For Want Of A Nail…


Winter Horseshoes from WW1 - Wikipedia

For want of a nail the shoe was lost.

For want of a shoe the horse was lost.

For want of a horse the rider was lost.

For want of a rider the message was lost.

For want of a message the battle was lost.

For want of a battle the kingdom was lost.

And all for the want of a horseshoe nail.

- Old Proverb

It wasn’t a conscious effort or a determined decision to skip a dinner shot the first time. I just got caught up in whatever insignificant thing that I was doing that evening (A teenager’s life is so important, so it was probably something like talking on the phone in my room while eating and painting my nails fire engine red.) and then I just went to bed. The next morning, I woke up and realized that I had missed my evening insulin mix (both long- and short-acting), but that I wasn’t…well, to be honest…dead. I took my morning dose, choose another black outfit from the closet (“Christel,” my father sighed with exasperation, “Are you going to a funeral?”) and waited for my friend to pick me up.

I knew what DKA was. I knew what ketones do to a body. I knew what a lack of insulin will do to your mind. My control was crappy already and life wasn’t entirely sane in my family, so I had a lot of independence when it came to my diabetes. My parents asked what my blood sugar was, and I would pull a random number out of my head (or another part of my body) to blurt out. They weren’t stupid. (The lack of prescription refills on my test strips were a dead giveaway.) And I took insulin. Just not every time I ate.

I was fat.  Why was I fat? I can name several reasons, but it started with a 3,500 calorie Diabetic Exchange Diet to put the weight on after my diagnosis. (68 pounds looked scary in photos. I actually threw out pictures taken at Joslin when I first arrived there, because I looked so sick.) I kept eating well after I packed pounds back on my little frame and a year and a half later, I started high school at 104 pounds. I graduated high school at 135 pounds, and at 4’11” inches, that put me in the “She’s got a nice personality and a pretty face, but…” dating category.

Eating was a way of socializing with my family and friends, and I was always of the mind: “I can eat anything I want and let me prove it to you.” I would skip a shot when I felt like it or was too tired to deal with it or out with friends and didn’t want to stop having fun. This attitude didn’t go away at university, but I added drinking alcohol into the mix. (Legal, people. I went to university in Canada, where it was legal for me.) I was scared of being low when I was drunk, so I wouldn’t take a full dose before we went out to bar hop, but we’d carb load before hand. And sometimes at 4am when we’d come back to the dorms. I knew where every bar’s bathroom was in Montréal.

I met someone who loved the whole package and it was with him that I had a summer of great blood sugars and healthy eating and biking the Lachine Canal every night. My size 14 clothes hung on me and when September rolled around, I was a size 4. And then the relationship ended and I drank coffee and cried a lot. Old habits rose up like zombies and skipping shots and eating what I wanted became de rigueur. 95 pounds. 94. 93. I just didn’t care. Nothing “bad” was happening to me and people told me how great I looked. Guys who wouldn’t give me the time of day before were now giving me their number.

I thought I could have lived like that for a long time. (Silly me.) Spilling ketones, downing liters of soda daily, taking insulin once a day with an arbitrary amount chosen (“Hmm… I’m feeling about 340 today… 10 of this and 12 of that and off we go…). I may have lived, but I was barely surviving.

My endo saved me. She wasn’t one to pull punches and knowing me for most of my diabetic life, knew that I could talk my way out of a lot of things, but I was cornered by a series of questions that ended with: “How long have you been skipping shots?” The jig was up. I was officially diagnosed with diabulimia.

Outpatient intensive individual and group therapy or inpatient treatment were my options. I chose the former. I didn’t see myself as someone with an eating disorder. I saw myself as someone who was fat and never wanted to be fat again. I saw myself as someone who didn’t want to be diabetic and was still hoped that it would just go away. I still saw the fat girl in the mirror. Body issues? I haz them.

There are a lot of us out there, struggling. I know that I’m not alone, but it was years before I met someone else in person (Lee Ann Thill) who also dealt with diabulmia. I wrote about it in a column on , was on dLife TV for an article on diabulimia and was even interviewed for a CNN piece. (They focused on a woman who developed irreversible complications and was still skipping shots rather than me, who was now healthy and not skipping shots. I wasn’t sensational enough.)

Therapy changed me for the better. It took a long time and even after twenty years, I still struggle with how I look to myself. But I haven’t skipped a shot since therapy ended.

And all for the want of a small dress size…

I could have lost so much more.

I’m not talking about my weight.


  1. Lee Ann Thill

    It’s good to recover from a train wreck, and move forward, and in my book, you’re sensational for that, and a bag of chips… and a bolus to cover it. xo

  2. Scott K. Johnson

    Thank you, Christel, for being brave enough to face your demons and work through them. AND being brave enough to tell your story. You are amazing.

  3. StephenS

    Funny… I started the same way: high-calorie diet to put the weight back on, but I never slowed down until I looked in the mirror and saw something I didn’t like. I tried (only for a very short time) skipping doses, but realized pretty quickly that it wouldn’t work long term. Especially if I wanted a long term.

    Thanks for shining a light on your story. It takes guts to write about this, and you are a champion for helping others in the process. I’m thinking that makes you the perfect size.

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