In the Himalayas, with Undiagnosed Type 1 Diabetes

During a round-the-world trip, a reporter begins to experience the symptoms of diabetes in Nepal.



Reporter Oren Liebermann discovered he had Type 1 diabetes during a year-long trip around the world. In this edited excerpt from his memoir, The Insulin Express, Liebermann first begins to feel the effects of his yet undiagnosed diabetes while teaching English at a monastery in Nepal.

The hike up the mountain takes 45 minutes, and I feel completely wiped out when we reach the top. A sign explaining the history of the World Peace Stupa informs us that this is one of 80 Peace Pagodas around the globe.

“I’m sick and tired of being sick and tired,” I tell Cassie, choking back tears.

Recently, we’ve both noticed that I’ve lost weight. My arms and legs have become rail thin, and both of our parents asked if I was on a diet when we Skyped. I’ve also been feeling weak, and it has gotten worse since our Himalayas hike.

We find a pharmacy in Lakeside that lets us use their scale. I step onto the scale, but the number staring back at me doesn’t make any sense.

“Are you sure this scale is right?” I ask the woman behind the counter.
“Yes,” she smiles back at me.

I start converting kilograms to pounds in my head. Multiply by two. Figure out 10 percent, then add that twice. That means I weigh . . . wait, double check the number . . . 180 pounds? If that’s right, I’ve lost 45 pounds. I thought I had lost 20 pounds at most, but 45 means I have lost nearly a quarter of my body weight.

You can read Part 2 of this series with “An Inaugural Type 1 Hospital Stay in Nepal.”

We email some of my doctor friends back home and describe my symptoms. Weight loss. Thirst. A constant need to pee. Weakness. Their verdict is unanimous: malnutrition. One of my friends says I have the classic symptoms of diabetes, but we both agree that’s incredibly unlikely, since there is no history of diabetes in my family.

We email the medical update to my family. They start sending panicked emails, begging me to go to the doctor. On a Skype call with my parents at night, I make a simple deal with them. I’ll go to the doctor if they go to a personal trainer.

“You have to go to a doctor.”
“I’ll go to a doctor when you see a personal trainer.”
“What does our weight have to do with your health?”
“You can’t worry about my health until you take care of your own. Write down what you eat for three straight days and see a personal trainer.”
“You’re not going to survive that long, and I’m not coming to Nepal to bury you.”
“Ok then. I’ll try to die in Laos so you can at least visit somewhere you’ve never been for my funeral.”

When we arrive at the monastery for our final week of teaching, one of the workers kindly informs us that the monastery has announced a holy day and canceled morning classes. Cassie and I decide to take advantage of the unexpected free day to visit a doctor.

We hail a cab to Quality Healthcare, one of the few medical providers in Pokhara. A doctor, whom we’ll call Dr. Griffiths, introduces himself. “What seems to be the problem?”

I describe my symptoms to Dr. Griffiths. He doesn’t look right at me, instead tilting his head ever so slightly to his left in a way that comes across as mildly disconcerting, as if he’s not quite listening to me.

The doctor has his assistant take my temperature and blood pressure. He says I have a low-grade fever, and he comes to the same conclusion every other doctor has: malnutrition. What I need, he says, is some protein and vitamins. He recommends juices and chicken.

“Don’t you want to take a blood test?” I ask.
“I can if you want me to.”
“I want you to.”

The blood test reveals that I am healthy, although with a minor infection. Dr. Griffiths gives me a multi-vitamin, electrolyte powder packets, and an antibiotic for the infection. Cassie and I stop at the store to pick up some extra nutrition—pomegranate juice, soy milk, and a few other snacks.

Improvement does not come quickly. The next morning, I’m feeling as bad, if not worse. On a one-hour walk to the monastery, I drag my feet along the sidewalk. My mouth is half open as my breathing drags. I stare down at the street a few feet in front of me.

At the bottom of the three hundred stairs to the monastery, I stop. For a long time, I stand still, trying to find the courage to attempt the first step. Once I start, I know I will have no choice but to keep climbing every single one of those steps, and that seems like a monumental task.

I begin working my way up, trying to keep up some forward momentum with a slow rhythm. Once at the top, I collapse onto a bench and polish off half my water bottle in one swig. Then I start walking to the bathroom, knowing I will have to pee in a few minutes. I tell Cassie I need to rest.

I spend the entire first period sleeping in the library, trying to find the strength to help my wife teach. I get through the next class but only manage to eat a few bites at lunch.

That night, I notice a strange taste at the back of my mouth, almost a fruity taste that won’t go away. I’m sure it’s the aftertaste of the electrolyte powder, which has an orange flavor much akin to an awful spin-off of orange Gatorade. But when I sip the electrolyte water, it’s obvious that it’s an entirely different flavor.

The next day is the same. I have to rest through the first class, I barely eat anything at lunch, and I struggle through the rest of the day. Even the students take notice.

“Are you ok?”
“No.”
“Oren is very sick,” Cassie says from the front of class.

She has no idea how right she is.

This excerpt has been edited for length.

You can purchase The Insulin Express from Amazon or Barnes and Noble.

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Oren Liebermann is a CNN correspondent based in Jerusalem. Prior to joining CNN, Liebermann served as a General Assignment Reporter in Philadelphia for CBS 3. Throughout his career, Liebermann has won a number of accolades for his reporting, including two Emmys and three Associated Press awards. You can follow him on Twitter @orenCNN.