By Virginia Butterfield
Patrick Gallagher was a closet diabetic. Diagnosed with the disease at 14, he kept his condition a secret for 17 years. As a youngster, he didn’t want to appear different from classmates. And in early adulthood, he had been denied jobs because he presented a "health risk"—meaning an insurance risk—in case he fell into a coma and hurt himself. That was public ignorance, of course, since diabetics are forced to take better care of themselves than most.
Then, on his second date with Judy Hahn, the woman who would become his wife, Gallagher blew his cover. Out for dinner, he had to rush home from the restaurant, saying he’d "forgotten something." What he forgot, she discovered, was his insulin.
When Judy signed them up for a diabetes workshop, Pat was surprised to discover how little he actually knew. "Here I’d lived with it all this time and just took the shots, and that’s all I did. The doctor had said four things: ‘No candy bars, no Cokes, take shots the rest of your life, and no more track team.’" As a freshman on the varsity track team, that last really hurt.
"And they were completely wrong," he says. "The best thing you can do is exercise. In fact, still today, they tell people these same things."
Now Gallagher makes films about the disease — recently, 108 episodes on diabetes for CNBC and Lifetime Television. He sold the series to Kaleidoscope Television in San Antonio, Texas, which now broadcasts the show in 170 markets seven times a week (it appears here on Southwestern Cable, Channel 16). Locally, he has done 500 radio talk shows with doctors as guests and diabetics as call-ins.
"There are millions of closet diabetics out there," Gallagher says. "Jerry Garcia of the Grateful Dead was diabetic—he never told anybody. You may remember that time when he passed out on stage about five years ago. Everybody assumed it was a drug overdose, and of course he did take drugs. I spoke with him about a year and a half before he passed away, and he told me he was cured of his diabetes. There’s no such thing as a cure. Because he had lost weight, he no longer took insulin. He was just on oral medications. Of course," Gallagher adds after a pause, "he died of a heart attack — and diabetes is the leading cause of heart disease."
Seven years ago, Gallagher’s mother died of the disease at the age of 53. "The death certificate says diabetes," he says, "but it really was the lack of education. Because she never knew so many things. By the time I started getting out of the closet and learning about the disease, it was too little and too late—for her."
So when a test for pre-diabetes became available at a Boston hospital, Pat sent blood samples from both his son and daughter to be checked. "Why would you want to know?" friends asked. The answer: The earlier you treat diabetes, the better the results.
Besides, in Type I (juvenile) diabetes, which afflicted both Pat and his mother, the hereditary factor is said to be only 3 to 5 percent—as against 50 percent in Type II diabetes, the kind you get after age 40. So Gallagher thought the chances of a bad report were slim to none. Imagine his shock, five weeks later, hearing on the answering machine that Courtney would be one of the unlucky ones.
"I felt like I’d been told she had leukemia or cancer," says Gallagher. "I had just watched my mom pass away, and here my daughter gets it. I would have done anything to stop it. I would have given my arm, my life, if it weren’t so."
The Gallaghers had three choices.
One: Do nothing. "After all, they might be wrong. It was a new study. They’d only done it on mice in the past. "
Two: Take immunosuppressants to counteract the antibodies that are attacking the pancreas—"but that would shut down the immune system, and she could die from that."
Three: Take insulin prior to getting the disease.
They opted for the last. They flew Courtney to Boston, where she was hooked up to an insulin monitor for nine days, with blood readings every 15 minutes around the clock. Gallagher slept on a cot in the hospital room.
"The scariest part was at the end, when she had to learn to give herself her own shots. They teach the child with an orange and a syringe. The best place for injection is in the abdomen, but the arm is okay."
ithout doubt, kids with diabetes have a different kind of childhood. "Ordinary kids come home from school, open the refrigerator, get a snack and relax with TV. The diabetic child comes home from school, pricks his or her finger for a blood-sugar test, takes the insulin, then gets a snack," Gallagher explains. "In Courtney’s school bag she keeps her baseball mitt, her blood-sugar meter, her insulin and, because she’s active and always worried about the sugar level getting too low, four or five candy bars. I tell people that diabetic kids are smarter, a little more with-it than other kids, because they have to be. As a 9-year-old child, you have to be organized. You grow up a lot faster.
"As a parent, you feel so helpless," says Gallagher. "Remember Eric Sievers, who played for the Chargers? He was in training camp for the Miami Dolphins when he got word his 2-year-old had diabetes. He rushed home and says the hardest thing he ever had to do was give shots to that baby."
But with proper parental guidance, life doesn’t have to be too hard. At 16, Courtney is a cheerleader, maintains a 3.5 average, plays on the baseball and basketball teams and was homecoming princess at Escondido High School.
Still, the constant discipline begins to wear on everybody’s patience. "The one thing you really want," says Gallagher wistfully, "is just one day off. One day when you don’t have to think about it."
At least, Gallagher points out, the shots are not as painful as they were when he was a youngster. When he first started giving himself shots in the Sixties, "you had to boil the syringes and the needle," he says, "and you had to file the little burrs off the needle." Also, when he took blood-sugar tests in the past, he got the results three weeks later. Now, with the new kits, he gets the result in 45 seconds.
Courtney was one of the first children in medical history to be pre-diagnosed for diabetes, giving scientists a unique opportunity to watch the disease as it developed. Many children suffer from a sudden attack. For a week or two they are very sick, and then, if not treated properly, the attack can be fatal, as it was for a diabetic San Diego teenager several years ago when her doctor continued to treat her illness as if it were flu. A simple test for ketones might have saved her life.
Does juvenile diabetes really come on as quickly as it seems?
"Well, that’s what they thought," says Gallagher. "My daughter is part of a research program at the Joslin Diabetes Center in Boston in which they found out that years prior to the development of diabetes, the antibodies start to attack. It’s a slow attack, so they’re eating away at those insulin-producing beta cells. All of a sudden something triggers a massive onslaught of these antibodies, and they destroy the rest of the pancreas." At the end of two years, almost to the month the program had predicted, Courtney had full-blown diabetes.
The alarming fact is that, according to Gallagher, 50 percent of family physicians don’t know how to treat diabetes. "In San Diego there are 240,000 diabetics, and half of them don’t know they have the disease," he says. "When you go in for an exam, they do blood pressure, other tests, but not a blood-sugar measurement. Most HMOs aren’t willing to pay. They’ll end up paying for kidney transplants, amputations, dialysis, but that will be some other HMO, down the line. They say, ‘For now, why invest the time and money?’ It’s short-term thinking."
Gallagher advises anyone over 40 and overweight to ask for a blood-sugar test. A family history of diabetes produces a 50 percent chance of developing Type II. With minorities, the risk increases to 70 percent. In many Indian tribes, he estimates, there’s a 50 percent incidence of Type II diabetes in people over 40.
There are two types of diabetes. Type I is called juvenile diabetes because it usually appears during the teen years, though Gallagher’s mother got it at age 24. "Juvenile" is somewhat of a misnomer, since it continues throughout life. Type I diabetics lack the ability to produce any insulin at all and depend on injections. Type II usually attacks after age 40, and since it lacks a dramatic onset, many victims are late in being diagnosed. In Type II, either the insulin is inadequate or the muscle cells won’t act on the insulin’s signal to take glucose from the blood.
The body is able to compensate for some time, usually until middle age, by increasing insulin secretion. However, when the pancreas can no longer compensate, blood sugar rises and symptoms develop. Even in the absence of immediate symptoms, though, damage is occurring in muscles and organs. Gestational diabetes, developed during pregnancy, is a form of Type II.
Gallagher has a small object like a pager in his pocket. This is his pump, connected to a thin plastic tube delivering insulin to his stomach. He carries a leather packet about the size of a small daybook containing a Lifescan blood-glucose meter. Five to seven times a day he pricks his finger, puts the drop of blood on a strip and gets a reading. If the level is low, he eats something; if it’s high, he dials himself a little more insulin.
"The managing is the hard part. Everything you eat, everything you do, if you’re upset with your wife or your boss, you need more insulin. If I go play golf, I have to have food with me all the time. It’s a balancing act.
"Very recently, life’s become a lot easier for diabetics because they’ve made a brand-new insulin that works instantly," says Gallagher. "With the older type of insulin, you had to give it 45 minutes before you ate. How would you know when that would be? Say I have a dinner meeting at 8 o’clock. But it gets delayed. Now it’s 9 o’clock, and the food’s not coming. So what do you do? You have little snacks of things in your pockets. That’s how we had to live. You did the best you could." Now, with instant insulin and a Lifescan meter, the dosing goes off like clockwork.
What "cures" do diabetics look forward to? The most dramatic would be an implanted pump combined with a blood-sugar monitor, acting just as a healthy pancreas does. Scientists are working on that. Another hope: implantable islet cells that produce insulin.
"Until they find a way to implant cells, we’re stuck," says Gallagher. His prediction? "The mechanical will be here before the implanted cells.
"But the hardest part is," says Gallagher with a sigh, "you’ve got this child with this disease, you know all the terrible things can happen—the child can go blind, lose kidney function, develop heart disease, all these terrible things that you know about, so you want to make sure they take care of themselves. So do you tell them about it, or does that just scare them so much that they think ‘I’m going to die anyway, so why do all this stuff?’
"You walk that fine line. I’ve told my daughter about the complications—well, she saw her grandmother pass away. She knows she has the same disease. I encourage her by saying, ‘They’re working on all of these things. And in the meantime you gotta take care of yourself, so when that cure comes along, you’ll be just perfect.’"