The 5 Stages of Diabetes Acceptance
When my husband returned from his semiannual physical, he marched into our kitchen and slammed down papers on the countertop, proclaiming, “My doctor tells me I have diabetes.” He pulled out a kitchen chair, scraping the feet along my freshly polished floor, slid onto the padded seat, and propped his fist under his chin.
The year was 2007. We were both in our mid-60s, enjoying the newfound freedom that came with retirement. During my career as a clinical laboratory professional, I’d done it all: hematology, chemistry, and immunology—to name a few of the specialty areas that encompass laboratory analysis of human body fluids. I’d just retired from managing a busy clinical laboratory in a bustling hospital environment in Sun City, Ariz. My husband of 40-plus years was winding down his computer consulting career, anxious to join me in exploring new vistas: traveling, gardening, and enduring the challenges of playing more golf.
Stage 1: Denial
I picked up the pages of his latest blood work results scattered on the counter. Sure enough. There were his elevated fasting blood glucose and A1C test results, standing out on the page with the insulting bold print intentionally intended to draw the eye to the results and a capital “H” indicating the results were “high.”
Over a hastily organized lunch, we talked about the implications of this shocking revelation—having type 2 diabetes. What exactly had his physician told him? What was the next step? Where did this come from? I explained the intricacies of what I knew about treatment options and improvements in protocols I’d witnessed over the many years of churning out laboratory test results on people with diabetes. At the end of our meal, we both sat silently for a while. Suddenly he broke the silence. “This has to be a mistake. There’s never been any diabetes in my family. These results must belong to someone else.” We agreed our action plan would be to follow his doctor’s advice: increase our exercise, watch our “sweets” intake, and return for additional blood work in six months, knowing the next set of test results would prove the doctor was wrong.
Stage 2: Anger
Fast-forward to 2008 and my semiannual visit with my physician. I could tell there was a “chatable” item on my laboratory report by the way she sat down next to me and withdrew her pen from her lab coat breast pocket. She circled my A1C and asked me if I knew anything about that test and prediabetes. Knew anything? Knew anything? Of course I did; during the span of my laboratory career I had evaluated and released tons of results for A1C tests to the docs of all those poor, unsuspecting patients. I was indignant. To add insult to injury, she left the exam room to go to the “supply closet” (as she put it) to retrieve a home glucose monitor and some lancets and test strips. Did I know how to use these items? Know how? Of course I did. I’d spent many a persistent hour instructing patients on how to use their new home-testing gadgets for goodness sakes. She reassured me that I could get my prediabetes under control with—you guessed it—proper diet and exercise. Now it was my turn to slam the papers down on the kitchen counter when I returned home.
That evening, my hubby and I discussed the fine mess we were in. Neither of us was obese—I was downright thin; he was a tad on the chubby side, but nothing alarming. We both made daily earnest efforts to exercise, including walking and an afternoon swim in our backyard pool. We rarely went out, preferring to eat our “five fruits and vegetables” along with portion-controlled home-cooked meals. Our only weak points were a before-dinner glass of wine and some type of dessert.
We spent our dinner hour conversation searching for someone in our families to blame for this misfortune. His no-good-deserted-his-family-years-ago-dad was our first target. He had to be the source of the “bad” genome on my husband’s side. But my stable, sensible family tree composed of staunch German, Danish, and French stock had not a hint of diabetes going back for centuries. We finally decided, after a rare second glass of wine, that it had to be the government telling physicians in geriatrics to start diagnosing more diabetes. That seemed perfectly logical.
Stage 3: Bargaining
We needed to regain control of our lives. I would use my laboratory background and research skills to plan our counterattack. I enrolled in a diabetes education class. I came home armed with brochures titled Exchange Lists for Meal Planning and Recipes for Diabetics. On the refrigerator door I posted a pamphlet detailing important medical tests and exams to help manage diabetes. If I could get a handle on how to modify our lifestyle maybe we could slow or even stop the progress of this affliction. Perhaps, if we substituted whole grains and legumes for refined carbohydrates, we could push those sugar trolls back under the bridge.
I subscribed to several consumer publications (one of them being Diabetes Forecast) and read each issue cover-to-cover. I purchased cookbooks that focused on cooking with artificial sweeteners and sugar-free desserts. I religiously read labels at the grocery store. We transitioned to reduced-sugar-just-about-everything. We upped our exercise routine. At our next doctor visits, things seemed improved. Could we be back on the healthy track?
Stage 4: Depression
The hardest part was the next step: starting metformin. It seemed like a defeat resorting to a daily pill at the lowest strength followed by two pills per day at an increased dosage.
The other depressing thing was admitting to family and friends that we needed to restrict our sugar intake. It meant denying that luscious strawberry shortcake with whipped cream for just the plain strawberries. We both resolved to read menus carefully and stand back and observe a family reunion table spread with goodies instead of automatically heaping our plates with Aunt Agatha’s cream tartlets and Cousin Sandy’s homemade croissants.
Stage 5: Acceptance
To our amazement our families were tremendously supportive. Our physicians praised us for improvements in our test results and heeding their suggestions. Now that we have openly admitted our diabetes, we receive better service from health care providers. We don’t have to explain why we need more frequent eye exams or a prescription for that extra-expensive foot moisturizing cream. Instead of withdrawing from interactions with peers and family, we’ve become more involved, enjoying long vacations, playing bridge, publishing my debut novel, and planting a raised garden for farm-fresh vegetables that grow right under the kitchen window. Our lives have changed, not necessarily better or worse—just different. Accepting our mortality is a sobering experience, but what choice do we have? Life is an adventure and we’re ready to ride.
Judith A. Grout’s novel, Chasing the Strawberry Moon, is based on the true 1939 hitchhiking adventures of a young woman.