At age 32, while pregnant with my oldest child, I failed a glucose tolerance test. My blood glucose was so high that the nurse asked me, "Why aren't you in a coma?" I felt like I should have been. I had none of the risk factors for gestational diabetes, and my blood glucose level was a perfect 90 a month before the pregnancy. But I required insulin, and the nurse told me I needed to inject it into my (very pregnant, very large) abdomen. This, it turns out, was flawed advice. But I will never forget giving myself that first shot of insulin, in tears, with my husband out of town. I couldn't get all the air bubbles out of the syringe; would they kill me? How did the doctor know that 10 units wasn't too much? Would I wake up in the morning? What if the needle punctured my uterus?
Six weeks after my (large, but healthy) baby was born, I failed another glucose tolerance test. The doctor said I had type 2 diabetes, and if I lost the weight I had gained while pregnant, it might improve. I lost weight-- I'd do anything to avoid those needles-- and my blood glucose went even higher. He tested me for autoantibodies, and the test was positive. I had type 1 diabetes. (Maybe someone will diagnose me with LADA (Latent Autoimmune Diabetes in Adults)-- then I will have been diagnosed with four different types of diabetes, quite possibly a world record).
Seven years later, for the first time, I was happy that I had diabetes, of whatever type. My second child, at 23 months of age, was showing some symptoms of diabetes. My husband suggested checking his blood sugar, but I couldn't bear to prick his little finger. After a week, we finally checked his blood sugar-- "HI." We went straight to the ER-- "critically high." It was almost 800. Thankfully I had seven years of practice dealing with this disease. He was on a pump within a month of diagnosis, and shortly after that a continuous glucose monitor. Without those tools, I might have lost my sanity by now, not to mention my child's life. I have been awoken out of a deep sleep more than once finding his blood sugar in the 40s and declining.
"Why do you hurt me Mommy? Me no want you hurt me."
- my son, at age 3, who does not like to be poked with needles.
I wondered, is there anything I can possibly do to prevent my older child from getting diabetes? He must be at some genetic risk, with two immediate family members who have type 1. I had heard that the incidence of type 1 diabetes was going up-- was it really? Why? What causes type 1 diabetes? And then I discovered PubMed, where I could read zillions of studies on type 1 diabetes. I took up a new hobby, reading scientific studies. It helped to have a husband with a PhD in biology. My background, however, was in the environmental field. I have a MS from the University of Michigan's School of Natural Resources and Environment in environmental policy and education. I had been reading about the role of environmental chemicals in various other diseases for years. I wondered, could chemicals have anything to do with type 1 diabetes? So I started reading studies on environmental health, looking for clues. This webpage summarizes what I have found, and I intend to keep it up to date with new studies as they become available.
I began this research while sitting with my dad, a noted economist, when he was dying of cancer. He told me he had once heard that his type of cancer might be due to pesticide exposure. He said, "If this is because of something in the air, I'll be pissed." It's too late for him, but the health effects of environmental chemicals are certainly not limited to their potential role in diabetes. I focused on diabetes due to self-interest, my own interests, and because hardly anyone else was.
I did not find all the answers to my questions, of course, but I learned a lot. I made this webpage to let others know who might be interested. Please let me know if you have any ideas, comments, suggestions, or questions: email@example.com.
Thank you to everyone who helped me by answering my questions, editing, or in other ways. Any mistakes or misinterpretations are my own responsibility. I have summarized and simplified a large amount of information here, and therefore ignored some of the details and complexities of the processes involved. Please keep in mind that biological systems are very complex and not well understood, and, different authors do not agree about how to interpret various findings. They are not all going to agree with my interpretations either, although I did make an effort to be fair, and present more than one view when appropriate.
National Coordinator, The Collaborative on Health and the Environment's Diabetes-Obesity Spectrum Working Group.
PS You can also read more about me on the Collaborative for Health and Environment Partner Spotlight page, and about my son in the American Diabetes Association's Diabetes Forecast magazine article, Teddy's Story (Jan. 2011 issue). Or listen to my tudiabetes interview on environmental factors and diabetes.
PPS As of November 2015, I am also now wearing an artificial pancreas! Thanks to Dana Lewis and Scott Leibrand (see http://diyps.org/ and http://openaps.org/). For more on this adventure, see my blog post, I am now a bionic woman, and also follow me on twitter, @sarhoward. You can also follow the open-source artificial pancreas efforts on twitter using #openAPS, #WeAreNotWaiting, and #diyps.
Articles in peer-reviewed journals
Russ K, Howard S 2016. Developmental exposure to environmental chemicals and metabolic changes in children. Current Problems in Pediatric and Adolescent Health Care, 46(8):255-285.
Howard SG, Lee DH. 2012. What is the role of human contamination by environmental chemicals in the development of type 1 diabetes? J.Epidemiol.Community Health 66(6):479-481. PM:21502091.
Sargis RM, Howard SG, Newbold RR, Heindel JJ. 2012. The Diabetes Epidemic: Environmental Chemical Exposure in Etiology and Treatment. San.Franc.Med. 85(5):18-20. PM:24771962.
Letters in peer-reviewed journals
Howard S, Howard T 2016. The genes associated with a high risk of type 1 diabetes are becoming less common. BMJ Open Diabetes Research and Care, 10 June.
Howard SG, Heindel JJ, Thayer KA, Porta M. 2011. Environmental pollutants and beta cell function: relevance for type 1 and gestational diabetes. Diabetologia 54(12):3168-3169. PM:21947423. Free full text PDF.
Howard SG. 2011. Comment on: Berhan. Thirty Years of Prospective Nationwide Incidence of Childhood Type 1 Diabetes: The Accelerating Increase by Time Tends to Level Off in Sweden. Diabetes 2011;60:577-581. Diabetes 60(9):e25. PM:21868789.
Howard S, Howard TG. 2009. Association of bisphenol A with diabetes and other abnormalities. JAMA 301(7):720-722. PM:19224744.
Russ, K and Howard, S 2016. Endocrine Disrupting Compounds and Pediatric Metabolic Disease. American Public Health Association Annual Meeting and Exposition. Poster presentation.
Howard, SG 2013. Filling a "Critical Data Gap": Type 1 Diabetes and Environmental Chemicals. Environmental Health 2013: Science and Policy to Protect Future Generations. Abstract accepted for oral presentation.
Howard SG, 2012. Environmental Chemicals in the Development of Diabetes and Obesity. American Public Health Association 140th Annual Meeting and Exposition. Poster presentation.
Howard SG, Heindel JJ, Thayer KA, 2012. Resources on Chemical Exposures, Diabetes and Obesity. American Diabetes Association 72nd Scientific Sessions. Published abstract.
Are there environmental causes of type 1? Insulin Nation, 2014
Environmental chemicals in diabetes and obesity: Unexplored territory, Physicians for Social Responsibility, 2013
Collaborative on Health and the Environment Blog
Review of the evidence on developmental exposure to certain endocrine disrupting chemicals and obesity 2014
Air pollution exposure during pregnancy and the risk of type 1 diabetes in the offspring 2015
An environmental perspective of the American Diabetes Association's 75th Scientific Sessions 2015
Air pollution and weight gain, insulin resistance and metabolic syndrome: Recent findings 2016
Scientific Consensus Statements on the Role of Environmental Chemicals in Diabetes, Obesity, and Metabolism 2016