Diabetes is the new AIDS. I’m going to make an argument supporting this assertion, which is triggered by the desire of some jurisdictions to list everyone who has the condition, regardless of whether it is controlled and without knowing the cause. Their position is that since uncontrolled diabetes leads to very expensive problems that require radical treatment like amputation of feet or renal dialysis and since (they assume) the main body of victims are poor people or people who otherwise neglect proper compensation for diabetes, then the cost for all this treatment becomes a public expense, so the authorities should find out who these people are and “guide” them through counseling about prevention.
So, here’s what I see:
1. First, the stigmatization of the persons involved. These people are not gay, but they’re poor and fat (the assumption is) and therefore have no rights. (Many people, asked whether they would rather be buff and gay or fat and poor, would have to think it over -- like Jack Benny considering “your money or your life.”)
2. Once people are identified, laws and requirements can be imposed. Already diabetics can be passed over for jobs or for health insurance, on grounds that they are too expensive and their condition might impair their thinking or performance. It’s a bit like being epileptic. And when people like the former governor of South Dakota use diabetes as an excuse for auto accidents, they encourage that thinking.
3. Diabetes is a wonderful marketing tool. If not inventing new wonder drugs, resourceful people can market membership in an organization like the ADA, which can then sponsor advertisements for special foods, shoes, and so on. It’s as big as Weight Watchers, at least. A mailing list of potential clients is worth enough bucks to likely overwhelm the need for privacy.
4. Once the demographics of diabetes are “proven” to be predominately Indian, Mexican, old, poor, fat -- in short, "other" or at least "not me") it becomes very easy to blame the victim. They are “sugar pigs” who can’t control themselves or follow simple instructions such as “eat high quality food” or “get lots of exercise.” This relieves the authorities of inquiring into the possibility of industrial contamination from plastics or food ingredients or feed lot “meds,” etc.
5. The basis of Type 1 Diabetes is clear: failure of the Isles of Langerhans to produce enough insulin or ANY insulin, sometimes due to the Isles being altogether missing. Success in understanding and compensating was brilliant. But the basis of Type 2 Diabetes is unknown. The research is only beginning to get below the surface, detecting “new” kinds of diabetes so there are several different versions of “Type 3” diabetes from gestational to brain insulin production, possibly keying into Alzheimers. No one wants to say “prion.” Many are now persuaded to say “metabolic syndrome,” meaning that blood sugar feedback loops are linked to lipid management and blood pressure, suggesting a common cause somewhere deep in the body’s “symphonic” system. Vitamin deficiencies, exposure to radio waves, genetic mutations, and so on present such a plethora of possible causes that it’s hard to keep order.
6. Doctors are not at all sympathetic to the management of diabetes. Their theories don’t work, their meds have strange consequences, the amount of explanation and “talking therapy” that is needed turns them off, the patients are not upscale or even grateful, and checking feet seems like nurses’ work.
7. This has encouraged people to form blog communities, support forums, and other “horizontal” ways to work on the problem. They have learned to bypass the doctors by using home meters or going directly to labs. This makes the doctors more insecure and irritable, which pushes the people back to their peers.
8. A certain amount of fatalism sets in. “There’s no use in trying, because I’m doomed.” Then avoidance, procrastination.
9. Helplessness soon follows. Inertia, resignation. “If I’m going to die anyway, I might just as well...”
10. The enormous social importance of food in our lives is VERY hard to handle. Birthday cakes, wedding cakes, Christmas cookies, Halloween candy, Valentine chocolates and friendship coffee klatches are the ways we structure and commodify our symbolic lives. “Taking lunch,” having “power breakfasts,” are the least of it. Your gramma wants to fix your “favorite food,” which his not likely to be diabetic friendly. It’s such a temptation to eat all that stuff and then medicate to compensate, instead of cutting waaaaay back on the food and training oneself to eat a different way.
And so secrecy, denial, failure to address the problem.
But what’s worse is that the right amount of money in the right sort of places is withheld. We do not need “no-fat Twinkies.” We need someone willing to go around small towns and reservations taking blood pressure and washing feet. We do not need research on how to produce no-calorie food, we need food distribution networks that are trustworthy and chemical-free.
I’ve come to hate and fear lists of “deficient” people, because they so often are just pass-throughs for mega-corporations, like the Medicare drug bill, so that the government will pay for stuff that is later discovered to be ineffective or dangerous (like many diabetes drugs). And because they are used to pass draconian laws, like requiring people to buy health insurance or publicly register as sex offenders. I can imagine quarantines, sequestration, putting people on reservations (Indians are already conveniently there, just as many ghetto dwellers are black and red-lined). Once the authorities have control of people, as they do prison felons, they can control what’s eaten or how much exercise one can perform. Is it too sci-fi to imagine institutions where diabetics are confined, as TB patients were once, forced to eat “healthy food” and marched around a yard? Don’t we already do that with fat camps for kids?
Of course, once the government is involved, they’ll look for the cheapest way to manage and if it’s outsourcing we may all find ourselves eating All-Bran noodles in China before our morning march.
Scared? Disgusted? Think I’m making it up? Watch the newspapers. Backlash? Bring it on.
9 comments:
I have to say, Mary, this was one insightful post!
Bravo!
As an RN with both types of diabetes in the family, I concur.
We discuss these things separately.
You are ahead of the pack putting it all together.
It deserves publishing in newspapers to spread awareness.
A
You're on to something important here, and it's really got me thinking.
I listen to TV morning news programs with a morbid fascination. They all have their on-camera physicians, reporting on medicine and health news. All of them scold sufferers of all diseases that have a life-style risk-factor component. Heart disease? You must not have been exercising and eating right. Diabetes, cancer, HIV? If you'd been a better person, you wouldn't have gotten sick.
Besides following the Puritan exercise/diet ethic, you must get expensive diagnostic tests regularly. Never mind that most insurance doesn't cover it, and that many people don't have any insurance.
Part of it is a way for healthy and wealthy people to imagine they will never get sick and die, but it's also a way of letting them think that working class people who get sick have brought it on themselves. There are no "deserving poor" in this world view.
Interesting. It does tie a lot of things together.
The only thing I strongly disagree with is your take on doctors, who, in my experience, are strongly sympathetic to their patients. One of the areas that doctors I know feel stress is that the HMOs and other business-model medicine providers often tie their hands, and don't let the doctors what they'd like to do. When medicine becomes a profit-making business, you get exactly the kind of out-of-control prices that currently exist. And then there's the pharmaceutical companies, who have far too much power and influence in Congress; this has led to patients taking arranged trips to Canada and Mexico alike, in order to afford their prescription meds.
My own father, who just died from cancer, acquired Type 2 diabetes some years after he retired. It just suddenly came on, as it does. He managed it well with a restricted diet and one of the diabetes drugs that worked for him. (Glyburide.) My experience of watching his doctors and nurses interact with him, after I moved back to be his principal caregiver, was that the doctors were the more caring people on the planet, except for the nurses, who were even better.
Art, I'm so sorry for the loss of your father. And grateful that he had good doctors. My mother died of a blood cancer (she was 89) in 1998 and her doctor was excellent. She was in Portland. My own doctors there were friendly and top-of-the-line, but often off the point. I had the "best insurance in town" they said and so they felt free to give me top-of-the-line tests when I'd have done better with some close listening.
Now I'm on the Montana Hi-line and my insurance is Medicare. Doctors here know little or nothing about Diabetes 2 though it is at epidemic rates. They've told me wrong things, haven't told me what I needed to know, and blow up if I tell them what I know about myself. I worked as a ward clerk for 5 months at my closest medical center. It was rather like finding out how sausage is made. It's owned by a doctor who has been repeatedly cautioned by the state. He fires anyone who angers him, including the other doctors.
Conclusion: Generalizations are dangerous but we could sure ALL use more diabetes information.
And I enjoyed your websites!
Prairie Mary
Thanks!
I totally agree with this:
Conclusion: Generalizations are dangerous but we could sure ALL use more diabetes information.
You'll get no argument from me on that point.
My Dad was in very good hands. I am learning that while that might be the norm where I am, in Wisconsin, it isn't everywhere.
I do have friends on Midwestern Indian reservations, like Lac de Flambeau in northern WI. I've been aware of the high incidence of disabetes among that population for some time. It's really a tough problem, and it's deeply entrenched. I admit to feeling helpless in the face of such a huge dilemma. I empathize with your situation out there.
(I passed through your region last January, driving between here and Portland. The Bighorns are awesome, and Lolo Pass into Idaho was astounding. I got lots of good photos. It's a big state to drive across, though!!)
Art, I become more and more convinced that diabetes 2 is related to something like food additives. I know MANY people who have developed the problem who are not in poverty, not fat, not lacking for exercise. And I think it's only one symptom that can be recognized and addressed but that is caused by a deeper disorder. Some speak of metabolic syndrome and suggest that several related feedback loops are involved: for instance, blood pressure and lipid management.
Prairie Mary
There's also the "shock to the system" aspect. I made friends with a man when I was living in Taos who was a liver transplant survivor. He knew the topic well. What I didn't know, but have since confirmed, is that virtually 100 percent of transplant patients develop diabetes, even if their pancreas, etc., is otherwise healthy. They don't really know why, but the shock to the system seems obvious, as does the use of anti-rejection drugs that transplant patients need to take continuously. There are aspects of immune suppression involved, naturally.
The (un)balanced systems explanation makes a certain amount of sense to me. I've studied aspects of traditional Chinese medicine enough to know that the paradigm there is of ecology, rather than of mechanical pathology, as it is in Western medicine. It would make sense that something like food additives, or other environmental pushes and shoves could destabilize the system. I wonder about acupuncture and Chinese herb treatments to ameliorate diabetes; they probably have some, but I don't know about them. It might be worth researching. I also wonder about detoxification. (Dad was able to manage his diabetes through diet changes, mostly, and low-level meds; he only ever needed insulin when he was in the hospital for the cancer surgery, and right after, and not eating properly or well.)
About it being (one of) the expression(s) of a deeper, more fundamental syndrome: This makes me think of parallel syndromes that are possibly the expression of similar ecological imbalances, such as chronic fatigue syndrome, fibromyalgia, and related autoimmune disorders. There is an aspect to this of people with innate sensitivites being the canaries in the coal mine for the rest of us: they get sick first, before everyone else does. It can be a warning, as it was in the case of people who have developed environmental sensitivities (I'm one of those, actually, as are several friends of mine).
Well, I don't mean to dominate your discussion here. LOL But you got me thinking! For which I'm grateful.
Art, I'm in complete agreement with you about the many disorders, like fibromyalgia and chronic fatigue syndrome, being the same sort of wholistic imbalance that seems related to the ecological imbalance we've created in the world. The body is much more like a symphony than like a pinball machine. We are out-of-tune and the Asian and NA ideals of harmony are highly relevant.
Comments, it seems to me, do not burden a blog but rather extend it in valuable ways. (I know of some blogs that attract HUNDREDS of comments until they are closed down! Not spam, either, but the discussion of extended communities.)
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