"Now I thought you couldn't eat that? Or can you just dose for it and it's okay?"
She wasn't being the dreaded "diabetes police," but she was just asking a question. Type 2 diabetes is a familiar disease for some of Chris's relatives, so I can understand his aunt's confusion about how my type 1 diabetes is handled. Wasn't I supposed to just avoid sugar?
"I can eat this," I gestured to the slice of cheesecake on my plate, "So long as I check my blood sugar beforehand, take the appropriate amount of insulin from my insulin pump, and I avoid a high blood sugar spike afterwards."
"So you can eat anything you want with that insulin pump?"
And this is where I get a bit confused. Being a type 1 diabetic since I was a kid, I've always taken insulin. Always. I don't know anything about type 2 oral medications and I have no concept of managing diabetes solely through diet and exercise. It's either been multiple injections or the insulin pump.
Insulin is cool stuff. It keeps me steady and solid on days when I'm following "the rules," but for things like holidays (where there is a whole dessert table and all kinds of sugary treats), I do have the option to up the bolus ante. But a cure? Nope. Using insulin requires a lot of work.
The thing is, I think that insulin makes it seem like I can eat anything I want. While I indulged in that piece of cheesecake after Christmas dinner, it was a risk I took. I took more insulin, and I've read all these obtuse reports about how taking more insulin is tougher on our bodies. (Is that true - does anyone have a study they can point us to that states how insulin ages us or something? I'm so curious.) I risked the immediate spike and the latent spike in my blood sugar after eating the cake. I wanted to indulge and I weighed the risk of this indulgence. It's a split-second decision that my brain is programmed to make by this point. Diabetes is all about coloring in the lines, i.e. keeping blood sugars well-controlled to minimize the impact on my body.
But I wonder what people think sometimes when they watch me eat. How does it look from their eyes? They know I have diabetes, and from their less-familiar vantage point, they view it as "serious" because I take insulin. I use Equal in my coffee and I never drink the eggnog or have regular soda. I almost always avoid the mashed potatoes and sweet potato casserole, and at family gatherings, there is usually a "sugar-free" dessert. They hear me talk about blood sugar control and they know I work in diabetes advocacy. They understand as much as they can, not actually living with the disease themselves.
But what to they think when I reach for a piece of cheesecake? Do they think I'm "off the wagon?" Do they think I'm being irresponsible because I'm eating a sweet? Responsible because I'm testing and shooting accordingly? Does it confuse them to see me clamor for a glass of grape juice when my blood sugar is low? Do they wonder why every time they see me, there appear to be new "rules" for managing my type 1 diabetes?
Diabetes is a constantly shifting platform that we're trying to balance on. Every day is different, every diabetic is different, and the rules do seem to change every day. On Christmas, I ate cheesecake and never sported a spike. Last night, a cup of tea tossed me towards 200 mg/dl.
"A pump isn't a cure, though, right? I mean, you still have to prick your finger and tell the pump what to do, don't you?"
She's learning, petal by petal. And despite all these years, so am I.