WilD

Welcome back to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

The Holidays are here! And we can't believe who's writing in for advice for the second year in a row (!)... Warning: naughty D-thoughts ahead.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

  

Santa, type 2 from the North Pole, writes: Dear Wil... I need your help! My mailbox, fax machine, and inbox are full of letters from type 1 kiddos and their mothers asking me for a cure for Christmas. The Elves are pretty good at technology (you knew that most of the iPads are built up here, right?). But biomedical research and pharmaceuticals? That's a bit out of our league. And while we do some miraculous things when it comes to logistics and delivery, we don't really work miracles. I don't even know what exactly I'm asking you to do, but I couldn't think of anyone else to reach out to! Oh, and I'm still working on getting you off the Naughty List, but you know how bureaucracy is, and it's not looking good for this year, either. Sorry about that. I hope you're still willing to lend me a hand!

Wil@Ask D'Mine answers: Wow! Another letter from Santa? I'm honored! I hope the tips last year on how to politely refuse holiday treats you don't want were helpful to you. And don't worry too much about the whole Naughty List thing; at my house, we've been using the lumps of coal to decorate the tree, and they make quite striking black ornaments against our red lights.

OK, all you good boys and girls, let's give the big man a break. (And all you bad girls should just give me a call instead, seeing as it looks like I'll be on the Naughty List for a while longer yet.)

But seriously, as it's the season of miracles and toys, this seems like a good time to talk about the ultimate diabetes end game: The cure. Is it a myth? A legend? A fairy tale? A Christmas fantasy? While I agree with Francis Pharcellus Church that, "Nobody can conceive or imagine all the wonders there are Dear Santa DiabetesMineunseen and unseeable in the world," I don't believe in the cure. Sorry. It's true. I don't expect to see a cure in my lifetime; and I don't really expect it will happen in the years, decades, or even centuries to follow.

Why?

Well, what is a cure? A true cure would have to be a medical treatment and/or drug(s) that would permanently reverse and eliminate the autoimmune response in type 1s and the insulin resistance in type 2s. It would also need to restore normal pancreatic function, and repair any damage done by the diabetes, such as neuropathy, nephropathy, retinopathy, and all the other "pathies." In short, at a minimum, a true cure would restore people with diabetes to the condition they were in before the disease struck. Optimally, it would restore them to full health. (I say that because many people with diabetes are more globally healthy with diabetes than they were prior to getting diabetes—myself included.)

No wonder Santa threw his hands up in the air. That's a tall order, even for a man with a legion of Elves at his disposal.

But along with believing in Santa (hey, he has written to me twice), I do believe that some day, somewhere over some rainbow we'll prevent type 1, and that will be a good thing for the generations to follow. But I suspect that this will prove to be child's play compared to fully reversing entrenched diabetes.

Does this make me a pessimist? Perhaps, but I think it just makes me realistic. I mean, think about it. We don't even have a very good handle on why diabetes happens in the first place! In my book: No cause, no cure. How are we to craft a cure without an understanding of the underlying mechanisms of the diseases? Yeah, we might get lucky. If you throw enough darts in a dark pub while under the influence of Irish whiskey, you'll get a bull's eye eventually. But curing diabetes this way is going to take a hell of a lot of darts.

So I have a different thought to share. It's heresy of the highest order, and will put me on some people's irrevocably Naughty List, my name carved into black marble. But here it goes anyway...

 

 

Do we really need a cure?

 

 

Whoa, whoa, whoa. Hold on, people. Hear me out. People complain all the time that all we have now are treatments. As if that were a bad thing. The way I see it is that we should be grateful that we have a beautiful range of treatments that allow us to live truly wonderful lives. If you disagree, perhaps you should have a chat with one of the ghosts of Christmas past. Boot up your Ouija Board and see how a D-Mom in 1901 felt about what befell her and her child.

And not only do we have treatments, but our treatments get better and better. From insulin harvested from feedlots, to insulin engineered to match our DNA. From peeing on an anthill, to CGM. From glass syringes and needles that need to be sharpened on whetstones, to insulin pumps that automatically suspend delivery when our blood sugar goes too low. Thanks, Santa!

I ask again, with all these great toys, do we really need a cure?

I don't think so. I think, to paraphrase Arthur C. Clarke, "any sufficiently advanced therapy is indistinguishable from a cure."

Instead of a cure, I think we should be asking Santa (and the ADA, JDRF, FDA, industry, and pharma) for more and better toys. I'd love to unwrap a better therapy at the end of each year, wouldn't you? I'd be happy with more accurate strips in my stocking and faster insulin under my tree. I would be eternally grateful if I could treat my diabetes with increasing accuracy and ease with each passing year.

And I can't help but wonder where we'd be today if all the wasted resources put into cure attempts had been put into improving therapy. Maybe we'd already have all we need under the tree to truly thrive -- diabetes and all.

And I don't think I'm alone in how I feel. I jokingly asked my patients this year what they wanted from Santa, and they all said the same thing: A cure for my diabetes (this is why his mailbox, fax machine, and inbox are overflowing). But then they all laughed and said, "No not really. I'm doing OK. I just want my family to be healthy, peace in the world, and for Congress to get off their asses and do something."Really Needs a Cure

The first two I do believe in. The third? Hah! I'm even more pessimistic about Congress than I am about the cure!

So most PWDs that I know seem, if not happy about their diabetes, at least at peace with it. Peace on diabetes, goodwill to PWDs. On the other hand, I suspect that you D-Moms and D-Dads disagree with me. But here's a game I want you to play around the dinner table at Christmas (or Hanukkah, Kwanzaa, Winter Solstice, or International Hallmark Card Day). Simply ask your children what is the worst thing that has ever happened to them. I'll bet their answers will surprise you. I'll bet that 99% won't say it's their diabetes.

Now, I'm not saying that your little one's diagnosis wasn't the worst thing that ever happened to you, but don't make the mistake of projecting your fears and stress onto them. Their lump of coal probably isn't your lump of coal.

So in this season of myth, magic, dreams, presents, love, and peace—should we wish for a cure? Maybe. But should we ask Santa for one? No. Nor should we take the risk of plugging into other pipe dreams of cures. If some demented or greedy bastard on the Internet is promising you that he'll cure your diabetes in 14 days with his miracle product... well, frankly, you're better off wiring your money to the North Pole, for all the good it will do you. And likewise, be careful whom you support with your money. A modern version of the snake oil salesman is the person who asks for money because they are close to a cure and just need a bit more dough to change the world.

Donate, by all means. 'Tis the season, after all. But donate to reputable players.

So there you go, Santa, I hope that helps. Maybe some of my brothers and sisters stop stuffing your mailbox, fax machine, and inbox, and instead start addressing their correspondence to the folks most qualified to bring us better diabetes tools. And as for the D-Moms? Hmmm... Well, despite my best intentions, I suspect they'll be too busy writing me to be bother you any more.

So Merry Christmas, Santa. And to all, a good night's blood sugar.

PS: Bad Elvettes, you know where to find me!

 

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.