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HER SUGAR WASN'T SWEET A decade ago, the glucose levels in type 1 diabetic Susan Greenwell's blood were out of control, threatening her life repeatedly. But that was before her pancreas transplant. T he medical ofce was calling again. "Now what?" Susan Greenwell thought. Hadn't she spent 45 minutes the day before answering their questions? What was left to ask? It turned out, just one thing: "Can you be here in an hour?" Te caller was the transplant coordinator for Jewish Hospital. Eighteen hours earlier, Greenwell, 56, was put on the waiting list for a donor pancreas. Te former oncology nurse was prepared to sit tight months for a suitable organ, even though the wait for a pancreas is never as long as the one for a heart or kidneys. But nobody thought she'd have a new pancreas in less than a day. Greenwell's son Neil, 24, a legal aide, got the call about his mom's imminent transplant and found a red-eye out of San Francisco that night. Meredith, her daughter and Neil's twin, hopped in her car as soon as her shift ended at Foode restaurant in Fredricksburg, Va., where she worked as an event coordinator. "I was at work and she called me, as excited as she could be," said Brett, 27, her oldest son and a trainer at Milestone Fitness. "I came right home. We didn't expect it that quickly. It was just a whirlwind." Greenwell's husband Mike, a 57-year-old gastroenterologist, was busy tending to other peoples' illnesses. He'd get to the hospital as soon as he could. Te transplant patient got a ride to the hospital from a friend. By 2:30 a.m., she was in the operating room. Six hours later she was in recovery, a new pancreas tucked just behind her stomach, atop the one that had turned her life, and the lives of her family members, into a series of almost routine life-and-death dramas. Now, she would be able to care for herself. She no longer would need insulin or show symptoms of diabetes. She no longer would need people to sit with her and check on her and be available to rescue her when she lost consciousness. Diabetes is so common that it's easy to forget how deadly it can be. Tere are 25.8 million diabetics in the United States and 79 million pre-diabetics, according to the U.S. Centers for Disease Control and Prevention. Most have type 2 diabetes, the kind one usually gets as an adult and is often — although not always — associated with obesity. Tere are fewer type 1 diabetics, about 3 million, according to the Juvenile Diabetes Research Foundation. Tese are the people who need an external source of insulin because their body no longer makes it. Susan Greenwell was a type 1 diabetic, although she wasn't diagnosed until her late 30s. By 1999 she was on an insulin pump with a continu- By Jenni Laidman Photos by Gail Kamenish ous glucose monitoring system. Te pump delivered a steady base rate of insulin; then, six times a day, Greenwell would trigger it to deliver more. But it was an imperfect system. Very imperfect. Greenwell's diabetes was out of control, her blood sugar either escalating frighteningly or falling quickly and dangerously in frequent hypoglycemic incidents. Despite the best eforts to keep it in check, it was trying to kill her. Neil Greenwell tells the story of the summer he was home from Vanderbilt University. He heard his mom pull her car into the garage but realized a few moments later that she still hadn't come in. He found her locked in her car, barely conscious. She fumbled with the lock, its workings beyond her. He shouted to her, but she couldn't act. He walked to the corner of the garage and picked up a 12-pound sledgehammer. It was break the window and rescue her blood sugar with a glucagon injection or let her die. His mother had what is called "hypoglycemia unawareness." When blood glucose levels fall, most of us sweat and feel weak and shaky. If levels continue to decline, heart palpitations, tiredness and dizziness may follow. Concentration grows difcult, behavior may be odd, speech slurred, vision blurry. In severe cases, left unattended, it is lethal. But some diabetics cannot feel those early warning signs of weakness, shakiness or even slurred speech. Dr. Sri Prakash Mushagundam, the endocrinologist who managed Greenwell's diabetes, says there are two possible causes for hypoglycemic unawareness. One is nerve damage caused, not by low blood sugar, but by the high blood sugar that is the principal symptom of diabetes. Te other possible cause of hypoglycemic unawareness is a tolerance to its bad efects. "If I take a normal person, bring you to our clinic and give you insulin so your blood sugar drops, you start to feel symptoms at 70 (milligrams of glucose per deciliter of blood). If I do the same thing in the afternoon, you may not feel anything until 60. If I do it again at night, you won't feel it until 50," Mokshagundam says. Te normal range for blood sugar is about 70 to 100 mg/dL. And that was Greenwell's state. After years of diabetes, she no longer knew when her blood sugar was plummeting. She would be on the phone with Meredith and start slurring her words. "She didn't realize it," Meredith says. "I'd try to yell at her, to tell her, but she couldn't tell." Meredith would hang up, call someone who lived near her mother, and call back 20 minutes later to make sure the situation was under control. 2.13 LOUISVILLE MAGAZINE 3 7