Not One Nanogram/A Dream Deferred


Insulin, the protein, begins as a single chain of amino acids called proinsulin. Proinsulin is transcribed, translated, cleaved, and folded in the beta cells before being released into the body when needed. When proinsulin is cleaved, it is cut into three parts; the two ends become the insulin protein, and the middle we call C-peptide.

Exogenous insulin– the man-made kind that I inject– comes as the mature protein, not as proinsulin that needs processing. So, if you have C-peptide in your blood, either you’re injecting C-peptide, or you’re making insulin.

Cebix is working on an injectable C-peptide with alleged therapeutic effects, but that’s still in its early stages. So, really, if you have C-peptide in your blood, you’re making insulin.

I have had my blood tested twice now. I have no detectible C-peptide in my blood. Not a single nanogram of it.

I’ve been working lately in microliters; they are pretty small. Not a nanogram of C-peptide means none.

This isn’t a surprise; I’m a type 1 diabetic, going on 17 years. Of course I don’t make and cleave proinsulin, right?

But some people do continue to make very little bits of insulin. The Joslin 50-year-medalists were recently found to still be making a teensy bit of insulin. Perhaps, people reasoned, this was related to the fact that they had survived so long, with so relatively little in terms of treatment, complication free.

I make no insulin. Not even a teensy bit.

The rational part of me wants to say, “So what? That’s expected. And, in either case, you have diabetes– a teensy bit doesn’t make much of a difference.” But, expected or not, I had hoped I was one of those lucky ones, still making even a little bit of insulin.

Why? Why did I hope so much? Well, if the endogenous insulin was causative of the Joslin medalists’ success, I fear what not making any means. Plus, a not-insignificant part of me has this fantasy that one morning I’ll just wake up, and forget to bolus, and my blood sugar will be okay. And it will continue to be okay, and I will slowly realize the autoimmune attack has stopped, and the few beta cells I had in hiding have come out and started making insulin again.

But there are no beta cells left. Not so much as a nanogram.

Dear self, I say, it’s okay; those beta cells wouldn’t have done anything. They weren’t causative for the Joslin medalists– likely it’s just that having some endogenous insulin made diabetes management just that little bit easier it needed to be to survive, complication free, in the days before the technology we have now. But with the technology we have now, you are by no means doomed to complications!

Self, I respond, I make no insulin. None at all. It’s not the medalists or the complications. It’s the knowledge that there is no fantasy, there is no chance a vaccine or an early-onset-prevention will help me. It’s the knowledge that my body is not breaking; it is, indeed, irrevocably broken.

But you knew that already; the tests merely confirmed what you had to have assumed was the case. Your tears– they are irrational!

My tears are always irrational, but that does not stop them from coming. And I learned nothing I did not suspect, but that does not stop it from hurting.

Think of it this way– no beta cells at all means it will just be that more miraculous when you are cured, right?

Yes, yes, I suppose. And I’m working as hard as I can to have faith that day will come. Lord, forgive these tears in the meantime.

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9 years ago

I’d been looking for this post for a while, read it when it first came out.  Last summer (’12), my 13yo daughter, dxd at 9, was tested for residual beta cell function.  And just like you.  Zero.  Even though we’ve fought to have her in good control since dx, hoping that was going to save her later on, when they figured out how to “restart” her beta cells.  ZERO. It is crushing.  Didn’t tell her right away, but did not continue with the trial the test was a part of.  She did ask after a while and I told her,… Read more »

11 years ago

I feel for you and wish that something could be done. Just hang in there!

Shauna McKenna
Shauna McKenna
11 years ago

Karmel, I’m speechless and so moved and so inspired.

11 years ago

A bright and beautiful piece.

11 years ago

Thanks for sharing this.  Tears in my eyes too.

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