Everywhere in the media we read about the increasing incidence of diabetes. In the last decade diabetes rose by 3.3% nationwide to 6.5% of the population. This immense increase of a chronic illness, with its personal, social and economic consequences, poses many questions.

We know that the biochemical problem underlying the clinical features is an absolute or functional deficiency of insulin. This insulin deficiency leads to impairment in the handling of body glucose (sugar), and problems in fat and protein metabolism. Modern medical research has made, and continues to make, ever more refined discoveries about the cause and manifestation of this disorder which involves essentially every aspect of the human body. The fact that we can treat diabetes with insulin, saving the lives of millions, is gratifying to the patient and physician. But we might also ask: what is going on beyond the biochemical problem? Could the rising incidence be a consequences of actions on the part of society or the individual?

To me this is an important question and unless we ask it the person will be excluded. Injecting insulin or taking medications may not be sufficient for some.

Anthroposophical medicine does provide insights which might be helpful in engaging the whole person as an important participant in the potential healing or therapy of this complex disorder. In the book by Rudolf Steiner and Ita Wegman "Fundamentals of Therapy," in the chapter on diabetes mellitus we read that: "Where there is sugar, there is ego organization; where sugar is generated, the ego organization appears and orients the subhuman (vegetative, animal) corporeality towards the human." The most dramatic demonstration verifying such a statement is the hypoglycemic (low sugar) state, in which very low blood sugar leads to unconsciousness and ultimately, if not replaced, to death.

In diabetes mellitus the ego orga­nization becomes so weakened that it can no longer effectively act on the substance of sugar. What should have happened to sugar through the ego organization then happens to it through the astral and etheric domains. The structure, substance, and function of all components of our body are not at our own service but act out their own "extra human" impulses. Our blood sugar level is not maintained within a stable range, it acts like sugar in a sugar jar, the more you pour in the more you have, only in the body it's not really yours—you can't use it! Blood vessels lose their normal structure, the finer tissue components of blood vessels overgrow, and become too `alive' to permit the ego to live properly in the body. The body can become estranged to the extent that limbs need to be amputated because of inadequate blood supply.

We can cite innumerable other examples showing how the body progressively loses its function as intended for the ego because the organization that needs to be active in the body is too weak. Hence the question: what can be done to strengthen the ego organization?

If health experts blame the wired couch potato culture of our times and realize that obesity is closely tied to diabetes, certainly we can realize that we, as ego beings, are not very involved in penetrating our body as our instrument, permitting vegetative and animal functions to predominate.

In fact, diabetes is aggravated by everything that diverts the ego organization from an engaged function in body activity, i.e. most of our passive-receptive activities today. It has been realized in the past, and still is today, that good hard physical activity, work in short, has a very helpful effect on those with diabetes or pre-diabetes.

As the body tissue used for movement becomes ever less penetrated by the ego, as the blood, vehicle for the ego, becomes less able to individualize the sugar, so also the nervous system substance becomes estranged from the weakened ego organization resulting in diabetic neuropathy.

In considering these problems it is helpful again to quote Fundamentals of Therapy: "Processes taking place in the head organization should be parallel processes to soul and spirit activity. However, because the latter activities take their course too fast or too slowly, they fall out of the parallelism. It is as if the nervous system were thinking independently alongside the thinking human being; but this is an activity which should only be carried out during sleep. In the diabetic, a form of sleep in the depths of the organism runs parallel to the waking state."

Of course much more should be said for a deeper insight into diabetes, but perhaps what has been shared here, out of a spiritual scientific view (never contradicting but always complementing and enhancing the natural scientific view), shows that this complicated chronic illness is a mandate to the human being—to wake and be active in thinking, feeling, and willing, and to engage in enthusiastic home and work activities.

In this way we can meet the illness-prone effects of our present civilization as active agents.

Gerald Karnow, M.D. lives and works at the Rudolf Steiner Fellowship Community in Spring Valley, NY, a community of all ages centered on the care of the older person and the land.