One morning in late September, I drank a cup of coffee without sugar and ate half an English muffin for breakfast. Boring choices, but I like routines; I always drink coffee in the morning, and I always drink it with some milk. If I eat breakfast, I don’t eat much. I didn’t think it mattered — I still wouldn’t, if I had any choice, but two hours later, a medical assistant pricked my fingertip and told me that my blood glucose was 330 milligrams per deciliter. That seems bad, I thought. A few minutes later, I learned my A1C was also much too high, which supported one undesirable conclusion: I have type 2 diabetes, like my mother and millions of other people in the United States, and I’ve likely had it for a while. The doctor sent me home with a sample continuous glucose monitor along with prescriptions for metformin and Mounjaro, a popular GIP and GLP-1 receptor agonist. The following morning, I checked the data from my CGM and saw that my fasting glucose had reached 400 milligrams per deciliter. I did not eat an English muffin.

Still, there is good news: Mounjaro and metformin are effective medications. I know that from my doctor, the scientific literature, and my CGM. A month after getting diagnosed, my blood glucose has declined to safer levels, and the disease frightens me less than it initially did. Pragmatism has taken over. I already have mild neuropathy in my feet, and I’d rather it didn’t get worse. If I want to feel all my toes again, the solution is medication, a better diet, and exercise. There isn’t an easy way to reverse the symptoms of type 2 diabetes, and I knew that the day I found out I had it. I also knew that my illness wasn’t my fault — or I thought I did. People develop type 2 diabetes for a combination of reasons, like a sedentary lifestyle and an unhealthy diet, but genetics matter, too, and I have a family history of the disease. Also, so what? Nobody deserves a life-threatening illness, and a medical diagnosis is not a moral failure. I’ve never thought I should blame my mother for getting sick.

Still, I began to berate myself. I thought about my meals — the small ones, the big ones, the occasional snack — and wondered when I’d crossed the line. Was it the Coke I drank for my headaches? Those English muffins? I told my husband that I felt stupid. I should’ve taken more Pilates classes, eaten fewer carbs, ordered more salads. My husband, an ex-Catholic, told me to be less of a Protestant. Shame has its place in the world, but not here, in this conversation or this illness. He’s right, but in the Make America Healthy Again era, I find it difficult to silence that angry voice in my head. Every time I scroll through Instagram, I see ads and videos that promote dubious supplements and fad diets — and then there is the Robert F. Kennedy Jr. of it all. Diabetes is a fixation for our Health and Human Services secretary, who believes America suffers from a “chronic-disease epidemic” that can be resolved through better nutrition. “Sugar is poison,” he said this year, and it is “giving us a diabetes crisis.” Conditions like diabetes deserve more attention than measles, he claimed amid a deadly outbreak of the infectious disease. Pharma companies want to sell GLP-1s like Mounjaro because “we’re so stupid and so addicted to drugs,” Kennedy told Fox News last year, adding, “If we just gave good food, three meals a day, to every man, woman, and child in our country, we could solve the obesity and diabetes epidemic overnight.”

The MAHA ethos contains an element of truth, which makes it even more insidious. Our choices do influence our physical condition, whether we’re at risk for type 2 diabetes or not, but we are also more complicated than MAHA admits. A woman who lives in a food desert needs more from her government than nutrition education; she can’t simply bootstrap her way out of medical danger. Neither can I despite my relative security. By the time I found out I was diabetic, I was too sick to........

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