38 Years: What Beating Natural Selection Actually Looks Like
For Josh and Frank and Vernon and Sheila... the diabetics I remember every January 13th, and many others.
On January 13th, 1988, I was diagnosed with Type 1 diabetes in Columbia, South Carolina. My blood sugar was somewhere between 700 and 800. January 13th, 2026, marks 38 years since that day.
I’m not writing this for the non-diabetics who stumble across it looking for inspiration porn or to feel better about their own lives. This one’s for you, the T1Ds who understand what it actually means to wake up every single day and wage war against natural selection.
Because that’s what we do, whether we think about it that way or not.
THE DAY THAT CHANGED EVERYTHING
My grandfather was Dr. James C. Thrailkill (aka “Pop”), a small-town physician in Cheraw, South Carolina. He could diagnose many common illnesses for our family over the phone and call in prescriptions when he was confident about what was going on.
The morning of January 13th, 1988, my mom called him to describe my symptoms: unquenchable thirst, rapidly decreasing energy, no interest in playing outside, purple lips. In his calm way, Pop told her to take me to my pediatrician and pack a suitcase because I’d likely be in the hospital for a few days.
What I learned years later: after that call, Pop immediately called my Aunt Betsy and told her she needed to head to the hospital because I was going to be admitted and diagnosed with Juvenile Diabetes (Type 1). He didn’t want to be the one to tell my mom what he already knew to be true.
At the pediatrician’s office, they checked my blood sugar. I was admitted to the hospital that afternoon, started on insulin, and officially diagnosed with Type 1 diabetes. I also met Dr. Frank Bowyer, a pediatric endocrinologist who would change my life by convincing my parents to send me to Camp Adam Fisher less than six months later.
Here’s the eerie part: my grandfather, the man who diagnosed me over the phone, passed away on January 13th, 2010. Exactly 22 years after my diagnosis, to the day.
So every January 13th, I mark two things: 38 years of beating natural selection, and 16 years since losing the man who first understood what that would require.
WHAT YEARS OF EXPERIENCE TEACHES YOU
I’m not going to give you the sanitized, “living my best life with diabetes” social media version. That’s not helpful to anyone who’s actually living with this disease.
Here’s what thirty-eight years has actually taught me:
Diabetes is exhausting. There’s no days off. No vacations. No remission. Every single meal, every single day, requires math. Every workout requires adjustments. Every illness complicates everything. Sleep doesn’t stop your pancreas from not working, it just means you’re unconscious while your blood sugar continues to go up and down.
The diabetes community will save your life. I learned more about managing Type 1 at Camp Adam Fisher in the summers of my childhood than I learned from any endocrinologist. The best advice you’ll ever get won’t come from your medical team, it’ll come from another diabetic who’s figured out through trial-and-error what actually works. Your endo can advise. Other diabetics can show you what’s possible.
Technology is a tool, not a solution. I’ve used almost every brand of pump, every CGM on the market (except a couple of the newest ones), and tried countless glucose meters since 1988. I started pump therapy in 1994. After more than 20 years on a pump, I switched back to multiple daily injections because lipohypertrophy made pump sites unreliable. Today I use Tresiba (long-acting basal) and Fiasp (ultra rapid-acting bolus) with an Eversense 365-day implantable CGM. My HbA1c runs between 5.6-6.2%. The point? Technology helps. But you still have to do the work. The pump doesn’t manage your diabetes… you do.
Emotional detachment from data is survival. My friend Bethany, a T1D and nurse practitioner, said something years ago that changed how I think about every blood sugar reading: “There is no good or bad blood sugar, only in range and outside of range.” That mindset removes the victim mentality that allows diabetics to have long-term pity parties instead of making adjustments and moving forward. Your blood sugar is information. Use it to determine treatment. Don’t attach emotion to it.
You will lose people from this disease. I’ve lost diabetic friends, people I met at camp, people I mentored, people younger than me who should still be here. Some to complications. Some to the mental health toll this disease takes. Some to the combination of diabetes and substance abuse that happens when you’re looking for anything to numb the exhaustion of never getting a break. Every loss reinforces the same truth: this disease is relentless, and managing it requires showing up every single day.
Natural selection doesn’t care about your feelings. Without modern insulin and technology, Type 1 diabetics die. Before insulin was discovered in 1921, a T1D diagnosis was a death sentence, maybe a year if you were lucky. We beat natural selection by taking responsibility for our lives. Nobody can check your glucose for you. Nobody can count your carbs for you. Nobody can rotate your injection sites for you. Nobody can live this life for you. The price of survival is personal responsibility, every single day, for the rest of your life.
THE QUESTION I GET ASKED
“What’s your secret?”
People, usually non-diabetics, sometimes the parents of newly diagnosed T1Ds, want to know how I’ve made it thirty-eight years without major complications.
There’s no secret.
Here’s what I do:
#1. Test blood sugar. This is the single most important rule. Wilford Brimley was right: check your blood sugar and check it often. Everything else flows from this.
#2. Take my meds. I inject insulin multiple times daily. I adjust doses based on what I’ve learned over thirty-eight years. I don’t wait for my endo to tell me what’s obvious, if something needs adjusting, I adjust it.
#3. Eat right. I cook at home most of the time. Not because I’m a health nut, but because you cannot manage diabetes well if you eat out for most meals. You need to know what’s in your food.
#4. Exercise Daily. Other than insulin, eating right and exercising have made the biggest difference in my diabetic life.
#5. Get advice… from other diabetics. Once you know more about your diabetes than your medical team, it’s time to start trying new things. Most endocrinologists aren’t Type 1 diabetics themselves. The best ones ask their patients what they think and learn from their outcomes.
That’s it. No secret. No hack. Just showing up every day and doing the work.
THE FIVE-YEAR MILESTONES NOBODY TALKS ABOUT
Male Type 1 diabetics have an average life expectancy of about 66 years.
I’m 45 years old right now.
If statistics hold, I’ve got roughly 21 years left. Maybe more if I keep doing what I’m doing. Maybe less if something goes sideways.
I view 66 years as a challenge, not a death sentence.
Every five-year milestone past diagnosis feels different. At 10 years, you’re just grateful you made it through puberty with diabetes. At 20 years, you start wondering when the complications everyone warned you about will show up. At 30 years, you realize you’ve outlived some diabetics you knew and you feel both grateful and guilty.
At 38 years, you understand something most people will never grasp: every waking day is a privilege. Every morning you wake up with working kidneys, functioning nerves, and decent vision is a victory over natural selection.
I don’t take that for granted.
WHAT I WANT OTHER T1DS TO KNOW
If you’re newly diagnosed, here’s what I wish someone had told me:
You’re going to be okay. The first few months… hell, the first few years… are going to be hard. You’re going to make mistakes. You’re going to have terrible blood sugars. You may end up in the hospital. You’re going to feel like you’re failing. You’re not. You’re learning. Diabetes is a trial-and-error disease. 99.9% of your trials won’t produce negative consequences as long as you’re checking your blood sugar regularly.
Get around other diabetics as much as possible. Camp saved my life. Being around other kids who understood what I was going through made me feel less alone. It taught me management skills my medical team couldn’t. If you have kids with T1D, send them to diabetes camp even if they don’t want to go. They’ll thank you later.
You can’t outsource this disease. Not to your doctor. Not to an AI pump. Not to your parents. Not to a CGM algorithm. At some point, you have to take ownership of managing your diabetes. The sooner you accept that everything involving your diabetes is your responsibility, the better your outcomes will be.
Master the basics before adding complexity. Learn how to dose insulin on multiple daily injections before you consider a pump. Understand how food affects your blood sugar before you start trusting an algorithm to do it for you. Build a strong foundation of knowledge first. Technology should enhance what you already know how to do manually.
If you’re a long-term diabetic like me, here’s what I want you to hear:
You’re doing better than you think. The fact that you’re still here, still fighting, still showing up every day, that matters. Some days managing diabetes feels impossible. Some days you’re just tired of thinking about it. Some days you wonder if it’s worth all the effort. It is. You’re beating natural selection. That’s not nothing.
It’s okay to grieve what you’ve lost. Friends. Energy. The illusion of spontaneity. The ability to just be without calculating and adjusting. Diabetes takes things from us that non-diabetics don’t even realize they have. It’s okay to be angry about that. Just don’t let the anger keep you from doing what needs to be done.
Stay connected. The diabetes community needs you. Newly diagnosed diabetics need to see that it’s possible to live 30, 40, 50+ years (or more) with this disease. They need to hear from someone who’s been through puberty with diabetes, who’s navigated college with diabetes, who’s gotten drunk while diabetic, who’s built a life and a family while managing diabetes. Your experience matters. Don’t disappear into isolation just because you’re tired.
My unCommon Sense
38 years ago, I was selected by natural selection to die from diabetes… I didn’t.
I beat natural selection by showing up every single day and taking responsibility for managing this disease. By checking my blood sugar thousands upon thousands of times. By injecting insulin more times than I can count. By learning from other diabetics. By treating every blood sugar reading as information instead of judgment. By exercising when I didn’t feel like it. By cooking at home when I’d rather have eaten out. By making adjustments when things weren’t working. By trying new approaches and devices through trial and error.
By accepting that nobody else could live this life for me.
That’s what beating natural selection looks like. It’s not heroic. It’s not glamorous. It’s just showing up, day after day, year after year, and doing what needs to be done.
If you’re a Type 1 diabetic reading this, you’re in that same fight. Some days you’ll win. Some days you’ll lose. The goal is to win most of the time.
Keep checking your blood sugar. Keep taking your meds. Keep eating right. Keep exercising. Keep getting advice from other diabetics who understand what you’re going through. Keep trying new things when what you’re doing stops working.
Keep showing up.
Because natural selection doesn’t take days off and neither can we.
If you want to have a constructive conversation about this or anything else, message me at dan@thrailkill.us, and let’s grab coffee or a beer.
Have a good one,
Dan