Difficult Diagnosis: Sugar High
How one incorrect medical conclusion can come crashing down years later.
It was only four days until the wedding, and Renee Miller and Christopher Bevis* were running from one prenuptial engagement to the next in their hometown of Mt. Adams, Ohio. The parties and showers were all in good fun, but the bride- and groom-to-be were both exhausted. Which is why Renee wasn’t overly concerned when her fiancé got dizzy climbing the stairs to his condo and almost fell backward. “At the time, I really didn’t think there was anything seriously wrong with him,” she says. “Christopher had been trying to lose weight for the wedding, and he had not been eating enough since we were so busy.”
Christopher wasn’t as sure, so he scheduled a physical exam for later that day. After all, they were leaving for a two-week honeymoon; he didn’t want to feel bad the entire time. Renee met Christopher back at his condo after the appointment. “When he sat me down on the couch,” Renee says, “I knew I had been wrong about all this being a consequence of his efforts to lose weight.”
Her six-foot-six-inch, 240-pound fiancé had come home with a diagnosis of Type II diabetes. His blood sugar was well over 600 milligrams per deciliter (anything over 200 mg/dL is considered diagnostic for diabetes). And he was experiencing diabetic ketoacidosis, a medical emergency that can lead to decreased blood pressure, cerebral edema, circulatory failure, and acute respiratory distress. In other words, Christopher was pretty darn sick. But the doctor had explained the disease, prescribed medication, and sent Christopher home to his bride-to-be.
For the first two years of their marriage, Christopher lived in what Renee describes as a living coma. He was agitated, foggy, and fatigued. His vision sometimes blurred. He slept all the time, going to bed most nights before 6 p.m. He experienced memory loss. No matter what medication at whatever dosage he tried, Christopher never felt any better. Even with a strict diet of chicken, fish, and vegetables, and an exercise plan that included walking after dinner every night, the Bevises’ diabetic nightmare continued. Everyone had told Renee the first years of marriage were the hardest; she was quite certain it wasn’t supposed to be this difficult.
When the couple learned of an opportunity to move to Denver with Renee’s job in late 1998, they took it. Christopher had spent his childhood in Littleton, and Renee had family in Denver. It seemed like a good opportunity to refresh their lives. After six months in Colorado, Renee took a job with a different organization, Takeda Pharmaceuticals North America Inc., partly because the company focuses on a variety of therapeutic areas, including diabetes. “I wanted to learn about diabetes desperately,” she says. “I wanted to dissect the disease. This job was going to help me help Christopher.”
But months passed, and although Renee was learning much about the disease, she hadn’t learned anything that would help her ailing husband. That is, until she started meeting with doctors, specifically endocrinologist Dr. Satish Garg at the Barbara Davis Center for Childhood Diabetes.
One day after mentioning her husband’s uncontrolled illness to Dr. Garg, the Bevises found themselves waiting on test results in one of the center’s patient rooms. “We had been waiting for a while when Dr. Garg and a nurse came into the room with a needle and syringe,” Renee says, recalling that her first thought was that they’d already taken many vials of Christopher’s blood. Christopher told the nurse he didn’t think he had any blood left to give her. The nurse smiled and said she didn’t need to take any more blood. The syringe was full of insulin.
Christopher didn’t have Type II diabetes. He had Type I diabetes. And he needed insulin immediately.
“Type I and Type II diabetes are completely different diseases,” says Dr. Michael McDermott, who has been Christopher Bevis’ doctor since shortly after the correct diagnosis was made at the Barbara Davis Center. “About 95 percent of Americans who have diabetes have Type II. But that leaves five percent that need to be treated very differently.” McDermott, who is the director of the endocrinology and diabetes practice at University of Colorado Hospital and is well-known for diagnosing former Broncos quarterback Jay Cutler’s Type I diabetes, says incorrect diabetes diagnoses are on the rise.
For decades, anyone who came in with symptoms as a child was diagnosed with Type I diabetes, which is the insulin-dependent variation of the disease. Anyone who visited the doctor with symptoms as an overweight adult over 40 was tagged with Type II. “But these days, with children becoming more and more obese, we have to recognize that you can’t just look at a person and make a diagnosis,” the doctor says. “These diseases are the single highest cause of kidney failure, blindness, and limb amputation, and the strongest risk factor for heart attack among Americans. We can’t miss diagnosing it correctly, especially when all it takes is a blood test.”
And that’s all it took for the Bevises. That, and a vial of insulin. “To this day, Christopher remembers the feeling as if it was a minute ago,” Renee says. “He said the fogginess and blurriness disappeared almost immediately. As the morning progressed, he felt more awake, more energetic, and more alive. Christopher was waking up again and hadn’t been that alert in years. My husband was back.”