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October 24, 2016
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The Religion of Diabetes Management

I'm not sure what it is about Lindsey's recent post about how we, as a society, tend to gloss over the daily rituals and worries of diabetes, but I flashed back to the rituals of the Nacirema people, and came to the following conclusion:


Diabetes is a religion.


Or more correctly, diabetes management reflects certain aspects of religious practice.


Those who follow the stricter paths of observance have their days prescribed and proscribed by their beliefs. Whether it's several sets of public daily prayers, the wearing of cilices or phyllacteries, or checking foods for ritual purity, each religion has a set of rituals and practices that -- for believers -- are irretrievably intertwined with the rhythm of daily life. Where does the individual begin and religious practice end? There is no clear demarcation. We believe, we observe, we practice. And when we fall short in that observance, we feel guilty.


In place of (or beside) dawn prayers, those of us with diabetes must check our fasting glucose levels. The metal thorns in our thighs are our CGM sensors and the canulas for our insulin pumps. Blood glucose checks replace Grace before and after meals. Instead of the symbols of Kashrut and Halal, our food is labeled "sugar-free", "low-carb", or "Atkins-approved". The Scripture of Science and Medicine teaches us that failure to follow these observances will punish us with Dreaded Complications and Early Death.


I expect a number of folk here to say, "I am X (religion) and we don't do that!" Of course not. Belief is personal, and most of us have chosen less ritually-rigorous methods of observance. But I defy you to tell me you have never met, nor read about, people who -- even today -- choose to follow the stricter path.


And so it is with Diabetics. Some of us are Puritanical Diabetics who never miss a blood glucose check. Any blood glucose reading under 70 or over 120 means that we must have consumed a Forbidden Food, miscalculated a basal or a bolus, or done something else to anger the Diabetes God, Who has sent us this "bad" reading to punish us. Some of us are Modern Diabetics who believe that if we occasionally misjudge a slice of pizza, prayers in the form of a correction bolus will be accepted and returned to us in terms of a Good A1c. Some of us are Reform Diabetics who check our blood glucose occasionally, take a pill (or shot) or two, and don't worry as long as the Diabetes Priest does not yell at us too much. There are even Born Again Diabetics who, like the Prodigal Son, have returned from the land of Diabetic Denial to "Spread the Word" of Good Diabetes Management.


You'll notice I have not avoided the issue of Guilt. Society may reinforce it, but Diabetic Guilt is both related to, and intertwined with, Theological Guilt. If we believe that we can, and must, always maintain ourselves in perfect health, at a perfect weight, and so on, then we may feel that any readings outside the range of Tight Control are our own fault, and we feel guilty for not having been able to foresee and forestall. If we believe that all adversity is Divine Punishment for some transgression, then we may feel guilt for having done something wrong to "deserve" the sentence of diabetes. If we see ourselves only as responsible to ourselves, for ourselves, then while we may believe an out-of-range reading reflects a lapse in self-care, what we feel guilty about is letting ourselves down. But if we see adversity as a Divine Test -- proofing us for some quest that G-d has intended for us, or for some task in which we are to serve as His Messenger, His Steward -- then instead of a sign of personal failure, our frustrations over our ups and downs are a way of G-d expressing His Faith in our ability to carry out His Will.


Diabetic Guilt -- just like Theological Guilt -- is a matter of how we perceive and observe religion, and a matter of how we perceive our obligations to ourselves. But unlike spiritual religions, ignoring the rituals of diabetes management has definite temporal consequences.

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