The Night Watchman

This past July, almost forty years to the day of my diagnosis with type 1 diabetes, I stood on the shore of Lake Huron, gazing at the jewel-blue water and the endless sky. It was here that my Aunt Nancy, a nurse, realized that with my multiple bathroom trips and endless need for a drink of water, I was sick and drove into the closest town to buy a urine test kit. Its results – demonstrated by a blackened square – confirmed that I was spilling glucose into my urine, a sign that I probably had diabetes.

She saved my life that day, and the events that followed – a quick packing of the car, my grandfather determined to get me to the hospital; the whirlwind diagnosis of type 1 diabetes – would also change my life forever. I was eight and tried hard to absorb all the new information I learned about choosing and measuring food, injecting insulin, checking my blood sugar and my urine, the different ways exercise and illness and stress could impact my blood sugar. It was a lot to know and coordinate. Even though it was new and I’d only been doing it a couple of days, I broke down sobbing in bed one night, not sure how I would live into adulthood.

I couldn’t properly articulate this well until a couple of years ago. As both a person living with diabetes and a nurse, I lived and witnessed the invisible brutality of diabetes but it was still hard to describe what it’s like to someone not living with diabetes. I now compare living with diabetes to being a night watchman who’s on the clock 24 hours a day, 7 days a week, 365 days a year. No breaks, no vacations, no paycheck, required to always be alert and vigilant for highs and lows, weighing how every decision about food, exercise, medication, and a handful of other things will impact us in the short term and the long term.

It occurred to me that while our American health care system is pretty good about telling us all the things we need to do to have a chance at staying healthy we diabetes, we have left out of the conversation a genuine discussion of how enormous the job is, and we don’t have consistent strategies to offer people with diabetes to help cope with that stress.

What’s more, when considering what it means to be a “night watchman,” who’s always on the job, on alert for danger, we’re really talking about a long term state of hypervigilance, a bowstring pulled tight and quivering, our muscles tensed to hold it at the ready as we wait to spot any threat, focus on it, and let an arrow fly in its direction for the sake of our own survival. We know that no one can exist in that state long term, and yet, this is the reality for so many of us living with diabetes and trying to get it right so that we don’t lose our kidneys, our limbs, our eyes, or suffer heart attacks and strokes earlier and with more complications than our peers.

Constant hypervigilance is like being in an endless (or primarily a) state of “fight or flight,” and it’s not sustainable. Using Stephen Porges’ polyvagal theory as a lens to further understand this, folks stuck in “fight or flight” have nervous systems  in sympathetic mode,  mobilized to defend against danger. Influenced by a stream of stress hormones, blood pressure and heart rate rise, breathing is constricted, and muscles tense (Polyvagal Institute, 2023). Rest, digestion, and sleep are not priorities here; survival is. A mobilized state is meant to be temporary, because in the early days of humanity, threats - hungry lions or feuding social groups - were temporary. But the long-term hypervigilance that is a part of our lives as people living with diabetes – that’s rarely temporary without a cost, and if we want to live, we have to return to it again and again. Is it any wonder that so many of us have anxiety, depression, and diabetes burnout?

I’ve found some solace and restoration in embodied practices (breathwork, meditation, and others) - the same things that helped me to heal from a major trauma that was completely unrelated to my diabetes: the sudden death of my younger brother. I’ll share some of the diabetes-specific embodied practices I’ve created here on this website, and in my forthcoming book, The Sweet Spot, in the hopes that they might resonate for you too, and help introduce more ease.

This year I’ve seen folks with diabetes posting videos of themselves doing the Blue Balloon challenge. They’re videos of themselves going through all the many parts of their day, keeping an air-filled blue balloon in the air. It’s the perfect metaphor, life with diabetes in a nutshell: balance that balloon always, and don’t let it touch the ground, or float out of your grasp.

We need a better way forward for folks living with diabetes. Research and then interventions that give us a chance to step outside the enormous work that is diabetes and find moments every day in which we can restore ourselves, and set down that balloon safely before we pick it up again.