I’d known the symptoms since I was ten years old. My maternal grandmother was a Type 1 diabetic with highly fluctuating blood sugar, what was called a “brittle” diabetic then, and I remember watching her give herself shots of insulin while sitting at a desk in her kitchen early in the morning beneath a small light. Like all kids, I hated shots. I told her I could never do that. “Yes you could,” she said most gently, “if you had to.”
At age thirty-seven, I began to notice a constant thirst, and of course an almost constant need to urinate. What I didn’t really notice was the weight loss, not until people I knew began to comment on how thin I looked. One symptom I didn’t know about was the fatigue. I just knew every afternoon I needed a nap, and in an attempt to keep my energy level up, I’d eat a candy bar, which now strikes me as downright funny.
I’m not sure how long I tried to deny the symptoms. After I aged out of my twenties, I thought, Well, if I was ever going to get diabetes, I would have gotten it by now. Still, at thirty-seven, I knew, though I wasn’t quite able to accept it yet. But finally the moment came. I was teaching freshman English at Auburn University at Montgomery. We had two-hour classes and would take a break halfway through, and at that point I would, of course, make a beeline for the restroom. While I faced the tile wall, I said to myself, Okay, damnit, you’re diabetic.
That might sound like a moment of complete acceptance, but I know now that it wasn’t. Acceptance isn’t so simple.
I made an appointment with a general practitioner, my mother’s doctor, who I’d never seen before. He was a big, tall man, had played college basketball I learned later, and was a bit gruff sounding. After he shut the door to the exam room and asked what he could do for me, I said, “I think I might be diabetic.” The words were more difficult to say aloud than I’d thought they might be. The doctor left the room and soon enough a nurse entered with a blood glucose meter. She pricked my finger and filled the test strip with a drop of blood. I asked her what normal blood sugar was. “Up to 120,” she said as we watched the digital zero circle the meter screen for a moment. Then the number 365 popped up. I’ll never forget her reaction. “Oooh,” she said, as if she were just as shocked as I was. But how could I be shocked? I already knew the reading would have to be high. And yet, seeing the number in front of me was, I suppose, another moment where I had to accept a truth. Then, if that weren’t enough confirmation already, the nurse left the room and in a little while the doctor came barging in the door and said unceremoniously, “Yep, you’re diabetic.”
He told me it was adult onset, Type 2 diabetes, and put me on an oral medication, which worked for some time, the honeymoon phase, it was called, which I learned about later, just as I learned about diet and counting carbs.
I then had to tell my parents and my girlfriend, Rhonda (who’s now my wife of twelve years). Telling my mother was most difficult because she knew from watching her mother struggle with diabetes just how serious the disease could be.
I told no one else, and was adamant that I didn’t want other family or friends to know. Maybe to some degree I was embarrassed about being diabetic, felt, illogically, that having the disease was somehow a weakness on my part. I think, though, I mostly needed time to absorb what was happening to me, to internalize it, redefine, to a degree, who I was. So I kept quiet about my diagnosis, and expected my parents, and Rhonda, to do the same.
That did not happen.
I went to lunch one day with a long-time friend who’s an artist here in Montgomery. I sneaked my oral medication with a glass of water when he wasn’t looking, and then gave my order to the waitress. When my friend Clark heard me ask for un-sweet tea, he looked at me oddly and said, “I thought you drank it sweet.” I wasn’t sure how to respond, and before I could figure out what to say, I heard him use the word “diabetes.” Then he said, “Rhonda says you’re diabetic.”
I remember feeling upset and angry, and Clark didn’t understand why. Later, when I saw Rhonda, I asked her why she’d told him. Turned out, she’d told other friends too because she was worried that I might have an episode where I suffered diabetic complications (low blood sugar I suppose is what she had in mind, though that wasn’t likely on oral medication), and she wanted anyone who might be with me to understand what was happening. She’d done it out of love, of course, and I had to accept the fact that others now knew about my diabetes. This was not easy, not while I was still learning how to live with the idea myself.
The honeymoon phase eventually ended. My A1C reached 8.3, and I went to see an endocrinologist who proceeded to tell me that I was actually a Type 1 diabetic, and had been all along. My pancreas, you might say, had given up the ghost. He told me I would need to take insulin before each meal, and at bedtime, and would need to test my blood sugar before injecting. I was used to testing only once a day, and I asked how long I would need to test four times each day. He looked at me somewhat strangely, and may have wanted to laugh, but he didn’t. There was simply a long pause. “For the rest of your life,” he said. The words sounded so final, like a sentence from a judge, though I’m certain he did not mean for them to sound that way.
I had known before seeing the endocrinologist that I probably would have to go on insulin, and I managed to take his words calmly enough when I heard them, but outside in the parking lot, in my car beneath a shade tree on an already cloudy day, I sat very still for a long time. In some ways hearing that I’d have to take insulin was worse than first hearing I was diabetic. Now I would have episodes of low blood sugar and would learn that, in those moments, I was weak, at least physically. It took time, but I learned how to handle shots, just as my grandmother had told me I could, and I grew far beyond thinking of myself as weak in any way.
In addition to teaching, I’ve been a fiction writer for most of my adult life. Several years after being diagnosed with Type 1 diabetes, I reached a point in time where my diabetes and my writing intersected, though it didn’t occur to me at first what writing about diabetes really meant. I’d published two collections of short stories and two novels. In all of that work, I’d never written about a major character with diabetes. It had never occurred to me to do such a thing. Then I found myself writing a story called “Pasture Art” where a single mother who’s diabetic does not take care of herself properly, and her teenage daughter has to struggle with her mother’s irresponsibility and failure. I had to use my knowledge of diabetes, even did some research, and realized, after I finished the story, that I had internalized my condition to such a degree that it now came out in my imagination, and I was able to use it to create something that I hope examines human nature in an honest and affirmative manner.
A final point of acceptance happened just a few weeks ago (though maybe there are others ahead that I don’t know about). I was with a group of friends, including Clark, the artist I mentioned earlier. He saw I was wearing a t-shirt that promoted diabetes awareness, and in fact it was the first time I’d ever worn it. I’d even been a bit hesitant to put it on that morning. I suppose I knew on some level that wearing it meant not just friends knowing I was diabetic, but every stranger who I might pass that day. “I can’t believe you’re wearing that shirt,” Clark said. “Remember how mad you got when I said something about you being diabetic at lunch that day?” It had been fourteen years. I laughed. “Yes, I remember,” I said and tried to explain why I’d been upset then and why I could wear the t-shirt now, but I don’t think I did a very good job of either.
What I tried to say is that it all had to do with acceptance, and acceptance doesn’t come all at once. It keeps coming—maybe like grace—when we aren’t even aware of its presence.