One underlying theme of diabetes blogs and complaints is the difference of our daily routines from those of people who have never known a blood glucose test, never chosen foods based on specific ingredients or an organization's endorsement, never had to dress in a manner different from those around them, and never had to follow a ritual not of the mainstream. Yet we see, meet with, and talk to people who do this on a daily basis, who could never think of not doing this (or who would never consider it)... who do not have diabetes, nor are they housemates of people with diabetes. Instead of blood glucose tests, they may remove their shoes to pray five times daily; they may perform intricate rituals of wrapping leather straps around their heads and arms; they may cover their heads with hats, scarves, or veils; they may wear long sleeves and turtlenecks in the heat of summer -- and they may limit their choice of foods, restaurants, and nightlife to those endorsed by particular organizations.

These people are people of faith.

Whether by birth or by choice, their lives are circumscribed by ritual, their clothes and foods often determined by ritual as well. When we see a Jew checking if a box of cookies is Kosher or a Muslim going to a Halal butcher, a shamanist or pagan rising early to greet the sun, or an Amish man hitching a horse to his buggy, the ritual and lifestyle we observe are bound by faith. It may matter little whether or not one honestly believes that his individual acts make any difference to an omnipotent Deity, or to his status in whatever presence might exist when his (present) body has decayed to dust -- the habit, the community, and his belief in the right-ness of his style of living keeps him on the "straight and narrow" of that Path.

When we grow up in a particular faith, we may not question its boundaries. (If we do question them, we are often given reasons for their existence.) Each religious denomination and each culture has rites of passage by which, when we freely accept the beliefs and boundaries of that group, we become fully-invested adult members of that society, and of the congregation of witnesses. The consequences of not accepting those beliefs and boundaries at the cultural age of majority (or of repudiating them later in adult life) can be devastating, ranging from shunning and banishment, to excommunication, (figurative or literal) death, and damnation. Still, people from outside these traditions actively choose to enter these communities of faith and to adopt their ways of living.

The applicable question for people with diabetes is, cumulative body damage and (risk of) complications aside, is it easier to follow a "diabetic diet" and the rituals of diabetes care when one is diagnosed before one has the opportunity to have learned another, diabetes-free life -- or is it easier to adopt the restrictions of diabetes later on in life? And is it easier for those of us who accept dietary restrictions and daily rituals as part of the daily course of one's religious life to adapt to the restrictions and rituals of diabetes, or for those of us who have never known any level of structure in our daily lives? One might argue that -- especially in a household in which most or all of the members have diabetes -- these rituals are no more different from the "mainstream" (in the USA, secular Christianity) than those of the Muslims, Jainists, or Modern Orthodox Jews within our midst. But unlike many restrictive religious orders, the option of leaving (regardless of the pain of banishment) does not exist. To reject diabetes self-care is not simply to reject a world-view and a philosophy of life, but to reject life itself.

Again, there are those who adopt religious restrictions by choice. Whether it is the Conservative Jew who marries into a Chassidic sect, a Christian who accepts Allah and marries into the Islamic tradition, or someone who gives up a secular life to join a cloistered monastic order, every day people make the conscious choice to dedicate themselves to "righteous living". The path is no easier for them than it is for us: learning new liturgies and rituals, new languages, new ways of life. These new lives are not learned overnight, and some who make the choice to leave their birth-faiths and -families behind may be forced to wear the placard of "convert" for the rest of their lives. Are these proselytes so different from us -- we, who must learn the languages, rituals, and diets of "diabetes", who carry the label "diabetic" (and very often, the burden of guilt that comes along with it), who must pay for our "cheats" and "deviations" with some portion of our lives?

Some of us adapt to life with "the big D" by attaching its rituals
on to those of our religions; others pray to our Deities for the
strength to keep following the restrictions that keep us (relatively)
healthy. Still others accept diabetes self-care as
a religion unto itself. Whether by upbringing or by choice, or by lack
of other alternatives, we accept the modernly-accepted truths of
diabetes management as readily (and as relatively-unquestioningly) as
we accept the daily rituals of our religions. Perhaps it is safe to say
that, just as each of us chooses to accept our religious paths through
freely- and publicly-professed rituals of faith, we accept our diabetes
as another facet of faith. Whether we call ourselves "diabetics" or
"PWDs" we are, in the end, no less Diabetics by Choice.