Managing Diabetes. Jeffrey A. Bennett
Searching for analogies to your budding ideas, you scan cypress trees with twisted trunks, a flock of pelicans flying low over the water, breakers shooting up the cliff walls like geysers.
—Gloria Anzaldúa, Light in the Dark/Luz en lo Oscuro
The song of the cicadas murmured through the streets of Bloomington, Indiana in the summer of 2004. After 17 years hibernating underground, the creatures extolled in Plato’s ode to rhetoric, madness, and love trumpeted their return with harmonious fervor. I vividly remember walking past the trees that lined the path from Ballantine Hall to the parking lot behind the Kinsey Institute, distracted by their rapturous hymn. The cicadas’ ubiquitous and ethereal orchestration crescendoed from a subtle whisper to an intense reverberation in a matter of steps. They animated the branches by giving them a pulse, enlivening the atmosphere with an energy that was somehow both electrifying and soothing. The hum from the trees was nothing short of overwhelming, imparting the feeling that at any moment they might conspire to overtake the walkway and whoever happened to be occupying it. Though invisible, they loomed large, effortlessly altering the scene with their euphoric chorus.
In ancient Greece cicadas represented spiritual ecstasy, rebirth, and immortality. Plato invokes the image of the cicadas in the Phaedrus to symbolize both restraint and honor, narratively crafting a link between personal control and dignity. Plato’s protagonist Socrates tells his companion, the book’s namesake Phaedrus, that they must resist the song of the cicadas, not succumbing to laziness, but practicing restraint against the pleasure-inducing cadence of the insects. Those familiar with the text know that Socrates is obsessing over his libido more than he is lauding some bugs in a plane tree. The storied philosopher reels in his desires for the titillating youthfulness of Phaedrus as he advocates for a disciplining of the passions and the virtue to be cultivated as a result. Socrates hopes that the cicadas will relay to the Muses his moderation and chaste disposition, and that he will be rewarded by Erato, the muse of love, and Calliope, the muse of rhetorical eloquence. Desires constantly encroach on Socrates, and he reproaches these temptations with overt gestures of self-control.
The relationship between duty and pleasure, what scholars frequently denote as hedonics, is a recurring theme in this book, which is dedicated to the manifestation and circulation of diabetes rhetoric. The tension between earthly desire and the platitudes of well-being is one I learned firsthand when I was diagnosed with type 1 diabetes the same summer the cicadas were resurrected in southern Indiana. Just a few weeks after defending my dissertation (a study about the relationship between blood and politics no less), the droning from the cicadas continued to stir as I was hospitalized suddenly after lower-back pain left me unable to sit, stand, or lay down comfortably. The pain was unlike anything I had experienced up to that point in my life and it still haunts me when I have the slightest backache. Because I was unaware that I had onset diabetes, my blood sugar was unregulated, inciting a condition known as ketoacidosis. In short, my kidneys had begun shutting down. I was immediately admitted to the ICU and spent a dizzying 48 hours immersing myself in a new language, a new routine, and a new way of life.
There were plenty of signs that trouble was on the horizon in the weeks leading up to my hospitalization, but they were not yet intelligible as something that might signify disease, illness, or however we want to classify diabetes in the medical order of things.1 For starters, I suffered perpetual exhaustion. Having just finished a dissertation, landed a job, and started the emotionally taxing task of finding a new home in a distant city while saying good-bye to my grad school kin, including my partner of just over a year at the time, I wrote off the fatigue as a by-product of stress. I was also terribly moody. Although I am a reliably easygoing person, I found myself regularly irritated. The hormonal changes that accompanied diabetes’s awakening left me undone, conjuring emotions that generally remained dormant in otherwise mundane situations. I had also lost a good bit of weight, but I tended to exercise frequently and was conscious of the scale, so again I attributed the weight loss to stress. When the doctors told me that I weighed a mere 120 pounds as a 5-foot,10-inch-tall man approaching age thirty, I was taken aback. The Greek word for diabetes translates to “siphon,” and the disease was living up to its etymological signifier.
The weeks and months that followed diagnosis were accompanied by a steep learning curve about diabetes care, but also a newly found appreciation for gauging my body’s response to fluctuating circumstances. Like all people with diabetes, I learned how to count carbohydrates, test my blood sugar, and administer shots. The finger pricks and shots were especially confounding, as I had lived for years with a pronounced phobia of needles. So strong was this aversion that I refused local anesthetics at the dentist’s office before having my teeth drilled for fillings. One of the nurses working with me early in my diagnosis quipped, “A diabetic who doesn’t like needles—how’s that working out for you?” Of all the medical conditions that I could have landed, this one seemed decidedly cruel, as if I was the butt of some cosmic joke. Clearly, the cicadas had delivered bad news to the wrong muse.
There were other complications that I could not foresee. Early on, my pancreas was still producing trace amounts of insulin (a normal phenomenon for those with type 1 diabetes) and when it interacted with the insulin I was manually injecting, it caused me to have unusual balance problems. I remember on one job interview shortly after diagnosis having a difficult time focusing on a senior scholar’s face as she posed a question. Although I was supposed to be answering her inquiries thoughtfully, I recall struggling to maintain composure and not embarrass myself during a dizzy spell. Driving and public speaking both became precarious endeavors because any mild change in heart rate or nerves left me unsure of whether my sugars were spiking or dropping rapidly. A friend from graduate school warned my partner to monitor me for depression, knowing that the first year after being diagnosed with a disease, chronic or otherwise, can leave a person despondent. I never pursued treatment or clarity about depression, worrying that any trace of flexibility in my concept of self would suggest that I was unable to contend with the multitude of changes I was juggling. Still, that first year I slept more than was normal, I lost time in ways I never had, and I became preoccupied with the life-altering ailments that awaited me. Assurances that “there are worse diseases you could have” or “things aren’t like they used to be” only made matters worse. In the years prior to the Affordable Care Act, I also worried that formal recognition of depression might be used against me in future health insurance matters. I grappled with the fallout of the diagnosis for years, consuming as much information as I could about cures (and some scientist is always curing some poor mouse of something), technological innovations, and the prospects of a long and healthy life.
But what caught me most off guard in those first months were the disturbing ways people in every realm of my life, from close friends to complete strangers, communicated about diabetes. Even the most well-intentioned conversations about diabetes quickly devolved into recitations about the need to “take care” of myself, a variation of a conventional narrative about personal responsibility and hard work. The number of people who told me stories about relatives who had diabetes, always in the past tense, was legion. On airplanes, in restaurants, during office hours, and at the gym (!) people implored me to be attentive to my body. Although I rarely engaged with those who attempted to discipline what I ate, what some people with diabetes call “hand slapping,” I commonly heard about death, folks who went blind from sugar irregularities, and the trope of the irresponsible diabetic who threw to the wind any thought of deliberate management. Sometimes the subjects of these cautionary tales were older men who had lost a foot to diabetes. At other times they were teenagers who died while in high school. One well-meaning relative told me the story of an acquaintance who had gone blind before dying from diabetes-related complications. Noticing the look of dismay on my face, she quickly added, “He was a crack addict too, though.” Of course, these stories of loss are generally heart-wrenching for the people sharing them. They disclose their experiences in the hopes that my loved ones and me might avoid the pain they endured and the misfortunes they witnessed. Still, it is little wonder that depression hits hard in the first year after diagnosis. On the one hand, people with diabetes are told their disease is not so bad; on the other hand, it is conveyed repeatedly as fatal. Deciphering which messages are pertinent to the immediacy of one’s livelihood can be a daunting undertaking when attempting to stay well.
Along with these dispiriting exchanges I was fast learning that vigilance