I had breakfast with customers on Friday morning and found myself (shockingly!) talking about living with diabetes. The doctors I was visiting that morning ran a busy primary care clinic, and were lamenting to me about their challenges of keeping their patients with diabetes well controlled.
“What’s your A1c right now?” one doctor asked me, testing the waters for what she was about to say.
“6.7” I answered, unflinching.
“Ok, so maybe you can answer this for me then – why do so many of my Type 1s come in here with these horrible A1cs and they just, they don’t seem to care! They think they’re just fine with these high numbers all the time and nothing I say makes them change. They don’t test, they eat whatever they want – they just don’t care.”
Her frustration was palpable, but my answer wasn’t going to help. Because the answer was that I don’t know. I don’t know what makes one person care about taking care of their diabetes and another person completely lose their give a shit. Some people find the motivation day in and day out to take care of this burdensome disease, others decide to live fast and complicate young. Shoot – I was almost one of the latter folks – a single bout with DKA at age 18 turned my trajectory around, but thousands of people with diabetes go in for DKA as much as monthly and never want to change. Other people never get access to the right information and education. I’d once met a man who was told by a doc as a teenager that he wouldn’t live past 30 with Type 1. So the guy partied like there was no tomorrow and then hit 30 and was still alive – but with massive complications caused by years of ignoring his disease thanks to that one doctor. You never know a person’s reasons for not taking care of their diabetes – sometimes they don’t even know why.
“You know doctor, diabetes is so hard from a motivational standpoint. We live in a society of instant gratification. People get annoyed when their iPhone won’t load an email in a half a second, so it’s understandable that most people can’t understand that being healthy now will prevent complications years down the road. They don’t want to deal with it now and they’d rather not think about it. And your patients with those high A1cs – they might be used to living with chronic high blood sugars and don’t even realize how crappy they feel because they’ve forgotten how to feel good. I don’t know why some people care and others don’t. I don’t think anyone, diabetes or not does everything right for their health. It’s always easier said than done. But all we can do is try. Your patients are lucky you care so much.”
She nodded and said she hoped she made a difference, but that some patients made her want to give up on them. If the patient doesn’t care, why should she? It was hard to argue with that.
The challenge of diabetes is ourselves. We have to manage this thing every second of every day. Insulin is a merely a treatment that keeps us alive, and it’s administered in an artificial manner that is at best a crude interpretation of the body’s mastery. It’s no wonder management is an imperfect and unpredictable science. And guess what? Human beings don’t like imperfect and unpredictable – we tend to abandon things that don’t produce consistent results. But with diabetes, you can’t abandon the project. It’s ongoing, and the only choice we have is to manage this disease the best we can. I lose my motivation as much as the next person, but I try to keep the power of tomorrow in my mind at all timse. If I take care of myself today, tomorrow can be guaranteed. And even if I screw up today, I can try again tomorrow. I want to be able to always say that, so I have to keep trying. So that I can have a tomorrow.