Diabetes Management No Match For Carceral Conditions

When Steve Brooks was diagnosed with prediabetes in November 2021, he found himself uniquely incapable of reversing his condition. His physician put him on the tried-and-true care plan: reduce unhealthy foods and increase exercise. But he faces an insurmountable barrier—his address.

Brooks is serving a life sentence in San Quentin State Penitentiary for violent crimes he committed as a young man. At 50 years old, he’s been in prison longer than he hasn’t, and for the last six has been at California’s penitentiary by the Bay. San Quentin is the state’s oldest, opened in 1852. 

Before the COVID-19 pandemic, Brooks considered himself to be a healthy man. He cares about his health, he works out—San Quentin has a running club he’s a member of—and stays informed about the latest preventative and testing guidelines for his age group. None of this prepared him for how the lifestyle of lockdown would become a health threat. 

Brooks—like many people across the world—was forced into a sedentary lifestyle. His regular running workouts were cancelled and meal routines were reconfigured to accomodate social distancing where possible. When the rates of infection were at their highest, the kitchen at San Quentin was shut down entirely and an outside vendor provided meals to over 3,126 prisoners. Brooks said it was “actually some great food. Everybody loved it.” They loved it so much, he said, that he and his fellow prisoners didn’t want to waste the opportunity; he ate more than he usually would have. “That contributed to these extra calories and extra pounds that we started to develop.” 

Diabetes affects the body’s natural ability to process glucose. In a non-diabetic body, insulin is secreted by the pancreas and processes glucose. In a diabetic body, insulin production is stunted and glucose levels spike and wane, events that can be deadly without intervention. Insulin is required from a pump, pill, or injections, multiple times a day. This becomes routine for diabetics, but, Brooks said, he fights everyday to avoid it. 

Diabetes is not uncommon in prison. Reporting from 2011 shows that 4.8% of the prison population has diabetes. This is less than half the average for diabetes on across the country, at 11.3%, but one major difference is how it's handled—and the San Quentin living conditions had become the precursor for Brooks’ prediabetes to take hold.

Prediabetes is a reversible condition—which is good news for the 38% of Americans who have it—but only for those with the knowledge and freedom to make the necessary changes to diet, exercise, and lifestyle. In October 2022, San Quentin launched a diabetes education and peer-support group, and while Brooks has yet to attend, he is hopeful about its impact. In the meantime, he navigates the diet provided to him, which often includes a carbohydrate-heavy rotation of waffles, breads, and cakes. 

The “Prisoner Diabetes Handbook”—for prisoners, by prisoners—recommends simply abstaining from unhealthy foods. They focus on mental strength and food rationing in lieu of meals that are actually healthy. Brooks agreed that this is the only way to manage his condition for now, but notes that abstaining from food leads to hunger later because there are no healthier substitutes available either in the kitchen or in commissary.

With lockdowns lifting, Brooks did begin training again—though not in earnest because his own bout with COVID-19 left his lungs weak and asthma exacerbated. In his cell, all 49 square feet of it which he shares with another man, “you might have enough space to do a pushup,” he said. “But it's gonna be an awkward pushup.” 

Brooks’ blood sugar levels are tested every three months, and so far, he said, every test has shown no improvement. If Brooks isn’t able to roll back his prediabetes, his condition will worsen. According to the CDC, it can take ten years for prediabetes to become Type II diabetes, which is where Brooks’ health is heading without appropriate intervention.

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