The T1D Cowboy
11/3/15
WRITTEN BY: Paul Britt
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I still remember the days of realizing that I was T1D – because of my medical background as a search and rescue professional, I recognized the signs. Before I ever got sick enough to go into DKA, I called my doctor and said, “I need to come in and get diagnosed with diabetes.”

The receptionist on the other end of the phone almost laughed, as if I couldn’t possibly know what I was talking about. At 29 years old, I walked into my local clinic in Missoula, Montana, wondering what it meant for the rest of my life.

Many years ago I had left my small rural hometown in North Carolina and moved to the Rocky Mountains in pursuit of a life that I had always dreamed of. I made my living as a cowboy, elk hunter, fly fisherman, ski and snowboard instructor, and search and rescue technician. I had friends and family from home tell me constantly that they couldn’t believe what I was doing. Now, I was sitting in a doctor’s office waiting for them to tell me whether my suspicions were true or not. I wondered what it would mean for me if I was right.

When my doctor came back into the room, he “regrettably” said I was right. I was T1D. He was a PA with little knowledge regarding diabetes, and I left with instructions to start at 15 units and increase my daily Lantus dose until I woke with a fasting BG under 180. I went back to work the next day, at the ranch I was currently managing, and didn’t tell a soul. Two days later, when my blood work came back, he called and told me to go to the emergency room because I was on the verge of ketoacidosis. It was during that first ER visit that I was given Humalog for bolus injections in addition to my basal, and learned that I would be pricking my finger and sticking myself with a needle four to five times a day. I was floored. I had no idea how this could possibly fit into my active, outdoor lifestyle. I used to take people into the mountains for days at a time and keep them safe. I used to go and find and save people who had lost their way or become injured. How could I, now practically an invalid myself, continue to do what I loved and share it with others?

My world collapsed as I struggled to come to terms with the cards I was dealt. I went several months without telling my closest friends, still in Colorado, or my family in North Carolina. I told just a few of my coworkers, purely out of fear of passing out from low blood glucose. They did their best to support me, but I didn’t accept it because they didn’t know what I was going through in my mind’s eye. There were plenty of times where I had to ask for something with sugar in it, and in retrospect, they were probably keeping things around just for me. I allowed my diagnosis to interfere with my social and romantic life.  In public settings, whether it was an evening with friends or dinner with a lady, I would excuse myself to the restroom or outside to check my blood glucose or give myself an injection before a meal.  I was afraid that disclosing that I was diabetic made me less of the man I wanted to be.

In my perspective, no real cowboy or mountain man had ever been handicapped the way I now was.

Due to my inability to accept and embrace the wonderful opportunity I had to continue living a healthy life, my blood glucose was often out of control. It wasn’t long before I had my first hospital visit for DKA, in one of the worst ways imaginable – on a multi-day rafting trip with my best friends on the Green River. I was responsible for rowing the raft with all of the overnight gear, and was one of three true river professionals. Myself and my two best friends were responsible for getting six other people down the river safely, and I couldn’t even manage that. On day two, I went into DKA. It was 25 degrees and snowing, and a swim could have been fatal, but I was so sick I had to let one of the less experienced members of the party row in my stead. I was mortified. That night, my friends wanted to take me to the local ER, but I knew if they did that, I would end up in the hospital in Salt Lake City so I insisted that we go back to Colorado and told them I was alright. Of course, as soon as I went to the clinic in our old town they sent me to Denver to the ICU. Lesson learned? Of course not.

I’ve been in the hospital twice since then, once as the result of another multi-day rafting trip, which I was guiding on, and once out of pure stupidity on my part and failing to have another Omnipod on a two-day road trip. Every time, I kicked myself, beat myself down, feared the moment my wonderful and supportive endocrinology team would walk in the door of my hospital room.

By my second visit in Montana, both the ICU and med floor nurses knew me by name. Evidently I was the only 30-year-old outdoorsman that routinely walked into the hospital in a cowboy hat because he was unable to accept reality and take care of himself. Luckily for me, the nurses cared. My endocrinologist cared. Someone else that had come into my life because of T1D cared. The last time in the hospital, my nurses gave me the grief I deserved. My endos came to my hospital room and told me that no questions asked, I was coming for a follow-up and we were going to get it sorted out. A white rose showed up from across the country, from that someone else with T1D. I decided that day to get it right.Because of the support that I was shown by people I didn’t think would care about me, and the love and inspiration shown by someone who was 2,000 miles away, I completely changed the way I approached my relationship with diabetes.


I spent the rest of the summer wearing sleeveless shirts so that my Omnipod was visible and the conversation could come up with complete strangers. Guests on my whitewater rafting trips, other bikers at the Harley Davidson shop, and pretty much anyone I met asked about my pump, and finally, I was ready to tell them! I was finally proud. Proud that I was continuing to do the things I do, to live the life I live, with T1D.  I find that I have made the most important decision of my life – I am going to live, and live beautifully, even if T1D has to be a part of my everyday life.

Everyone will be presented with an opportunity to do great things in their life. For me, our opportunity to do great things, even in the face of T1D, is even more amazing. The greatest calling in life is in the service of others, and as a community, we have that ability, even if we don’t see it at first. Love and support each other, inspire and encourage each other, and give each other the strength and determination to live our lives the way they were meant to be lived – Beyond Type 1.

Paul Britt

Paul is a cowboy, elk hunter, fly fisherman, ski and snowboard instructor and search and rescue technician who has called the Rocky Mountains home for the past ten years. Originally from the foothills of North Carolina, Paul has spent time roaming through Colorado, Montana, Wyoming, Utah and Idaho. He was diagnosed in February 2014 and graduated from insulin shots to an OmniPod Insulin Pump this past Summer! Paul lives beyond by continuing to ride, continuing to explore, continuing to share his passions, continuing to show other the way and by getting back on when he gets bucked off.