With Pesach (Passover) starting tonight, and so many media report and blog regarding both how far diabetes care has come and how far diabetes care has yet to go, the thoughts are fresh in my mind as I study the Haggadah this year.
[Note: A Haggadah is a sort of prayer-book and story-book for the home, prescribing the order of the seder, the ritual holiday meal that begins the eight-day festival. It describes the various foods used during the ritual, provides the story (the Exodus from Egypt) that is the reason for the ritual, and the various prayers that are said during the ritual.]
One of the themes of the Passover seder is to understand that we, personally, have been delivered from slavery in Egypt. (The Christian’s equivalent is the soul-deep understanding that he, personally, has been saved-and-delivered by the death of Jesus, about 2000 years ago.) While there is no true comparison to the physical and psychological abuse of enslavement, one way in which we can begin to understand the rigors of enslavement is to draw analogies, and to discuss any metaphorical enslavement in our own lives.
For many of us, diabetes is a physical, if metaphorical, enslavement.
- We are tied to a schedule of when to eat, what to eat, what medications to take, and when
- We are often tied to unbalanced diets
- We do not have the luxury of a day of rest, EVER
- We often have multiple unsympathetic diabetes taskmasters (our care team, the Diabetes Police, our own expectations, and our blood glucose levels)
As the story unfolds towards its climax, ten plagues are visited upon the Egyptians. The first of the Ten Plagues visited upon the Egyptians – blood – reminded me of how much blood is involved in diabetes care – from finger pricks to test our blood glucose levels, to our quarterly A1C checks and liver function tests, to the very words, “blood glucose”. While I don’t know if anyone can draw a one-to-one correspondence, some of those plagues have some interesting counterpoints:
- Blood. Again, blood work, blood tests, etc.
- Lice. One of the major symptoms, itching. What happens when a wound heals? You itch. What happens when your skin gets very dry? You itch. And then there's the constant pain reported by PWD with early neuropathy. Yeah, I think that works.
- Wild beasts. Kerri Morrone, in her blog Six Until Me, and in a commentary on dLife, defines Regan-Rage as "the behavior some diabetics exhibit when having a low bloodsugar. Regan-rage behaviors include swearing, screaming, spitting of juice, and stretching body parts in unnatural ways." In short, acting like a wild beast.
- Boils. OK, not the same thing, but "diabetic ulcers" come to mind.
- Darkness. Diabetic retinopathy -- what else?
- Slaying of the first-born. Decreased projected lifespan is possibly the closest analogy here.
The “happy ending” of the Exodus story is that, after all that Divine Fist Shaking at Egypt – most of it (arguably) just for the heck of being abusive – we were ejected from the country. Mind you, as soon as Pharaoh did the math again, he sent out the border agents… but the flight had already left the country…
And because we have been freed by the Almighty, Blessed Be He, we are grateful. One of the best-recognized portions of the seder service is the song Dayenu, which in translation is sometimes given the English subtitle “we are grateful”. It is both a timeline and litany of that which the L-rd did for us from the passage from Egypt through the presentation of the Torah and the building of Solomon’s Temple in Israel.
Given the state of diabetes care today, we can say that most of us have been “delivered” from a premature death – or at least, from a much more premature death than we might otherwise have had. All of us have the tools to monitor and treat our condition. Many of us lead “normal” lives, with diabetes being no more an interruption of that routine than daily prayers.
In short, there is much to be grateful for, including:
- The understanding of what diabetes is
- The discovery of insulin and its therapeutic use in treating diabetes
- The understanding of the therapeutic effect of dietary regimens on health in general, and diabetes in particular
- The development of home glucose monitors
- The development of disposable syringes and ultrafine needles
- The development of new types of insulin and less invasive delivery systems
- The development of oral antidiabetic agents, and of course
- The people in our lives who care about us, care for us, and without whom life would be a lonely and painful place
Take a moment tonight, and consider: what still enslaves you? what liberates you? and for what are you grateful? – both in terms of your diabetes and in terms of your life in general.
Be strong, and have a joyous Pesach.