The Seven Stages

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Craig: From Beta Cell, this is Thicker Than Water, I'm Craig Stubing. It's been six months since my Aunt Laura was diagnosed with type 1 diabetes, all in all, a pretty short time but these were probably the most important six months she'll have with type 1.

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Not only did she have to have a crash course in the practical aspects of how to live with this disease, from how to test her blood sugar or how to give a shot, how insulin really works, what different foods do to your blood sugar and on and on and on, but she had to lay the foundation of how to live a life with type 1.

I use this phrase a lot on Beta Cell, your relationship to type 1 diabetes, it throws people off because, how can you have a relationship with an autoimmune disease? You can't talk to it, arguing with it, fight it, it's just there, but the way that you view the disease fitting into your life affects how you live with it. If you view it as a burden, it will feel like a burden. If you think that it limits what you can do that's how you'll act. If you treat it haphazardly, your control will be chaotic, but on the other hand, if you're trying to work with the disease instead of fighting against it, you won't view it with such animosity and have negative reactions to it.

Like any relationship, yours with type 1 can change over time, but also like any relationship, the beginning is when you lay that foundation. With all that in mind, my Aunt Laura and I looked back at the last six months of her figuring out how type 1 now fits into her life and we look forward to what the future might bring.

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Happy six-month diaversary.

Laura: Thank you.

Craig: Did you do anything to celebrate?

Laura: No. [laughs]

Craig: Do you think you will in the future?

Laura: I don't think I'll do anything to really celebrate. I feel like I just maybe did a little bit of reflection about how it's been six months and how it seems like it went by pretty fast and how much I've had to change in six months, but I think I'm still working out some of the things that I deal with in daily life that are different.

Craig: What do you think the biggest thing, the biggest change has been?

Laura: I think the fact that I have to think about this so much, having this disease adds so many more decisions in a day that I think that's really huge.

Craig: Do you feel like that's getting in the way of life?

Laura: I think sometimes it just makes it, I don't want to say harder, but it just makes it more of- when you are making your decision about what you're going to eat for breakfast, it's not just, "I can just eat a banana on my way out the door." It', "No, I have to take my shot in." At this point, I don't even have the decision about how many units of insulin, so I'm not even making that decision yet, but I still to make the decision how am I going make the 30 grams of carbs that I need to take and every meal. That's a different kind of decision, it's not just pick three things. It's like I have to pick things that I'm sure are going to meet my calorie requirements, meet my carbohydrate requirements and then make what I consider would be a balanced meal.

It's a lot of thinking. I think I read somewhere, some people who are, especially in tech careers that's why you see them in the same clothes because it's one less decision. I wear jeans and black t-shirt, done, there's no decision, and so I'm thinking, "Well when you're a type 1, you make so many decisions every day." Then when it gets to the point where to, I'm high, how much insulin do I take to go low, if I'm low, how much more carbs do I eat to get high? Then it's even more decisions.

I just think decisions take up a lot of your day and it gets a little tiring sometimes I think. I can see after doing this for a number of years that it's like, "I'm hoping it just becomes that's the way it is."

Craig: Because you're still so new, all the decisions are very obvious to you in the sense that you know you're making that decision as opposed to, for me, I feel like I'm so used to making these decisions that they're almost like autopilot. I know I'm getting a little high and I can just make those decisions without spending a lot of time thinking about it.

Laura: I can give you another example about thinking about things differently. This past weekend, we went to see a play in Spring Green, it's an outdoor theater, then I was thinking, "I wonder what time the intermission is for the play." Because I take my basil at night, and so I like to hit it around the same time, so I called to find out what time the intermission was, and then they said, "Okay, the intermission is at 9:20." I said, "Perfect." Because I usually take it around 9:30. Then I'm like, "Okay, now, I know there's going to be a huge line for the bathroom. Do I want to wait to get into the bathroom or do I take the shot at my seat at intermission?" Then I decided, "Well, I'm just going to take my shot at my seat," but then I had to decide what am I going to wear because I always give it to me in my self in my thigh. Then, I thought, "Okay, well, now I have to wear a dress."

This is what I mean, it's like I was thinking about what I'm wearing in a totally different way, just those decisions about new experiences, being diabetic that I think a lot more about.

Craig: How do you feel like you've changed in the last six month in regard to your relationship to type 1?

Laura: When it first happened, I was really, I don't want to say nervous, but maybe overly cautious, but now I think it's become more routine with the thinking about the shot and the eating but I still can't tell you, I don't like it.

[laughter]

Craig: It hasn't changed, you haven't learned to love it?

Laura: It doesn't changed, no, some days I used to get mad, I'm like, "Why do I have this stupid disease?" I think it's like when you go through any bad thing in your life, you have to go through stages to get to where you're okay with it.

Craig: It's like the seven stages of grief, right?

Laura: Right. I don't know if it's really grief, but maybe in some ways it is grief because most of my life I was not diabetic, so it's like I'm grieving that life I had because it was a long time, versus you were diagnosed at 13. I think that's with any major change in your life that changes your life so much, I think that you do have to go through some kind of process.

Craig: Yes. I pulled up the seven stages of grief.

Laura: [laughs] What are they?

Craig: Shock.

Laura: Yes, shock.

Craig: Denial.

Laura: Denial.

Craig: Guilt.

Laura: Guilt, yes.

Craig: Bargaining, depression, reconciliation and acceptance.

Laura: Yes. If we do them again?

Craig: Okay. Shock.

Laura: I don't know if I was shocked, but yes, you do get shocked, I think no matter what, you're shocked.

Craig: Yes. I guess the shock was really, you going into the doctor and your blood sugar being so high.

Laura: Right. I was expecting diabetes but I was expecting type 2. Okay and then the second one was?

Craig: Denial.

Laura: I don't think I denied it. I think you hoped, in that period where I wasn't sure maybe I was praying, like bargaining to hope it wasn't it, but once it was confirmed and that was confirmed.

Craig: Do you think you went through a guilt phase?

Laura: Since I know more about it, I didn't feel guilty because I knew I didn't do anything, there was nothing I could have done to prevent it, but I think you always think no matter what happens, "Did I miss something?" or "Did I--?" Because we really don't know enough about type 1 to say there could be a trigger somewhere down the line but we don't know what it is so, no, I don't think I hit a lot of that.

Craig: Some people say it's guilt, other people say it's anger.

Laura: Yes. Maybe the anger I would say, yes, because you're like, "Why am I getting this thing?" [chuckles] and not so much so, "What did I do?" Because I don't think I did anything but it's just kind of like, you just don't understand, you can't, how do you understand it?

Craig: Then it says bargaining; seeking in vain for a way to get out.

Laura: I think that bargaining was more the week where I was not officially diagnosed. Like "Could I just-" I don't think there's any way to bargain out of this.

Craig: Depression?

Laura: I haven't been depressed.

Craig: This describes it as the final realization of the inevitable, which sounds very ominous. I guess this looks at as a way of just you're depressed in the sense that you know there's like no way out.

Craig: Right.

Laura: The bargaining is like maybe you seeking for a way out, "If I lower my calories or my carbs if I exercise more," and then depression is just "No, it's not going away."

Craig: Right. Like you told you I think there's kind of like a sadness about previous life. We talked about this before, sadness that I just can't have ice cream without thinking about it. Sadness about when I bake I can't have this, or sadness of being able to just go out to dinner and not worry about is the menu going to be something I can work with. It's like it's just kind of sad. I'm not depressed. I'm doing all the things that I normally do. I think that's a good thing. I'm living my life the way I did before. It's just, like I said, a lot more thinking, a lot more decisions, and then making just some minor adjustments when I have to.

Laura: The sixth stage is testing, which is described as seeking realistic solutions.

Craig: Mostly, I think I've always kind of done that, but then that's for you get into that. The deck is calm, making sure I had pen needles instead of using-- I didn't want to use insulin where I had to draw it out of a bottle. Things like that, I think right, just trying to figure out ways to manage it. We go to baseball games. We've talked about this before. They have to go through your bag when you go through. It's just such a pain because if I put my meter in a black bag, they got to open it. Anything that's zipped they have to open. I was like, "Okay, there's got to be a way to make this better."

I ordered myself clear makeup bags. Now I'm going to have my meter in a clear bag, I'm going to have my insulin in a clear bag. I'll have my snacks in a clear bag. I'm just thinking anywhere I go, even in an airport, everything is going to be in a clear bag. That's just takes away one step of feeling stress when you have to go through something. That's what I mean about being organized and figuring out and then say I want to go for a walk with my grandson. It's easy to just make sure I have what I need, because I can see it in the bags. Maybe that's part of it, I don't know. One more now?

Laura: The last one is acceptance.

Craig: I think I'm getting there but you still "Am I dreaming?" Especially in the bad nights when I wake up three times with the decks combo on. I think I've pretty much accepted it. I've been to the doctor, I went to the doctor again, two weeks ago. This is the new life and I'm doing pretty well.

Laura: One of the things that people always say with type 1 is they look for the silver lining. "I'm healthier now." or "I've met all these people," or this or that. Do you think you found any silver lining yet?

Laura: Well, I think I am healthier. I think I feel healthier.

Laura: You weren't unhealthy. You are a registered dietitian. You don't eat Big Macs every day.

Craig: Right, but I could have afforded to lose weight, which happened. I lost the weight. I think it's more of a silver lining for me, being older is it's like a second act in my life. I think this is supposed to be my second act. This is supposed to be or when I figured out I have an Instagram account and I educate people, I talk about things. If it's just a little niche, it's a little niche but I think this is supposed to be what I'm supposed to be doing.

Laura: I'm not sure what will be on the next Thicker Than Water. Stay tuned and we'll find out together.

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Thicker Than Water is a production of Beta Cell. As always a very special thanks to Aunt Laura. Our amazing cover of Lean on Me is by Nina Ragonese.

I'm Craig and this is Thicker Than Water.