Diabetes As Referred Pain

When my mother was diagnosed with diabetes in her early 70s, long before her memory started to deteriorate, she immediately went out and bought two AccuCheck machines in case one broke. She kept them side by side on the dining room table, next to a squadron of test strip vials. The thought of being unable to monitor her blood sugar terrified her for much the same reason being without a scale terrifies the person with an untreated eating disorder.

As a home health social worker I’d evaluated hundreds of patients my mother’s age. Their level of compliance with (or defiance of) a diabetic treatment plan could sometimes be predicted by examining a person’s medical record. Did he or she follow doctor’s orders? Take medication as prescribed? Attend follow-up appointments? It’s totally unscientific, but from this perspective, my mother was, in general, a good, obedient patient. She never questioned authority directly; healthcare professionals loved her.

Still, I knew in my heart it was likely that my mother wouldn’t be able to control her blood sugar. Long before the official diagnosis my mother couldn’t control her eating. Before that, she couldn’t control her smoking. It turned out, as well as being unable to control her blood sugar on a consistent basis, her blood sugar monitoring became unwieldy. Over time she was testing herself so often—fifteen or twenty times per day—her fingertips shriveled and toughened with scars. But while her blood sugar level—or weight—might be within normal limits on paper, the numbersdid not reflect the actual disease process—mental, emotional, spiritual, physical—at work deep inside. This I understand, though I do not have diabetes.

Always at the dining room table (symbolic), my mother pricked her finger with a needled stick, squeezed two drops of blood onto the test strip and slid it into the machine. “I hope I get a number I can live with,” she’d say, applying a Band-Aid to her fresh wound. Then she’d fold her hands in her lap and wait.

When the machine beeped, my mother crossed her fingers. Either she “hit a winner” or “got a loser,” she said. A loser—any number higher than her endocrinologist suggested was healthy—prompted more tests and a strict diet of peanut butter sandwiches to stabilize her blood sugar. Meanwhile, a winner necessitated celebration, complete with any food she felt deprived of that, naturally, made her sugars spike.

It dawned on me that this was a reincarnation of how my mother used to smoke, puffing through four hard packs a day. She attempted to quit many times, but always came back smoking more. As a six-year-old I drew circles around the tips of her cigarettes, as public service announcements on television back in the 1960s implored kids to do. In theory, when the smoker hit the red line—which you were to strategically place as far away from the filter as possible—the smoker would extinguish and actually thank you for the gentle reminder. But Mom felt controlled by my inky red lines, policed by my fears that she might die and, literally, blew past every red line I drew. “Thanks,” she said, “But don’t waste your red markers.” She did quit years later, but only when X-rays proved her lungs were black and the threat of cancer loomed. Within two sessions with a hypnotist, Mom threw her leftover cigarettes into the garbage and announced, “I’m free!”

Then she started to eat.

It started with healthy snacks, peanut butter on apples, toast, a clear chicken broth, but soon progressed to fried chicken. McDonald’s French fries and A&W root beer floats. She gained weight, as ex-smokers sometimes do, when one compulsion is traded for another. Her struggle with food led to her late-onset diabetes. Her compulsive behavior, I believe, was the real disease. The diabetes, in this case, was secondary, almost like referred pain.

Not that it’s logical—these things never are—but I understood how it could happen—and my clinical training had nothing to do with it. In my late teens and early twenties I was that person who’d climbed on the scale, checked my weight, ate erratically—binging, starving, binging—as a means to get a weight on the scale I could live with. I understood that compulsions progress (worsen) over time, and can be exchanged for other compulsions (food for smoking, for example). The compulsion is the underlying disease, the root. And realizing this in myself scared me enough to get help.

It hurts to be an out-of-control person and it hurts to love one. You feel not only powerless but impotent to make them stop hurting themselves and, by proxy, you. Out-of-controll-ness—compulsivity—sometimes runs in families. Letting go, balanced with selective action becomes the higher form of love. Because any other kind of love—which is, in reality, only worry, veiled attempts at control and manipulation—isn’t love at all, and doesn’t work.

It was a mixed blessing, then, when my mother’s memory began to weaken, requiring she move to an assisted living facility and then a nursing home where her blood sugar was tested at normal intervals. Even then, some behaviors don’t go away. Whenever I visited her, even in the later years before her death, she often had a little smudge of peanut butter at the side of her rouged lips. When I hugged her, I felt the crumbs of bread on her cheek, like I always had.