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Hypoglycemia Chronicle #1: Thanks, Popeye

About five years ago, I stumbled upon an industry of psychologists who promoted the many benefits of gratitude. Citing studies that show that grateful people are happier and healthier, they recommended keeping a “gratitude journal.” I tried but it didn’t work. I rarely had a palpable, physical experience of gratitude, just didn’t seem to be built for it. But lately, while planning a blog on diabetes and mulling over its impact on me, I have found it easier to give thanks. One gift of a chronic disease is that it yields a trove of people and incidents that can be used to prompt real gratitude, raw material for a quickening of the heart.

In the summer of 1977,  when I was 23, I washed ashore to my parents’s house in Woodbridge, Connecticut after spending my first year out of college teaching in the Caribbean. I had a broken ankle, memories of a romantic affair that had gone very badly, no clue about how to earn a living and frequent visits from what Churchill, my second favorite depressive after Abraham Lincoln, famously called the “black dog.”  During my first week in Woodbridge, I had some furious arguments with my stepfather. His dry cleaning business was failing, and he was as glum as I was about the universe. So he was understandably unable to welcome the sulking, semi-grown-up step-son sprawled on his living room couch. (more here)

Why Am I Still Alive and Intact?

What’s going on? After more than 50 years with Type 1 diabetes, I am not only still here; thus far I have none of the dire complications I’ve been hearing about since I was a little kid. By ticking off all the things that aren’t wrong with me, I don’t mean to brag, but to convey a sense of astonishment:

People with diabetes (PWDs) are at least twice as likely to develop cardiovascular disease as people without it. The odds against me are stacked even higher because of family history: my father died suddenly of a heart attack when he was only 40. His father died of a heart attack at the age of 53 (it was his third). I’m 59. My body shows no traces of cardiovascular problems. Why am I here at all?!

My kidneys are normal. My eyes are fine, there is no trace of diabetic retinopathy, one of the leading causes of blindness in the U.S. There is no diabetic neuropathy in my feet or anywhere else. I can still make love. Wounds in my toes sometimes don’t heal as quickly as I think they should, and that might have something to do with diabetes, but it’s unclear.

Yes, I’ve wrestled with lifelong depression, and there is strong evidence that depression is also a complication of what I used to call My Shitty Condition when I was a teenager, but it is also a complication of the human condition.

Why have I beaten the odds and remained intact? (more here)

Eliot Joslin and the War Resisters League

Elliot Joslin’s life ended on January 28th, 1962, a few weeks after I checked into Babies Hospital in New York City and my life with diabetes began.

Joslin literally wrote the book on the disease (the Joslin Guide To Diabetes, a popular guide for decades) and founded the Joslin Diabetes Center in Boston. He was well known for his fierce insistence on relentless, tight blood sugar control as the key to staving off diabetic complications. Not all clinicians agreed with him, but I’m fairly certain the diabetes clinic at Babies Hospital took its cues from the Joslin group in Boston

It was only after reading Cheating Destiny – Living with Diabetes, by James Hirsch, that I began to fathom Joslin’s influence on my psyche. Hirsch notes that Joslin had roots in Puritan New England, and that one of his ancestors was sentenced to death during the Salem witch trials. On Joslin’s office wall hung a picture of John Wesley, the founder of Methodism, who believed “each man could control his own fate through faith in God and virtuous conduct –a message of personal responsibility that Joslin would impart to his patients.” So he drilled into caregivers and patients the notion that diabetes “was not strictly a metabolic disorder but a profound moral challenge that tested the character of its patients…While he praised those who successfully managed their disease, he faulted others for their own demise.”

In other words, he helped to keep many people alive…and somewhat miserable. (more here)

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Diabetes, Inner Chatter and the Monkey Mind

In a fine essay about Type 1 diabetes, Riva Greenberg conveys how much mental energy is necessary to “stay between the lines” –e.g., keep blood sugar within the narrow range displayed on her continuous glucose monitor:

If you met me…you would have no idea that half my mind space is not free, like yours. It’s busy doing what it needs to do to stay between the lines: guessing at the amount of carbohydrates in my meals, then checking my blood sugar to see how well I guessed. If not well, taking another injection or eating.

Or I’m preparing and drawing up my shot of insulin, also guessing at the dose, and remembering where on my body I took my last three injections so I don’t inject in the same place which can cause scar tissue.

Or I may be switching my syringes, checking my stock of pen needles, putting on a new sensor, ordering more supplies, and feeling my blood sugar plummet when I only meant to lower it a small amount. Then berating myself for over-compensating…

…That’s why the simplest I can put it is Type 1 diabetes is staying between the red and yellow lines all day and night, every day and every night.

Well said. What’s more, the incessant chatter that dominates the inner life of people with diabetes (PWDs) can feel like a terrible burden. Much of the time, nearly everyone has what some meditators call a “monkey mind,” which leaps constantly from one thought branch to another, one feeling to another. But if you are an insulin-dependent PWD, you have many extra branches for your monkey mind to grasp, and it is generating more noise, more instructions, more screeching, than the minds of non-diabetics. And you feel like you need those branches in order to get through the day. Greenburg conveys a distinct sense of being embattled, grim and weary because of this, which I’ve often shared.

One way to ease this burden, like every other burden, is to laugh. Chuck Eichten offers an uncannily accurate picture of a PWD’s inner babbling about food when things are not going smoothly on the metabolic front: (more here)

Coming Soon

Thinking with the Bodymind