The Angry Type 2 Diabetic: April 2013

Friday, April 26, 2013

Temptation Wears a Red Dress Pin

Many of you might know that, currently, I work as a cashier for a local restaurant. It can sometimes be a fast paced job, with unique 'diabetes adventures,' as well as unique opportunities to meet people. Sometimes, it's just an opportunity to see people react weirdly to their environments.

Our restaurant isn't exactly a health venue. It's a local fast food type joint, which has at least, some merits: it's privately owned, it makes all of it's food fresh-from-scratch, and since it's family owned, the people are wonderful to work with. For the most part. Every job has it's ups and downs.

I admit I've never been what you would call -- a people person. But I can be a congenial person, and I do love watching people; studying them in their environments, when they think I'm not watching them. Especially as a cashier. Cashiers are like wallpaper to a customer.

One thing which has come as a sort of surprise to me is that most of the people who eat at our restaurant are pretty thin. They'll order the largest thing in the whole joint, deep fat fried, and a trash-can sized cup of soda. Some come and eat this EVERY DAY. Always looking the same weight. Lucky bastards. Then there's the heavy women. They're always ordering salads. A salad, and a cup for water... or a salad, and a diet Coke. And they always look heavy. They never seem to lose weight.

Of course, I don't live with these people -- I don't know what they do or eat when they're not at our restaurant. Who knows if the thin people go running every day, or if the heavier people go eat their entire refrigerators, later. I don't know. But it's a very interesting thing to watch. It makes me feel curious about all the accusations people always have for the obese, like they live, and breathe, fast food... and the level of self awareness some of them must have when they dine out.

And speaking of self awareness... a very curious thing happened to me last Monday. This slender, tall, vivacious looking woman approaches the register, and I happily greet her. She makes eye contact with me, and suddenly, starts freaking out: "Please don't judge me for what I'm about to order because I'm wearing a red dress pin, and I'm about to order really unhealthy food." Quite frankly, I hadn't even noticed the red pin. I was simply more intent on getting her order, and getting it right. I tried to reassure her "Oh, don't worry, it's okay." She looks at me, half smiles, and places her order: two fried items, with a side of fried tater tots, and soda. Then she says "You know, we're allowed to have a treat once in a while." Again, I offer the supportive reply, "Of course. I completely understand." Then she looks flustered, and says "You know what, I'm just going to take it off," as if it were an electronic ankle bracelet, from her local parole officer.

So many responses ran through my mind... like "Lady, I don't give two shits about your damn red dress pin." Obviously, I couldn't have used that one. I smiled warmly, and just offered a light-hearted "Oh, don't you worry yourself about it!," and with a side wink, an "I won't tell."

I also thought... Should I have told her "Hey, I have diabetes. I understand?" I didn't do so... I try not to tell people too much about my private life -- mostly, because I can tell people like that wallpaper feeling when they get their food. (I admit, I don't care too much for knowing people's personal stories when they're just selling me something.) I also thought to myself, "What if she judges me the way she thought I was judging her?" She might think to herself "Of course she has diabetes... look at where she works!" or "look at how heavy she is!" or some other lame conclusion -- as people often love to believe about us people with type 2 diabetes.

But I have to admit, I was quite surprised at her. She felt guilty, from the pin, and it made her aware of her behavior. It was giving her an accountability -- which was only in her mind, really -- but which was a reminder to herself of how she wasn't taking care of herself.

That this woman was embarrassed because of a disease she didn't even have, and of choices she knew were poor, was quite the irony... She may have the option of removing her red dress pin, and ending the stigma, but people who are obese can't easily remove their weight, and put it away, like some sort of suit, and weird fashion statement. We can't easily shut down the stigma, and judgment, others might give us for our condition -- nor can we cure our diabetes with a green salad and a diet Coke. And I sure as heck wish I could 'put my diabetes away,' like some kind of pin, for when I wanted to eat junk... as I'm sure many women with heart disease might wish they could do the same.

And I thought... well, maybe I ought to get a diabetes pin. A pin which always reminds me that I must care for myself. That my health is important... a pin which might make people ask me what it is, perhaps. Blue Fridays is just something meaningless at my workplace, because all my shirts are blue. :-) No one would think to ask, nor could I claim it was 'my choice.' But a blue circle pin, on the other hand... that's a different thing.

A blue circle pin can be awareness, accountability, responsibility, and advocacy. A way to not only remind ourselves of how we matter -- to care for our own bodies -- but to also show others we can do this, and we're not afraid to show it. If I feel bad, on a certain day, I can always take it off.

It's an idea, anyway... Do you feel self conscious in front of strangers when you order junk? Pin, or no pin? Some people always seem to emphasize the diet drink, especially. That's a DIET drink, with the side of fried food. heh We're silly humans, after all.

We're all just so easily embarrassed, I guess.

But perhaps it ought to be a BIG reminder that if we can't handle the imagined stigma of any one disease, even for ONE moment, perhaps we ought to be kind to those who CAN'T easily remove any of their health challenges, like a pin. We need to give others some empathy, some respect, and some space... Especially, when it comes to occasionally letting their hair down, and tasting life.

Wednesday, April 17, 2013

The Privilege of Living with Diabetes

Dear Beautiful Person (who happens to have diabetes),

Today, you are here. Is there a purpose to your being here? A universal, master purpose? Many claim to have the answer to this, but the honest response is that no one knows. The question is, in fact, irrelevant. You are here. That is a fact. Everything else is just speculation.

It matters not if it's an illusion, a grand plan, a godly design, or a happenchance. You are here.

And while you are here, think upon the magnitude of your existence: The last science knew, the universe was 13.8 billion years old. During much of that time, Earth was a big, hot mess. Life only began to evolve 3.5 billion years ago. Modern man, alone, has only existed for about 200,000 years...  and only in the last 30 years or so, have we seen vast improvements in industry, technology, education, science... and medicine.


If you would have been diagnosed with diabetes (of almost any type) back in the 1800s, it was most certainly a death sentence -- if not, a very challenging life.

Insulin wasn't discovered as a treatment for diabetes until the 1920s, thanks to Banting and Best, when many children were literally dying of malnutrition and emaciation. Banting had the heart to insist on not patenting their new-found medicine, so that it could reach as many as needed it.

Metformin was invented in the 1920s as well, and has been used in other countries since the 40s, and 50s. It was not, however, approved in the United States for use with type 2 diabetes until 1994! Yes, that is not a typo. 1994.

Back in the pre-insulin days, starvation was all people knew to do to control diabetes. To eat basically no carbohydrates, or really anything much -- as proteins and fats can also raise glucose (though, admittedly, to a lesser degree). Many simply died because it was so stressful -- or they just couldn't resist pinching food, while no one was watching.

It wasn't until the 1980s when a person with diabetes was able to monitor their levels, independently, and the first glucose monitors appeared. If they had insulin -- that was a good tool -- but if they didn't, all they knew to do was avoid eating sweets. Diabetes has always been with us, at least in the archaeological records, since Egyptian times, and we've known it's a disease about high glucose, but aside from that, there wasn't much monitoring of glucose levels until well into the 80s. Ask anyone who was diagnosed many years ago, and they will tell you stories of urine testing (sometimes, once a month, at a doctor's office), and sharpening and boiling their own needles, for sterility.

In fact... we really didn't know that diabetes was not a disease caused by eating excess sugar and sweets, until at least the early 90s. The other day, I saw a very old VHS tape for an old Vitamix blender I have acquired, and in it, they recommended diabetics substituting honey, in place of sugar. I guess in their minds, anything that was natural sugar, was not really sugar.

And here we are now... 2013. With a variety of different types of insulin, mimicking both basal and bolus outputs from our pancreas, insulin pumps and CGMs to allow us to eat with more freedom and catch hypoglycemic events, the knowledge of counting carbohydrates and the freedom to eat cake, diabetes alert dogs, and glucose meters small, sleek, or indistinguishable from an iPod, small, and painless needles... and on the thresholds of smart insulin, biohub and artificial pancreas options, and noninvasive glucose testing.
. . .

Yes. Diabetes is still hard. But we are blessed to live in 2013, and not 1913. We can see ourselves as the victims of fate, or as the blessed recipients of a grand universal lottery. Think about the kind of life you have the chance to pursue, right now... that you would have never had a chance to pursue back then. Let it sink in -- let it's blessings humble you. 

Yes... diabetes can be embarrassing. But all disease is humbling. 

Even if you never had diabetes, life is much of an embarrassing process, as well... At birth, and near death... someone has to wipe our behinds. We get old, and lose our good looks... we may get cancer, and lose our breasts, we may get alopecia, and lose our hair... We may be like Farrah Fawcett, and get colon cancer -- colon cancer. 

Illness is humbling -- for we have to accept that we are frail, that we get sick, that we get old, and yes, sometimes... that we haven't always done the best to take care of ourselves. But, can you think of anyone who has been perfect -- all of their lives? Always perfect? I know one or two who claim they were -- and you know what -- I honestly don't like them very much. For one, they are liars. They may have read the manual on living, but they haven't actually lived very much. No one learns to ride a bike from reading a book -- and thus it is with living. Some of us just have to fall a few more times, than others... and it is our beautiful, gnarly scars, which make us who we are.

I never thought of Farrah Fawcett as much of a hero -- until her war with colon cancer. And I never thought much at all, about Ryan O'Neal, until his passionate devotion to the woman he sought to wed on her deathbed. 

Don't be angry at your loved ones, beautiful person (who happens to have diabetes). It is not a matter of blame. It is not a matter of fault. Don't leave this world, and lose hope... for these massive amount of events I have listed had to have gone through... and for you to be here, in this point in time. Your loved one, well... your loved one simply LOVES you. They are in deep fear because they do not want to be without you -- at least -- not sooner than life will will. Can we blame them? 

I was angry once... at my father for (in my own warped perception) not trying harder, at life and circumstance, and God, and you name it. I was once that angry loved one... living in FEAR. Sheer fear. But, you see... for whatever reason, you are here -- in this very moment in time, and a time when you happened to meet your loved one. This is a very precious moment in time... In fact, to quote Lawrence Krauss -- a renowned Theoretical Physicist: 
“Every atom in your body came from a star that exploded. And, the atoms in your left hand probably came from a different star than your right hand. It really is the most poetic thing I know about physics: You are all stardust. You couldn’t be here if stars hadn’t exploded, because the elements - the carbon, nitrogen, oxygen, iron, all the things that matter for evolution and for life - weren’t created at the beginning of time. They were created in the nuclear furnaces of stars, and the only way for them to get into your body is if those stars were kind enough to explode . . . The stars died so that you could be here today.”
Is diabetes embarrassing? Well, sometimes... But I am in fact honored to be so privileged to be alive, today... right now... Experiencing this universe, the love of friends, and family... The patter of rain on my window pains, the loving purr of my cat, and the imperfect love and friendship of that idiot that still lives here which I call my husband.

Yes, I am honored... to be living here, and living with diabetes.

Thursday, April 4, 2013

The Diabetes Funk

One of the wonderful things of having a blog is that, often, people ask you deep questions; deep questions which you may be working towards resolving, yourself... (unbeknownst to the reader) thus, giving one ample opportunities to think "out loud," if one could, on the internet. 

I'd like to address one of those questions...

It's a particularly common one. Many people ask me this question, and it's truly one which is bound to come up in a person with diabetes' life sooner or later: "How do I get out of a funk??? Can you point me in a direction to get my eating back on track?"

I think it's safe to say, this question has no easy, or simple answer.

Whenever we get into a funk, we are in many ways, tired of the burden we have to bear. We have to come to grips with that, and acknowledge it, before we can even begin to understand how to fix it.

We have to recognize that we are tired... 

In particular, with type 2 diabetes, we are tired of having to guard against an invisible monster -- who much like the boogeyman under the bed, or inside the closet -- seems as a figment of our own imaginations. That's the big problem with pre-diabetes and type 2 diabetes -- particularly, at the stages where we have no complications, or can manage with just diet and exercise, or even with some oral medications. How does one keep being a lookout for something that never seems to show up? How can one take it seriously? Why does one need to keep taking pills for something that doesn't seem to show up? It seems a bit hard to believe that the minute we stop being a lookout, something will show up. And then... outsiders don't help. They can't see anything serious, either, so many egg us on to just 'enjoy life,' or to quit being 'melodramatic.' "Come on, it's not like you have cancer."

This particular dynamic makes it hard to commit to making serious changes in one's health, particularly when one has had a lifetime of other choices etched into our internal scripts.

We have to recognize that this is real... 

Sometimes, we forget that the point of the exercise is NOT the waiting for something to show up -- but to intimidate the something into NOT showing up. It seems as a futile exercise with no rewards. But... if I shine a light in the closet, well, the monsters never materialize. The child never asks "But what's the point of this flashlight? I never see monsters in the closet, so why should I need it?" No. The child merely reasons "the flashlight scares the monsters away, and keeps them from coming." The things we do... the exercise, the diet, the medications. They all come together, in one big, powerful flashlight.

We can change part of our mindset by simply changing how we ask the question.

Now, how sensible would it be... if a person with HIV decided that all their treatments were pointless, because AIDS was not a real threat (somehow)? And we all understand how nonsensical it is for a person with a deep mental health concern, to forgo medications, because they now feel well... But it is, in essence, the same dynamic. We are all fighting to keep something larger, at bay, which is as real as full blown AIDS, or as real as cancer. In fact, it is so real, that diabetes kills more people than AIDS and breast cancer, COMBINED.

Yet, people like to speak of it as if it were a mere inconvenience -- like some kind of bunion on your foot, that bugs you when you walk... when it's more of a darker, more sinister situation. I'll save you the metaphor... I'm sure you don't need it, right now. But I'm sure we've all been there, and thought deeply about the darker sides of diabetes.

We have to recognize that diabetes is scary... 

Especially when people are always gracing us with stories of their Aunt Jenny, who lost her foot, or their Uncle Bob, who had to go on dialysis. Diabetes can instill a serious dose of fear into those who live with it, and who struggle holding up that flashlight into the closet -- often making us feel we're doomed into an uncertain future. We get tired, we don't want to face reality, and we get scared into inaction. And it's probably because diabetes is more like an endless night, and the flashlight eventually needs new batteries.

So we fumble. 

We fumble, and we won't eat 'right,' or we won't take the god-awful medications, or we 'fudge' the insulin. We want to pretend normalcy, again. We want to believe we live in a world where we are not the ones with diabetes. Or, perhaps, where we sinned and then got diabetes. But... why shouldn't we be the ones with diabetes? Do you know of anyone else more worthy of having diabetes than you, or I? More deserving, somehow? Who had it coming? What makes someone worthy, or not, of having diabetes? Or of having any disease? The answer is nothing. Both birth, and death... happen to all of us. The number one risk factor for getting ill... is living. And if you enjoyed your living, thus far, make peace with it. Don't somehow, 'forgive yourself',' as if you've erred. You haven't. No. Make peace with it. You lived, you loved... and that's what we ALL do. In our own way. Now it's time to live differently. To enjoy differently.  

Diabetes is not a judgment on your previous life; it is merely, a different life. In many ways, coming to terms with accepting diabetes, is coming to terms with our own mortality, for managing one, is preserving the other. 

And we have to strive to preserve life, to enjoy life. To take life one step at a time.

We have to recognize that it takes baby steps...

It takes baby steps to accept our life, our mortality, and the things we need to embrace to preserve that life. Managing diabetes is an exercise in self-love. And self love is something that takes a great deal of patience, and self-awareness. 

There are a few things one can do, such as:
  • Start small: Seek to make one small change a day, and focus on it for an extended period of time. Perhaps that change can be as small as taking your medications as prescribed, until it becomes an innate habit. Or, perhaps that change can be going out for a small walk around the block, every morning... Maybe even just having ONE meal a day in which you have a non-starchy vegetable. You get the idea... 
  • Work on other projects: Often, when I feel my health life is a mess, I simply go and deep clean the living room, or the bedroom, or the bathroom... or I organize the kitchen. It seems silly, but it often helps give me motivation to take on almost anything -- and put it back in order. Plus, it helps give me some immediate victories to focus on, and not look for the constant 'far away' victory of 'not worsening my diabetes.' In essence, I shift the focus to something else, more immediate. And it's silly, but it helps me feel a bit whole. It's a great big victory when one has cleaned out an entire closet full of junk! So... shift the focus.
  • Give yourself time off: Diabetes is like a job. Diabetes IS a job. It's a 24/7 job in which you get no time off, and constant worry. You're meant to always watch your health, mind what you eat, and test, test, test... always worried the boogeyman is coming through the door. We tend to get very strict with ourselves -- jump on all manner of fad diets, cleanses, and various things -- because we want to fix the problem NOW. (It's a leftover problem from how we deal with weight, and obesity, and they don't work, and they are wrong.) Look... even skinny people let their hair down once in a while. Schedule one day a week, where you let yourself have some kind of fun, with yourself -- or friends and family -- and look forward to it. You can have a slice or two of pizza... if you like. The world will NOT end, and your foot will NOT fall off. 
  • Do not judge yourself: "I can't believe that wimp's been running that marathon for 10 miles, and he's already tired! Let's berate him until he makes it to the finish line!" -- said no one, ever. Diabetes is a marathon. You're going to get tired, emotional, upset... and sometimes make bad decisions. IT'S OKAY. Tomorrow is another day. Recognize and accept those feelings. DO NOT ABANDON YOURSELF. Simply acknowledge yourself... and see what you learn! Tomorrow is ALWAYS the beginning of a brand new year, not January 1st. 
  • Don't hide: Find a support system. I know... family, and friends, often don't get what we go through. But if you're reading this blog, you're probably already a bit familiar with the diabetic online community. In it, you can find lots of people who like you, and I, are going through this struggle. You can vent to us! We know, and we can relate. There are a lot of places where you can read through people's sincere journeys of struggle, and hope -- or where you can read others' questions, and learn from the responses they get -- even if you want to remain anonymous. 
  • Ponder the benefits: Do you like feeling good? Do you like having energy? Do you like feeling confident that you can set, and complete goals? Do you like not getting sick as often? Do you want to have health and energy for your family? I know I take these for granted more than I would like, and when I do... it's easy for me to get into a funk. 
  • Seek appropriate medical advise: Find a medical team that is willing to work with you, and to educate you. If need be, find a therapist who has experience with patients facing chronic health conditions. Diabetes is very much a psycho-social health condition, as well as a physical ailment. It's very hard to make progress when you work with people who seek to blame you, or leave you off on your own, with few tools to work with. This also goes for managing any side complications you may have, which may add to the burden of diabetes, such as hypothyroidism, depression or carpal tunnel worries. With carpal tunnel, for example, a good doctor can set you up with overnight braces, to keep pain at bay, as well as with a steady Vitamin B6 therapy to help reduce inflammation. Proper hypothyroid medication can also help reduce depression issues. And -- it's important to mention -- that reducing blood glucose levels helps improve ALL of these conditions to some degree, or another. 
  • Seek to learn about 'the funk': There are quite a few resources, available, from persons going through 'the funk,' which can help you be better prepared the next time you feel you might stumble. The goal isn't so much 'averting' a stumble -- but learning from it, and getting back up!  
As a person living through her third year of a type 2 diabetes diagnosis, I am far from being an expert in these topics. I struggle along like a blind man, in a dark room, trying to find a black cat. I have to constantly remind myself that, though I may know how to play the game, I need to actually play the game. I hope that, even with all the things I have said here, just the thought of knowing someone else out there is going through a similar battle... is enough of a wind beneath your wings. 

It's certainly given me an excuse to ponder some of these things... a bit more than I would like. :)