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For days, Liz Moughon had been struggling to breathe. Now she was on her way to an emergency room, prodded by a concerned sister and the realization that, in the past 24 hours, it had gotten worse.
In the previous two months, she’d lost 20 pounds, constantly felt the need to urinate, had noticed something off about the taste of water and had become so fatigued that she struggled to carry the equipment for her work as a freelance photographer and cinematographer. She blamed the weight loss on the marathon she was training for. But when that marathon rolled around, she was barely able to make it a quarter of a mile before dropping out. It felt like bricks had been stacked on her chest.
At the ER, a nurse listened to her symptoms, asked whether she was diabetic and did a blood sugar test. It came back at 501 milligrams per deciliter (mg/dL) — more than 350 mg/dL higher than it should be. Moughon also had diabetic ketoacidosis, a potentially fatal complication of unchecked diabetes. She was quickly moved to the intensive care unit.
Moughon had developed Type 1 diabetes, which used to be called juvenile diabetes because it most often hits between ages 5 and 14. It is much less common than Type 2 diabetes, which tends to strike older people and is often triggered by being overweight.
Type 1 diabetes, which has genetic and environmental components, is caused when the pancreas creates little or no insulin. Insulin is the hormone that enables the body to convert glucose into energy.
In Type 2 diabetes, people develop a resistance to insulin, which can be lessened with weight loss and healthy eating. But in Type 1 diabetes, that is not the case. The cells that produce insulin — called beta cells — are thought to be targeted by the body’s own immune system. A lifetime of regular doses of insulin is the only therapy.
“You have two organ systems that are not working well,” says Scott Soleimanpour, director of Type 1 Diabetes Basic Research at the University of Michigan Caswell Diabetes Institute. He also has Type 1 diabetes.
Without insulin, the body’s blood sugar levels can reach levels far beyond the normal range for a nondiabetic person, which is typically in the range of 70 to 110 mg/dL. Starting at 250 mg/dL, diabetic ketoacidosis can set in for some patients, resulting in the symptoms that brought Moughon to the hospital. If left untreated with regular insulin, it can lead to mental confusion, a coma and death. The condition is brought on when the body cannot produce enough insulin — which drives up the body’s blood sugar level — and begins to break down fat for energy, producing high levels of blood acids called ketones.
A person finding themselves in diabetic ketoacidosis is “a very common way for a new onset person to be diagnosed,” Soleimanpour said.
Of Moughon developing Type 1 diabetes as an adult, Soleimanpour says, “There are people who have Type 1 diabetes at all ages of life.”
Moughon was discharged from the ICU after two days, on Sept. 28, 2019. It was her 23rd birthday. Her sister Hannah, who had cared for patients with diabetes as a nurse, had driven to the hospital in the middle of the night and pledged to spend the next week with Moughon to help monitor her new diagnosis.
That first week, Moughon recalls, was a mess of needles and numbers, all of which had to be reported to her sister. But every day since leaving the hospital, her blood sugar was high.
“Looking back at that time, I didn’t know what Type 1 meant,” Moughon, now almost 26, says. “Fortunately, I have an incredibly selfless sister, and she understood how important it was.”
After that first week, she moved back to her childhood home and devoted herself to learning about Type 1 diabetes. She tested her blood sugar eight to 10 times a day. She gave herself four to five insulin shots a day. Her sister and other members of her family who work in the medical field helped answer questions and explain the science of how her body, insulin and carbohydrates worked.
“It was the first time in my life where I had no other responsibilities but to take care of my body,” Moughon said.
Even before her diagnosis, Moughon was using her skills as a photographer to create portraits of herself.
“I think it’s one of the best ways to be vulnerable in a safe space,” she explained. And so, when grappling with her illness became difficult, she turned to photographing it as a way to create something tangible from her frustrations — as she described it, “I’ve made something, let’s move on.”
It was two months after her diagnosis that she realized she was building a real body of work about her diabetes. She remembers the first set of pictures she made, knowing they would be contributing to a larger project: two images of her stomach, one with it covered in the needles she had used to administer insulin, the second with the devices she’d received that would help manage her diabetes.
One of those devices is a monitor that connects to her phone, gives a reading of her blood sugar and alerts her if it is too high or low. The other is a pod that administers insulin. Both have to be changed on a regular basis and both leave small purple scars that Moughon simultaneously dislikes and recognizes as “a mark of healing.”
She has to maintain a relationship between the food she eats, the insulin she takes and the physical activity in which she partakes. Since her diagnosis two years ago, she has noticed that her body needs more insulin now than it used to. All of these things she describes as “just maintenance.”
“It’s a thing I deal with, but I live a good life and it’s not held me back,” Moughon said. “I want this project to serve as a way for people to see that, no matter what you’ve got going on in your life, it can be a release.”
