As a doc, it’s easy enough for me to think I understand a disease state, and then to write a prescription for a medication to be taken two or three times daily.  I can spend hours and hours studying that problem.  I can even talk with patients who have been diagnosed with that illness, and learn how it has changed their lives.  But all it takes is to have a member of my own family diagnosed with asthma for me to really understand what it means to have that disease.  It’s completely different, like understanding from the inside out.

Diabetes has been a little like that for me.  I learned a ton in medical school.  But in the end, my friend Dee has taught me more about diabetes than anyone else.  She became an expert because she had to: she was diagnosed with it when she was 9.  Dee is a type 1 diabetic, which means that her pancreas doesn’t make any insulin at all.  All the insulin that she uses comes from outside, via a pump or a needle.

Dee is absolutely expert at keeping her blood sugars normal.  I wish everyone’s blood sugars were as good as hers.  Over the years and decades since her diagnosis, she has come to be able to predict with virtual certainty which foods cause her blood sugars to spike, and which ones don’t.  But she doesn’t leave anything to chance.  There’s no guesswork here.  She uses her glucometer to check her sugars all day long, before meals, after meals, before she takes a walk, or a drive, or a nap.

Dee is not into self-deprivation.  She loves ice cream, cookies, and cake like everybody else.  She just uses them like medicine, to keep her blood sugars normal.  Once, when her blood sugar was low, I saw her eat a quarter of one of those gargantuan chocolate chip cookies from a fancy bakery.  It was definitely an adequate single serving.  It’s just that I never saw anyone actually break one of those giant cookies into quarters.  Halves, yes.  Quarters, no.  Not until Dee did it.  But it worked, and her sugars normalized shortly.  She put away the rest of the cookie for another time.

Of course, you should know that she never creates low blood sugars on purpose to give herself an excuse to eat a treat.  She doesn’t create opportunities for treats.  But when her blood sugars drop, she treats them with treats.  Also, if she exercises more on any given day, she will lower her insulin dose to keep her blood sugar from dropping too low.  Keeping her sugars normal requires her to constantly juggle a lot of variables, but the truth is that it’s become second nature to her.

There’s a place in her diet for candy, too.  But she doesn’t just load up on it whenever she feels like it.  She carries individually-wrapped jelly beans and uses them as “medicine” when her blood sugars are dropping.  She told me once that each jelly bean raises her blood sugar about 6 points.  So 5 jelly beans will increase her sugar from 50 to 80, as long as she’s sitting still.  If she’s walking, her blood sugars become a moving target and it’s harder to get them back up into a normal range.  So we’ve sat on a bench or a curb for a few minutes more than a few times, waiting for things to stabilize.

She also has a deal with her family:  It’s fine to have ice cream any time you want — you just have to be willing to walk to the ice cream store to get it.  She’s happy to go with you!  Of course, she gets the sugar-free ice cream.  But if you don’t feel like walking, then no ice cream.  You have to earn it.  This might seem drastic, or it might sound like the sanest approach to treats that you’ve ever heard.  Before you decide which, remember that Dee’s blood sugars are perfectly normal.  You should also know that everyone in her family is slender and active.

I look at type 1 diabetes like a “canary in the mine.”  Long ago, miners would carry caged canaries down into the tunnels with them.  If poisonous gases (like methane and carbon monoxide) leaked into the mine-shaft, the canaries, more sensitive to the stress of the poison, would be affected (and die) before the miners began to experience difficulty breathing.  The miners would then, theoretically at least, have time to escape.

We can use what Dee has learned to keep our own blood sugars normal right now.  We don’t have to wait until we start running out of insulin and we get diagnosed with type 2 diabetes.  We can take a page from Dee’s healthy approach to blood sugar management to keep our own blood sugars in the normal range right now.  Here is what I have learned from Dee:

#1 Don’t feel guilty every time you feel like having a treat.  Just make yourself “earn” it.  That’s why it’s called a treat.

#2 Give each of your kids another jelly bean every time they pass one more block the next time you go on a family hike.  Walk to the ice cream store.

#3 One serving is a slice of cake, or a cup of ice cream, or two small-medium cookies.  One serving is enough.

#4 Ready for more drastic measures?  Got two diabetic parents?  Buy a glucometer and check your own blood sugar 60-90 minutes after you eat.  If your sugar hasn’t returned to the normal range (80-120), think back to what you ate, and see if you can figure out why.  Over time, you will get better and better at predicting which particular item(s) caused your blood sugars to spike, and preventing it from happening the next time.  [More on this next week.]

What I am trying to get across is that this is how to keep your blood sugars normal.  Why wait?