Cartoon by Craig Rohlfing It’s the same worldwide. When the doctor prescribes a couple of pills and weight loss, the seriousness of a permanently elevated blood sugar doesn’t register. Diabetes only seems serious when Insulin or the threat of it is brought into the conversation. Then terror strikes. The threat of complications loom large when the diagnosis is new, but over time take a back seat to the occasional doughnut or the daily round of sugary sodas.
It’s understandable. The silent, often invisible nature or the disease encourages misunderstandings.
As a diabetes educator, I walk a fine line between encouragement and concern. I never intentionally scare anyone. My worries and dooms day scenarios are my own. I’m only too aware that I can’t predict with certainty who’ll have which misfortune when or who’ll be spared life-altering complications. Besides fear is a short-term motivator. It’s disrespectful to nag and hound and counterproductive to out and out petrify. Even a skillfully worded message is will elicit a glazed look if I don’t know when to stop.
To avoid this I’m-checking-out look I have developed some skill at reading body language. I can tell a lot when talking directly to someone and from observing. I recently had the opportunity to do just that. I was one of two grandmothers who’d traveled many miles to celebrate a first birthday.
My cohort and I had discussed diabetes before. The first time was in Bahia, almost three years ago, when my son and her daughter were about to marry. I don’t speak Portuguese, and she doesn’t speak English, so who knows how we ever got on the topic? Vaguely, I remembered discussing carbohydrates, while inches away bowls of mangoes, papayas and bananas beckoned.
What could possibly be wrong with plenty of fresh fruit?
But it wasn’t just the consumption of fresh fruit that had tickled my tongue with uninvited advice. I’d swallowed the wad of warnings. After all, she’s the other grandmother, not a client.
This visit was different. Vovo was recently put on twice-a-day combination long acting and intermediate acting insulin. For the first time I thought some of my expertise was being solicited. An air of doom and gloom had descended. I’m the cancer survivor, but my son and daughter-in-law were genuinely thinking that the clock was ticking for the younger of us. The death knell had sounded.
“We need to talk to you,” they said seriously.
Of course, I saw the addition of this wonder drug differently. To me, it seemed like good news. In fact when I saw her this time, she’d never looked better. To my trained eye, I would have guessed she had been shed fifteen to twenty pounds. I complimented her on her weight loss.
At that point my son and daughter-in-law, Vivian, asked me to talk to her mother.
Vivian interpreted as I went through some basic questions – What was she on and what was her dose? How long she’d been on it? What were her self-reported blood sugars? How is her A1C? Any insulin reactions, dizzy spells? I did a quick overview of how she’d changed her diet, what she’d already done.
The conversation went as it might have if she were my patient, new to insulin. I made sure she was safe, for the time being. I explained the onset, duration and peaks of her insulin and gave a bit of advice about eating and nighttime snacks. I asked her about her next doctor’s appointment, since follow-up is critical. About ten minutes into this, Vovo’s expression became blank.
“I’ll be here a while. We can finish this some other time. Just tell her that I think it’s a good thing you are on insulin. Your blood sugars will be better controlled.”
My daughter-in-law seemed to relax, and Vovo smiled before she picked up her phone and began checking her Facebook messages.
“I could see when she’d heard enough,” my son said. His observation was keen. He’s teaching now, and he knows that overload look.
I had her attention for long enough. During the week we talked again without the human interpreter. My phone has a convenient app. During this exchange we practiced reading labels and discussed carbohydrates again. I suggested she ask her doctor about increasing her dose. I could tell from watching her food choices that week that she was doing well with her diet. Our chat this time engaged her longer, maybe fifteen minutes.
The most important part of the of out exchange came at the end.
I typed a question into my phone for translation Como voce se sentiu desde que voce esteve na insulina? How have you felt since you’ve been on insulin?
She stood tall and smiled, “Estou menos cansado. Eu tenho mais energia.”
I didn’t need my translator, nor did she. “Insulin is your friend,” I said
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