How Do You Define Child Endangerment?

My son was born on June 9, 2014. I was 46. It had taken a long time to decide that I wanted to be a parent at all, what with my disjointed childhood and a future full of increasing uncertainty. Plus, I had to deal with the question of my condition. What would I pass on to my offspring? The genetic blueprint for a confused immune system hell-bent on pancreatic beta cell destruction?

I spent hundreds of hours researching the question. People assume that type 1 diabetes is genetic, and type 2 is environmental. This distinction is important, but not entirely correct. In fact, if one of your parents has type 1 diabetes, you do have an increased risk of developing it yourself, up to around 1 in 20, 1 in 4 if both parents have it. However, if both of your parents have type 2 diabetes, your chances of developing type 2 is double that: 1 in 2. Lifestyle and family environment can't be escaped. There may be genes related to insulin resistance as well, but there are definitely genes associated with insulin dependence.

Over 40 genetic loci have been associated with type 1 in multiple studies. but many people who have those loci are fine, and others without them have type 1 anyway. Obviously the picture is far from complete, and genetics is only a predisposition. It is thought that there are environmental co-factors, mysterious things that confuse the immune system, trigger it to overreach: a yet unidentified virus? Casein? Gluten? Endocrine-disrupting pollutants?

I still pondered genetic testing to help me in my decision. My endocrinologist had opinions on the subject: “I wouldn't do it. We don't know what those tests will say and how they could affect you and your child's insurability in the future. Medical privacy is limited. Your records could be open to anybody who really wants them on the internet. Anyway, if you want to have a child, do it. Your condition may be a challenge, but you still have a life. And there could be a cure in just a few years.”

He gave me a number of good articles on the subject. That, plus my Google informed research, convinced me. Statistics always need to be questioned, but they still do have value. Children of insulin dependent fathers have a 1 in 17 chance of developing it themselves, with that chance lowering somewhat if the father developed it late, as I did, at age 41. For some reason the chance of a mother passing it on is lower. For comparison the general population has an approximately 1 in 200 chance, although there are many conflicting figures with different explanations to back them up.

In any case, I now have a child, and it has been far from low-stress. We didn't give him cow's milk or wheat for his first three years, as there seemed to be a correlation to autoimmune disease in studies I'd seen. I was always anxiously observing him, hoping not to see any telltale signs. One week in his second year he smelled strange, so I waited until after he went to bed, then pricked his finger and dipped a test strip. 92 mg/dl. I will never forget how soft his fingertips were compared to mine, and what a little poke it was that yielded such a willing drop. A year later he seemed uncharacteristically thirsty for a few days: another late night test. 85 mg/dl. He is very active, and not the biggest eater, so, after he didn't gain any weight for six months, I tested again. Still fine; still I worry.

The real danger to him, though, is my own condition itself, especially on the road. Diabetes educators recommend testing before you drive—every single time—and if you're below 75 mg/dl, delaying the trip. That is hard to engineer in the modern world with a modern schedule. Since we live out of town on a dirt road, I drive him everywhere. I have definitely been low behind the wheel with him in back.

The same has happened on my bike, more than once. The worst time was a short family ride we took when he had just turned three. With him strapped into his bike seat, my wife and I sped down the hill from our house to the coast, then pedaled around the path on the headlands North of Jughandle Beach, admiring the windswept crests of the waves. As we got back onto pavement, I could feel a low coming on. I ate a bunch of glucose tabs for the 1.6 mile uphill back to our house. It normally wouldn't be that much of a workout, but he and his seat together added an extra 45 pounds onto what is already my heaviest bike.

By the time we were 100 yards from our driveway, with only one incline left, I was feeling very lightheaded. Small pieces of my vision turned gray, as if every third pixel were dark matter, but in a flickering, arbitrary fashion. Each rotation of my legs was slower and more labored than the one before. It felt like a number of strong fingers were squeezing my occiput. I held tightly onto the sound of my wife's voice as we passed our gate and parked our bikes. Inside the house I carefully sat down and tested. 35 mg/dl. I wasn't even sure if I could make it to the fridge for a large cup of grape juice, wasn't sure if I would stay conscious until the sugar took effect—but I did. I never told my wife just how low I was that day, cranking up that hill with our beautiful son balanced behind me, unaware. .

We must have taken our helmets off just for this picture.