diabetic privilege: the socio-economic reality

Farmgirl Fare bread recipe, it was nice knowing you while I could. Baked goods, I miss you so much.

Farmgirl Fare bread recipe, it was nice knowing you. Baked goods, I miss you so much.

I’ve been meaning to write more about the diabetes lately, but it’s been so all-consuming.  Since my last post about my diabetes class (which got cancelled after that first session, BTW, what a let-down!) I have actually started insulin treatment.  My irrational fear of needles and blood has morphed into 4+ finger-sticks a day, plus 4 shots of insulin a day.  Under doctor’s orders, I’m still in the “tight control” range, meaning that I need to keep blood glucose (BG) really low, and I have to send a report to the doc every week.  I’ve been using MyNetDiary (Diabetes Edition!) to dutifully record all my BG readings, my insulin administration, and my food/carbohydrate consumption. I’ve been seeing an endocrinologist who reviews my BG logs and makes suggestions.  I’ve been seeing a nutritionist who checks in on my BG logs and my food logs and makes more suggestions.

What was supposed to be “6 weeks off” this summer has turned into a constant battle of “what to eat”, “how much to eat”, and “when to eat”.  At the moment, I’m still in the battle of counting and logging carbs, and it is stunning to see how my years of living to eat has been detrimental to my health.  I’m no crazy glutton (ok, maybe a little), but I was definitely not cautious when it came to looking at the nutritional value of what I needed.  I once read (skimmed, or maybe overheard) something about Clara Davis’ 1939 study where babies left to choose from an array of healthy foods would choose what they nutritionally needed, and somehow justified all my whims using this (unsound) argument.

My carbohydrate goals for the day are 30g for breakfast, 45g for lunch, and 45g for dinner, with 2 or 3 15g snacks between meals or before bed.

What this looks like in reality:  eggs.  Lots of eggs.

Just kidding.  Sort of.

After a few weeks of fastidiously measuring and reading labels and typing things into my phone like a tech-obsessed nerdulon, I’m getting better at figuring out that almost all things are possible, when choices are made.  A few things I’ve learned:

  • Breakfast can be a very pathetic looking 1/4c of granola-based cereal and 1/4c of milk.  Or it can be a blueberry waffle with peanut butter instead of syrup.  Or it can be 9 tater tots, 1 fried egg, and 2 breakfast sausages. There are days when I want one and days when I want the other.
  • 56g of pasta (1 serving) is less sad when it’s bulked up with other friendly ingredients.
  • A McDonald’s burger is not out of the question.  Fries with your burger—now that’s out of the question.
  • When I’m told can’t have carbs, that’s when I’m going to want to start eating all sorts of fruit.  Also, only eating 3-5 cherries for a snack is really sad.
  • There are many things that you can’t adequately account for with an app:  dim sum, non-chain restaurants, soup. Sometimes, you just have to hope that you did OK.  It would be more fun to eat these things without the worry and the guilt.  Perhaps that will dissipate in time.
  • When in doubt, get the hangar steak, and substitute the fries with a vegetable.

It’s this last point that really gets me thinking about diabetes and nutrition education, and the phrase which I’ve adopted: “diabetic privilege”.  The truth of the matter is, I’m able to adapt for my health quickly and (fairly) successfully because I have two very precious resources right now:  time and money.

Time

I’m currently in a 6-week phase where I don’t have to report to a daily job.  (This ends next week.)  I started on my current insulin-taking, carb-counting regimen in mid-June, after I had stopped working.  This has given me the ability to do several things:

  1. Read all the nutrition labels.  ALL OF THEM.  My first grocery trip probably took me about 2 hours. I had to read the labels to see what I could eat, what I could portion out by serving size, and what had to be avoided right out.
  2. Figure out what I can choose from when we go out for meals, provided that there is a menu online and that there is some basic nutrition information available online.
  3. Try out new recipes of things I had never made before, using all the low-carb substitutions (coconut flour, almond flour, flax seed).  Truthfully, I have not found anything I have loved yet.  Maybe the coconut flour mug cake, with whipped cream on top.
  4. Go to multiple specialty doctors to learn more about getting my diabetes under control.  Read about diabetes online, participate in forums, and generally learn more about the effects that different types of food choices and food timing will affect my BG.  I have been devouring diabetes knowledge like Johnny 5 lately.  (Yes, that does totally date me.)

I could not do any of these things without the luxury of time, and I am fortunate to have a support system that allows me to take this kind of time.  Soon, I will be back to work, without this kind of time, but the knowledge framework is already there, and I know that things will get faster as I get used to them.

Money

Obviously, money makes it a lot easier to do many things, but specific to my diabetic journey, I have been able to:

  1. Buy a lot of different kinds of foods to “experiment” with.  On that first 2 hour grocery trip, I had a hard time distinguishing between things that were necessary now, and things that “I could have”—so I bought a LOT of things.  Some food went bad, some were way too expensive, but the glamour of having things that I could still eat was really difficult to resist.
  2. Not worry about medication “experimentation”, because my insurance is good, and covers a good portion of my insulin and supplies.  In addition to that, if I use more test strips than prescribed, buying strips off-prescription is not prohibitively expensive, so I have not had to curtail my BG testing due to worries about supplies or money.
  3. Just eat a steak when I’m confused.  Yeah, it’s really nice to be able to say, “hey, I don’t know, I’ll just have a steak.”  I mean, we’re not made of money, but an occasional (or more than occasional) steak won’t break the bank for us right now.

What happens to people who don’t have these luxuries?  The fact that I have diabetic privilege does not escape me, and it plagues me to some extent.  No, I’m not going to sacrifice my own care because others do not have the ability to maintain this standard of care, but it really makes me feel for the diabetic parent who doesn’t have time to read the label or spend 2 hours grocery shopping, measuring, and recording in order to stay on track.  Or the many many families who do not have the ability to say “I’ll just have a steak” when they are faced with a number of carb-heavy bad choices that are fast, cheap, and available.

And what happens to these people when they are forced to choose from bad choices?  There is so much judgment in nutrition choices.  You can’t buy the food you need to eat to manage your diabetes?  Well, then you chose this health for yourself and you gave yourself diabetes/obesity.  You just need to choose better.  Or worse yet, you must not be smart enough to make the right choices, here’s someone to tell you what to do.

I get frustrated with memes/comments/things that blame people for their health like it’s always about choices, but there is so much more to it than that.  I’m not obese (well, actually, according to BMI, I AM obese, I guess…I’m just big-boned) and my diabetes is genetic.  Many ethnic groups are pre-disposed to Type II diabetes.

I wouldn’t say I feel lucky that I have diabetes, but I definitely feel lucky that under my circumstances, I’m well-equipped to treat myself properly.  So lucky and so grateful.

 

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