MICRO-MANAGING ONE'S SELF

Diabetes II is pretty much like any other chronic disease that can be maintained with proper meds and protocols.  In other words, it’s a drag.  At first, powered by the horror of diagnosis, you do finger-stick blood glucose tests practically on the hour and fill out big worksheets noting times of pill consumption, amount of exercise, food eaten, etc. etc.  Every time you pick up the newspaper you scan for “death due to complications of diabetes” and you find it.  Probably more than is really accurate.  I mean, pull on diabetes and you discover it’s attached to everything else in your body.  It was just the handiest way to look at the demise.

In fact, now the med people have kind of stopped calling it diabetes and started saying,  “metabolic syndrome”.  That’s not what they mean.  What they REALLY mean is that your life is going to be different now -- either shorter or entirely foreign -- but not in any way you can see with your eyes.  First the diet.  Okay.  Then you discover that your diet is connected to every social relationship you have, including neighbors you hardly know and cafe waitresses.  You aren’t going to just manage what you fix and eat in your kitchen, but also you must participate in an international and political food movement.

In the Sixties John Kyle, Browning school system dietician, used to tell us that eating white flour or white sugar was just like eating white lead:  addictive and destructive.  I’ve learned to put corn syrup, white potatoes, white rice, alcohol, and Twinkie-like substances on that list.  Over the years when I ran across really healthy looking granolas (which is what Montana folks tend to call hippies), I listen to hear what they eat and they have the same taboos.  It took a while to figure out what I can eat that I WILL eat.  I make muffins with fruit and nuts.  I mix black beans with cottage cheese.  Lots of bagged greens.   Olives and green beans for snacking.  It wasn’t too tough to convert my diet, except that I do best with a lot of meat and I mean expensive RED meat.  I’m glad they say eggs are okay again.

Back to the subject of meds.  Here’s a sharp edge on this diabetes movement: all the complex and computerized stuff that is done mostly because it CAN be done.

One pharmacist takes my prescription with no question, the next one makes me fill out a worksheet.  A few simply won’t accept Medicare.  Policies are all over the map.  My pharmacist, whom I do not want to lose, works for a Big Box Store that manages purely for profit.  They keep just enough pills on hand for the normal pill flow so they won’t have money tied up in meds on shelves, but that means that if a lot of people fill prescriptions at once, there aren’t enough pills.  I have to be “owed” and the balance of them follow by mail.  With luck.

This pharmacy is thirty miles away.  In a hard winter it is inaccessible in a little old pickup like mine.  At one time neighbors with big drift-busting pickups who were in that town on business would swing by the pharmacy and pick up everyone’s little white sacks, but now that’s illegal.  They said people stole pills, but I think it’s more like sales fell because people weren’t going into the store.  But their “good-will” pledge is that they will mail for free.  Sometimes things get confused.

Last summer I ran out of pills before I was entitled to renew, so I just didn’t take them for a week.  I tested daily and it looked to me as though the results weren’t much different from when I took them.  I showed that to my doc to ask her why I even had to take them.  She showed me how it says so on a schedule because statistically people taking them have better outcomes.  Next I get a scolding letter from the insurance company saying I’d better take my pills.  Who ratted me out?

From the beginning I have never been able to predict how much my co-pay will be.  The pharmacist can’t tell either.  I want to get a shingles-prevention shot but no one, not even the insurance claims manager for the hospital, can tell me how much my co-pay will be.  (The shots cost over a hundred dollars.)  It all depends on what the computer says at Big Brother Central Command according to ever-changing regulatory algorithms.  My income is very small.  Even $5 makes a difference.  When I’m suddenly presented with a bill for $75, it’s a shock.

But the big shortfall on my side of the ledger is not money -- it’s exercise.  I write (you’ve probably noticed) and when I’m not writing, I’m reading. I have no dog to walk.  I have no interest in exercising on the floor, which is cold.  I know, I know, exercise works.  I used to take a bedtime saunter around the park, but that was before the Citizen’s Watch went out (armed) to find bad guys.  Their eyesight isn’t so good.  And grizz bears -- which go by their noses -- have realized that not all the structures in this town are houses:  some are grain bins.  With spillage.

I got bored, bored, bored with constantly taking blood stabs on little slippery bits of plastic that cost $1 each.  Medicare will only pay for one a day.  The companies who make the readers are capable of making readers that don’t need the little bits but they make their money from selling little bits.  It’s like those cheap printers that bankrupt you buying toner.  That means I’m politically opposed to this practice.  I don’t mind blood stabs, but I just don’t remember to do them.  I have a very defiant subconscious.

Anyway, it seemed as though I was on the path to salvation.  I haven’t eaten sugar for years.  I don’t attend community feasts where affectionate farm cooks try to force you to eat high calorie food.  I don’t eat out.  I don’t drink.  I eat in moderation.  I pursue a “high glycemic” diet which means dense, slow-digesting foods.  So I got careless and reckless.  For lunch I had a peanut butter sandwich with a banana in it.  It was on a new kind of bun.  An hour after lunch, just for the heckuvit, I took my blood sugar:  325!  Normal is 100.  One wants to return below 140 in an hour after the meal. 

Luckily it was a cool but clear and bright day.  I grabbed my hat, drove to the Lake Francis campground, and walked double the length as fast as I could.  On coming back my blood sugar was 165.  Whew!  The lake is low.  There are no geese.  And my metabolism is kicked up enough to make my brain roll again.  It suggests exercise and reminds me I'm about out of pills again.