Diabetic Guilt

When I first started receiving emails from something calling itself the Patient-Consumer Parade, I was a bit put-off. I'm not a Patient-Consumer, I thought. I'm a health-care user, a diabetic, someone with a chronic illness maybe, but not a Patient-Consumer. It's so typically America-centric to take a phrase that only makes sense in a country without universal health care and apply it willy-nilly to people from all over the world. And I ignored it.

Besides, what would I say? Diabetes is not one of The Big Five for me; it's a personal priority but not a personal interest. I'm glad there are people out there who are passionate about it, because they're the ones who will drive the push for a cure, but at best I stand on the sidelines and cheer them on. At worst, I wave before skipping off to immerse myself in something else--green parenting, maybe, or climate change, or writing, or feminism, or the politics of motherhood. You might think that given a diagnosis with a serious chronic illness that requires so much daily maintenance, it might take up more of my mental space--but no. Mostly I ignore it.

And it's not even the only one! There's asthma. Poor little asthma, neglected and left in the corner to starve. Half the time I forget to even use my puffers or take the singulair, and then wonder why I can't sleep in August.

I'm fickle. There, I said it. I'm as fickle as a Hollywood romance. I want novelty and change. I like new. I've had diabetes for fourteen years this month--fourteen years! I can barely stay interested in something for fourteen weeks; fourteen days is tough sometimes. Fourteen years? I have nothing else in common with the person I was at 17; my politics, religion, values, priorities, daily lifestyle, concerns, everything else about me has changed. Except the diabetes.

No wonder it bores me.

But when the lovely Kerri of Six Until Me put out a call for entries for a PCP to be held at her place, and when I saw that the topic was to be how health concerns weave themselves into daily life, I thought--aha! This is something I can sink my teeth into. (Waiting times? Treatment options? New technology? Not so much. I should, I know, I should, but I don't.)

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I'm reading a book which I will shred before your very eyes in a few weeks. It will take me that long because it's so bad that if I read more than fifty pages in a day I can't sleep that night for speechless rage. I can't recall the last time I hated a book this much. I won't name it--I'd hate to spoil the surprise--but I will give you a little foretaste:

The author argues in part that people with chronic illnesses are "narcissistic."

I won't get into the rest of his argument in this post, since I have such a treat saved up for you all for later on, but in this regard he argues that the current state of the environment is so bad that every part of modern civilization must be destroyed by any means necessary, including and especially modern medicine, and those of us who object because--hey! If you take away my insulin, I'm going to die!--are narcissists. If we truly valued nature or other people we would understand that our death is a small price to pay for a healthy world.

What bothers me even more than advocating the death of hundreds of millions of people without doing even the most basic research to prove that modern medicine really is too toxic is his assumption that no one with a chronic illness has ever considered this.

Every transaction in my day is conducted internally on an invisible environmental register: I drove my car (ghg emissions, smog, sprawl, oil spills). I bought a magazine (deforestation, toxic inks, effluent from paper processing, landfills and recycling). I bought a bag of potato chips (industrial agriculture, water pollution, spread of pesticides in the environment, fuel wasted in processing and transportation, packaging, destruction of useful nutrients, pollution, waste). And: I used a blood sugar test strip. I opened another sterile package of insulin pump supplies. I replaced the battery in my insulin pump. I finished another bottle of humalog. I waste, I waste, I waste.

I have been acutely, painfully aware from the time of my diagnosis that a lot of waste is involved in treating diabetes, and that the manufacturing and transportation and disposal of the products we need to survive might be environmentally costly. I have asked myself a million times if I have given enough back in the fourteen extra years I've had so far to justify what I've cost. But what have I cost?

Insulin analogs are grown in vats of genetically modified yeast or bacteria which is incinerated when it's reached the end of its useful life. I suppose it might emit the smell of burning bread, but I find I can live with that. The jar it goes in is another matter; it's glass, and glass production is toxic and because it's medicine you know it's not recycled, nor can it be recycled when I'm done. But the actual bottle is smaller than a tube of lipstick and I use about one each month. I find I can live with that, too.

The insulin pump itself is a small electronic gadget in a plastic housing. This I am not thrilled with, since electronics are highly toxic and their wastes are shipped to the third world where they are picked over by children. Still, it's small, it will have been used continuously for five years before I replace it, and it has the advantage of being used for something less frivolous than the laptop I bought last weekend. When I'm done with it, maybe it can be refurbished and given to someone who could not otherwise have one, instead of thrown away. Also, I know that electronics manufacturers are beginning to wake up to this problem and are working hard to make products that can be disassembled and recycled, instead of landfilled or incinerated. Maybe my next pump will be greener. I hope so.

Every four or five days I need to replace my insulin infusion site, which is where the pump is attached to me. There's a little bit of metal in the needle (which goes into the biowaste bucket and is incinerated--a strike against me, but it now takes several years to fill that little yellow pail, whereas when I was on injections it took only a few months). Most of it is plastic. So--oil extraction and refining and transportation and pollution. Lovely. But I only change sites at most seven times in a month, and the total plastic waste produced by this is far less than the average family throws out in plastic bags after the weekly grocery trip (we use bins for shopping).

The battery bothers me. About once a month one triple-A battery needs to be replaced from my insulin pump. But they can be recycled, and twelve triple-A batteries each year is less than we use in the computer mouse and the remote--and again, less frivolous.

Test strips. I should be using four each day at least, and let's assume that I use twelve, just to maximize my impact. They are made of plastics, fabric and small amounts of reactive chemicals. They are also about a fifth the size of the strips I used when I was first diagnosed and bought the One Touch II fourteen years ago. When I lay twelve strips out on the table side by side, they make a sheet of plastic smaller than a credit card. Normally I use one-third that amount, but even if I were to use all twelve, how does that compare to the environmental effects of one diaper, one can of soup, one juice-box? My entirely non-scientific answer is that it must be much less.

The difference between a regular Canadian and a type 1 diabetic Canadian isn't the difference between a firecracker and a nuclear bomb after all (more like the difference between a musket and a rifle). I'm not particularly more toxic or environmentally destructive than everyone else. My environmental efforts do much more than compensate for my diabetic sins; as I supposed, the "you're narcissistic for wanting to stay alive because you'll drag the whole earth into the apocalyptic toilet if you do" is just a modern take on the old neo-Darwinian "You should have died anyway, so it's not hateful of me to ask you to die now (quietly, gracefully and off-stage preferred)."

I'm not just a diabetic. My health care concerns are driven by more than what works best or what's cheapest, and that's true of most of the diabetics I know. We know how much waste is involved with maintaining our health better than anyone--we live with it. I want to know how much pollution is produced by the companies who manufacture my insulin and test strips; I want to know what happens to old meters and pumps when they wear out; I want to know how much fuel is consumed in getting my prescriptions to market; I want to know how much the workers are being paid and if they're being asked to do anything unsafe. And when there are problems, I want them fixed. I want to know that the companies are being responsible, using resources wisely, conserving energy and water, preventing pollution and pursuing sustainability. I was ridiculously happy when I saw Norvo Nordisk's Environmental Management System and report online. I'm not just a diabetic, I'm not a selfish bitch who cares about nothing as long as I can stay alive; I'm part of the world and I care about it.

I'm an environmentalist. Everything I do is tied up into that, including my health care. When I take those little plastic strips out of the bottle and insert them in the meter, when I unpack another insertion set, when I open a new bottle of humalog, I am not just toting up dollars and cents, effectiveness and convenience; I am also asking myself, How much did this cost? Who paid it? The poor, the soil, the air, the water?

How can I pay them back?

Posted by Andrea at August 17, 2006 8:35 AM under Pins and Needles

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