"Clearly, there is. But in most cases, without the genes you don't become diabetic. You could weigh 400 pounds, but if you don't have the genes, chances are your blood sugar would be normal. And," she continues, "some of the things that can trigger diabetes—age, stress, high fever, even certain medications—antagonize the effect of insulin. Someone could put you on prednisone for poison ivy and your blood sugar goes up, or you could be a really conscientious exerciser and hurt your back. It's the combination of pain and the fact that you're no longer exercising that can raise your blood sugar. I see that kind of thing once a week here. You just can't control every factor. So it's never exactly the patient's fault." She sees my doubt but plows ahead. "This is a disease where there's a huge amount of guilt and blame. Angry wives are always coming in here pointing to their husbands and saying, 'If he'd just taken care of himself, this never would've happened.' That's actually incorrect. It might not have happened at the time it happened, but it would probably happen eventually."

My lips say, "I suppose," but my eyes are glued to the scale across the tiny room.

"I think it's a little unfortunate that we believe eating is completely an issue of free will. It's not. Food intake is carefully regulated. It has to do with survival of the species. There are important circuits in the brain that are hardwired to direct how much we eat and when we feel satiated, and it's increasingly clear that there's a derangement, probably an inherited derangement, in the circuits of a person who struggles with weight."

And here I thought it was my needle phobia and constant weeping that would convince her I was deranged. "Now," she continues, "this isn't to say you couldn't go on a diet and lose weight after the baby is born—you could. It's just extremely hard to keep it off when the circuits are altered and your body is telling you you're hungry. It's also much easier for some people to gain weight. And that's their genes talking again. The thing is, if you really pay attention and you're willing to be a little hungry and exercise regularly, your genes are not your destiny."

"It's all so hard," I say.

"If it were a simple matter, nobody would be diabetic or overweight," the doctor agrees. But the good news is that I've got patients who are quite overweight—even after they take off ten or 15 pounds, they're still overweight by anybody's standard, especially their own—but through that little bit of weight loss, their blood sugar is now normal.

"They always say to me, 'What are you so excited about?' But that's what I want people to understand: For your long-term health, the difference between having a blood sugar of 100 versus 200 is enormous, and often it's those ten pounds that change everything. Diabetes is a chronic, progressive disease, but it can be staved off for years. And that's huge!"

I vow never to touch spaghetti carbonara again.

"People who struggle with diabetes still have to live in the real world. It's unrealistic to tell someone they can never have the good stuff. If there's something you love to eat, I want to make sure you can still eat it from time to time. It's impossible to always be perfect. You have to learn what your blood sugar levels are supposed to be and keep them within those limits 80 percent of the time—shoot for a solid B; the other 20 percent is a quality of life issue."

Two years later, my quality of life no longer involves shots of insulin, and I check my blood only randomly every few days. I lose weight, gain some back, and try to be kind to myself in the process. Dr. Goland tells me that my latest hemoglobin A1C is at 5.7—perfectly normal. "So does this mean I'm no longer diabetic?" I ask hopefully.

"I actually discourage my patients from thinking they're cured. The real question is, Do you have well-controlled diabetes or poorly controlled diabetes?" Mine is well under control, she tells me. And so I continue to eat a lot of vegetables, some protein, and an occasional dish of spaghetti. I walk home from the office at a fairly brisk pace two or three evenings a week, but the secret to my fitness program involves chasing after a sticky little toddler with a voracious curiosity and a mind-boggling level of energy. It took a village, but on April 26, 2003, Julia Claire Labusch was born perfect and pink, healthy and happy—the most delicious sugar substitute I've come across.

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