Over at Salon, there's an interesting article about the struggle to treat widespread diabetes in rural Appalachia, where a third of the population is thought to be diabetic and even lettuce is served dribbled with bacon fat. The good news about diabetes is that its long-term complications, including blindness, lower-limb amputations and kidney failure, can be prevented with a combination of exercise, healthy eating and medication. But many impoverished Appalachian patients aren't managing their disease effectively, or at all.
The problem, according to public health officials quoted in the story, is a toxic combination of poverty that makes it difficult for patients to afford clinic visits and medications, and a fatalistic attitude among patients that nothing can be done about their diabetes. One patient describes seeing this outlook among members of her family:
Maxine R., whose family was full of diabetics, thought she was healthy until last year, just after she turned 61. "The minute they told me I saw my mom with the needles stuck in her.” And then she went on, “I had a brother-in-law that had his legs amputated. He was sitting at the table one day eating a whole lemon pie. I remember he said, 'Oh, my blood sugar is 900' (normal is between 70 and 100 units). Then they amputated his legs, and even so gangrene set in. Then he died. Yesterday my sister-in-law collapsed even though she was on insulin. They took her to a hospital in Lexington and told her she had to go on dialysis. She weighs 400 pounds."
The story reminded me of my own first peek into the world of medicine when, as a 16-year-0ld high-school student, I spent part of a summer observing and volunteering in the local diabetes outpatient clinic in my home town in Canada. With universal health care in place there, some of the problems of Appalachia were non-existent, but still I was stunned at how widely patients' attitudes toward the disease varied.
On one end of the spectrum was a middle-aged man with a daily habit of downing several cans of full-sugar Coca-Cola. At his appointment, after hearing the dietitian suggest several alternatives to Coke (water, black coffee, diet soda, artificially-sweetened Crystal Light drink mixes...) he made it clear that, diabetes or no, he had no intention of changing his ways. It's been nearly 20 years since that afternoon, and I sometimes wonder what has happened to him. Can he still walk? Or see? Or was someone able to pull him out of denial before it was too late?
More hearteningly, on the other end of the spectrum were an elderly couple, married more than 50 years, who visibly doted on each other seemed undaunted by the idea of handling a severe chronic disease. The wife, who was diabetic, cheerfully described for the nurse and dietitian how her husband helped her check her blood sugar, eat properly and take her medications at the right times every day. The husband proudly produced a notebook of meticulous blood-sugar records that showed, indeed, his beloved's disease was well under control. Given their ages when I met them, it's unlikely that either the husband or wife is still living, but I still think of them as an inspiring example of rejecting a fatalistic attitude and instead gracefully addressing a very daunting health problem.