Dateline: Gotham City, 13 days post-transplant

Since SUPERMAN’S successful liver transplant surgery 14 days ago, things have continued to improve, with just one worrisome specter: Diabetes.

That’s right, despite being in relatively good shape, normally showing very low cholesterol levels, possessing a strong heart and lungs (a result of over 30 years of high-altitude living, an active and athletic lifestyle, and the well-developed lungs of a professional singer), and a well-balanced diet, America’s favorite superhero has suddenly found himself exhibiting high blood sugar levels.

What?! How? Why?

Evidently, SUPERMAN is still shaking off the effects of the kryptonite exposure he experienced in our last episode . . .


This development was not completely unexpected. In fact, I received diabetes education before I was discharged from the hospital, and brought home a blood sugar monitor, test strips, pages of instructions and information, a testing kit including lancets and other necessary equipment in addition to a five-month supply of insulin and the necessary items in case I need to self-administer treatment, since the ounus of diabetes treatment falls upon the patient’s shoulders.

Some daily reality items that came with my new liver.
Some daily reality items that came with my new liver.

So, you may be wondering, why? And how? Take a deep breath, here we go . . .

Immediately after the surgery, I received my first massive dose of steroids as the first step in preventing rejection of the foreign material (my anonymous donor’s liver) that my body is currently being strong-armed into accepting. Anytime that happens, the recipient’s body starts screaming “Danger! Danger! Foreign tissue aboard! All Hands on Deck!! BATTLE STATIONS!! ATTACK!! ATTACK!! ATTACK!!!!” The steroids allow my new liver to gain a foothold before being executed immediately by my well-meaning but misled old-crony network of tissue.

The result of the massive input of steroids is a rise in blood sugar levels. As a result of that steroid infusion, there’s an immediate 50/50 chance of developing diabetes. For many patients, it’s short term. For others, it’s a long-term, sometimes even lifelong complication.

Although I had taken a few small doses of insulin in my short five-day hospitalization, my first five days at home showed no signs of my body having any problem at all dealing with it. How do I know? By testing my blood at the recommended four-times-a-day rate: 15 minutes before breakfast, before lunch, before dinner, and again before bed.

Although I don’t like to poke myself with needles, I’ve found it to be very simple and usually completely painless. Once in a while I feel the little pinprick but even then, it’s no big deal, especially after what I’ve already been through.

Suddenly, 11 days post-transplant, I saw a spike in my blood sugar, in the afternoon, and needed to self-administer a small dose of insulin (2 units). Again, the needle is really, really small and the process painless.

On the 12th day, again in the afternoon, I needed a small dose of insulin.

Again yesterday, day 13, my sugars spiked in the afternoon, requiring the same small dose. Then, in the evening my blood sugars rose to the highest level yet, requiring a correspondingly larger dose of insulin (4 units), though still a very small dose as far as diabetics are concerned.

As a result, last night I called a personal friend, a nationally recognized figure in the diabetes world, Andy Mandell, aka Mr. Diabetes®. I’ve been doing video work for the Defeat Diabetes Foundation for quite some time now, of which Andy is the founder. A remarkable man, after spending two years in bed due to diabetes complications, Andy spent eight YEARS walking the perimeter of the United States, a previously undocumented feat. This year is the 10th anniversary of the completion of that 12,00 mile adventure wherein he spoke to everyone who approached him on the street (including the late Robin Williams, who he bumped into on the sidewalk in Sausalito, CA), plus state legislatures, hospitals, classrooms, civic groups, basically anyone who would offer him the opportunity to speak out on behalf the now-epidemic proportions of this insidious disease. He accomplished the Herculean task with NO FEELING IN HIS FEET, another common side effect of diabetes (peripheral neuropathy).

So I was already aware that type 2 diabetes (adult-onset) is 95% preventable, merely through diet and exercise. That’s right, there are millions of diabetics in the US, and many, many million more people who are pre-diabetic and quickly approaching a full-fledged diabetic crisis, who are too self-absorbed to take control of their health and change their lifestyle in order to prevent and avoid the number one cause of adult blindness, amputation, heart attack, and many other nasty results!

Again to re-iterate and further define it, the epidemic of obesity in this country is causing agonizing pain and suffering, by causing diabetes, which is totally self-inflicted in 95% of cases. **Yes, there are some unavoidable medical causes, and that figure does not apply to Type 1 diabetes (juvenile onset) diabetes, which is a completely different issue and cause.

So, simply because we’re so self-indulgent as a society, lacking willpower and determination in regards to exercise and taking control of our eating habits, we inflict diabetes upon ourselves. You and I can almost always avoid diabetes with knowledge, determination, and willpower.

Additionally, because I’ve been pro-active in my healthcare journey (at least since I realized the gravity of my situation), I was aware of this possible complication. That’s largely why I was so anxious to get up and walk as soon as my medical team would allow me, and have continued to walk daily, AND have been closely monitoring my blood sugar levels regardless of my aforementioned aversion to needles, especially when it’s ME that has to do the sticking.

Yet I digress.

Andy was the perfect one to call, because although he’s not a doctor, he’s been living with diabetes for over 25 years.

He gave me some great advice, and when I dropped by to see him yesterday, he provided me with an important piece of equipment (a specialized food scale) and priceless information.

From my friend Andy Mandell
From my friend Andy Mandell

His first recommendation? “Test your blood sugar more often than they’ve recommended.” WHAT? NO!! More sticking?!! BOOOOO!!!!! (hoo, hoo, hoo, poor me, pity party, etc, etc.)

Okay, SUPERMAN, that’s enough. Man up. Pity party over. Chin up. FOCUS! **humming: “Shake it off, shake it off ...”

Visiting Andy
Visiting Andy


So, here’s the adjustment to my previously defined routine:

Step 1: test my blood sugar 15 minutes before meal time. Eat the meal, write down everything I eat. Every slice of cucumber, every gram of protein, every ounce of fruit and fruit juice, every ounce of rice, cheese, peanut butter, every gram of carbohydrates, every ingredient. Additionally, don’t forget to keep track of my activity (walks, etc.) **Heavy sigh of resignation.

Step 2: retest my blood sugar 2 hours after eating.

Step 3: tomorrow, repeat. Test my blood 15 minutes before eating the exact SAME MEAL at the exact SAME TIME. Repeat the exact SAME ACTIVITY, and retest 2 hours later.

Step 4: compare the results.

Step 5: repeat this process two or three more times, either in sequential days, or at separate intervals in the next month or so.

Step 6: compare all the results again.

Step 7: do the same thing with different meals at different times of day.

Step 8: begin to substitute different ingredients, different fruits, different veggies, etc, tracking everything, comparing differences, analyzing, and PAY ATTENTION!

The end result? Become aware of how different meals and different ingredients affect my blood sugar levels, and begin to be aware of how my body responds, which will in turn lead to greater insight and understanding, all designed to increase my understanding, increase the control of my life and health, and help me manage my situation.

Is this going to be easy? NO.

Is it going to be worth it? Unequivocally YES.

**In my second follow-up appointment today, my coordinator pointed out two things. First, that my blood sugar challenges are drug-induced and should soon disappear as my meds are tapered off to a maintenance-level dose. Second, that my insurance will only cover enough supplies as prescribed, and there may end up being some out-of-pocket expenses. Further, she intimated that I was a bit crazy, but hey, I’ve already admitted I’m an overachiever, which I partially attribute to my current success, and they’ve already acknowledged that I’m way more involved and informed about my care than most patients. I choose to continue to be as prepared as possible for all eventualities.

Continuing ...Is SUPERMAN indestructible and infallible? NO.

Is SUPERMAN on his way to a fully functional life, complete with a bright shiny future thanks to the wonderful gift I’ve received from a generous and life-saving gesture from a total and completely anonymous stranger and his family? YES!


In closing, the slow-dawning realization, brought to my attention by my dear friend Andy:

BROTHER DAN is back! That has been my stage name for many years, the source of which will be revealed in an upcoming episode.

For years people have asked me “are you a monk?” and “are you some kind of religious freak?” NO.

I have explained it thusly: Music is the heartbeat of life. If your heart beats with mine, we are truly “brothers.”

Brother Dan, opening the show for the band War, Gardnerville, NV, 2003
Brother Dan, opening the show for the band War, Gardnerville, NV, 2003


And the final revelation? I am not SUPERMAN. I am EVERYMAN.

My donor is anonymous. I could now be part Asian, African American, Native American, Hispanic, Cuban, Russian, Pacific Islander, Redneck, Ivy League, Rebel, Yankee, Female, Transsexual, Gay, Bisexual, Republican, Democrat, Tea Party member, virtually anything. I may never know.

The accompanying final result? Any last remaining vestiges of prejudice, discrimination, or resentment against anyone for any possible reason has been removed from its existence within me.

I am truly EVERYMAN. The Unknown Soldier. YOUR brother. BROTHER DAN.

Look out world. I’M BACK.

I love you.

I wish you peace.

10 days post-transplant, a family walk in the rain selfie
10 days post-transplant, a family walk in the rain selfie


For more info about Andy Mandell and the Defeat Diabetes Foundation, to order your own really useful food scale, to take a short on-line self-assessment test of your risk of diabetes, and to access more information about diabetes than you can possibly retain but includes anything you may possibly need to know, go to  Tell them Brother Dan sent you.

This post first appeared on Dan’s Perspective blog, June 17, 2015 and is reprinted with permission.