Sweetness

Once I told a skittish lover I’d only be as sweet as she could bear, knowing too much would startle her out of my bed. I kept most of the sweetness safely in pastries and unsavoury breakfasts, handing her snacks of pancakes dipped in chocolate tahini while we waited in line brunch-starved, or laying out suhoor trays of breakfast cakes to break fast.

Both fasting and viruses do strange things to sugar. Normally, the body breaks the carbohydrates you eat into glucose — from the Greek glykys (sweet) and gleukos (sweet wine). Sugar in the blood is cellular energy, stored for later between meals, when we lack the sweetness to sustain us. Glucose not circulating lives in the skeletal muscle and liver cells — it’s uptake managed by the hormone insulin.

Blood glucose levels are supposed to be tightly regulated as part of metabolic homeostasis; maintaining approximately four grams of dissolved glucose in the blood plasma at all times, for a 154lb human. Too much leads to glucose toxicity, damaging the pancreatic cells producing insulin and worsening hyperglycemia. Too little and the brain, which consumes 60% of your glucose when sedentary and cannot synthesize or store it’s own, starves for energy. It requires a continuous bath of blood glucose to operate, falling into temporary functional brain damage when hypoglycemic.

I have been baking since I was eight: perfecting chocolate chip cookies and making breakfast for my friends when they slept over. When I first got sick, the whole world was inventing new sourdough concoctions and trading pastries like catan cards and I could not stand to mix dough or count tablespoons. I bought cookbooks I couldn’t read, and broke down over the same simple recipes over and over, wasting ingredients I was took sick to lift to the top shelf. Slowly, baking became, not easy again, but achievable. A task worth labouring over to feed someone hungry for sweetness but shy to ask; an alchemy kind of care for myself and others.

Post-viral illness has been described as a failure of homeostasis, every automatic process malfunctioning under crisis. Pro-inflammatory cytokines, molecules like IL-1 or TNF that cause fever and tissue damage and often remain elevated post-viral, also mediate insulin resistance in complex downstream ways or impact the uptake and oxidation of glucose in skeletal muscle. A study of 100 Long COVID patients found 34% had insulin resistance four months later and hypothesized a more direct connection: SARS-CoV-2 replicated in insulin-producing pancreatic β-cells, causing metabolic dysregulation.

In Germany, a large project called the Disease Analyzer used 1171 physicians’ practices and 8.8 million patients to track increases in Type-2 diabetes diagnoses post-infection. Other studies have tracked diagnoses of Latent Autoimmune Diabetes (known as Type 1.5 for it’s shared characteristics between both Type 1 and 2), in which the body produces antibodies to insulin-producing cells. Patients with Type 2 Diabetes patients are so prone to infection they have their bouquet own pathognomonic diseases: emphysematous pyelonephritis, malignant otitis externa, mucormycosis, and Fournier’s gangrene.

Post-COVID, my own body seemed to grow slippery hands, unable to control it’s internal dials. Often in the ER, barely able to stay conscious, the only thing triage’s blunt measurements caught was low blood sugar and labile blood pressure and heart rate, writing the later off as health anxiety, and the former as anorexia. Patients report losing sight of hunger cues and studies in older COVID-19 survivors report malnutrition and muscle wasting, due to loss of appetite, taste and smell, and low-level chronic inflammation. The body burns it’s own sweetness, til it burns itself out or someone offers us some.
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The Impairing Curse is a long-form, serialized experiment in personal essay, science journalism, policy analysis, and poetry. To start at the beginning and read it in order, go to the first essay or read about the aesthetics and labour of illness, the science of salt, and the failures of public health. To support this project, share it online or subscribe. The series is intentionally not behind a paywall, to ensure broad access to patients and timely circulation of information in our evolving public health crisis, but paid subscriptions are welcome.