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July 28, 2014
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Cold Turkey

One of the earliest "grown-up" movies I remember seeing in the cinema was a comedy called Cold Turkey, starring Dick Van Dyke. The premise was that a small town would win what, for them, was an obscenely large amount of money if everybody in the entire town could stop smoking, "cold turkey" that is, suddenly, as if the "off" button had been pressed and the power disconnected for an entire month. The lengths the town fathers went to, to win, and the lengths the tobacco company went to, to ensure they didn't, made for laughter and hijinks that were accessible to even middle-school children.


Yesterday was the Great American Smoke-Out, a day dedicated to encouraging people to quit smoking, and supporting people who have chosen to quit. In a world with "the patch", electronic (it's only water vapor) "cigarettes", quitters' hotlines, and a pharmacy full of prescription medications, quitting smoking does not have to be the exercise in extreme willpower (and physical withdrawal symptoms) that it was in the days of Cold Turkey.


The dangers of frequent exposure to tobacco smoke have been drilled into our heads since childhood; however, the adult role-models who smoked, or who made smoking look "adult", "hard-core" or glamorous, or as an acceptable form of stress relief, often give us a different message. Indeed, when I was a child, popular birthday sweets included "candy cigarettes" (thin cylinders of dinner-mint-like candy with a touch of red painted at their ends to simulate burning embers), "chocolate cigarettes", eponymously-styled cylinders of milk chocolate in white paper wrappers, and "bubblegum cigarettes" (just like the chocolate ones, but with bubblegum instead) and cigars. We used to take bites out of one end of our pretzel logs, sucking on the other, pretending they were cigars. And in summer, we had pipes that blew soap bubbles. Is it any wonder we grew up entranced by smoking?

My dad quit smoking. Twice. Cold turkey. The first time, he was smoke-free for a year, until one night, while my grandfather was driving them home from work, they narrowly avoided an accident and my grandfather handed my father one of his Kents. Dad smoked for about a year after that, before he decided he was quitting for good. Cold turkey. He hasn't smoked a puff since 1967.


Sometimes diabetes makes us think we need to pardon the pun go "cold turkey" off food. I know I was afraid to eat pretty much anything in the week following my first diagnosis, lest I exceed the strict sodium limit the combined diet sheets provided. And if you've read about the Allen Diet (which was prescribed to people diagnosed with diabetes in the years preceding the discovery of insulin), it certainly sounds like going "cold turkey" off food. That said, we all need some form of food to survive which is pretty much what leads to the obsessive-compulsive, schizophrenic mindset of living with non-insulin-dependent diabetes (or a "minimize-insulin-needs" therapy philosophy). Certainly, we, like today's quitting smokers, have a number of medications in our toolkit, ranging from oral medications to appetite suppressants, but like yesterday's smokers, sometimes cold turkey at least where specific foods and ingredients are concerned is the way to go. Most of us can choose to avoid high-fructose corn syrup and hydrogenated vegetable oils, and we don't need a hypertension diagnosis to cut out high-sodium foods, or celiac to avoid white (refined) wheat flour.


Even so, just as "cessation aids" do not help every ignited-tobacco user to overcome the need to smoke, diet sheets, exercise, and medications (including insulin) are not sufficient to help every person with diabetes overcome high or unpredictable blood glucose levels, or any of the other medical conditions or complications that are often associated with that diagnosis. But just as many people who quit smoking see a reversal of lung damage over time, so too do many people with diabetes see some abatement of diabetes-related tissue damage when they minimize their glycemic excursions. While we cannot force people to quit smoking, or exercise tight glycemic control, we can offer encouragement to do so, and support them in their choices whatever they are.

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Megan Holmes
Michelle Kowalski