Dee and Bill Brehm: Working Toward a Type 1 Diabetes Cure

Delores (Dee) Brehm was diagnosed with Type 1 diabetes in December 1949 — 63 years ago. She had been experiencing the classic symptoms of Type 1 – extreme thirst, frequent urination, and weight loss despite increased food intake. She lost 30 pounds in just a few weeks.

At the time, Dee was 19 and a student at Michigan State Normal College (now Eastern Michigan University) in Ypsilanti. The less-than-understanding doctor who diagnosed her said bluntly, “This is the worst case of diabetes I’ve ever seen.” Dee was admitted to the University of Michigan hospital in Ann Arbor, where she was stabilized, and her insulin and diet programs established. She was discharged two weeks later, on Christmas Eve.

Dee attended a few diabetes classes in the hospital; however, she learned very little about the disease, and few details concerning her care and future, simply because so little was known. Dee left the hospital with a daily program of 80 units of insulin. The tools were primitive: She had to purchase expensive glass syringes to inject her insulin; to economize, Dee boiled her syringes, sterilizing them for reuse, sharpening the needles with emery cloth. Testing her blood glucose levels was complicated: Dee had to boil her urine, then test it for sugar using a chemical reagent that caused it to change color according to the sugar concentration. She would then compare that result with a chart to estimate the actual BG concentration. Later, urine dip-strips became available that would read from negative BG to 4+; however, a “4+” reading could indicate anything from 180 to 800. And urine tests were only an indirect measure of BG, since they merely tested sugar that had spilled into the urine; to obtain an accurate BG assay required a blood test at a doctor’s office. Yet that was not very useful for daily control, since it took two days to produce the lab result, well after the fact.

At about this time circumstances also brought William Brehm into her life. Bill was an undergraduate student studying mathematics and physics at the nearby University of Michigan. As it turned out, Bill was the man that Dee was destined to marry. Bill and Dee had dated a few times before her diagnosis, and Bill visited her during her hospitalization. He asked her out soon after her release. They soon fell in love and knew then that they would spend their lives together.

Dr. Jerome Conn, then the Michigan Medical School head of endocrinology, decided to provide Dee’s primary care. When he learned that Dee and Bill planned to marry, he asked to see them together. His purpose was to give the couple an honest appraisal of their future with Type 1 diabetes. Dr. Conn told them that Type 1 would shorten Dee’s lifespan, that she would suffer serious complications within a few years, that she probably would not have any children, and that she would have diabetes for all of her life. Well, Dee and Bill have been blessed with two healthy children and six healthy grandchildren. Moreover, even after nearly 64 years with the disease, Dee is healthy and entirely free of complications. She says, “I have already exceeded my life expectancy!”

No one has been able to explain Dee’s freedom from complications. “My doctors can’t believe it,” Dee said. “But something is protecting me. I didn’t have a meter for testing my blood sugar until 1980. When I think back to the days before that, I must have been over 200 all of the time.”

Fortunately, Dee has proven Dr. Conn wrong on three of his four points — and no one would be thrilled more than Dr. Conn at that result. What remains is to find an effective Type 1 diabetes cure, and Dee and Bill are working diligently with medical scientists toward that end.

One Sunday evening in 1999, as Dee was preparing dinner, Bill entered their kitchen and asked if he could do anything to help her. Dee turned quickly and said defiantly, “You can cure this disease.” Bill was quiet for a moment, and then said, “OK”. So that began their serious quest for a Type 1 diabetes cure and Type 1 diabetes prevention. And thus began another chapter in Dee and Bill’s life together.

Bill and Dee sought out advice from a broad spectrum of scientists and physicians, visiting many institutions, including the NIH. From these discussions, they developed a set of proposals aimed at a frontal assault on the disease. On November 22, 2004, the University of Michigan Health System announced that Bill and Dee Brehm were prepared to pledge $44 million for a major program that would fund new laboratories designed to gather top investigators in an environment that would encourage close collaboration.  The Brehm Center for Type 1 Diabetes Research & Analysis was created at the University of Michigan in Ann Arbor. The program also funded the recruitment of six new investigators and several other elements aimed at a balanced program of activity and resources.

“Our dream is to discover how to prevent and cure Type 1,” Dee said. “But a second dream is to find the causes of complications and then ways to prevent them. Complications are relevant to both Type 1 and Type 2.” Dee is proof that type 1 diabetes doesn’t have to come with complications; the challenge is to discover what her protective mechanisms are.

So, for nearly a decade now Bill has been working with a team of scientists to achieve their objectives. And while the research continues, Dee does her best to stay strong and healthy.  “I have always been careful of my diet,” she said.  “I count carbohydrates, try to eat on time, and exercise for half an hour three mornings a week.”

Despite Dee’s caution, her disease is very labile, which means that she endures wide swings in her blood glucose. “The nominal target is a BG of 100; yet this morning my fasting test was 336,” she said. “But, while I swing wildly, I have a wonderful coach who guides me in deciding the steps each day that I need to respond to highs and lows, for lows of course can be a severe problem as well as highs. It is a continuing challenge to try to stay within a safe range.”

Dee’s daily program requires 6 units of Humalog and 8 units of Lantus, spread over the day, with the Humalog keyed especially to meal times. I am very sensitive to insulin; when we must make adjustments, we work with amounts as small as ¼ of a unit.”

While scientists continue to search for the discoveries to understand cause and prevention of Type 1, one clear observation is that Dee and Bill have been a team from the beginning, long before they were involved in diabetes research. “Bill has been my constant and understanding caregiver,” Dee says.

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

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Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)