bite I remember how much I hate altered cheeses. I gulp without tasting, but still taste bile creep up my throat.

We talk. She of Vietnam, scrubbing her grandmother’s bedpan and biking between wet rice fields. I feel a rapid heartbeat, trembling hands, and my vision starts to vignette. My blood sugar might be 60 or 55 by now. I reach into my jacket and feel a package of fruit chews for an emergency sugar fix. I smoosh the package and realize it’s already been opened. Within the hour I’ll be unconscious. I listen to her some more. When death feels imminent, I say I need to write a paper and leave my friend in front of two full bowls of poutine.

§


The Diabetic Joke. At some point, probably when you’re eating dessert, someone will make a diabetes joke. The joke goes: I ate so much cake, cookies, or candy it’s going to give me diabetes. Keep in mind, this joke is about type 2 diabetics, but there is an unspoken kinship between all diabetics, and you will be upset. Learn quickly how to hide this. The proper response is mild laughter.


Parties


So, you want to drink and smoke and generally fester in debauchery—great choice. Let me offer a few party tips outside our life-thinning illness. Pulling the fire alarm is fun; do it often. Never sit on the couches. Get comfortable surfing social superpods. Okay, now the diabetic shit.

Your insulin pump is a miracle of modern science. The device lets us act as a self-aware pancreas and allows us to maneuver the world without a satchel of clean needles, alcohol swabs, and insulin. That being said, yeesh it is impossible to conceal at parties. At parties where clothes are minimal and touch is maximal, what do you do with this carbon plastic brick attached to your body like a leech? The coiled tubing that transports insulin is apparent, and you’ll have the constant impulse to pull down your shirts to cover tubing, so much so that your collars will sag. I advise detaching the pump. However, if you insist on keeping your life-saving medical device on, a word of advice, don’t attach it to the center of your pants. When people close in for drunken hugs, they will pull away thinking you have a square and rock-hard penis.

If you’re sane enough to follow my advice, you’ll detach your pump. Although you won’t connect the insulin device to your body, you’ll want to keep it nearby. This is for the sleepover situation when you stay in a friend’s room long enough to fall asleep. Nighttime attachment is required. I know what you’re thinking. I didn’t need it last night, what’s a few more hours without insulin? Here’s why you little shit: There’s a big difference between a night of booze, sweat, and dancing, and sleep. Your blood sugar will spike so high you’ll think you got instant chlamydia—like that 5G, fiberoptic chlamydia. You will experience body sensitivity, vomiting, and heart rhythms that beat gorilla loud and so slow it scares you.


Drugs


Alcohol. If you followed my detachment advice, you stopped the release of slow-acting insulin in your system and your blood sugar is rising. Alcohol lowers blood sugar in the fed state (10). Be careful drinking on an empty stomach, as the lack of carbs can lead to hypoglycemia (11). Try tallying the number of consumed drinks on hand to monitor how low your blood sugar will go. Alcohol is a short-term solution to counteracting high blood sugars. Long-term alcohol consumption leads to ketoacidosis, peripheral neuropathy (12), impotence, and retinopathy (13).

Marijuana. I’m naked except for my socks. The endocrinologist wheels back in her chair and runs through the illegal drug questionnaire. When she asks about marijuana, I reply no. (14) She fiddles with a turquoise ring on her finger and explains, “When you hit a doobie, you’re gonna get a munchie.” We can pick on her singular declension of munchies, but her advice is sound. Intake of marijuana increases appetite and saturates the flavors of fat and sugar. If you’re high and hungry around other people, this presents a problem. How do you satisfy your appetite and input insulin? I’ve found two options: low carb and big wave.

Low-carb snacks can be eaten without spiking your blood sugar. Low carb is also the most covert method because you can eat without ever pulling out your pump. I find pretzels, almonds, and chicken wings (15) are great options. This works if you can control the eating environment. You’ll have to be at home, a convenience store, or have enough social capital to choose the restaurant.

The second option is big wave. Big wave works if you experience another marijuana alteration, short-term memory loss. This method requires a one-time bathroom break, which goes undetectable in a social setting. In the bathroom, you’ll retrieve your insulin pump and raise your basal rate (16). The additional flow of insulin allows you to eat without remembering how many pieces you’ve consumed. I often programmed 150% for two hours, which covered Oreo handfuls and several Sour Patch children.

Study Drugs. Adderall, Ritalin, and caffeine. (17) They come in pills, skin patches, and if you’re feeling frisky, powder. They all present the same complication: suppressing your appetite. Prescription drugs silence your desire to eat for 6-10 hours, caffeine for about 2-4 hours. If you use, ingest with lunch. This will give you two solid meals of energy that sustain you until a late dinner.


Sex


Whether you participate or not, sex is a never-ending discourse at college. I find my perspective on sex is frustratingly narrow. I’m a cisgender male that knew I liked girls right as I saw them, but here I am, cutting to advice.


§


We’re in her basement watching Moonrise Kingdom. Her head lays on my shoulder and mine rests on top of hers. I have mere minutes until the credits (18), lights up, go home. I want to kiss her, but our cuddling posture creates a dilemma.

Do I lift my head and reposition for a kiss? This would create clear eye contact, and I risk seeing the panic flare in her gaze as I tilt my head, confirming my worst suspicion: she doesn’t find me attractive. There is another option. I could slide my face down hers until we’re cheek to cheek facing the same direction and use taste and touch to suction onto her mouth without ever looking at her. Indecision freezes me between these two equally great plans. Neither happens. Directed by Wes Anderson flashes on the screen, and she laces her fingers in my belt loops and leans into me.

Let this be a cautionary tale, reader. Avoid the mistakes I made.

As a secret diabetic, your insulin pump is a dead giveaway, an instant shatter to your manicured illusion. You must anticipate moments where you will be shirtless, the plastic tubing revealing itself. Of course, you can’t always predict when.


§


Freaks, geeks, and queers (19) were all on the high school fencing team. So, after 3:15 pm, I stayed an extra forty-five minutes after school and hung out with them before practice. One friend, a girl from Chinese class, liked to steal my backpack and sprint away. I chased her, and she slowed down enough so she could tackle me to the floor and wrestle. One time, we were in a low-lit hallway, away from our friends’ ambient laughter. She straddled my torso, I looked up, and she filled my entire field of vision. She lifted my shirt up to my neck, exposing spools of tubing and a plastic needle punctured into my abdomen. She saw my stomach covered in raised white bumps from all the other places I’ve pierced my skin. Her expression mutated to horror.

It happens.

Anytime you can predict sexual interaction, take off your pump. (20)


§


This night, in her basement, I still wear my pump. She removes her shirt. I take off my socks. I try removing her bra. She removes her bra, but my shirt stays on; it’s only a matter of time before I’m caught. I owe my preserved secrecy to her horrible hay fever. Thirty minutes after partially undressing, I notice a salty taste on her upper lip. I pull back and see two lakes of mucus gushing from her nose. She leaves for a tissue and I shoot my arm down my underwear, pinch both ends of the adapter to detach, and stuff my insulin pump in my coat pocket. This maneuver only works because of the obscured infusion site. (21)

Maintaining a healthy insulin flow requires rotating your infusion site. The American Diabetes Association (ADA) recommends the upper arms, thighs, upper buttocks, and stomach as ideal insertion places. To be a discreet diabetic, the arms are out. Even in New England, there are months of T-shirt weather. On these warm days, the tubing will be visible from the shoulder attachment down to wherever you’ve hitched your pump. The ideal locations are places where you can conceal the piping under the most minimal of clothing.

In the winter, you can get away with a stomach placement, but in all likelihood, you will want to choose the thighs, alternating from left to right every few days. Thigh placements give you the social privilege of thoughtless hugs. With a stomach infusion site, you have to suck in your stomach and arch your back to avoid the hug initiator touching the hard plastic lodged in your body. Personally, the upper buttock freaks me out, because I can’t see where the needle is aiming. (22) It could be pointing between two spinal plates and paralyze me (in my mind), or I could tilt it in the other direction and literally stab my asshole. Is that irrational? Possibly, but let me ask you, would you want to stick a needle in your butthole? Trust me, thigh placement is the perfect location for sexual concealment. The stomach is a visible body part during sexual interaction (23), but a thigh-high infusion site can be concealed.


Rationing/Cost


Behind the oat milk and Tupperware filled with folded pizzas, I keep my doomsday stash: rows of unopened insulin vials with expiry dates years away. I don’t need much insulin. My endocrinologist prescribes three vials of Humalog a month. I use one and add the remaining two vials to the doomsday stash, dormant until I turn twenty-six, when I’ll be removed from my dad’s senior management health insurance and the burden of payment will fall on me.

The net price for in-state public universities is $3,740; private universities are $14,610. Now let’s add the average annual cost of diabetes at $9,600. Now, narrow-faced eighteen-year-old, do you have tens of thousands of dollars weighing down your britches? Your financial burden may make you consider rationing insulin.

Don’t, please.


§


Three years ago, the story of Alex Smith made national press rounds. He was like you and me, a type 1 diabetic. He was twenty-six and newly detached from his parents’ health insurance. He earned $35,000 as a restaurant manager, which priced him out of state medical assistance, but he could not afford any private plans. He went to the pharmacy and found out the uninsured cost for a month’s worth of insulin was $1,300. He went home with nothing. Days later, he died from diabetic ketoacidosis. With no insulin regulating his glucose levels, Smith’s liver burned fat to create energy. This released an influx of ketones that turned his blood acidic. Acidic blood caused cerebral edema (24), kidney failure, and cardiac arrest.


§


Diabetes will bankrupt you and it will kill you. The Minnesota Health Department found that residents who made less than $35,000 were more likely to have diabetes. The CDC and WHO found that diabetes-related deaths spike in developing countries as opposed to rich nations. If you have diabetes, you need disposable income to stay alive. While you have it, it’s time-consuming, restrictive, and painful. You wish it didn’t exist—or at least that you didn’t have it. Because you don’t want to be seen as a three-legged puppy.

So, you hide the clear plastic tubing under your shirt and pretend you’re normal. You activate your practiced laugh at the diabetic joke and feel cold insulin drip from your pump to your body. Friends leave for cups of soda, second helpings, and ingest without considering a single carbohydrate. This sour loneliness can curdle you. You may feel like the only one living the existence of a secret diabetic.

That’s why I wrote this guide. If you choose to live in secrecy, you are still entitled to safety and happiness.

 

(1) Roughly translates to honey-like urine. [Back to essay]

(2) The pre-meal diabetic experience is a showy display. You unzip a bulky, metallic device and insert a test strip that makes the device emit a loud beep. You probe a fresh finger, cock back the needle, and puncture your skin, squeezing a big enough blood globule for the machine to register a blood sugar reading. The machine beeps again when the sufficient amount of fluid cloaks the test strip. There is a zero percent chance you can do this in public without a flurry of questions. To keep diabetes secret, these tasks must be completed in bathroom secrecy. [Back to essay]

(3) Known as dosing. When an insulin pump calculates how much insulin to deliver based on your blood sugar and the amount of carbohydrates. [Back to essay]

(4) Bolus: a dose of medicine administered at once. [Back to essay]

(5) Most likely Domino's. I defy you to find a college town without a nearby Domino's. [Back to essay]

(6) Where pizza has a late-peaking insulin release that spikes blood sugar two to four hours after ingestion. [Back to essay]

(7) Example: Your carb intake and blood sugar require 7.2 units of insulin. You use dual-wave to have 60% of the insulin delivered now and 40% in two hours. [Back to essay]

(8) When a second dose is required. [Back to essay]

(9) Course evaluation panic is real. [Back to essay]

(10) A full stomach of food. [Back to essay]

(11) Hypoglycemia: a low blood sugar. Untreated, it leads to extreme confusion, blurred vision, seizure, unconsciousness, and death. [Back to essay]

(12) Nerve damage in the hands and feet resulting in weakness, pain, and numbness. [Back to essay]

(13) Diabetic eye disease. The leading cause of blindness in American adults. [Back to essay]

(14) You know, like a liar. [Back to essay]

(15) There’s a point when I became a recognizable patron at Buffalo Wild Wings. One night my friends and I ordered the hottest wings, rubbed our eyes, and had a hysterical crying fit. [Back to essay]

(16) Basal rate: the amount of slow-acting insulin released every hour. [Back to essay]

(17) I would include cocaine because of its prevalence, but I believe using cocaine for schoolwork is like going to an archery range with a bazooka. [Back to essay]

(18) I know, because I watched the movie this morning in preparation. [Back to essay]

(19) AKA: all of my friends. [Back to essay]

(20) I imagine this is the same confidence felt by women inserting birth control sponges. [Back to essay]

(21) An infusion site is a plastic tube inserted into the body, allowing insulin flow from the pump to the limbic system. The ADA recommends changing the infusion site every 2-3 days to prevent infection. Anecdotal evidence from friends and myself claim 5-7 days is perfectly safe. I speculate the frequent set changes are a result of the close relationship between [scandal company] and the ADA, so they can sell more equipment. [Back to essay]

(22) Inserting an infusion site requires jabbing a metal needle into the skin to embed the plastic tubing that delivers insulin. [Back to essay]

(23) Unless you are having gymnastic sex. In which case, I’d say…relax. Stop raising the standard; I don’t like stretching. [Back to essay]

(24) Fluid buildup in the brain, which restricts oxygen flow and kills brain cells. Possibly fatal. [Back to essay]


 

SPENCER WILKINS was born in a hospital and raised in Tokyo and New Jersey. He wrote the stage play WALDO, which ran at Pickard Theater in Brunswick, Maine, and “We People,” which was awarded the 2021 Bowdoin Nonfiction Prize. His essays and poetry have appeared or are forthcoming in Puerto del Sol, Essay Daily, and The Foundationalist. Wilkins is an active MFA candidate at the University of Iowa, Nonfiction Writing Program.