On Monday I did a storytelling event about diabetes of all things. I will be offering a class on cooking for diabetics inworld too. If you're curious, IM Laila Tomorrow or I. Here's the text of the talk.
In my career as a storyteller, I’ve been asked to tell tales about all sorts of things – what it’s like to be a noob, romance, health and healing, and even global warming. But this is the first time I’ve been asked to tell a story about diabetes.
Ironically, my first life has prepared me beautifully for this event. My story begins about four years ago when my mother was diagnosed with Type 2 diabetes. At the time she was seriously overweight (at five foot two she weighed over 250 lbs.), had high blood pressure, high cholesterol, and needed double bypass surgery to keep her arteries open. The diagnosis of Type 2 diabetes was no surprise, but she didn’t seem to understand how serious it was.
For those who aren’t familiar with diabetes and the forms it can take, it is a disease that affects your body’s ability to process sugar. The hormone that allows your body to move sugar from the bloodstream and into the cells is called insulin. In diabetics, the insulin is not doing its job adequately. There are three types of diabetes: Type 1, Type2, and Gestational Diabetes. If you have Type 1 diabetes your body isn’t making insulin. In folks with Type 2 diabetes, the body is making insulin, but the cells aren’t allowing it to do its job. Gestational diabetes is similar to Type 2 diabetes, but it occurs during pregnancy and typically disappears after childbirth.
Dr. Neal Barnard, author of the terrific book Reversing Diabetes, compares Type 2 diabetes to doors with malfunctioning locks. Insulin tries to unlock the doors of the cells to bring glucose into them, but the cells resist. As a result, the body produces more and more insulin in an effort to overcome the resistance. If the body’s insulin supply cannot overcome the resistance, glucose simply builds up in the blood.
If glucose is unable to enter the cells, they are deprived of the fuel they need. This produces fatigue. In addition, when the glucose that can’t get into the cells stays in the bloodstream, it causes all kinds of problems including kidney disease, damage to vision, and restriction of the blood flow through the arteries. If left unchecked, this last can lead to blocked blood flow and amputation.
Which brings me back to my mother’s diagnosis. Alarmed by what I read about Type II diabetes, I flew from my home in Hawaii to see my mom at her home in Los Angeles. There I shared the books and articles I had been reading, helped her figure out how to use her blood test kit (my mother hates any and all forms of technology, including her TV remote), and created a comprehensive eating plan. Having cooked my way through eight years of college and worked as the restaurant critic for The Japan Times, I was pretty proud of that plan. It included foods I knew were tasty as well as healthy. I was confident that if she followed the diet, avoided simple sugars and refined carbohydrates, took the medications prescribed by her doctor, and exercised moderately she would be fine.
I returned to Hawaii secure in the knowledge that I had done the right thing for my mother. Little did I know that diabetes is as much a disease of the mind as it is of the body. Not only wouldn’t my mother follow the eating plan I’d devised for her, but she would refuse to test her blood, continue to eat Top Ramen, processed cheese spread, and sugar frosted corn flakes, and forget to take her medication. Is it any wonder that I was back at her side just two years later fighting for her life?
The call that caused me to uproot my life and relocate to Los Angeles came late one afternoon in April. I’d just returned from my sunset swim and was about to hop in the shower when the phone rang.
“This is your mom,” said an unsteady voice at the other end of the line.”
“Mom?” I replied. “Are you okay?” Visions of her falling (she’s been quite unsteady on her feet since she had a hip replaced) raced through my mind. “What’s wrong? What happened?”
“Well, I didn’t want to bother Dr. Martin,” she said. My mind raced. Who was Dr. Martin? She had so many specialists she saw – the orthopedist, the endocrinologist, the physical therapist, her primary care doctor….
“Okay,” I said, trying to curb my impatience.
“So I cut my own toenails,” she said. There was a long silence. “And I cut my toe by accident.”
Anyone who knows about diabetes knows that diabetics’ wounds are slow to heal, particularly wounds on the legs and feet where circulation is often compromised. “Tell me what it looks like mom,” I said.
“Well I went to Dr. Lacy,” she said it was just a little MRSA infection. She gave me antibiotics, but it doesn’t seem to be getting any better. There are red lines going up my leg.”
MRSA?! Red lines?! I knew right then and there that I needed to get back to Los Angeles as quickly as possible. “Okay Mom,” I said, “I’ll catch a plane tomorrow if I can. But in the meantime, can you please call my doctor?”
“Oh I don’t think you need to do that,” she said, clearly not meaning it.
“Oh yes I do,” I said. “I’ll call you back when I know my flight number.”
As you’ve probably guessed by now, my mother had much more than a “little infection.” When my doctor got a look at it she flipped and ordered blood work. “This doesn’t look good,” she commented to me privately.
Meanwhile, back at my mom’s home I discovered the frosted flakes, iceberg lettuce, salad dressing loaded with high fructose corn syrup, and meatloaf made with breadcrumbs and catsup. When I asked to see the chart of her blood tests she said she hadn’t been able to get the tester to work. That’s when I discovered that she had never opened the box.
Things went from bad to worse as the infection began to spread from her foot and leg into her bloodstream. Though I’d started cooking for her right away and was monitoring her blood sugars three, four, five, sometimes six times a day, I couldn’t seem to get them stable. One hour they’d be up in the 300s, the next plummeting below 100. Then came the day I walked in to check on her and found her slumped over in her chair. No amount of shaking could rouse her. A quick check of her blood sugar showed 40. She was in a coma. I grabbed the shot we kept in the refrigerator for just this kind of emergency and gave her an injection. A few long, agonizing minutes later she began to come out of it.
I won’t bore you with a long drawn out discussion of her decline. It’s enough to say that I almost lost her several times as her kidneys shut down, the MRSA infection became systemic, and her toe became gangrenous. In the end she had to have part of her foot amputated and a pic line inserted so that an industrial strength antibiotic could be administered via IV each day. It’s not something I ever want to experience again, but some very good things have come out of it.
First, I began teaching myself how to prepare foods that would not spike her blood sugars. As someone who loves to cook and experiment with food, this was fun.
Second, I began to get a glimpse into the mind of a diabetic, which I soon realized was capable of rationalizing almost anything. I should preface this by saying that as someone who once spent an entire night at the kitchen table refusing to eat my spinach, I shouldn’t have been surprised when my mother wrinkled her nose at the salad I’d prepared and vehemently declared, “Cow fodder!”
Though I was five when the spinach incident occurred, and my mother 81 when she made her pronouncement, the basic assumption was the same. Neither one of us had any intention of eating our vegetables.
For one long moment mom and I eyed one another with a mixture of annoyance and dismay. She and I both knew the reason she was being served “cow fodder.” Thanks to her failure to monitor and deal with her diabetes she had almost died and her daughter had taken over her kitchen. For an independent, strong-willed woman like my mother, whose only concession to age was a sturdy pair of orthopedic shoes, the situation was galling to say the least.
For my part, I wasn’t happy with the role that had been thrust upon me either. Juggling a full-time career with the care of a cranky, diabetic in denial wasn’t fun. It was all I could do to keep myself from tossing the salad in the garbage and leaving her to fend for herself. The trouble was I knew she’d soon be eating a white bread sandwich filled with processed cheese and margarine the minute my back was turned.
Instead I closed my eyes, took a deep breath, and swallowed my annoyance. “Look, I’m not feeding you salad to torture you Mom,” I said. “As far as I’m concerned, you can eat anything you want so long as your blood sugar doesn’t go up.”
“Fat chance,” she muttered, picking up her fork and stabbing a piece of broccoli with evident distaste. “My blood sugar goes up if I so much as look at a banana!”
Which brings me to the third and probably most important thing I have to share with you tonight. Despite all her complaints, and the occasional cookie or piece of chocolate I find stashed in the drawer of her bedside table, mom’s health has slowly but steadily improved. Taking the nutritional supplements prescribed by our naturopath, exercising for 20 minutes each day, and eating the foods I prepare for her, she has dropped 96lbs, is off of her high blood pressure and cholesterol medication, and rarely needs insulin.
The message to me is loud and clear. If an 84-year-old woman with almost every age related illness can normalize not only her blood sugar but her blood pressure and cholesterol as well, then there is real hope for the approximately 23.6 million people who have diabetes in the United States. Moreover, despite mom’s cow fodder comments, I believe it can be done without a lot of drugs, suffering, or mental anguish.
Which brings me to the final thought I’d like to share with you. Over the past two years of working with my mother and others who have asked me to help them rethink their diets, I have seen that the hardest part of treating diabetes is changing your relationship with food and your body. It is an adjustment for sure, and one that usually takes patience and support from others. The body is not a machine. It is linked and responds to your thoughts and feelings. So when you crave a chocolate bar to help you feel better about something unkind said by your boss, your body reacts. Unfortunately, it also has to deal with the extra calories and sugar you ingest.
Clearly a lasting and effective solution will have to entail a change in not only what we eat but why. I know from talking to some of you that the foods you were raised on – in other words the ones you associate with love and nurturance – are also ones that could literally kill you over time. Not just sugars, but saturated fats, processed carbohydrates, and additives all take their toll on your body.
I thought long and hard about how to end this little tale – how encourage you to embrace change and all the challenges it entails – and decided to share this poem entitle “Mindful” by Mary Oliver. It helped me at a time when I was dealing with an intestinal problem that forced me to change what and how I ate.
Mary Oliver’s poetry is a gentle, loving reminder of what we forget to stop and notice in our hurry to get through our days. Listen:
Mindful
Every day
I see or I hear
Something
That more or less
Kills me
with delight,
That leaves me
like a needle
In the haystack of light.
It is what I was born for –
To look, to listen,
To lose myself
Inside this soft world –
To instruct myself
over and over
In joy
and acclamation.
Nor am I talking
about the exceptional,
The fearful, the dreadful,
The very extravagant –
But of the ordinary,
The common, the very drab,
The daily presentations.
Oh good scholar,
I say to myself,
How can you help
But grow wise
With such teachings
As these –
The untrimmable light
Of the world,
The ocean’s shine,
The prayers that are made
Out of grass?
