So your diabetes must not be the bad kind, right?

"There's no bad diabetes, only bad patients."  This quote comes from the endocrinologist for whom I used to work.  I see 2 flaws in this statement.  The first is that it reduces diabetes to a simple process and is disrespectful to its complexity.  Secondly, I am unable convince myself that diabetes is not bad.

However, the overarching theme is a wise comeback to a remark that us patients and others tend to use as a crutch.  I've heard it a million times; "she's a brittle diabetic"; "he's diabetic, but thank God, it's not the bad kind"; "my diabetes has been bad this month."  The doctor's clever phrase simply reminds us that we are the managers of our disease.  If things are out of control, it's likely a result of poor management.  But if it's a tightly run ship, then let's give credit where credit is due.....to the patient.

Diabetes is a progressive disease, so this is certainly an oversimplification.  Nonetheless, it does debunk the myth that some types are worse than others.  The definition of all types of diabetes is a state of high blood glucose, or hyperglycemia.  Hyperglycemia, over the course of many years, causes vascular complications including nephropathy, neuropathy, and retinopathy (kidney, nerve, and eye damage, respectively).  Thankfully, we have determined that lowering hyperglycemia and living a healthy lifestyle has the potential to prolong the onset of some of these complications.

Ultimately, the point is that our medical providers offer guidance and coaching, but we do the heavy lifting.  And if we don't, then the journey will be long and difficult.

One other point of confusion that I would like to briefly touch on is foods that are off-limits for diabetics.  Generally speaking, there is no such thing.  While large amounts of sugar at one time is a good thing to avoid, it is nearly impossible to avoid sugar altogether.  In fact, even foods that have no sugar or carbohydrate will likely include some ingredient that gets converted to sugar in the course of digestion.

Therefore, carb-counting is the key.  The quantity of carbohydrate ingested is most important, while the type of carb (also important) is secondary.  This is by no means an endorsement of sweets.  However, I do believe in having all things in moderation.  Ask your dietitian about the amount of carb appropriate for your age, gender, and type.

Until next week, folks.......let's be less than seven, greater than low!  
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