Eating a healthy, diabetic-friendly diet is not enough. I have to walk. There is a direct correlation between my blood glucose level and the amount of physical activity I get. I don’t need to run or do Zumba. I’m not sure yoga would offer any benefit, but I know that walking lowers my levels every time I make a serious effort to get out.

Walking, though, sometimes feels like a full-time job, as it takes me roughly two hours to get my six miles in. Luckily, this situation with my elevated readings occurred in the Arizona winter when the mornings are still quite cool and the days are not much warmer than about 70. In the summer, the need to walk in a depressing mall is disheartening. The idea of walking a couple of miles under the 110-degree sun is a non-starter.

It was 34 degrees this morning when I first stepped outside, two hours later and I needed somewhere else to get another mile in. I could choose a trail, but even after things had warmed to 39 degrees, the shadows were still a bit icy. So I drove over to Costco (which was still closed), and after my walk, I sat down at a coffee shop in the same plaza to start this blog entry while having an iced drink. The problem with walking around the vast Costco parking lot is that the morning crew is in there making cinnamon rolls before the doors open to the public, and in a large part of the lot, I’m being seduced by the wafting smell.

After coffee, with Costco now open, I walk over for some shopping with the aim of gathering another 1,000 steps before dropping the groceries at home and going out for another couple thousand. At that point, I should have a solid three miles on my Fitbit, and I can start tending to lunch.

In this race to correct my sugar imbalance, I have to be rigorous in my effort, and lunch, in particular, is a struggle. All restaurants with a drive-thru are automatically disqualified as carbs are the primary and often only option on the menu. Mexican food, which is abundant here in the Southwest, is off the list as I have zero discipline to stay away from the tortilla chips. I could go out for a salad, but either I’ll be forced into something like an iceberg dinner salad that will leave me hungry in one hour, or I’ll be sitting in front of a 1,000-calorie monster.

An hour after eating whatever protein-heavy lunch I cook up, I have to force myself to break the lethargy and go out for at least another 2,000 steps.

Before dinner, I aim for another couple of miles, so I finally reach my 6 miles/ 12,000 step goal. Anything over that, and I’m thrilled and hopefully working towards weight loss.

Initially following this routine, I start shedding weight quickly, but just as quickly, it plateaus, sapping a bit of my enthusiasm. This time around, though, I’m jotting down these notes to myself in order to remind me of my recognition of this imperative. Getting complacent in the past did not serve me well, and this time around, I have to force myself to get my weight down to a more reasonable 200 pounds. I’m weighing in at 241, which is 5 pounds heavier than I was about a year ago. I hate publishing this here, as it makes it more real than the self-delusional fantasy I like to entertain.

Fighting diabetes is a serious struggle that requires vigilance that feels like an elusive moving target. Three years ago, when I was diagnosed, I was adamant that I would never go on insulin. The problem was that this was exactly what my doctor wanted me to do. On the exact day I was given the diagnosis, I did a hundred-and-eighty-degree turn and changed my behaviors.

Lucky me, I wasn’t supposed to start using those needles to inject myself until after I saw a dietitian who would discuss diet and the process of self-injection. My appointment wasn’t for two weeks, so I had time to attack the invader who was taking advantage of my genetic predisposition for this ugly disease. I fully understood that I’d brought this on myself with my overeating and obesity, but still, I had wished that before it ever happened to me, the healthcare industry would have invented the magic bullet that would save me the hassle.

When my date with the dietitian finally arrived, I’d reduced my fasting blood glucose from around 320 mg/dL to about 160 mg/dL. I was confident that I was moving in the right direction and that with just two more weeks, I could get this under control; I was right. In those early days and the ensuing ones, I changed my diet by eliminating any sugar, potatoes, pasta, and rice. I started looking at carbs and portion sizes. I bought a Fitbit for me and one for Caroline, which turned out great as we became competitive about step count.

The day after my appointment with the dietitian, we traveled to North Carolina for about a week, and while we were there, we took every opportunity to eat BBQ and walk. Proteins and green veggies were my new favorites. One month after my lifestyle changes, I had a follow-up appointment, and by then, my blood glucose tests were consistently within normal ranges

Four months after my original diagnosis, I had another appointment that again tested my A1C; this time, instead of the 11.2% I had back in April, I was at a healthy 6.2%. For all intents and purposes, I did not have diabetes. Of course, I was now taking the drug Metformin, but at least I wasn’t on insulin. Armed with my “clear” bill of health, I took it as a license to occasionally cheat on my diet. For the next two years, even though I had some serious fear that I’d pushed things too far, my A1C reading continued to come back in the range that gave me nothing to worry about.

Initially, I was extremely vigilant in testing my blood glucose, maybe to a fault, but I didn’t want to let this get away from me.

Now, here it is nearly three years later, and over the last six months, I grew lazy with testing; the matter of fact was that I simply stopped. I thought my diet was “mostly” under control, though I was aware that my portions had grown. There were no diabetes symptoms, so I grew arrogant.

Then, last night at 2:30 in the morning, I woke up needing to pee. Damn it. Two hours after breakfast this morning, I checked my blood glucose, and I was in the mid-200s; fuck you, diabetes. I felt panicky and a bit of despair as I had no idea how long I’d been out of control again. I’m trying to tell myself this is only temporary because I ate pineapple and raspberries last night, but I think that might be delusional.

I’m in a constant battle with my metabolism, genetics, and the convenience of eating out in a restaurant culture that rewards you with large portions.

Maybe this will prove to be a good thing because I’m seriously pissed off right now and feel like I need to be done with this. I lost nearly 40 pounds after learning I had this ailment; my hope is that if I can shed another 50 pounds, I could be done with it for good.

Until my numbers come down, I’ll have to deal with some anxiety, and I have to return to hyper-awareness of how insidious this monster known as diabetes is. Wishful thinking is not my best friend in keeping this life-destroying shit at bay. There are about 100 million of us with diabetes here in the United States, which is almost one-third of all Americans, and still, it is not a national discussion. The restaurants, grocery stores, and convenience foods cater to self-indulgence and are making a serious contribution to America’s ill-health.

It’s estimated that about 3 million people in the U.S. have a sensitivity to gluten, and everywhere we look, they are being catered to. Many people who likely do not have any sensitivity at all to wheat products imagine they have problems and have joined the bandwagon of self-diagnosed hypochondriacs who insist on a gluten-free meal. If you have diabetes and try to find carb-free meals, you are going to have to look far and wide and still come up empty-handed. So the “easy” fix is that those with diabetes should turn to cooking for themselves, but convenience is not part of that program, and as everyone knows, cooking for healthy eating is a seriously time-consuming job.

It was the threat of taking insulin that made me change my routine and try to take this disease seriously. I don’t want this to be a dilemma of choosing between an easy way and a longer life. Too many people don’t want to change their relationship to convenience and so will continue eating what they want while regulating their blood glucose with a jab in the stomach. The problem with this type of treatment is that I’ve seen too many others go through the ugliest of complications that are a part of diabetes. So in my frustration, I am left with the hope I can muster the fortitude to fight for my life and find a tiny amount of solace in screaming, “Fuck you, diabetes!” for making food so difficult to enjoy.