Lately there has been a string of patients coming into clinic for various reasons (e.g. a visit to the podiatrist, wanting medication refills, etc.) and incidentally found to have severely high blood sugars, often in the 500s or 600s. As I’ve said before, I’ve never seen any of these patients in diabetic ketoacidosis. Our normal protocol is to have them drink several cups of water (or IV fluids if they are dehydrated or found to have acute kidney injury), give them subcutaneous insulin, and to recheck their blood sugar in 30 minute increments until it’s in an “acceptable” range. The ER usually does not want us to send them there because they never admit for this, even though the ER in Missouri would very frequently call me for admission if a patient’s blood sugars were this high.
The patients are very commonly noncompliant with their insulin (but not always). Sometimes they go weeks without taking it, or maybe they just miss it for a day or two. Not only that, they live surrounded by the worst possible foods, in a milieu of refined carbohydrates, simple sugars, and saturated fats devoid of enough fiber from legumes, vegetables, etc. Their genetic predisposition also leads to premature insulin resistance and abdominal adipose deposition which sets them up for this condition. There also seems to be a sort of cloud of despondency over this place in which many people do not seem to want to take charge of their health by making the drastic changes necessary to treat these common conditions.
Seeing the same patients over and over again in a very precarious physical state often leads to a sort of “repetitive futility”, in which it feels like you’re treating something that will only matter for a very short amount of time (because you’re not addressing the root cause). I’m tempted to feel hopeless in many situations, which has prompted me to try to make sense of all the health chaos I see. Why do they have such bad diabetes in the first place? Why should they, as opposed to another, have to take such high doses of insulin 4 or 5 times a day. Not only has the lot fallen to them, it seems that their race (American Indians) seem to be more prone to diabetes and obesity than whites, as well as other major health complications. Why is there disease, drought, car wrecks, etc. to begin with?
I often ponder the beauty of nature. I think this world’s beauty is a gift from God. I also often wonder at our capacity to be awed by the beauty of nature, which I also believe is a gift of grace from God. God himself saw that his creation was “good” as recorded in Genesis 1. I am particularly drawn to places and things of rugged beauty like an ancient, twisted juniper tree growing on a rocky bluff; or the beauty of deserts; or the majesty of old growth forests where things are in such a balance, yet are still fragile. Yet there is a certain harshness to this beauty. An easy example is 35 minutes from our home – The Badlands. There is an undeniable rugged beauty but it is extremely harsh: hardly any rainfall, bitterly cold winters, intense heat and rattlesnakes in the summers. The settlers who tried living there didn’t stay long.
I was reading in Ezekiel 1 and was struck by how everything related to God is described as beautiful (“like the awesome gleam of crystal” vs22, “something resembling a throne like lapis lazuli in appearance” vs 26, “as the appearance of a rainbow in the clouds on a rainy day” vs 28). Even the scroll given to Ezekiel in chapter three was “as sweet as honey in my mouth.” Everything God creates is good and perfect, so I’ve been difficult reality of the harshness in the world as well as the utter chaos and madness of society, prevalence of disease such as cancers and epidemics, and the fact that everything seeming spinning out of control.
I believe the first explanation is found in Genesis 3 after the fall in which God explains to Adam that “the ground is now cursed because of you; both thorns and thistles shall grow for you.” This is in addition to “painful toil” and “sweat” in working for food as well as greatly multiplied pain in childbirth. This indicates direct physical repercussions to sin to our bodies. You begin to see a gradual decline in life expectancy from 8-900 years with the first people down to 120 described at the time of Noah.
Then, according to the Genesis account, approximately 1,700 years later the great flood occurred due to the “wickedness of mankind being very great,” and because “every intent of their hearts was only evil continually.” And the “waters that were over the sky” first described in Genesis 1 fell to the earth.
Immediately after the floodwaters receded God says
“As long as the earth endures,
seedtime and harvest,
cold and heat,
summer and winter,
day and night
will never cease.”
Cold, heat, summer, and winter were never actually mentioned until after the flood. My theory is that losing the waters above, which would have served as a protective layer shielding the earth from damaging UV rays, led to the massive temperature fluctuations, the intensity of the sun (it always felt so abnormal to me), sunburns, as well as other effects which I’m not smart enough to think of. If this is accurate, you already have an earth that is dramatically different than at the time of creation. God’s design for creation, marred by sin.
“Bondage to Decay”
But what about all the disease, famine, epidemics, and so on? Notice I did not list things like wars, genocide, rape, etc. as these are blatant acts of sin against God for which the clear explanation is the corruption of the human heart (sin). I listed physical maladies which happen seemingly out of nowhere to a person (not a direct result of sin).
For this, I feel Romans 8 is helpful, when it says, “19 For the creation waits in eager expectation for the children of God to be revealed. 20 For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope 21 that the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God. 22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 23 Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies. 24 For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? 25 But if we hope for what we do not yet have, we wait for it patiently.”
As stated above, “The whole creation has been groaning as in the pains of childbirth,” and is in “bondage to decay,” The world is in a state of constant decline, entropy, disarray, chaos, etc. Things are not as they were originally designed. This decaying process also affects our DNA leading to innumerable genetic diseases, predispositions to various inherited states, the aging process, and so on. “Who will rescue me from this body that is subject to death?” asked Paul in Romans chapter 7. In 2nd Corinthians 4:16, Paul says, “Therefore we do not lose heart, but though our outer person is decaying, yet our inner person is being renewed day by day.”
But why is this so? The quick and easy answer would be sin, which is accurate, as it was triggered the disarray and chaos to begin with. But this implies that God was surprised by it, or that creation as he wanted it only lasted a short while before man changed his plans. But the passage in Romans states that it was the will of God to subject the world to frustration in order that there may be a redeeming process, a turning to Him, resulting in his glory. He wants the pain of this life to draw people to him. It is the rule, rather than the exception, that this life is full of pain and disease. There is absolutely no escaping it. It is a very modern idea to think that you can somehow skirt through life without pain, and if you do you are exceptionally lucky.
Some would say this makes God cruel, but we are the ones with the law of good and evil written on our hearts, and violate it constantly.
In this passage is also the promise of “redemption of our bodies” as sons of God. Even though in this world we will have back pain, headaches, and diseases of all kinds, there is this promise of redemption for those covered by the blood of the Lamb. In the new heaven and new earth described in Revelation 21, “He will wipe away every tear from their eyes; and there will no longer be any death; there will no longer be any mourning, or crying, or pain; the first things have passed away.” It goes on to describe the new city of Jerusalem and it a thing of amazing beauty.
So, in thinking of my patients with uncontrolled diabetes or other difficult-to-treat medical problems living in a broken world with little hope; yes, medical care is good and important, but the most important need to address is their spiritual poverty and the fact that without the Gospel, they have no hope of their bodies being redeemed from this very dark world we live in. This is not a new answer. Maybe their level of need is God trying and trying to get them to see how much they need a savior, to see that their ways are not sufficient.