I was diagnosed with type 2 diabetes in 2011. I had a routine physical, I got my bloodwork results in the mail, I knew what to look for. And I knew it was probably coming.
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SPOKESPERSON
You know who Paula Deen is. She’s the not-thin Southern lady who has a restaurant and cookbooks and some TV shows and lines of cookware and housewares and clothes. The one who makes Food That Is Bad For America, who is hilarious to watch when she’s on Craig Ferguson’s show. It turns out she’s had type 2 diabetes for years, and she’s coming clean about it because she’s landed an endorsement deal with Novo Nordisk, a pharmaceutical company that makes the diabetes drug Victoza.
This makes my head explode. Yours too, maybe. But I’ll wager my blast pattern is different.
BACKGROUND
I was diagnosed with type 2 diabetes in 2011. I had a routine physical, I got my bloodwork results in the mail, I knew what to look for. And I knew it was probably coming.
I had gestational diabetes in 2000. Gestational diabetes is otherwise known as Type 2 Diabetes That Goes Away When You Expel A Fetus – and my odds of getting Non-Fetus Expellation Related Type 2 Diabetes went up sevenfold after GD, according to the National Institutes of Health. Bonus: I had insulin dependent gestational diabetes. I had to inject insulin once a day for the last month I was pregnant. That was practically a VIP invitation to…to…
THE NAME
Type 2 diabetes should have a different name. To put it far too briefly, type 1 diabetics’ bodies can’t make enough insulin to manage their own blood sugar. Type 2 diabetics’ bodies give insulin the finger until the pancreas says “You know what? Fuck this,” and gives up.
I’ve spent some time trying to come up with a new name for type 2 diabetes. It hasn’t been easy. You can’t name it Fatty Fatterson Disease or The Obesity Apocalypse or God Sorting Out First World Consumerism because type 2 diabetics come in all shapes and sizes, and not all fat people have it, even though, as it happens, I am a fat woman who does.
As a result, renaming type 2 diabetes requires some deeper thought. Type 2 sucks — but it doesn’t suck as much as, say, cancer. You can’t name it after people who suck but not as much as cancer sucks, because then people will think Kim Kardashian has type 2 diabetes…and if she does, she’s keeping it to herself for now. You can’t name it after a body part, because so many are implicated. Ask any physician to finish the sentence “Type 2 diabetes is a disease of the ________.” and you won’t get the same answer twice.
My current favorite name for type 2 diabetes is Six Years Off. That’s how much an average Type 2 diabetic’s lifespan is shortened, according to this study. But that, understandably, creeps some people out. So until this gets dealt with by a UN committee, I mostly call Type 2 diabetes The Reason I Don’t Eat Your Blueberry Muffins, Even Though You Have Assured Me They Are Healthy. And even that doesn’t work, because some type 2 diabetics do eat them. Do you see why this is taking me so long?
YMMV
So. I have an epidemic-level disease that has a bad name. But what does that mean, exactly?
For me, it means that I am urged to do things like get flu shots, get referrals to other medical specialists, go to diabetes education sessions, take statins, and take high blood pressure medication when my blood pressure is not high by normal standards. For me, it means that I take 500mg of a generic drug called metformin every morning, for which I pay $14 a month. It means I check my blood sugar often enough to have a little black zippered case that sits on my kitchen table. It means I exercise more than I used to, and I eat differently than I used to. For me, for now, it means these things alone are enough to keep my Six Years Off under control. And in the world of Six Years Off, I am quite fortunate.
Other type 2 diabetics are not as fortunate as I am. Victoza, the type 2 diabetes medication that is now on Paula Deen’s list of endorsements, can cost $500 a month if it’s not covered by insurance – and often, it isn’t. Overall, the CDC estimates that diabetics’ healthcare expenditures are, on average, 2.3 times higher than nondiabetics. Drugs like Victoza are only part of the reason why.
For all of us type 2 diabetics, the disease means we might lose a foot or a hand or eyesight or six years or a heart. Even if we tried everything we could to stop it from happening.
It sometimes means people think we had it coming.
BLAME
Six Years Off is exacerbated and diagnosed through high blood sugar. Eating foods that are high in simple carbohydrates elevate blood sugar. Foods that can be high in simple carbohydrates include white bread, soft drinks, cereals, juices, and milk. Other types of foods with carbohydrates can affect blood sugar as well. Foods that are never high in simple carbohydrates include meat, eggs, butter, and cheese.
Even before her diagnosis came to public light, Paula Deen took a lot of shit for the stuff she cooked. Every article since her announcement (and all of the ones before) mention examples of her cooking, because it’s pure food porn. Nearly every article mentions butter and bacon as the culprits for diabetes. Articles that mention Paula Deen’s donut hamburger focus on the hamburger.
Those articles should focus on the donut.
LUNCH
The amount of carbohydrate in food, or how it affects each Six Years Off, is not always synonymous with our country’s perception of what is healthy.
Foods I usually turn down include pizza no matter what’s on it, rice, pasta, bagels, muffins, potatoes, cherries, regular beer, and most things with sauce where I haven’t read the label or watched it being made. I eat meat of all kinds, and fish. I eat eggs. I also eat vegetables – lots and lots of them – but not much fruit.
The RDA for carbohydrates is about 300 grams. Most of the time, I’m at about 100.
With Six Years Off, there is nothing that goes into my mouth that I don’t think about before I put it there. Nothing. If you see me drink a beer or eat a bagel, know I have done a fair amount of mental weighing of the issues at hand.
You should probably also know that if type 2 diabetes eating plans were global spirituality, I would be a member of a large and prominent cult. The American Diabetes Association does not recommend eschewing carbohydrates to the degree that I usually do. But I am reasonably happy with my path, because I am very happy with my results. And for now, it only costs me $14 a month.
As I write this, I’m eating baby spinach out of a bag. I dip it in blue cheese dressing that I’ve poured into one of the little cups my (preteen, non-diabetic, non-obese, because I know you’re wondering) daughter used to eat Cheerios from as a toddler. The blue cheese dressing has bacon in it. I don’t know how much fat is involved, but I do know this dressing has somewhere between zero and one carbohydrate per tablespoon.
I know how many carbohydrates are in lots of things. Go on, try me. Cottage cheese? About 20g for a regular size tub. Sliced bread? It varies, but usually between 10 and 40g a slice. That’s a pretty big spread, by the way, and there’s no way to know for sure unless you actually read the label. Two tablespoons of chocolate chips? 18g or so. A liter of Diet Pepsi? Zero. Sugar free candy? Not much fewer than regular candy, not worth it. String cheese? Less than one per stick. I fucking love string cheese.
THE PROBLEM
It pisses me off that Paula Deen takes shit for her type 2 diabetes. Paula Deen, according to her own website, knows a thing or two about grief, poverty, and mental illness. Paula Deen came to her success during an era where mental health treatment was costly, full of stigma, and sometimes terrifying in what it could do to patients and their families. It’s not hard to imagine choosing addiction instead. It’s not hard to imagine choosing food addiction, which, unlike other types of addiction, allows one to continue functioning in the world as a responsible human being even while you’re being judged by others. That this choice ended up lucrative for her is not unheard of, either. Would Robert Downey, Jr. be as interesting without his backstory? (Or Anthony Bourdain, for that matter?)
At the same time, Paula Deen really pisses me off.
Imagine you are a successful, famous person for whom money is no longer a problem, and you are diagnosed with a chronic disease that, according to the Centers for Disease Control, affects 8.3 percent of the American population. In addition, it’s estimated that over a third of the population is pre-diabetic. And on the American causes of death hit parade, diabetes is Killer Number Seven. (Which might be even catchier than Six Years Off, actually.) Now, imagine that you famously live in a certain state, and it’s a state where private insurers can deny coverage to Type 2 diabetes patients. And that the advocacy group for this chronic disease, the one that works on health care reform in this area, could probably use some star power.
What do you do with all of that? If you’re Paula Deen, you ink a deal with Novo Nordisk to promote a drug that you yourself would probably not have been able to afford thirty years ago.
For the record, I’m not thrilled with Wilford Brimley, either.
EASIER
I don’t eat at night anymore, but I’m still a nightowl. Sometimes I watch Adult Swim on the Cartoon Network. One of the perennial commercials between Metalocalypse and Moral Orel and King of the Hill is The Diabetes Care Club. A couple that’s older than I am tells me that I don’t have to stab my fingertips anymore! There’s a new method of testing my glucose that’s nearly painless! They don’t say what it is, but I know because it is now my business to know these things! It’s stabbing my arm!
Here’s the truth: Testing glucose hurts less than a bad paper cut. If stabbing your fingertips hurts that much, you might want to work on technique before you get a brand new meter. Oh, and what you need is a new lancet…not a new meter. The meter reads the test strip. The lancet stabs.
Self-mutilation is easily the part about Six Years Off that freaks other people out the most. People get visibly uncomfortable when I bust out my little kit with the lancets, and they look away when I cock the spring mechanism before I bring it down on the side of my pinky (see above: technique). God, I hope I never have to do that, they think.
The paying attention to everything you eat, the exercise, the physicians, the expenses, the fear of what the future might bring. None of it seems as bad as sticking yourself with a lancet.
I know that’s how people think. I used to think that way myself.
“Fuck you,” I say to the old couple, every time. If I wake up my husband, he knows it’s just the Diabetes Care Club. And he goes back to sleep.
21 responses
I was diagnosed in 2007. My “relationship” with my “disease” is a complicated one. I don’t buy into the standard take this drug and eat all the pasta you want (when I was diagnosed my doctor sent me home with magazines filled with drug ads and recipes for high carb dishes). I feel like it’s become a big business and so there will be no real understanding of it anytime soon. Thanks for this piece.
love this piece, erin.
this is great!! informative and impassioned. thanks.
Wow, I reviewed Shut Up/Look Pretty in JMWW! I’m interested in seeing this other side of your writing! I, too, watch Cartoon Network. In 2011 I was diagnosed with pre-diabetes (only 0.1 off on being an “actual diabetic,” though). Sister love at you.
This essay is tremendous.
My grandmother had Diabetes. I worry about it often. I’m thin- but I know that doesn’t necessarily matter. On the lookout…at 30 years old. Thank you for your frank and informative writing.
Thank for sharing your struggles. I hope that with Paula Deen coming out of the closet with her diagnosis will allow her to use her celebrity status to bring a spotlight to this disease state. It would be also helpful to other people with Type 2 diabetes to see someone who has diabetes and who looks like them, change their eating and cooking habits and improve their health like you have. Changing your diet and not spending $300/month on medication to control your sugars is definately the best way to go and I applaud you in your tough choices!
Great writing. Thought-provoking and affecting. Manages to be a fun and easy read despite its grim topic.
Nicely written, thoughtful piece. I appreciate what you have to say about Paula Deen knowing a bit about grief, poverty and mental illness. A little compassion in regards to food addiction goes a long ways. Thanks for your story and your insights.
An interesting and refreshing take on a topic a lot of us just really don’t understand. Thanks for this.
Thanks for your kind words, everyone. They mean a lot.
I like a good joke. Hell, I like a bad joke. But when Paula Deen’s news came out, nearly all of the jokes fell flat with me because they had no understanding of how type 2 works. Given the level of its presence in our population, that’s a really dangerous thing.
And I need to make something abundantly clear: On the relative scale of Six Years Off self-management, I have it *very* easy — both financially, and practically. For many of us, even the most stringent lifestyle changes aren’t enough to keep it under control, and that can have devastating results.
My 8 year old was diagnosed with Type 1 last year. We hate Paula Deen in a visceral, uninformed way. Thanks for this. I love your way of describing the difference between Type I and Type 2! They really do need different names.
I like this essay too. But here’s a different perspective on Paula Deen: Speaking as the mother of a daughter who’s struggled with anorexia for seven years, I <3 Paula Deen. And her cookbooks.
Erin, I want to be your best friend. You’ve said everything I wanted to say on these subjects, and said it well and clearly.
I’m glad to read that you are self managing your chronic disease Erin. Living with a chronic condition can be very difficult. For some people, dealing with constant pain and loss of good health may lead to feelings of anger and isolation and even depression. Fortunately in many states there is a free federally funded workshop that lasts for 6 weeks that can help anyone willing to learn the skills needed to manage their chronic disease. My wife and I have trained to teach, and are teaching in our county, what is called “Living Well Alabama”. It empowers people through what is known as an “action plan” to become partners with healthcare providers in getting the most out of their lives no matter what age or chronic condition they may have. This helps relieve the huge burden of healthcare expenses that will only grow as our aging population grows. As we all age, chronic conditions become more apparent, and any person over the age 30 could use this course work, even if it is to help a family member (sometimes family interactions are the most difficult). This nationwide program was developed by Stanford University, and as I mentioned before is –free–. Check with your local Area Agency on Aging or health department to find out more about your own local workshops. Just a reminder–this is not about Acute disease, but Chronic disease. Good luck !
Nice article.
By the way, I take 2 500 mg. Metformin tablets/day and it costs me $10 for a three month supply at Target. Worth checking out what they (or Walmart or others) charge for generics–there are a lot of those programs out there.
Having had Type 2 for over a year, I am also on Januvia and injected insulin along with metformin. Chicken or egg: Having been HIV+/AIDS for 26 years and having lipodistrophy (fat redistribution thanks to protease inhibitors), does HIV and fat accumulation put enough stress on the internal organs to cause Type 2 diabetes? Probably…some doctors think so, some don’t know.
I became VERY depressed reading your article because with all the other medical stuff I’ve got going on, and if I subtract 6 more years for the diabetes, I probably should be dead last year. Hell, I probably should be dead 25 years ago like most of my friends.
At 57, many things can start to go wrong, so it seems that diabetes and HIV are new partners these days in teaming up to tear your body down.
My advice: enjoy life, keep it simple, no stress, no sugar EVER, even if you are NOT diabetic and stop worrying about stuff, period.
Thanks so much for this article. I am type 2 diabetes borderline. My mother was diabetic and since we inherit our mother’s mitochondria and those little cell parts control much of our metabolism (Mighty Mitochondria!) there is a genetic factor to this disease through the maternal line(you don’t get your daddy’s mitochondria because the sperm have no place to pack them in). I am dong very much what you are and it is working but I do need to work on keeping those carbs down. I knew enough biology when I was diagnosed to be really scared by this and I did change my life style for the better because of it. Had not heard the 6 years disease label and think its a good thing because it makes you take it more seriously. On the political side it really pisses me off that corn (and high fructose corn syrup) is highly subsidized by the federal government so we have cheap high carb food in almost everything processed.
Great article. I live like you and I’m not diabetic. My son lost 150 pounds from eliminating carbs. He eats 90% meat and typically eats once a day. Works for him.
Keep doing whatever it takes.
Hi Erin, nice article. Do you know what your A1C is? (You can get a test kit at Walmart for about $10) I say this because if you’re keeping your A1C below 6% you most certainly will not lose “Six Years Off” your life. Poor control, not Diabetes, is what’s dangerous.
Dear Erin, I have been doing nutrition research for 3 years and, uncovered, as a result, my type 2 diabetes. In my case I manage my diabetes with diet alone and don’t eat more than 15 starch carbs in any one meal. Works like a charm and it sure takes off the pounds — which, by the way, I didn’t need to do. I agree with everything you have said and one my goals in life is make diabetics understand and show respect for their condition rather than “hope” their medication will just let them keep eating badly forever. The other major goal I have is to help non-diabetics (who are likely already per-diabetic) people know what is going to cause their diabetes in the first place. Beyond genetics, diet is the biggee as you know. What we know now is that the inflammatory condition of our circulatory system attached to high blood sugar and tons of insulin is the very same one that will give you atherosclerosis, strokes, and all those handy little dilemmas like kidney failure, amputations, and blindness. Keep making noise, girl. The more the better.
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