Some years ago, when my patient, Mrs. Price, heard me say that her blood sugar measurement had come back from the lab at 204, a single tear ran down her cheek as she said,  “My eldest granddaughter is getting married next year.” A blood sugar measurement over 200 is one way to confirm a diagnosis of diabetes. Both of Mrs. Price’s parents had died in their 60’s from complications of uncontrolled diabetes, or chronically elevated high blood sugars. This is what I told her.

“Right now, the most important difference between your situation and mine is that your body is no longer able to keep its blood sugars in the normal range automatically. But that doesn’t mean you are going to suffer the terrible complications that your parents did. Kidney failure, blindness, heart attacks and amputations are not inevitable complications of diabetes. It’s not diabetes itself that’s the problem; it’s uncontrolled diabetes.”

“There is some good news here. First, we found out about this before it became a serious problem. Secondly, as long as you keep your blood sugars in the normal range, your risk of developing complications will be pretty close to mine, which is to say, low. A diagnosis of diabetes doesn’t mean that you’re going to develop complications. What it means is that you’re going to need to involve yourself in the process, because your body can no longer control its sugars automatically. But as long as you give your body the help it needs, and you learn to conserve your insulin, the payoff will be huge. With a few relatively straightforward changes, I have no doubt that your sugars will return to the normal range. You’re just going to need to involve your brain in the process.”

“How do I know that your body is no longer able to keep your blood sugars in the normal range? Because if it could, your blood sugars would not be over 200. Of course, I can’t keep your blood sugars in the normal range all by myself either. But if we work together, we can and we will. So let’s figure out what is spiking your sugars, and then let’s make some adjustments.”

When I used to care for patients with diabetes, I had many goals. I wanted to get their average blood sugars under 125. I had goals for total cholesterol, triglycerides, HDL and LDL. I wanted blood pressures below 135/85, and kidney function in the normal range. I wanted strong peripheral pulses and expert foot care, both at home and in the podiatrist’s office, not to mention my own office. I also made sure to have my patients schedule annual eye exams.  

“But you, Mrs. Price,” I continued, “have one goal. Your goal is to dance at your grandchildren’s weddings. Not just attend them, but dance. At all of them. Beginning next summer.” She smiled a little.

“Did you know that one hundred years ago, before we had medicine for diabetes, the only treatment for diabetes was a high fat diet?,” I asked. She did not. I taught Mrs. Price to conserve her insulin. She stopped buying the cereal and orange juice she’d been eating for years. I prescribed medication to make her insulin work more efficiently. We made an agreement that she would begin to walk 5 minutes every day, and when she wrinkled her face at me in disbelief, I reminded her that “Slow but steady wins the race,” because I didn’t want her to sprain an ankle or get shin splints, two complications that would prevent her from getting much exercise at all for months. She also made a plan to walk in the nearby mall in bad weather. This is Cleveland, after all.

Mrs. Price got a glucometer, and I showed her how to determine which foods were causing blood sugar spikes by testing before she ate and then 90 minutes afterward. She got better at predicting which foods were causing spikes, and which foods kept her blood sugars in the normal range, and then she stopped buying foods that fell into the former category except on birthdays and holidays. She stopped eating items labeled low-fat, diet, quick, or instant. She started eating a nourishing, protein-rich breakfast, and discovered, to her surprise, that it resulted in significantly less after-dinner snacking. As the year passed, her blood sugar averages drop from 190 to 150 to 120. 

The following summer, I am pleased to report, Mrs. Price danced at her granddaughter’s wedding.