Yesterday was TrialNet day. For Jack’s Anti-CD3/teplizumab thing.
This will make no sense if you aren’t a d-person and might not make sense if you are. It’s written for an audience of an imaginary, time-traveling me considering whether or not to participate in a drug trial. (Participate here = signing up a child.)
Yesterday, Jack had a Dexcom on. Not for science, for personal use. Earlier in the week he’d been on and off feeling kind of sick/tired and sometimes crazy hungry, and we wanted to see if this could be related to BG. It kind of was, but not in an actionable way. Also we were curious what would happen to him post-OGTT, i.e. would he crash like his ancestor? (Requires stat visit to Shake Shack.)
During the test I was watching the mayo and mustard and the movies How to Eat Fried Worms and The Muppets.
Fasting 94 mg/dL. Nice.
An hour after that, the test was about to end and I thought there’s still time. He’s probably crashing really fast and will be under 200 on the meter and the Dexcom is just having a normal lag.
And then even at the very end he was still 240+ and the Joslin meter said so too and I thought maybe the Dexcom is having a normal lag and Joslin’s meter is broken.
So. 2-hour pp OGTT result >200 mg/dL. For someone with autoantibodies, that’s Type 1 diabetes. If you are >200 mg/dL twice in a row, that’s it. You are a diabetes people. The next step for us is to get called back for a repeat OGTT. Pfffft.
This is not my bag. I’m no Tina. I’m no Meri. I’m no Laura, although I might like to be. This is dumb. Jack is just so, so different from his brother, in terms of demeanor, body type, idiosyncrasies. How could they have something like this in common? It’s ridiculous. My surprise is ridiculous too, since there have been ample clues, vibes, and lab values pointing to this for years.
And then, while we were at lunch, I looked at the past 24 hours in blood glucose, mostly to console myself that he’d had a fantastic fasting BG of 94, and it had come after a long, straight line. From the three hour view I pressed back to six, and from six to twel—uh.
Maybe he’d had a vivid, prescient dream of the OGTT?
Clarify these dangles:
- Will he be >200 mg/dL at the follow-up OGTT? Proly. We’ll see. No one knows.
- Would you recommend being in a drug trial like this to a friend? Yes. You have a 50% chance buying your kid some non-d time and a 100% chance of being science.
- Shouldn’t he start taking insulin as soon as possible to preserve his beta cells/prolong the honeymoon? I don’t think so, because of the risk of lows. I mean I don’t think any doctor would prescribe that yet.
- Shouldn’t he start eating a low-ish carb diet so he won’t be high? I think so. Maybe.
- No, you should let him eat whatever he wants now, since he’ll be a food math person soon enough, right? Probably. Maybe. I don’t know. This is going to be hard.