I’ve been debating writing this post for a while now. Actually about three months to be exact. It’s been a heavy topic on my mind for the whole time.
This post is all about diabetes, advocacy, education, health and what the hell happens when you care about someone you barely know because they are literally killing themselves.
I’ll start out and say that I’m angry and frustrated. If you read any of my other posts, you’ll already know that me being angry isn’t a common occurrence. I try my hardest to embrace the feelings of anger when they come (which, c’mon, they always do) and then let them go. But in this particular situation, I find myself feeling frustrated and angry all the time. I get irritated when I see the person involved. But I also feel sad and scared. I feel a whole mess of things, and I think, if you were in my situation, you would too.
I met Mandy (*name has been changed) about three months ago at work. In a new employee’s first week, I give several meetings on social media and online representation, so it was in Mandy’s meeting where I divulged my love for Twitter and all three of my accounts. I told her that I keep my most personal account separate from my more professional ones because I tweet a lot about diabetes and am very much an advocate for the education about diabetes (thanks, #DSMA and #DOC!). It was at that point that I told her I had Type 1 diabetes and she said she had Type 1 too.
So, what happens when one Type 1 meets another Type 1? Well, with me, I got excited! I also started asking her about her diagnosis, insulin, etc. After the blank look she gave me, I quickly shut up. She then corrected herself and said she thinks she has Type 2, but she wasn’t really sure.
Mandy had absolutely no clue. None whatsoever.
Mandy has Type 2 diabetes. I met her in November of 2012 and she had been diagnosed in March of 2012 and given Metformin to help control her blood sugar. She has (to this day in January of 2013) never owned a blood glucose meter, seen a real endocrinologist, taken her Metformin when she is supposed to, and attempted to eat a better diet. She has however experienced worsening eye sight, extreme fatigue, lots of bathroom breaks and a trip to the ER after she passed out and almost went into DKA (diabetic ketoacidosis= HIGH blood sugar).
I talked to Mandy pretty soon after she started working in my office about diabetes and what was happening inside of her body because she really had no clue. I explained what happens to the body when blood sugar stays elevated for too long, what happens when it goes too low. I explained the fundamental differences between Type 1 and Type 2. I also explained ways she could manage her diabetes, including better nutrition and exercise. I told her she definitely had to go to the doctor and get a blood glucose meter and emphasized that when I tested her blood sugar two hours after a lunch of Ramen noodles and her blood sugar was pushing 300.
I explained as much as I could about diabetes (of course, there was a lot that I intentionally skipped so as not to overwhelm her) and sent her a bunch of information and resources. The same information and resources that I found when I had been misdiagnosed as Type 2. I explained the DOC in case she wanted to reach out. I sent her a few great blogs that talk specifically about Type 2. I did everything for her that I wish someone had done for me.
She nodded her head and thanked me after we were done talking. I felt good. I felt like I was able to help someone.
That good feeling lasted about two weeks. Mandy said she would make an appointment to get a meter. She hadn’t yet. I also had noticed her diet hadn’t changed and carbs, carbs, carbs seemed to be the theme of the day, every day. I didn’t say anything because I (and every other diabetic) hate the food police. I hate being told from some know-it-all that I shouldn’t be eating a donut or a piece of chocolate. I have Type 1, so that makes things a bit different, but I would never ever want a fellow Type 2 deprived of a delicious and sugary treat every once in a while. I totally believe that moderation in diet is the key for everyone, diabetic or not!
Mandy and I talked here and there and it became increasingly clear that she wasn’t taking her diabetes seriously. I tried expressing just how serious it is and really had hoped my impression had been made.
Fast forward through the holidays. We are finally back at work after the New Year. It was the Friday after New Year’s and I overheard Mandy and her manager talking in the kitchen about the hospital. It had just dawned on me that Mandy hadn’t been at work the day before, so I casually (yes, I’m nosy!) walked into the kitchen. Mandy’s manager saw me and told me I had to talk to Mandy…
Mandy wasn’t at work the day before because she had been in the ER. After a morning where her boyfriend had a hard time waking her up, her eyesight turned completely fuzzy and she passed out as she got out of the car, she landed in the ER where the doctor quite literally asked her if she was trying to kill herself.
As an aside, the thought of going into DKA is terrifying. It’s something I think about a lot and it’s why I’m so vigilant with my health. To have someone with diabetes that I personally know almost enter into DKA is surreal and really grounding at the same time.
Anyway, Mandy and I went into a conference room to chat about what happened. I told her that what happened is really serious and could be avoided. I didn’t want to lay into her too much because it sounded as though the ER doctor and her boyfriend had already done that. What I did do was bring up the emotional side of diabetes. I asked her why she wasn’t taking car of herself. What was preventing her from taking her medicine and making mindful eating decisions?
“I think I’m in denial,” she said.
Denial, I’m thinking. We’ve all been there, I’m sure. Shock, denial, anger, sadness, confusions, frustration. These are all very common and typical reactions to getting life-changing news such as having diabetes. I get that. I’ve also read enough blogs and personal accounts to know that everyone gets the other D word. I told Mandy as much. I did my best to let her know that was a normal feeling.
“It’s time to leave da Nile in Egypt,” I said, trying to lighten the mood with a corny joke. In all seriousness though, I emphasized that there comes a point where you have to get past the denial. Sometimes people can transition into things easily. I was one of those people who got my diagnosis with shock but immediately jumped into a plan of action. I’m not sure I can say I was ever in denial, although I have my bouts with it every now and then. Denial, for me, was never an option. I felt so terrible and unhealthy that I wasn’t going to deny something was wrong with me. I also am a Google fanatic. My friend Liz and I (name twins!) often have conversations about our unhealthy obsession with using Google to find information about anything and everything, from subjects like English literature to current ailments. So, it was in my nature to Google around the internet until I had a bunch of information about diabetes and what I could do to live a healthy life.
Mandy isn’t like me. I have to keep reminding myself of that. Mandy is Mandy and Mandy is going to do what Mandy wants to do, even if it’s the wrong thing to do. And who am I to judge it’s the wrong thing to do? Granted, I’m sure a lot of people think her denial and lack of motivation to do anything about diabetes is the wrong thing to do, but who are we to judge? (See my problem!)
We ended the conversation talking about resources to help with coping. I suggested she talk to a Certified Diabetes Educator and maybe even a psychologist. I stressed the importance of her getting over the denial in order for her to start on the road to a healthier life. We talked about what would happen if she continued down the path she was on. That path would include insulin injections, complications or even death.
I hoped her trip to the ER would snap her out of denial and wake her up to what a life with uncontrolled diabetes can cause. I thought she would take that as a sign to do research for herself and change her lifestyle for the better.
I understand lifestyle change is hard. But I don’t understand at the same time. I’m not sure if that makes sense, but when I was diagnosed with diabetes, I immediately cut out all carbs. I’m serious. My diet became vegetable and protein rich. I stayed away from carbs. I ate cheeseburgers without buns, avoided pasta, gave up pizza. I did all of that (at least until I got my blood sugar under control). I’m not saying that’s the right path for Mandy, but I don’t think drinking a regular Coke is a way to control diabetes either.
A regular Coke, people! This happened about a week after Mandy’s trip to the ER and our conversation. I saw it at lunch and was flabbergasted. I mean, I haven’t had a regular Coke since about 2008 and would only ever drink it now if I was super low (my treatment of a low is usually glucose tabs or something desserty, like a cookie). Even then, just a little bit of that 24oz bottle would be enough to bring a low back to normal. I was stunned that she would drink the whole bottle.
I spent my lunch break walking around like I usually do and kept going back and forth on whether I wanted to talk to Mandy about this or not. Food police, like I’ve said, is not something I’m interested in doing.
But I was so worried about her that I decided to talk to her. This conversation was similar to the last one I had with her. I told her what the Coke was doing to her body right then and there. I told her she has got to start reading labels and looking at carb counts. Things like Coke and apple juice have more carbs in one bottle than a lot of people with diabetes eat in one day. Spending a lot of time reading labels is something she would become used to.
Again, the issue of denial came up in our conversation. She doesn’t want to change her lifestyle. She loves food. I told her that I got it. I understood. I’m a self proclaimed foodie too. But, I said, things HAVE to change for her health. She HAS to do this for her health. If she wanted to have a healthy pregnancy (which she mentioned) she would have to get her blood sugar under control. If she didn’t want to take insulin, she had to get her blood sugar under control. I again mentioned resources and information.
Sensing a pattern yet? Getting frustrated by the same conversations? I was.
I wasn’t only frustrated by the time we had this conversation. I was annoyed.
When I think about Mandy and her diabetes I want to scream. I literally want to pound my fists into a wall and scream. I want to yell at her. I want to do something that will wake her the fuck up. No more denial. Let’s get real here!! It is time to get real!
I know this post is long, and I’m hoping it makes some sense, and I want to thank you for bearing with me. Maybe if I had written this out as it was happening, I wouldn’t be at the point I’m at now. That point is feeling a bit desperate for Mandy. I’m feeling desperate and worried.
The day after the “Coke incident” I saw Mandy drinking apple juice. I bit my tongue. I tried to forget about it.
I keep telling myself (and my mom does too) that people have to want to help themselves. Change only comes about if a person wants that change to come about. I know this. I know that I can have fifty more conversations with Mandy. I can show her pictures of amputations. I can show her statistics. I can give her information about support. I can encourage her to eat better and point her in the direction of great healthy food blogs. I can do a variety of things, but it won’t matter because Mandy has to want this for herself. Many won’t change because I want her to change or her boyfriend wants her to change. Mandy’s health is solely Mandy’s and she can do what she wants with it (which, she is). But I still feel like I have to do something.
I feel a responsibility to do something. Is that normal? I barely know her. I think it’s because I’ve met so many people through social media that are a part of the DOC. It’s that bond that immediately happens through diabetes that makes me feel compelled to help, I think. But would you?
Mandy was out yesterday going to the doctor. I briefly talked to her today about what happened. Her primary care doctor told her she thinks she needs to go on insulin and got her a quick appointment with an endocrinologist who said the same thing. I asked her if either of them gave her a blood glucose meter. She said no and this is where things smell fishy. Why wouldn’t either of these doctors give this poor girl a meter? Why didn’t Mandy ask? She knows how important this is. Mandy went on to tell me she wanted to get a second opinion about going on insulin.
I laughed. Or maybe it was a scoff. I’m not quite sure.
A second opinion? Really? Mandy, dear, you don’t have time for a second opinion. Your blood sugar is out of control. You need to do something! You’re killing yourself. You need to do something to help yourself and right now it might mean taking insulin (I told her this would happen if she didn’t get it down). She’s scared of needles. Scared of insulin. I understand that, but what choice has she left herself with? What other option is there? No second opinion needed. Also, who are these doctors and why didn’t they start her on insulin when she was at the doctor’s office? Some of her story seems a bit fishy, but I’m giving her the benefit of the doubt that she did actually go to the doctors and not just tell the office she did (everyone at work is worried about her now).
Readers, DOC, non-diabetic friends… what would you do? Would you give up on Mandy? Would you feel as frustrated as I do? Is there anything I can do to help her out of denial and on a healthier track in managing her Type 2 diabetes?
I feel an obligation to help. I feel even more of an obligation because I keep failing at helping her. I also don’t know how to go about helping anymore. In the past, when I’ve worked as a teacher, I knew my role and I knew what I could do to help my students succeed. I’m not Mandy’s teacher. I’m not her doctor or her CDE, so what’s my role? I can’t just watch someone with diabetes do this to themselves.
So, I’m asking again. What would you do when you care more about someone’s health than they do? And thank you. Thank you for reading this and for being there for me when I need you. I promise, in return, to always be there for you.