Blood Sugar Purgatory

I take the meds, three different kinds, religiously. (Add up all the different drugs various doctors have prescribed over the past 10 years, and I've been on about eight kinds at one time or another.) I've even learned to inject insulin every evening. It's no big deal, really. Not painful. Just one more tiresome task to add to the average day's other tiresome tasks. If I did the evening shot plus one before every meal, as my doctor recommended, now that could be a bother. Oh, and of course, assaying my blood. Each morning. If I were truly doing the right thing, I'd stick my finger and collect a drop of blood on the test strip of the glucose meter at various times after every meal.

But the thing I -- a type 2 diabetic -- can't quite reconcile myself to is reading about my condition, beyond the basic minimum. What I have come to think of as the Official Medical Literature on diabetes is worse than boring, although it could put a coffee tester to sleep. It's written by people (well-meaning people) who live in an alternative universe.

There is no cure for type 1 or type 2 diabetes, you see. (They are different enough, while both involving excess blood sugar, that some authorities question whether they should even have the same name.) Medical science has been brilliant at overcoming infectious diseases; chronic diseases, not so much.

With no cure available, the best the Medical Establishment (which includes institutions like the American Diabetes association, the Mayo Clinic, the pharmaceutical companies, and popularizing writers who synthesize the Establishment guidelines) has no recourse but telling patients how to ameliorate -- "control" -- their diabetes.

Thus, the typical product of the Official Medical Literature starts by explaining the features of the disease, then the dangers: vastly increased risk of heart attack, stroke, blindness, kidney failure, and limb amputation. It's enough to freeze a patient's blood. (Blood sugar popsicles?)

Then comes the sermon about how ("most") people can control diabetes through diet and exercise. And a little emotional massage. You can really do it!

The diet exhortations could fill a book, and do. Read food labels. Count calories. Count carbohydrates. "Size up" your servings. Use "exchange lists": if you have a craving for some verboten food, you can enjoy it by knocking off some other food. The Mayo Clinic says:

An exchange is basically one serving within a group. One starch exchange, for instance, might be half a medium baked potato (3 ounces) or 1/3 cup of baked beans or 1/2 cup of corn.

"I had a busy day in the Starch Exchange today. Sold half my baked potato holding, bought a half cup corn. I'm telling ya, the smart money is buying into corn."

Your dietitian will recommend a certain number of daily exchanges from each food group based on your personal needs and preferences. Together you'll decide the best way to spread the exchanges throughout the day. Exchange lists, which are developed by the American Diabetes Association and the American Dietetic Association, help ensure variety in your meal plan as well as the proper serving size for foods to help keep your blood sugar level within your target range.

Next, the orthodox diabetes manual will list a bunch of healthful (although they always call it "healthy") recipes. Here is "Grapes and Walnuts With Lemon Sour Cream Sauce" -- not even an entree but a dessert -- again courtesy of the Mayo Clinic:

Ingredients: 1/2 c. fat-free sour cream; 2 tbsp. powdered sugar; 1/2 tsp. lemon zest ("Excuse me, Mrs. Prandial, I wonder if I could borrow a half teaspoon of lemon zest?"); 1/2 tsp. lemon juice; 1/2 tsp. vanilla extrat; 1 1/2 c. red seedless grapes; 1 1/2 c. green seedless grapes; 3 tbsp. chopped walnuts.

Preparation: "1. In a small bowl, combine sour cream, powdered sugar, lemon zest, lemon juice, and vanilla. Whisk to mix evenly. 2. Cover and chill for several hours. 3. Divide grapes equally among 6 stemmed dessert glasses or bowls. Add 2 tablespoons of the lemon topping to each dish. Sprinkle each serving with 1/2 tablespoon of chopped walnuts. Serve immediately."

Let's visit reality for a minute.

I daresay that most of us could prepare a dish like this, or one of the other diabetically correct recipes, occasionally. A retired chef with lots of time and money might cook something along these lines every day. But how much use is this to 99 percent of people who set the alarm for 7 am, go to work, get home at 6? And then, advisedly, "get active," with lotsa lotsa exercise?

Again, I'm not suggesting that people who write (edit, really: they are committee products) these publications are less than sincere in wanting to help people stay as healthy as they can with their disorder. It's just that they design their idealized program for ideal patients who don't exist, who if they did exist would spend their entire days on diabetes treatment, just as the doctors and nutritionists do.

The average diabetic is trying to fulfill other responsibilities, give his or her family some time, have a little social life, perhaps enjoy a spot of reading or entertainment to round out the day. He looks at these pages of do's and don'ts, checklists, carbohydrate content tables, elaborate recipes, exercise regimens, weight loss tips, motivational cheerleading, "addressing your eating triggers," and so on and says in effect: "Sod all this. If this is how I've got to live to 'control' my diabetes, I'll take my chances."

That is not, of course, a sensible response. Like it or not, all of us diabetics have to change our lifestyle (especially eating habits). But I expect that most do what I do: follow procedures that are practical in their own circumstances, gradually expand the range of diabetes management behavior, and hope for a cure or better kinds of mitigation to be developed.

Meanwhile, we inhabit Blood Sugar Purgatory, neither saved nor damned, cured nor terminal, expecting something or nothing.