Former Facebook Engineer Dies of Undiagnosed Type 1 Diabetes
Editor’s Note: Get involved in Beyond Type 1’s #SeeTheSigns of diabetes campaign and save lives. Learn more here.
For support navigating life after a type 1 diabetes death, please visit Jesse Was Here, a unique program of Beyond Type 1, providing resources to spouses, siblings, grandparents and friends in need.
On September 26, 2017, former software engineer at Facebook, Michael Cohen, died suddenly at the age of 25 from undiagnosed type 1 diabetes. At the time of his death, Cohen was a doctoral candidate at MIT. He passed away in Berkeley, California while attending a workshop at the UC Berkeley through the Simons Institute for the Theory of Computing.
It was believed that he had a stomach flu with symptoms of fatigue and vomiting, and he missed nearly a week of the seminar, staying at a rented airbnb flat in Silicon Valley. When he couldn’t be reached for several days, authorities were called and found Cohen. He was pronounced dead onsite. Cohen’s official cause of death was diabetic ketoacidosis (DKA).
Type 1 diabetes is an autoimmune disease in which the body attacks the healthy insulin-producing beta cells in the pancreas. The cause is unknown, though there may be environmental or heredity triggers for the disease.
As the beta cells are destroyed, insulin levels drop and blood sugar becomes elevated. Untreated, the person with type 1 diabetes runs the risk of entering DKA, a life-threatening condition that leads to diabetic coma and death. Essentially, when the body can’t access sugar, it begins to break down muscle and fats, releasing ketones into the body. Excessive ketones in the system destroys vital organs.
“Gastrointestinal (GI) symptoms usually develop after ketone accumulation and represent the late manifestation of acidosis (ketone/acid accumulation in the body),” explains Marina Basina, MD, a lead endocrinologist at Stanford University. “Nausea and vomiting is typically present in up to 2/3 of patients in DKA.”
“In individuals with no prior history of diabetes,” says Basina, “GI symptoms can be mistakenly attributed to viral gastroenteritis or food poisoning that can lead to delaying the diabetes diagnosis and worsening of the severity of ketosis/acidosis.”
The missed warning signs
Four months before his death, Michael Cohen had also started losing weight without trying—likely an earlier and unrecognized symptom of type 1 diabetes onset.
While a sophomore at MIT, Cohen worked as a software engineer at Facebook. His mother, Marie Cohen, said that he’d put on weight during that time, so when he started losing weight, it was perceived as a good lifestyle change and not an indication of an illness.
Senior Researcher at Microsoft, Sébastien Bubeck, who mentored Cohen during his summer internship at Microsoft said, “When he was working with me, he seemed to be a little underweight. It never crossed my mind that it could be a sickness and there was something else going on. In hindsight I realized that this was one of the signs you should pay attention to.”
He also was drinking fluids excessively those last weeks, another indication of the onset of type 1 diabetes.
“By his bed,” says Marie, “we found four large trash bags of empty two-liter bottles of soda. But no one else mentioned seeing him drink a lot or going to the bathroom a lot.”
Unexplained weight loss, excessive thirst, frequent urination and exhaustion are the four early symptoms of type 1 diabetes. Other symptoms might include vision change, headaches, changes in appetite, irritability, or mood changes, fatigue, weakness, stomach pain, nausea and in the later stages, vomiting, fruity breath odor, rapid or heavy breathing, which are indicators of DKA.
Unmatched talent and worth ethic
Cohen was known for putting in long hours and possessing an unmatched enthusiasm for his work.
“‘Brilliance, joy, generosity and energy,’ were how people described him,” said Marie Cohen. “He was always in motion and helping others with their research.”
“Many people who he worked with said he would often accompany them while they ate or commuted home, continuing to collaborate,” said Marie Cohen. “He had unbelievable stamina.”
“I didn’t view him as a student. He was really a collaborator,” said Bubeck who recruited Cohen out of MIT for the internship at Microsoft the summer before he passed. “We really get the world’s best students. But even in that space, Michael stood out.”
“The vast majority of the candidates that we are currently looking at hiring [at Microsoft],” said Bubeck, “many did joint projects with him. Despite the fact that he was in the field for only a couple years, many of the top people graduating in the field this year, their best work was joint work with Michael. I have never seen that in my career.”
Bubeck explained that at their first meeting, he’d come to MIT to give a seminar on convex optimization and later, during the summer internship, Cohen helped him answer the question proposed in that seminar. The research team also tackled online learning, mathematical (convex) optimization and the k-server—an incredibly complicated breadth of topics that a select group of mathematicians in the world were looking at.
“Every hour I would get a message from him,” said Bubeck. “He was always working. He always had new ideas. I believe he was working very hard and spending all his time on this research. One reason I am confident about this was that as papers were appearing on the archives, he would tell me about them, and new interpretations of them. He was still a human—he had to read those papers, so he was working very hard.”
His mother, Marie Cohen, also said that he was not the type of person to go to the doctor when sick and hadn’t been since he visited his pediatrician. This coupled with a demanding work schedule may have contributed to the fact that Cohen did not seek medical attention when he was presented with symptoms.
“I’m worried about young adults, especially guys,” said Marie Cohen. “They don’t seem to ever go to the doctor. I’d like to work on spreading awareness. To die in your 20s is just too terrible. Ideally, I’d like people to just be aware of this. It should be taught in health class and a matter of common knowledge.”
Marie Cohen started her advocacy efforts on Facebook, reaching out to organizations like Beyond Type 1, which launched its Warning Signs Awareness Campaign in 2016 with a goal of sharing the signs and symptoms of type 1 diabetes to prevent unnecessary tragedies and complications. She currently serves as a national advocate in her state, disseminating posters within her community and collaborating with the organization on ways to spread awareness on the warning signs of type 1 diabetes. (Editor’s Note: Sign up here to receive posters to share within your community.)
When asked about Michael’s future, Bubeck said the hope was that Cohen would have returned to Microsoft and continue research there.
“He wanted to be an academic working on the real interesting questions,” says Marie Cohen. “His dad is an academic, professor of physics at University of Maryland.”
“All of us felt that the best was yet to come,” agreed Bubeck. “Despite his amazing results and already the very large impact he had, the feeling was that there was even greater scientific discoveries to be made by him. I am convinced of that.”
Learn more about Beyond Type 1’s #SeeTheSigns of Diabetes Awareness Campaign here.
Jesse Was Here, a program of Beyond Type 1, is supported by the JDRF—Beyond Type 1 Alliance.