Let’s face it, when you’re a college-educated 57-year-old slinging parcels for a living, something in your life has not gone according to plan. That said, my moments of chagrin are far outnumbered by the upsides of the job, which include windfall connections with grateful strangers. There’s a certain novelty, after decades at a legacy media company—Time Inc.—in playing for the team that’s winning big, that’s not considered a dinosaur, even if that team is paying me $17 an hour (plus OT!). It’s been healthy for me, a fair-haired Anglo-Saxon with a Roman numeral in my name (John Austin Murphy III), to be a minority in my workplace, and in some of the neighborhoods where I deliver. As Amazon reaches maximum ubiquity in our lives (“Alexa, play Led Zeppelin”), as online shopping turns malls into mausoleums, it’s been illuminating to see exactly how a package makes the final leg of its journey.


Brand’s talk veered only more earnest, about his own trials with addiction to crack and heroin and how 12-step programs helped him “get the keys to his life back.” Drugs are a symbol, he implored. “The craving isn’t for drugs. All yearning and desire are inappropriate substitutes for what you want, which is to be at one with God, which is connection.”
Without insulin, that extra sugar starts to hang out in your blood with nowhere to go. Just like with honey or sweet syrup, high concentrations of sugar causes the blood to thicken. Physiologically, this pulls fluids and water from other parts of the body into the bloodstream, causing swelling and dryness. Early symptoms of diabetes are relatively mild, including excessive peeing, dry mouth, itchy skin, hunger, fatigue, and blurred vision.
The WHO estimates that diabetes mellitus resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death.[9][101] However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes.[101][104] For example, in 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9 million deaths worldwide,[19] using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes.[20]
“The field has suffered from a checkered history 20, 30 years ago, when there were operations that were dangerous. But modern metabolic surgery is very safe,” Cummings said. “The risk of dying from a laparoscopic gastric bypass is a little bit less than the risk of dying from having your gallbladder or appendix removed. But we never consider those risky surgeries; they’re totally bread-and-butter procedures.”

Inhalable insulin has been developed.[125] The original products were withdrawn due to side effects.[125] Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014.[126] An advantage to inhaled insulin is that it may be more convenient and easy to use.[127]
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that it has not been approved for. However, a doctor can still use the drug for that purpose. The FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. Therefore, your doctor can prescribe a drug however they think is best for your care.
The results of his medical tests are still being analyzed, Darkes said, but he hasn't needed insulin injections for a year and a half. "It took a long time to sink in," he noted. But Darkes is confident he no longer has type 1 diabetes. He said that doctors told him that he has a "rare" gene that somehow facilitated his cure. "I'm the only one who carries [the gene], at the moment," and there's no further explanation so far, he said.
After rising to MySpace fame in the mid-aughts, the singer-songwriter Kaila Yu amassed a following of nearly half a million fans on Facebook and 70,000 on Twitter and Instagram. Like all “influencers”—people who leverage a social-media following to influence others—Yu now makes her living monetizing her audience with branded content, promoting products and events through sponsored posts.
"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.[39] Still, type 1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low blood sugar levels. Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).[39] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.[40]
“The field has suffered from a checkered history 20, 30 years ago, when there were operations that were dangerous. But modern metabolic surgery is very safe,” Cummings said. “The risk of dying from a laparoscopic gastric bypass is a little bit less than the risk of dying from having your gallbladder or appendix removed. But we never consider those risky surgeries; they’re totally bread-and-butter procedures.”
Even as things stand now, there are a lot of people left out in the cold. A 2016 study, for instance, found that only 41,000 people with diabetes annually get bariatric surgery in the US—fewer than 5 percent of the total new cases diagnosed every year. And the longer someone has diabetes, studies have suggested, the less likely they are to go into remission if they eventually get surgery. Getting those numbers up will not only require changing the minds of insurers, but public opinion, too.
Health ProMed Nursing Director Angel Rodriguez, Ruben Bras of the Puerto Rico Primary Care Association and other ProMed staffers quickly load Humulin R insulin into cold storage at the ProMed San Juan clinic. Humulin R is used to stabilize a patient’s blood sugar. The medicines from Direct Relief were critical after Hurricane Maria, with many patients battling stress and limited access to nutritious food. (Lara Cooper/Direct Relief)

One of the most studied programs in the National Institutes of Health’s Diabetes Prevention Program (DPP). This program helps people who have pre-diabetes or a high risk of developing type 2 diabetes lose weight. Studies of the program have found that those who lost about seven percent of their initial weight, kept some of it off, and maintained an exercise program delayed the onset of type 2 diabetes for three years in 58% of cases.
It was the same endorsement the first Diabetes Surgery Summit, also organized by Cummings in 2007, had made, but the landscape had changed since then. In addition to more accumulated research, this time, their stance was backed by over 50 international professional organizations, including the American Diabetes Association. And while other medical societies and organizations had long backed surgery as an option for diabetes, the DSS-II guidelines are the first meant to guide clinical practice.

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

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