A diabetic's lament

Doris Day once quipped that “middle age is youth without levity, and age without decay.” She may as well have uttered that famous line in Carrie’s home. The sour faces of the fortysomething guests at her Thanksgiving dinner reflected work and family stresses felt by everyone at the table. Luckily, Carrie’s humorous tales of sustained weight loss following a comprehensive diet-and-exercise plan elicited some smiles and responses from her guests. Several days later, buoyed by turkey leftovers and Black-Friday bargains, she popped into her doctor’s office for her annual physical exam. That is where she faced her nemesis: Jill, the svelte young nurse, who asked her to step on a scale. As Jill loudly announced her 10 lb. weight gain to the world, Carrie was overcome with depression.  She wanted to give up and rush out in the wintry weather for a cup of hot chocolate with whipped cream. Instead, she checked herself and listened to her primary care physician. The doctor empathized with her and related how she was not alone in experiencing disease self-management issues. However, Carrie was taken aback when her doctor suggested augmenting her treatment plan with psychological care.

The words: “You have not achieved your glycemic goal” hit her like a ton of bricks. Carrie could not decide whether to laugh or cry. For the moment, she could only think about her finances. Her annual expenses for diabetic supplies far exceeded the routine care cost of about $6000 cited in 2009 by Consumer Reports. Her employer had decided to forego high-premium/low-deductible health insurance policies in favor of low-premium/high-deductible (catastrophic) health insurance plans in an effort to eliminate the specter of Xmas layoffs. She was unclear as to how these changes would affect her ability to intensify her treatment with options suggested by her doctor, including the possibility of adding incretin-based therapies to insulin, pending verification in clinical trials. The post-Thanksgiving pounds, worries about paying her child’s college tuition, and withdrawing her retirement funds to pay for her aging father’s care seemed to compete with the doctor’s words in her brain. She could barely squeeze in her bi-weekly zumba class following her daily battle with rush-hour traffic. The thought of additional appointments to take care of her mental health (in order to improve her health-related quality of life) made her feel nuts.

Was her mental fog a sign of stress or the onset of the dementia possibly associated with diabetes, namely Alzheimer’s disease? Something had to be done. She discussed a must-have disease-management checklist with her doctor. They both agreed that the Internet could not provide all the answers to her condition. In addition to coping with her illness, she needed family/friend/peer support, and did not wish to fend off “food-police,” especially over the holidays. Her doctor patiently explained how behavior change really happens. Carrie and her doctor then identified aspects of her disease management that required improvement. After consulting with other members of the medical care team, the doctor tailored a patient self-management scheme based on the National Standards for Diabetes Self-Management Education and Support.

Armed with the latest issue of “Diabetes-Self-Management” and a calorie-counter app on her iPad, Carrie left the doctor’s office motivated to continue her battle with Type 2 diabetes. She power-walked past Crumbs bake shop and a Cinnabon® store near her doctor’s office. She counted the calories in a German chocolate cupcake (156). The calories in her one-time favorite Caramel Pecanbon® added up to a whopping 1080. It felt good to be rushing by those treats. Time would tell if she could apply the same discipline in avoiding her mother’s apple pies and Xmas cookies. At least she would be able to confess her sins to a local diabetes support group and shed some excess pounds dancing the night away. She tucked the party invitation from Jill, the nurse and new friend, into her bag. Life was not so bad after all if you could share it with friends.