The Sugar

At the end of the Apostle Paul’s message to the Thessalonians, he tagged on a bunch of random encouragements, reminders, and commands. It’s a list of things that are good for all Christians (really all humans) to keep in mind:

Live in peace with one another. We urge you, brethren, admonish the unruly, encourage the fainthearted, help the weak, be patient with everyone. See that no one repays another with evil for evil, but always seek after that which is good for one another and for all people. Rejoice always; pray without ceasing; in everything give thanks; for this is God’s will for you in Christ Jesus.

1 Thessalonians 5

There are a lot of critics of this passage. They would call themselves realists. They would say you shouldn’t take this passage too literally. “You should aspire to pray more,” they say, “but surely you can’t pray always! You should try to find something to always be joyful about… but it’s impossible to always rejoice in it!”

It does seem crazy to orient our thoughts towards something all the time! It seems like the only things we can do without ceasing are things that we don’t have to think about (breathe, beat our hearts, pump out hormones). But I disagree.

I disagree because of personal experience in the matter. For the past 10 years I have unceasingly kept something at the front of my mind…

Type 1 Diabetes

In a healthy human, the insulin-producing cells on the pancreas operate one of the most vital, necessary, delicate, and precise functions of the human body—providing fuel (sugar) to every other organ, tissue, and cell in the body. The pancreas, of course, does this unconsciously and independently of any coordinated thought whatsoever.

Numerous organs are involved in absorbing, processing, creating, and distributing sugar. Each individual cell in your body uses (read: needs) sugar to have the energy to function. But every single cell* in your body also needs a good, universal way to get sugar out of your bloodstream—they can’t let too much in (or they explode) and they can’t have too little (or they stop working and die). That gatekeeper for sugar is insulin. Insulin is a hormone which the insulin-producing cells can regulate down to the picomole (an amount of insulin which is equivalent to one-ten millionth the weight of a water drop).

Type 1 diabetics produce zero insulin. That means what non-diabetics’ pancreases do for non-diabetics 24/7, we have to consciously and thoughtfully do for ourselves 24/7. Managing type 1 diabetes essentially consists of taking insulin (by needles or pump), counting carbs, and monitoring our blood sugar.

How important is it that we manage our blood sugar religiously? Well, for one thing, we can die if we don’t. (Ever tried running your car with no fuel in the tank? Consider that a severe low blood sugar. How about replacing the gasoline with the darker, heavier diesel? Consider that as having a high blood sugar.) Also, we feel like garbage and have a very-not-fun time functioning if our blood sugar is any kind of high or low.

So what does that look like?

• When our blood sugar is low, we have to put more sugar into our bloodstream (e.g. eat carbs like our lives depended on it… because they do).

• When our blood sugar is high, we have to give ourselves more insulin (by needle injection or by telling our insulin pumps to pump at full steam).
• When we exercise, we have to be cautious for the next several hours that our muscles don’t suck more sugar than there is in our blood.
• When we go to sleep, we have to be sure our blood sugar isn’t rising or dropping so we don’t threaten our lives while trying to rest.
• When we drive, we have to make sure our blood sugars are in a good range so that our brains are capable of safely operating a ton of high speed metal past hundreds of human lives and inanimate obstacles.
• When we walk out the door, we worry if we have enough insulin in case we eat, have a high, take longer to get back home, or stumble across a magic genie who only grants wishes involving candy, cake, or fruit-filled pastries (#dontjudgemyfantasies).
• When swimming or taking showers, we have to make sure we didn’t just inject insulin, won’t have to inject insulin immediately afterwards, or that our pump sites are attached securely.
• When we get stressed out, the stress gets multiplied because we worry about those stress reactions raising blood sugar.
• When our schedules change, so does the daily pattern in our blood sugars. So, we have to monitor if changes are needed in our insulin-to-carb ratios for different meals and change the amount (or rate, for those with pumps) of insulin regulating baseline blood sugar level.
• When we look at menus or inside our pantries, we have to mentally calculate how many carbs are in each option (and then convert that to units of insulin required to eat it).

• When we sleep-in or don’t sleep enough, we have to watch our blood sugars because they’ll start going all over the place (usually up).
• When we go somewhere by ourselves, we have to keep something on us indicating we’re diabetics—just in case we can’t indicate for ourselves.
• When we walk anywhere, we have to consider if it’s going to be the kind of walk that gets our heart rate up, or if it’s relaxed, or if it’s going to be a really long walk or a short one, because each one will affect our blood sugar differently.
• When we give ourselves an injection or put our insulin pump on a new site, we have to try to remember where the last several injection/pump sites were, otherwise we risk damaging (aesthetically and physiologically) that location in the long-term.
• When we sit for long periods of time, we have to wonder if all the inactivity might cause our blood sugars to be higher than normal.
• When we get sick… well there’s lots of stuff to worry about when we get sick:
  • Will this kind of illness make our blood sugars spike a lot or just a little bit?
  • Should we try to eat about the same as usual to avoid drops in blood sugar despite nausea, throat pain, or lack of appetite?
  • Will the over-the-counter medicine we’re taking raise or lower blood sugar despite no warnings on the package? (Looking at you Sudafed/pseudoephedrine!)
• When we feel what would otherwise be completely normal body sensations (lightheaded, hungry, sweaty, warm, tingly, angry/grumpy, tired, bad taste in our mouth, etc.), then we have to make sure it’s not related to a high or low blood sugar, because you don’t always feel the symptoms when they occur.
• When our blood sugar is low (or high, let’s be honest), we have to try harder than normal to not say anything we’ll regret later… “grumpy” can often be too mild of a word to describe how our blood sugar effects the emotional parts of our brain.

• When we get a minor cut or scrape, many diabetics take forever for them to heal over, even those of us with decent glycemic control.
• When we get absolutely any kind of injury to our feet or ankles, we immediately get the mental image of nasty ulcers or of toe amputations looming over our heads, no matter how unlikely it might be.
• When we eat, we have to calculate the mass of carbs per serving, the number of servings we’re eating, and an estimated relative glycemic index for each carb-containing ingredient in the meal, convert that into units of insulin, (and if not using a pump) determine where in the building we can stick ourselves with a needle without judgment, then decide where on our bodies to inject.
• When we get ready for a doctor appointment, we have to worry about whether we’re developing any of the other diseases we’re much more prone to. Examples include: high blood pressure, high cholesterol, cardiovascular disease, kidney disease, thyroid disease, glaucoma, neuropathy (pain/tingling/numbness in the arms and legs), psychiatric disorders (especially depression), and problems with urinary or sexual function.
• When we consider sexual function…
• When the moon is a certain phase, women have to worry about their blood sugars going up and down with the different changes in various hormone levels.
• When we’re out in the sun, we worry about our blood sugar dropping (but some individuals say the opposite). And if we get sunburned, then our blood sugar will be higher than normal for the next day or so.
• When we’re outside for a long time in the cold, we also have to worry about our blood sugar dropping.
• When we make budgets, we need to consider all the unreasonable craziness wrapped up in the sky-high price of insulin, glucose test strips, our insurance systems, and other financial burdens tangential to having diabetes.
• When we drink alcohol, our blood sugar usually goes up, but it’s almost impossible to guess how many carbs are in a drink (I dare you to check for a nutrition facts label on any alcoholic beverage). However, drinking more than a couple glasses of non-sugary stuff can make blood sugar drop later on.
• When we are with non-family, we usually have to be discrete about all the extra supplies we carry everywhere to avoid people asking those same questions we’ve all gotten hundreds of times. (What is that? Are you a diabetic? How are you diabetic if you’re not overweight? Is there a cure? So does that mean you can’t have sugar?)
• For those of us with pumps:
  • When we go to sleep we can only lay certain ways or we might cause an obstruction in the tubing/cannula.
  • When we put on the pump we have to think about if the site (arms, legs, or waist) would be inconvenient for the next 3 days of activities.
  • When we go to hug/hold someone we have to make sure there are no awkward moments where the other person puts their hands on your pump site.
• When we hear anything related to diabetes, food, drinks, exercise, dysglycemia symptoms, physicians, amputations, ulcers, airport security, auto-immune disorders, restaurants, obesity, illness, blood, stress… or most other things in life, then we think about our diabetes.

Did I miss some situations? You better believe I did!

So What Else?

Of all these things I mentioned, can you guess how much I wind up communicating with the non-diabetics around me? I don’t know. But it’s definitely a lot less than 1%! There’s a lot of confusion about how diabetes even works, so trying to mention any of it leads to us having to explain a lot of it. So we keep quiet… and internalize 99% of everything.

Did I mention that glucometers (the thing that measures blood sugar) can be inaccurate? So we also have to worry if the calculations we base our life around are even correct to begin with!

Did I mention that the price of insulin has skyrocketed over the last couple decades, and it only seems to keep going up? Or that the current Secretary of the US Department of Health and Humans Services is the same person who raised insulin prices 300% in his 5 years as president of a giant pharmaceutical company?

Oh, and did I mention the existential crises that accompany a diagnosis of type 1 diabetes (like I’m sure most serious chronic conditions have)? The questions of “Why me? Am I broken? What do I do with the rest of my life? What is the rest of my life going to be like? Will I wind up dying from this? How much shorter will my life span be? How many dreams will this keep me from reaching? What does it mean to live inside a body that’s damaged in such a vital way? What does it say about God that this can happen to people… or to me!?”

Maybe I’ll try to answer more of those questions another day or outside of this blog, but for now…

What do we do?

Considering not-having-diabetes isn’t really an option, we’re kind of stuck with two choices: 1) try to always take care of ourselves or 2) don’t take care of ourselves.

One of these options is clearly preferable to the other. But that option (as evidenced by the ginormous list above) is also much more difficult. Diabetic burnout is a thing, guys. All the thought, effort, and sacrifices that go into diabetic self-care leads to (extensively) well-documented mental, emotional, and even physical fatigue. That is fatigue which will exacerbate any and every other problem we have to deal with just because we’re human beings living on earth.

Life doesn’t stop just because our insulin-producing cells did. But also, we still have life! Type ones can still live…

Always

Diabetics prove that “always” is possible.

Our body tear themselves apart, fight against their own interests, and at times seems like they’re straight-up trying to kill themselves. But with a bit of awareness, a little bit of effort, and a healthy dose of acceptance, we can always resolve any of the conflict raging within our bodies. We bring our bodies back into well-functioning harmony on a daily basis. If that’s not good proof that it is possible to always “live in peace,” I don’t know what is.

Type 1 diabetics are notoriously stubborn. (After all, who knows how to manage our health better than the person that does it 24/7? Who do those physicians think they are, telling us what to do!?) But so many of us have been brought back to awesome glycemic control after recklessly self-destructive behaviors. We diabetics occasionally get burnout, and some much worse, but we have all been through it. And (with support) we have all rededicated ourselves to healthier living. We show there is hope for every person, and that there is tremendous benefit in always “admonishing the unruly, encouraging the fainthearted, helping the weak, and being patient with everyone.”

More than that, diabetics are walking proof that vengeance, anger, destructive desires can be tamed in any circumstance. When our blood sugars are low, it triggers physiological processes in our brain to become aggressive, short-tempered, and straight-up angry. Yet, despite our bodies screaming out and forcing our hand to be evil to others, we’ve all overcome those instincts. We’ve all bitten our tongues, acknowledged the idiocy of hostility, and pushed through with love in order to build others up even as our blood sugar fell down. Even when our natures fight it, we demonstrate that we can “always seek after that which is good for one another and for all people.” (Granted, we’ve all given in to hypoglycemic grumpiness too…)

Finally, we type ones display to the world that the human mind can intentionally, methodically, and unceasingly dedicate itself to a function that is in no way natural (brain ≠ pancreas), in order to combat the fact that one part of our being is in opposition to another (immune system vs. pancreas). Our minds are just as capable of dedication to unending joy even in the face of a broken world. We, the people who can shout our thanks to the heavens for low-blood-sugar-binge-eating despite our bodies shutting down, we can certainly “give thanks in everything.” And we, who can relate thoughts to our health almost every minute, we can relate at least as many thoughts to the Light of Life, “praying without ceasing.”

“For this is God’s will for you in Christ Jesus.” May it be done on earth as in heaven.

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P.S.

This post was written in response to a good friend’s recent diagnosis of type 1 diabetes. I rarely discuss such things friends and family, nonetheless strangers, but relieving the burden of type 1 diabetes is a subject near and dear to my heart.

For those who are unaware of the problem posed by type 1 diabetes, the global incidence (rate of new diagnoses) of type 1 is increasing by 3% each year. In countries with poorly developed healthcare systems (or healthcare systems that seem to be greed-driven rather than need-driven), resources such as insulin are increasingly difficult and expensive to come by. Even in the USA, insulin prices continue to soar, forcing hardworking, under-insured patients to make heartbreaking financial sacrifices.

A true cure for auto-immune diseases such as type 1 diabetes doesn’t seem to be on the horizon just yet, despite the tremendous leaps and bounds made by research scientists in the past decade. However, we are getting incredibly close to treatment options that would completely take away all the exhausting effort involved in current diabetes management.

If you’d like to learn more, find resources for yourself or a loved one with type 1, donate to a proven organization that effectively directs funds to both research and patient/patient-family support, increase awareness/advocate for type 1, or discover ways to volunteer your time to relieve the burden of type 1, then I can only make one recommendation. While I’m sure it is not the only organization that does such fantastic work, the Juvenile Diabetes Research Foundation (JDRF) is the only organization I have experience with both as a recipient of their care and as a volunteer/advocate. I can’t sing their praises enough.

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*Wanted to mention that what I said is not 100% scientifically accurate. Most of your brain and a lot of cell types in your liver do not need insulin to absorb sugar. However, if you’re blood sugar is low due to an excess of insulin in the rest of your body, or if your blood sugar is high due to an universal lack of insulin, it will still impact the function of these organs—hence, the notorious hypo-brain-slow.