My father’s sister Margaret died of complications from diabetes at the age of 51.  It was an awful thing to watch.  The years between her fortieth birthday and her dying day were overfilled with pain.  She had issues with her toes, issues with her eyes, she had multiple strokes.  My father, a decorated Marine and police officer, held his little sister’s hand through too much heartache.  When she died, in a nursing home, too young and too sick for words, he cried.  

We cleaned out the apartment she’d lived in before the final strokes took her away from us.  On a Saturday afternoon, we emptied her life from a small one bedroom home in a community housing project in Massachusetts.  What struck me that day were the boxes and boxes of unused diabetes medication and supplies we removed.  Thirty boxes of bottles of untaken pills and unused test strips and meters and lancets.  Alongside those boxes were matching boxes of untaken depression medications.  The only used drugs were pain medications – hundreds of bottles.  

It’s challenging to understand how something like that happens.  How someone gets to a point where their choice about their life is to let go.  How a person lands up at a point where numbing the pain is preferable to actually putting in the work to feel better.  

But it happens.  All too often.  

And I can’t help but think – how could someone choose that?
I know a lot of people don’t have choices.  Choices go out the window in the face of the expense of medications, or a misunderstanding of illness and treatments, or bad advice from healthcare teams.  But if you’ve got medication available to you,  skilled doctors working with you, a brain that functions well enough to grasp what needs to be done and a family willing to help.  Well, you have a choice.    

My Aunt had a choice.  Diagnosed with diabetes at age forty, she had access to excellent medical care, the medications she needed, and a family with some experience with diabetes and a willingness to help if help was needed.  She understood  her diabetes, but seemed unwilling to sacrifice the things she liked to eat, the time she needed to test her bloodsugar and monitor her disease, and she would brush off questions about her medication with “well, I feel just fine without it.”  In the meantime, diabetes ate away at her, little by little, a virtually unseen but ultimately fatal parasite.  

Two years after her diabetes arrived, came her depression diagnosis.    My aunt, a generally happy and friendly person, had started experiencing wild mood swings and periods of just staying in bed for eighteen hours or more at a time.  On my grandmother’s insistence, she saw a doctor who diagnosed depression and prescribed medication.  At the same time, her Primary Care Doctor noticed issues with her bloodsugars and recommended a week stay in a hospital for both diabetes education and getting all of her medications regulated.  She stayed the week, returned home, and it appeared from our clean-out of her place years later, immediately stopped taking any of her diabetes or depression medications.

She also, in spite of having them available to her, almost never saw the doctor.  Oddly enough, she would go in often enough to have prescriptions refilled – and she seemed to fill them all.  But the only things she was taking were pain medications.  She switched doctors at least once a year, presumably to avoid having a doctor discover that she was relying on pain medication to sustain her lack of care of the diseases that were destroying her.  

She made a conscious choice.  And she was persistent in her maintenance of that choice.  

It’s a choice all of us living with chronic, persistent physical or mental illness must face.  Will we use the tools available to us to live well?  Or will we deny or ignore, choosing self-sabotage and likely pain and suffering?  

I know the arguments in my Aunt’s case.  Her depression crippled her.  She was in denial.  She was suicidal.  

But the truth is, she let her depression cripple her.  And she let her diabetes kill her.  

She made purposeful choices that led to her dying.  

I know a lot of people won’t like that I believe that.  Won’t like my saying it.  But those are the facts.  

When we’re diagnosed with a chronic condition, the choices are laid out before us.   If you’re diagnosed as a child, those same choices are laid out before your parents.  

I have the good fortune of having had a mother and father who were not just aware of the choices, but engaged in the process of helping me to see those choices and to understand the consequences of some of them.    As I grew, there were times as a teenager and as an adult when I consciously made poor choices, knowing full well the damage they might do.  But for the most part, I’ve chosen to live healthfully, to take advantage of the tools and medicine available to me, to follow my doctors’ advice, and to do my best to eat well and exercise.  

It is why I get frustrated with people who have type 1 who make no effort to choose wisely, but complain about how difficult it is to be sick.  Who go days on end without insulin, not because it’s not available to them – but because of whatever excuse they’ve made for themselves that day.  Who make poor food choices and then fret about complications.  Who don’t test, then are upset when their A1C is too high.  

Most of all though, I can’t stand when a type 1 (particularly one who chooses to not take care of themselves) makes a pleading passionate case for how much harder it is to have type 1 than type 2, essentially implying that a type 2 might have brought the disease on themselves.  

I heard this happen the other day.

“Well, I got this as an innocent child.  You had a choice.  You could have eaten better.  You could probably control it with diet.”  

The type 2 stood there, first trying to explain genetic history, then pointing out they are pretty thin.  

“Well, type 2 is generally about lifestyle.”  

Thankfully, the argument ended there, with the type 2 sort of “yeah, yeahing…” to her counterpart’s tirade.  

The type 1, someone I consider a friend, had really no right to make any judgments about another person’s disease.  None of us does.  

But more to the point, that same type 1 rarely tests, often doesn’t dose, and eats as poorly as any person I know.   They choose to let diabetes have its way with their body.  How can someone in that position cast stones at any other person with regard to health?

The fact is, diabetes of both types “happens to” a lot of people.

What doesn’t “happen to” any of is the choice we make about how we’ll take care of ourselves.  

For the most part, we make our good or poor health happen.   We decide the course we’ll follow.   We set out on roads that makes us stronger or roads that allow our enemy illness to have its way with our bodies.  

I’m not saying we must always be perfect.  Hardly.  And I’m not saying that diabetes doesn’t sometimes throw up roadblocks that we simply couldn’t have anticipated and often struggle to maneuver around.  

I am saying that we are allowed to choose many things around our health.  And if when given those opportunities,  we consistently make poor choices, we’ll consistently get poor results.

I for one, want better for myself.  Better than my Aunt Margaret chose for herself.  And I’m willing to put in the work, the struggle to achieve that.  Are you?