Embracing the Challenge: A Personal Journey Through Diabetes Management

by Gary Wunder

Delivered at the Knowledge is Sweet Seminar, St. Louis, Missouri, April 27, 2024

Good morning, everyone. Today, I stand before you not just as a speaker, but as someone who walks the same challenging path as many of you do—a path marked by a constant companion named diabetes. This journey is not just about the physical hurdles we face daily; it's profoundly shaped by our knowledge of this disease, an honest acceptance of ourselves, and a realistic look at what it takes to change our behaviors.

My journey into the world of diabetes management began with a mix of anger, denial, and disbelief. Like some of you, diabetes was not a stranger in my family. Yet, I carried on with life as if I was somehow immune to its grasp and consequences. My attitude toward managing this condition through diet was passive at best, summed up to my doctor and family by the statement "I can do that," rather than by a commitment, "I will do that." Unlike some of you, I was warned by my doctor and had a clear sense that I was on the road, being what she called prediabetic.

My lax approach continued until the day I received my first bottle of Metformin. I remember calling my pharmacy with anger, being convinced that they had made a mistake and had given me my wife's medication. Yes, I was riding that big white horse, sword in hand, wishing to recite to them all of the dangers in medication mix-ups that could be caused through their inattention. They listened politely, and then they read me the prescription from the doctor saying that Metformin was in order because my A1C was 7.2. A1C is a measurement of one’s blood sugar for the three-month period prior to the test. The blood sugar for a person not yet a diabetic is about one hundred, meaning an A1C of about 5.0. My blood sugar level was at 163, firmly placing me in diabetic territory.

I hung up the phone and started experiencing denial, anger, and frustration. Normally when I feel these emotions, I look around me and figure out who is to blame. I didn't have to look far.

I grudgingly took my first dose of Metformin, and then bought my lancets, the Prodigy meter for announcing my sugar, and plenty of test strips. All of that showed resolution, right? But using it was a different matter, and every finger stick reminded me I had not been smart, especially when I did not get enough blood for the strip or in some cases did not get any blood at all. Every time I got ready to do the finger stick, I heard a choir standing behind me singing the chant, "stupid, stupid, stupid." They were singing it to me, for in fact it was a musical version of part of my autobiography of which I was not proud.

When I came to the dinner table, I was not a happy camper. For me, it brought back memories of childhood restrictions: a time when choices were made for me, not by me. Suddenly, I was that child again, facing a world of "can't haves" and "shouldn't eat that.” I never thought I would face such a psychological battle when it came to my plate. Suddenly I realized with new clarity that food is not just sustenance; it's a source of joy, a centerpiece of social gatherings, a cultural identity. When we become a diabetic, suddenly we are watched whenever we eat. This statement is not all about being paranoid. Take a piece of pie and listen as someone says, "Is that really good for you?" It made me want to yell, "Do you remember when, two weeks ago at the family picnic, you urged me to have a piece of your cake and assured me that you had made it just for me, it always having been one of my favorites?”

Once you decide that the drugs only go so far and that it's really up to you to determine what and how much you will eat, the question then becomes what you will eat, what you won't, and how often you will make an exception. Before I got my continuous glucose monitor (CGM), I made many more exceptions. There wasn't any problem with that small piece of sweet roll or that generous serving of mashed potatoes. They wouldn't affect my blood sugar much, and if I didn't bother to test that day, there was no evidence to argue I was wrong.

If I was going to have to limit what I ate, who was the authority I could rely on to help me figure out what to eat and what to avoid? I find reading easy and enjoyable, but when you don't want to give up eating certain foods, it is easy to argue that with regard to nutrition, nobody knows what they're talking about. The case is easily made given all the contradictory theories and their numerous opponents and proponents. This is a great excuse for not acting, but it doesn't bring down the blood sugar one little bit and therefore does not lessen the damage occurring to the diabetic.

After listing all of the excuses, the question then becomes what motivates us to embrace this challenge? For some, it's the desire for longevity, to be there for our loved ones. My wife dreams of seeing our grandchildren graduate and perhaps find their callings. For others, including me, it's more about the fear of complications, the desire to maintain quality of life. Although I have no desire to hasten death and shorten my time with loved ones and friends, I find that my motivation has much more to do with holding onto the quality of life I have now. I want to maintain the feeling in my feet so that I can have a better chance of keeping my balance. I like feeling the texture of my wood floors and using my feet to tell me whether I’m doing a good job while vacuuming. I love being able to feel Braille under my fingertips and the softness when petting a golden retriever. The thought that I might lose feeling in my hands or feet helps me to make better choices. The CGM keeps me honest; the desire to maintain my sense of touch makes hard choices easier. Just how important is the Frosty or the banana split blizzard? I don't always make the right choices, but the easy availability of my blood sugar number and the fear of what I might lose does keep me on a narrower path.

In an age where information is abundant, finding the right path to manage diabetes can feel like navigating a labyrinth. Competing theories on diet, exercise, and medication can leave us feeling lost and frustrated. I find myself constantly trying to find a balance as I sift through this information, armed with knowledge from healthcare professionals and a personal understanding of my body. I'm frustrated by all we don't know but challenged to figure out what seems to be right for me. I’m also challenged to keep in mind that I am a learner and not a teacher, and what proves true for me may not be for someone else.

Using psychological tools and seeking support can transform our approach to diabetes management. Mindfulness, cognitive-behavioral strategies, and support groups offer us a compass in this journey, guiding us through moments of temptation and frustration with a renewed sense of clarity and purpose. This is part of what we do in the Diabetes Action Network: help provide good information and then help each other be honest with ourselves. Have I been adhering to a reasonable eating regimen, have I been exercising, have I been taking my medication regularly, and have I shared my numbers to get a gentle prod or some congratulations from those who understand?

My journey with diabetes has been filled with ups and downs, moments of denial, and eventual acceptance. It has taught me that managing diabetes is not just about the physical aspects—monitoring blood sugar, adjusting my diet, or taking medication. It's about confronting the psychological battles, embracing change, and finding a sense of balance.

Let us move forward, not with a spirit of denial but with a commitment to action. Let us not see diabetes as a barrier that will stop us but as a challenge to live our lives more fully, more consciously. Together, we can navigate this journey, supporting one another in embracing the challenge with courage, determination, and hope.