Doug’s beard and mustache were integral to his visual self-image, having spent almost his entire adult life faithfully maintaining them. With the resolve of Samson he wouldn’t let the convalescent staff take a pair of scissors to the ensemble in the many months that they were charged with his care. He lay there emaciated, looking up at me from sunken eye sockets, as if recently liberated from a WWII concentration camp; his drawn features etched with sadness and desperation, his once proud facial hair caked with the remains of meals past.
His could feel his end nearing and wished he were anywhere else.
My father, at fifty-seven years old had lived almost three decades as a Type 1 diabetic, a smoker and a functional alcoholic. Years of poor diabetes management and wildly fluctuating blood sugars had taken a tremendous toll on his health. He’d had so many ambulance rides from low blood sugars that he was afraid to take enough insulin to prevent his body from wasting, and suffered episodes of dehydration due to resulting high blood sugars. Then came several other long-term complications; impotence, declining vision and strokes.
By this point he had wasted away to just one hundred pounds. Due do the damage from his strokes, he could no longer support his own weight, as meager as that was. I had received the tearful call from my sister days earlier saying that it was time to come and say goodbye. After yet another of a series of strokes, his doctor was dubious regarding his chances of surviving the week.
Our relationship had suffered its ups and downs over the years. Mostly downs. While still in my teens, I’d walked out of a holiday dinner following a blow up over both his treatment of my grandmother and years of repressed anger over his alternately absent and capricious history of family leadership. I never returned, and years went by without a word between us, but then a window of dialog opened when my grandmother passed, and stayed open for Doug’s remaining years.
By the time I had turned twenty-eight I’d spent so much of my life defining myself as ‘not my father’ that I wasn’t sure who I actually was independent of his polarizing influence. Then my immune system gave me the opportunity to fully appreciate some of Doug’s day-to-day struggles. I went to the hospital after weeks of increasing fatigue, a bottomless thirst and urinating at least once an hour, day and night, and after having lost a considerable amount of weight. At twenty-eight and ten months, the exact age as was Doug at the time of his diagnosis, I received the diagnosis of Type 1 diabetes.
I’d settled in the San Francisco Bay area after a few years in the military and bridged the distance to my father in Sandusky, Ohio with a phone call every couple of months. That phase of our relationship was my opportunity to appreciate with the eyes of an adult the person that had behaved so counter to my youthful idealism. I learned that my moods, mannerisms and style of communication, while more under control, were not all that different from his… a revelation that I’m afraid caused me to lose respect for myself more than gain an appreciation for him.
As long as I had known my father, he had kept his diabetes care and concerns to himself. Had it not been for the needles and bottle of insulin at the bathroom sink, I may not have known. After my diagnosis, Doug pulled a reversal and used our shared condition as a bonding opportunity. He had a morbid need to talk to me about the bitter prognosis for our old age as insulin dependent diabetics. The litany of his maladies became our main topic of conversation, as I witnessed his rapid decline from twenty-four hundred miles away.
That decline stirred a battle for space in my heart between empathy for his plight and resentment for my genetic inheritance; my sense of dread over what I perceived subconsciously was our shared fate. I still clung to the illusion of immortality that is youth, and that denial had led me to call less and less often.
Now I sat by his bedside, for the first time seeing the degree to which he had wasted away; shocked at his frailty. I asked him to let me clean and trim back his facial hair, as much out of a wish to recall the icon I remembered from back when I was a toddler and he was still infallible as to ease the effort it took to feed him solid food. That act of grooming became the final act of tenderness between us before he passed.
I would like to say that observing the consequences of his bad choices made me more devoted than ever to care for my own condition, but the sad truth is I spent more time in denial than proactive self-care. With a perceived inevitability, as I approached my mid-forties, I began to notice a few frightful symptoms. While I had never either smoked or drank alcohol, and stayed physically active thinking that it was the best way to keep my insulin resistance down and my blood sugars tamed, diseases of chronic inflammation driven by high blood sugars started to manifest. Adhesive capsulitis made push ups and chin-ups a thing of the past. A neuroma in my foot presaged by an arthritic ache in the toes above the affected metatarsals brought an end to my running. Despite the ache deep in the joints of those toes, a numbness started to creep across their surfaces. Not enough that I could not pass my endocrinologist’s quarterly pin prick testing, but I was aware that the fullness of their sensations were ebbing.
Today, however, I have full feeling in my toes, minus the arthritic ache. The neuroma instead of my running, is a now fading memory. I can do pull ups to exhaustion without pain, and push ups in moderation. While I am not sure that this near full reversal would be possible had I not changed my eating habits so early in their progression, I am confident of the following statement: Regardless the stage where you begin turning things around, you can manifest much less of the debilitating effects of this disease with a diet that greatly reduces your insulin requirements and tames your inflammation.
How my self-care evolved to this point had surprisingly little to do with a desire to care for myself. It was not a matter of getting more self-disciplined. It was not a result of beating myself up over my neglect of the disease’s progression. It was the result of a wish to help a friend who was struggling with weight-loss, honoring a commitment I once made to myself to run a fifty mile ultra-marathon before I turned as many years old, and my obsessive need to thoroughly research and understand the history and mechanism of any subject in which I take an interest. Once I made the distinctions necessary to change the way I ate — a way that runs counter to the conventional “wisdom” about the proper diet for diabetics — and ritualized my recording of meals and dosing, my numbers naturally began to fall in line without much effort at all.
To be quite honest with you, I’m not always perfect with my diet, and quite often fall short. (Damn you Halloween inspired, free-chocolate filled cookie jars at work! Why are you so perfect a target for my anxiety eating?!) But the standard I compare myself to, and the ease of self-care that I experience when I am on track is so much more compelling than riding the blood sugar roller-coaster that I never stray very far for very long. Perfection is the enemy of progress, and falling short of a desire for perfection is a recipe for depression. All that we can ask of ourselves is progress.
A friend recently asked me about my motivations for writing this blog. She knows why, but she was concerned that my readers didn’t and that I get so into the biological minutia that I might lose people on the bigger picture. This essay was an exercise in answering that question. While I still think my first real introductory post has value, this is the one I wish I had posted instead.
This blog is a record of distinctions I have made over the years which lead me to this point. A point of vitality and health; a point of feeling mastery over challenges that our friends without diabetes can never fully appreciate. I write for Type 1 and Type 2 diabetics alike, out of a sense of duty to share with others a path out of the dark forest of diabetic complications. It is a path that I wish I had found in time to help Doug escape his fate. If you are reading these words, then it is a path you can walk too.
Don’t be too hard on yourself. Take what makes sense to you and leave the rest.