In the days leading up to Rosh Hashanah and Yom Kippur, there is a custom amongst Orthodox Jewish men to gather at midnight to say an additional set of prayers, called Slichot, in which they call upon G-d's mercy in the days leading up to the "Days of Awe", that He might judge us more favorably, more mercifully, when He inscribes all people in either the Book of Life or the Book of Death for the coming year.

 

These prayers of repentance, and forgiveness, carry through to the High Holy Day services in haunting prayers such as Al Cheit, in which we list our sins, and B'Rosh Hashanah, in which we recall the ways in which people may die ("...who by water and who by fire, who by sword, who by beast, who by famine, who by thirst, who by storm...")

 

The most beautiful of these prayers, of which we usually hear only the refrain, is Avinu Malkeinu "Our Father, Our King". At this time we ask forgiveness

 

For the sin which we have committed in Your sight through arrogance of our will,
And for the sin which we have committed before You by breach of trust...
For the sin which we have committed in Your sight, either knowingly or unknowingly...

 

Note that instead of listing specific circumstances of sin and perhaps omitting one or two which slipped our mind at the time of the confession we group our sins together by type, and by confessing to every potential type of sin we could have committed, we acknowledge that we might have sinned or transgressed without knowing that we had done so.

 

For all of these... forgive us, pardon us, grant us atonement.

 

We confess for the entire community, not just ourselves, both to honor and protect those who are unable to participate, and because we believe that the misbehavior of a single person can reflect poorly upon the entire community. If this sounds a lot like the way fat people, skinny people, rich people, poor people, people with diabetes are portrayed... welcome to the crowd.

 

For the sin which we have committed in Your sight by casting off responsibility,
Log? I don't feel like logging.
And for the sin which we have committed before You by denying and lying.
Sure, I can have that piece of cake even though I'm 50 pounds overweight and my blood glucose is at 300. People with diabetes can eat anything, as long as we bolus for it.
For the sin which we have committed in Your sight by scoffing,
It's just a touch of "the sugar", nothing to worry about!
And for the sin which we have committed before You through excess in eating and drinking.
Really? Who are you? The Diabetes Police?
For the sin which we have committed in Your sight by yet being proud,
We did not do this to ourselves. Not even type 2s.
And for the sin which we have committed before You through our lack of zeal...

 

A lot of this sounds like the list of "sins" that people with diabetes are expected to own up to, to guard against, and to ask our healthcare providers' and insurance companies' forgiveness for:

 

For the sin of forgetting to Test! Don't Guess,
And the sin of SWAG bolusing.
For the sin of not counting carbs,
And the sin of overcorrecting a low.
For the sin of neglecting to change our lancets,
And the sin of using insertion sets and sensors for longer than they are designed
And the sin of using test strips past their expiration date.
For the sin of desiring a slice of chocolate cake la mode,
And for the sin of consuming it.
For the sin of ignoring a CGM or pump alert
And the sin of neglecting our health in favor of fun with friends...

 

If Avinu Malkeinu seems like it has special lines for people with diabetes, so too do we live with the daily litany of to quote the Spike TV show title 1000 Ways to Die:

 

Who shall die from lack of insulin, and who from its overdose; who by consistently elevated blood glucose levels, who by DKA;who by heart disease, and who by kidney failure; who from starvation, and who from the inavailability of appropriate foods; who shall lose their toes and who shall keep them; who shall be dead-in-bed from hypoglycemia, and who shall suffer a fatal automotive accident because of it..

 

While none of the remedies of B'Rosh Hashanah prayer, righteous living, and charity will truly "avert the fatal decree", we know that proper self-care can limit (but not completely stave off!) the probability of both short-term death and long-term complications of diabetes, and that giving money and data to researchers and diabetes-advocacy organizatons can bring about new and better therapies (both physical and social/psychological), as well as the possibilities of vaccinations and cures. Perhaps in some version of l'dor va-dor from generation unto generation our children's children, or their children's children, will be able to strike out who by diabetes from our personal versions of this prayer.

Kein yehi ratzon May it be His Will.

Blessings for a good, sweet, healthy, and prosperous 5773.

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