Life with Type 2: Big D, Meet Little D

When you are first diagnosed with type 2 diabetes, all that you hear about it from your doctor is a standard description of what I call “Big Diabetes.”

Big D is the classic list of symptoms, common to everybody who develops type 2: thirst, increased urination, blurred vision, fatigue, and so on. It’s an “everybody’s-in-the-same-boat” disease.

But there’s another D that appears after a few months or a year of starting to deal with type 2: “Little Diabetes.” Little D is your own personal, peculiar, idiosyncratic version of diabetes. It’s the one that the boilerplate descriptions of Big D don’t quite cover.

For example, one type 2 may do extremely well at controlling his weight and blood sugar levels on a low-carb diet. But another may manage to enjoy similar results when she goes on a low-fat diet. Some people–admittedly rare—not only can go years before starting on insulin, they can go a long time exercising good control over their diabetes without taking a single diabetes medication. (See my column about my neighbor Paul, whom I consider to be one of luckiest type 2s alive. Input “To Good to Be True” on this website’s search feature.)

What got me to thinking about Little D is something I recently began experiencing. I’ve written about my Little D form of neuropathy, namely the inflammation of one of my thoracic nerves, running from my spine up to my sternum. As the diabetic assault on my nerve continued, the pain went from making me occasionally chirp in discomfort during the day to loud, involuntary squawks and squeals a dozen times an hour. My wife, who has never liked my singing voice, certainly was even less taken with my barks of pain. “Go discuss this with your doctor,” she said. (It was not a request.)

So I did, and I began taking Nortriptyline, a drug originally designed as an anti-depressant but had turned out also to have a serendipitous effect on nerve pain. After three weeks of figuring out the right daily dose, I enjoyed an almost complete cessation of the constant pain. The nerve still reports to me loudly at times, but nothing like what it did before.

I deeply appreciate that my doctor knew about the drug and that it has worked as described. But my Little D’s reaction to Nortriptyline soon up in the form of a constant bitterness at the back of my mouth, which has pretty much destroyed my sense of taste. Food and drink have an initial burst of good taste at the front of my mouth, but once they reach the back, they are overwhelmed by what I describe as an acid bitterness.

The drug also has created an intense craving for sugar and carbs. I sometimes wonder if that’s my body’s way of trying to deal with the back-of-mouth bitterness because sweet tastes are less affected by the drug than other tastes.

For awhile, I assumed that my reactions to Nortriptyline were common. But a look at several medical websites told me that they weren’t. On one website where Nortriptyline users had been invited to the drug’s share side effects, I found that people’s problems with it were all over the map. A few people listed carb cravings while others described bad back-of-the-mouth taste. Others mentioned dizziness, or constipation, or spaciness. Nobody had quite my reactions to the drug, which made me realize I was dealing with Little D.

So Little D is the reason why my list of Nortriptyline’s side effects wasn’t quite like everybody else’s. But enough people mentioned my symptoms to make me realize that I didn’t have to think I’m the only one with weird side effects.

Another thing is that like Pollyanna, I try to see the good in things. My loss of a certain amount of interest in food has countered my craving for carbs and allowed me to lose some weight. With a high school reunion coming up in September, I’ll have a reasonable chance of wowing my old classmates and making them falsely believe that I’ve always looked this good.

For that, I will have to thank Little D.

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