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Commitment to reality

I’ve been pretending to myself, these days, that I’m not paying attention to research. I pretend I’ve accepted and adapted. Cure, shmure. I’ll be delighted if it happens, but I’m not holding my breath. I am fine; I am strong. I cope, I manage, I deal. I am Getting On With My Life; I possess a Healthy Detachment.

Hmm.

It’s come to my attention that what I actually do, these days, is to glance sidelong at the research news, pretending not to look but in fact making quiet note of every development. (It’s an interesting talent, reading websites without consciously acknowledging that I do so.)

I’ve had to confront my tendency toward surreptitious monitoring after last week’s news that the Edmonton protocol is essentially a flop.

In a nutshell for the non-D-obsessed, this experimental procedure entails a noninvasive transplant of islets, those little jobbers in the pancreas that make insulin in a healthy person. In type 1, the immune system mistakenly eradicates the insulin-producing cells, leaving their former owner with diabetes.

So: insert happy, functional islets from organ donors, salt liberally with immunosuppressant drugs, cross fingers.

Variations on this procedure have been attempted for years with limited efficacy, but the most recent study had encouraging results at 1 year following transplantation. About half of patients were manufacturing all the insulin they needed, and a large percentage of the other half were manufacturing some and achieving improved blood glucose control thereby.

Last week brought the news that at the 2-year mark, only 16% of patients were still functioning without insulin injections. It seems that the immune system continues to recognize the islets as invader cells and systematically destroys them. Unless/until more effective immunosuppressant drugs can be found, the Edmonton protocol is not a viable cure.

Certainly I had no conscious fantasy of ever receiving a transplant and a cure via this process. I’m more realistic than that.

But...crap.

I’ve written elsewhere about my mind’s habit of making contracts with the universe. What I realized this week is that I’ve done it in this area as well: If I do my job as a patient and forge ahead with gentle optimism and courage and blah blah blah, if I extend myself toward other PWDs and do my bit to help us all cope, I (and the rest of you) will be rewarded someday, someday, with the cure.

Truth be told, there is no such contract. There are no guarantees. Optimism may be mentally healthier than pessimism(?), but none of us can know if or when a cure may be found. There’s a tightrope to walk here—I suppose it’s properly called realism—that lacks the comforting safety net of my previous subconscious understanding with the universe.

So it’s time to renegotiate. What it must be, all it can be, is something like: If I do my best to take vigilant care of my diabetes, if I do my best to connect with others in my situation, I will be as physically and mentally healthy as I can be for as long as possible. In the meantime, a cure may or may not be found.

Bah. I liked the old contract a lot better.

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