Diabetes is considered by some as a disease of self-management. In fact, according to David Spero, author of “Diabetes: Sugar-Coated Crisis,” 90% of diabetes care is self-care. Further, he says, diabetes is a disease very dependent on self-management. Physical movement, healthy eating, blood sugar monitoring and, in the case of insulin dependence, insulin adjustment are paramount in successful control of diabetes.
One must think of all the tasks that are required in the care of diabetes to fully appreciate the effort that must be put forth on a daily basis by the patient, especially in contrast to any other disease. In the case of type 1 diabetes, individuals are immediately thrown into acclimating new tasks into their routine, such as calculating and injecting insulin, frequent glucose testing, changing eating habits, learning new terms such as carb counting, carb to insulin ratios, correction ratios, insulin absorption, digestion rates, etc. Diabetics must not only learn the physical task of testing their blood sugar but also how to translate the results to a form of data they can understand, analyze and adjust to daily life changes.
Type 2 diabetes requires many of the same tasks; however, because this version of the disease is progressive, individuals often (though not always) have more time to adjust to the changes without facing severe adverse symptoms. Doctors may tell them the initial primary treatment is weight loss and, perhaps, a once or twice a day medication such as metformin. However, even the single idea of “weight loss” turns into many other learning opportunities. Type 2 patients frequently must learn “good” carbs, “bad” carbs, carb counting, “good” fat versus “bad” fat, the effects and/or effectiveness of their new medication(s), etc. They may also need to learn glucose testing and that exercise (or as Spero terms “movement”) is of utmost importance.
All of these new tasks, regardless of the version of the disease, require an inordinate positive vision of “self” and self-reliance. The fact that physicians, Certified Diabetes Educators (CDEs), diabetes nurses, and nutritionists are frequently over-extended and often under-educated makes the situation even more problematic. Patients often have difficulty getting quality time with their practitioners, getting insurance companies to pay for required services, test strips or medication. It is enough to make the average, newly-diagnosed diabetic gasp for air just thinking about what they need to do – often by themselves.
Some people are taught to be self-reliant or fall into circumstances at a young age that require it. Others are born to be self-reliant and the surrounding skills come easily. Yet others seem to have a very difficult time being entirely self-reliant and, therefore, need a strong support system. As Spero indicates, patients sometimes require assistance from society. As often stated by then First Lady Hillary Clinton, sometimes it takes a village.
Therefore, I am often reminded of the lessons in Ralph Waldo Emerson’s essay “Self-Reliance.” Often, the first thing a newly-diagnosed diabetic says is “I can’t do it.” Patients often feel that being labeled a diabetic is too hard and too overwhelming. Emerson disputes this as he says “The power which resides in him is new in nature, and none but he knows what that is which he can do, nor does he know until he has tried.” Or, as children are often coaxed, patients can be the “Little Engine Who Could.”
So too do patients often express concern about what others “think” about the everyday tasks of a diabetic. They cringe at altering their eating habits and being pushed to explain their food choices to others, at testing their blood sugar and/or taking insulin in public. Often patients then make poor food choices to avoid the comments; they skip blood sugar testing, or scurry to a dirty bathroom stall to take insulin and pay negative consequences in return. They do not want to inconvenience friends or family members if they need to eat. In response, they choose to place themselves in a position (or others around them) to cope with a potentially dangerous instance of hypoglycemia.
Instead, according to Emerson, “…it makes no difference whether I do or forbear those actions which are reckoned excellent…What I must do is all that concerns me, not what the people think.” In this case, our health “concerns” us. It is up to us to take control of our health for which Emerson says we, instead of facing regrets, will feel contented with enacting our own ability to be self-reliant. He continues, “The secret of fortune is joy in our hands.” What more fortune for a diabetic is there than avoiding hyper- or hypoglycemia?
So, it is easy to see that self-care, in the world of diabetes, translates to self-reliance. This may include receiving support from friends, family, medical providers or society. Ultimately, though, it is our health and our responsibility to take control of our treatment and diabetes management. We can and will feel much better, both emotionally and physically, from successful self-care (however, success is defined). And as Emerson concludes, “Nothing can bring you peace but yourself. Nothing can bring you peace but the triumph of principles.”