In today's environment of cheap-to-the-patient pills that can cure almost anything from a hangnail to cancer, it's sometimes difficult to make significant and often-difficult lifestyle changes on account of a disease or a medical condition. Rarely is this more evident than in the public appearance of Type 2 diabetes.

Large percentages of the population know [Type 2] diabetes as "an old folks' disease", with its dietary restrictions limited as much by (sic) "high cholesteroil", cardiovascular disease, or "gallbladder trouble" than anything else. While the complications of diabetes are taken seriously ("My aunt lost a leg..."), its daily management is not ("My doctor never asked me to test") -- and the advanced age of many newly-diagnosed T2s fosters an attitude of "I'm going to die of something soon, anyway". What people don't see is how uncontrolled diabetes robs us of life little by little, gnawing away at us, until we are the great-uncle who went on dialysis, or the great-grandmother who went blind.  

Even so, many people who are not diabetic have no idea that diabetes can be -- at least to some degree -- controlled, or what level of commitment it takes from us. Unless we're out there with our glucometers, syringes or pens, pumps, and CGMs, measuring and correcting, and our portable scales or Calorie King books with which to weigh our food options, diabetes care looks like a bit of a crapshoot. But at even at craps, sometimes you hit your point.

The Scylla and Charybdis of diabetes self-management are the obsessive-compulsive tester/measurer and the nonchalant "I don't care, I have a pill for it". (One might argue the "I don't care" end to be the mostly young, T1 women with diabulimia, but that's tangent to this T2 story.) Each has a lesson to teach, and both lessons can be used to motivate us.

I've often mentioned that I have two diabetes role models -- my childhood orthopaedist, and my stepmother's father. I'd known more people with diabetes than they, but the circumstances suggested that these two men had to take more responsibility for their own care than the other diabetics I knew. Both of these men passed on long before I was diagnosed, but each has left a legacy that motivates my obsessiveness and keeps me striving for something better.

My early childhood included many visits to an orthopaedist to correct problems with my walking. The orthopaedist (I'll call him "Dr. G.") was a couple of years older than my grandfather, who was born in 1912. I had not known Dr. G. had diabetes until some time in my teens. For the many years I knew him, there was nothing that screamed out "diabetes" -- and to this day, I'm not sure how my grandparents (and later my parents) learned he had the condition. What I saw of Dr. G. was an intelligent man who took care of himself as well as he took care of his patients. While he did eventually lose both legs to diabetes, it wasn't until he was in his 80's, and he did not let that slow him down.

Dr. G. showed me that by caring for one's self, it was possible to live with diabetes for many years without being hammered by complications.

I met my stepmother's father, "B.", several years after I had graduated from university. I don't remember the particular occasion, but I do remember that he had already lost a leg to diabetes, and he appeared to be one of those people for whom amputation heralded a deep, permanent, and untreatable depression. While I had few direct encounters with B., the constant news stream suggested that his diabetes was not well-managed; that he was not choosing what medical science considered to be healthier foods; and that he did not try to move or exercise. Piece by piece, I saw -- or heard of -- his remaining leg being whittled away by gangrene and compensatory surgery. A year or two -- maybe three at the outside -- after he lost the remainder of his second leg, B. died from complications of diabetes.

B. showed me that uncontrolled diabetes kills you piece by painful piece -- that it could be as painful and as life-threatening and as difficult to live with as metastatic cancer.

While Dr. G. did end up with some complications of diabetes, he lived to be 95 years old, and as far as I know, diabetes never adversely affected his attitude. Dr. G. is my model for someone who "lived with diabetes", took care of himself, and spent many years in its company.

On the other hand, B. let diabetes depress him, draw him down, and -- eventually -- kill him. In short, B. died from diabetes. Slowly. Painfully. Not the manner of death I'd expect most people to choose -- nor, the one I would choose.

Seeing the good that can come from taking care of one's diabetes, and the ill that can become of not caring, keeps me motivated to stay on the (relatively) straight and (somewhat) narrow. I can either live with diabetes, or I can die from it. I'd rather live with it.

And if a "bad role model" can serve as "positive inspiration", well then, that, too, is a mitzvah.