Surviving, But Barely: A Type 1 Diabetes Diagnosis in Nepal

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Last September, my wife Cassie and I left our jobs in the U.S. to backpack around the world for a year. Lots of hostels, plenty of couchsurfing, and many nights spent on friends’ couches. Before we left we scheduled appointments with our primary doctor and travel doctors, got stuck with plenty of vaccine needles, and were given the “all clear” to travel. We were healthy.

And that lasted for all of four months.

It’s impossible to know what triggered a change in my body. All I know is that I suddenly had an unending thirst and an uncontrollable need to pee. But it made sense at the time. We were in Israel, and I rationalized my thirst was a consequence of the dryness of the desert. When the thirst continued in Thailand, it made sense to me, too: it was 95 degrees everyday in Bangkok. The thirst stretched with me into Nepal. Again, perfectly reasonably. It was the dry season there. Of course I was thirsty.

My wife and I also noticed I had lost weight. I didn’t complain because I’d been hoping to lose a few pounds. Despite the thirst and the weight loss, I still felt ok – just a bit weak and tired. Nothing I couldn’t get over. To prove it to myself, I went on an eight day hike in the Himalayas, and though I had a few tough hours on the trail, I finished and felt proud of what I’d done.

We spent the following few weeks teaching English to young Buddhist monks in Nepal. It was an incredible experience to work with kids who were so willing to learn and so eager to teach us about their culture and religion. Every class was a look into a different world, and we learned as much from them as they did from us. But I found my temper kept growing shorter. I lost my cool quickly when the students were out of line. And, yes, young Buddhist monks do get out of line.

Finally, I’d had enough. On a short hike to the World Peace Stupa near Phewa Lake, I was far more tired than I should’ve been. A few days earlier, I’d also caught a glimpse of myself in a mirror and noticed how thin I had become. Far too thin. So, after nearly two months of feeling under the weather, I did something about it. I took the simplest first step. I got on a scale. It read back a funny number. 77 kg.

I knew I’d weighed about 100 kilograms when I started the trip, so I took a moment to do the math before I looked at the woman behind the counter.

“Are you sure this scale is right?”

“Yes,” she smiled at me.

If she was to be believed, I had lost about 40 pounds. I had gone from about 220 to 180. I hadn’t weighed so little since high school.

I reached out to a few of my doctor friends. They agreed with my personal diagnosis, malnutrition. The Nepali diet of dal bhat – lentils, beans, and rice three meals a day – didn’t provide me the nutrition I needed to stay healthy. I had also become vegetarian when I got to Nepal, since I’d been told not to trust the meat. I even visited a doctor in Nepal who concurred. I just had to eat more protein, drink more fresh fruit juice, and I would be just fine.

I soldiered on for another week, convinced I would be absolutely fine when we left Nepal and headed for Thailand. In Bangkok, I would be able to eat all of the delicious Thai food I could stomach. Pad thai and spicy papaya salad and panang curry.

But I never made it to Thailand.

In the span of just a few days, I got much weaker. I was far more tired, and I had an awful taste at the back of my throat, like rotten fruit. It tasted different than the electrolyte powder the doctor gave me. On a Thursday morning in mid-February, I went back to the doctor.

“What seems to be the problem?” he asked, as if he hadn’t seen me a few days earlier.

I explained my continuing symptoms and told him they were getting worse. His assistant pulled out a small blue device that I recognized as a blood sugar monitor. I have friends who’ve had diabetes since childhood, so I’d seen glucose meters before. The assistant pricked a finger on my left hand, scooped up the drop of blood with the test strip, and waited for the result.

The number staring back at me on the display was in the low 400s. I had no idea what that meant, but I sensed it was bad. The doctor held his breath for a moment before speaking.

“I’m sorry to tell you my friend,” said the doctor, “but you are a diabetic.”

That’s it. In that brief sentence, one part of my life was over, and another part had begun. The doctor told me to come back the following morning to do a fasting blood sugar test and a postprandial blood sugar test.

When I got back to my host family’s house, I broke down in tears. Everything now made sense – why I was so tired, why I felt weak, and why I was losing weight. Yet nothing made sense.

I tried to tell my host mother – a wonderful woman named Bimila – to call her husband Krishna. I needed Krishna to call the monastery where my wife was still teaching to tell her to come home. When Cassie walked through the door, I couldn’t hold back the tears. Yet she never cried. She instantly became the rock upon which I was able to right my violently yawing world, and she began to plan the necessary steps for us to get home as soon as possible. I needed her by my side as I called my parents to let them know about my diagnosis and my need to come home.

My parents were instantly and completely understanding, and they were happy that I finally knew what was wrong. They also knew how important it was for me to get quality medical care as soon as possible.

I broke down more than a few times that night. But after talking to my parents, I booked tickets home from Nepal for the next night. First we had a short flight from Pokhara to Kathmandu, then a long flight from Kathmandu to Qatar, and finally a flight home from Qatar.

Cassie and I woke up early the following morning. We raced to the doctor’s office. A quick blood sugar test revealed my fasting blood sugar was in the 300s. A postprandial test showed a similar number. My Type 1 diabetes diagnosis became official.

To prepare for leaving we had to pack our remaining gear, drop off extra school supplies at the school, and say goodbye to our host family.

None of that ever happened.

When we got back from the doctor’s office, I broke down in tears again. I didn’t feel like I could last the few hours until the flight. I felt like I was on borrowed time.

Cassie looked at me. “Do you want to go to the hospital?”

I thought for only a second. “Yes.” Our plans to fly home would have to wait.

We checked into Manipal Teaching Hospital in Pokhara, Nepal. The doctors ran every possible test on me, even though I told them why I was in the hospital. They reassured me I shouldn’t be in the hospital more than two days. Then I would be well enough to fly home. I put on 15 pounds in 24 hours as an IV put fluids into my system. I’d been missing two gallons of water, and my body soaked it up like a sponge from the IV firmly secured to my right hand.

 In the hospital in Nepal

Four days later, I was still in the hospital. They couldn’t get my blood sugar into the normal range. And the taste at the back of my mouth – a taste I now knew was diabetic ketoacidosis – wasn’t going away. The problem was that they treated me like I was Nepali, as if I were half my size. They gave me two shots of 70/30 insulin a day, but it wasn’t nearly enough to lower my blood sugar into the normal range. I was still in the high 200s every time they checked.

It was time to do something drastic. A missionary doctor my wife’s family knew in Kathmandu recommended a Western clinic there. He said it was four hours door-to-door from one hospital to the other.

We expected a fight when we told the hospital we were leaving. Instead, they told me I was fine to fly all the way home. I knew the doctor was absolutely wrong. I was barely well enough to leave the hospital, let alone start a 30-hour journey home.

Cassie booked a flight from Pokhara to Kathmandu for the next day. I had spent four nights in the first hospital without any success in lowering my blood sugar. I hoped the Western clinic would fix things quickly and clear me to fly home. They took one look at me and told me I was staying at least two nights. My blood sugar was still 320, and I was showing very high levels of ketones. I was upset, but it didn’t take long to realize this clinic was exactly what I needed. The doctors were excellent, explaining everything to me about how to manage my blood sugar and what was happening inside my body.

They regulated my blood sugar within 24 hours and kept me another 24 hours just to be safe. We caught a late flight out of Kathmandu, had an overnight stop in Abu Dhabi (where I got to hang out with my brother-in-law!). Then we caught a flight home.

With my arms around my doctors, the day I was cleared to fly home
With my arms around my doctors, the day I was cleared to fly home

Of course, it’s never that easy. Our flight was diverted to DC for four hours while weather cleared around New York City. While my parents waited at the airport, we waited in our seats. Finally, we were cleared for a quick 45-minute flight to JFK International Airport. We were home.

Home at Last

It felt great to see my parents again. Only a few days earlier, it had seemed like I would never be able to get home. I don’t remember us talking much in those first few moments. We were just happy to be together again. On the drive home from the airport, we filled them in on our journey back to the States and the last few months.

A few days later, I had my first doctor’s appointment with my regular physician. The clinic in Kathmandu had done such a good job teaching me how to use insulin that my doctor back home said there was little he could add. He gave me a few pointers, but sent me on my way.

I still can’t believe I made it through that first week. Those were my darkest hours. But I made it home, and I started recovering and learning.

Cassie and I made an important decision. We vowed that diabetes would never slow us down, and that we would always live life to the fullest. I say “we” because she is a part of my team. She is as important to me as insulin. She was there with me from the very beginning, and I know I can always count on her.

True to our word, a month after coming home, we packed our bags once again and resumed our trip. We boarded a flight from JFK to Bangkok, Thailand, and picked up our travels exactly where we’d left off. It wasn’t an easy decision, and I certainly screwed up my blood sugars a few times, but it was the best decision I ever made (other than marrying my wife). It was a promise to myself and to Cassie that I controlled my disease, not the other way around.

Also by Oren Liebermann:

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Michelle Sorensen

What an amazing story! Wow. I too became very sick while away on a trip (after months of symptoms) and was admitted to the hospital the morning after I arrived home. I sometimes think back to how I was on the plane and I know I am very lucky I made it. I love how you describe your marriage and say that your wife is “as important to insulin”. I met my husband 4 years into living with T1 and I feel the same way. The support changes everything. Best of luck to you!

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