I saw an endocrinologist and CDE for the first time this week, after being diagnosed for 6 years. Predictably, they recommended blood glucose and carbohydrate targets that I completely disagreed with:
- 45g of carbohydrates per meal
- A1C of 7%
- 2 hour post-meal blood glucose of 180
As a “Bernsteinian”, however poorly I manage to follow his advice, my gut reaction was to argue and somehow convince her … of what I’m not sure. I started by saying that I preferred the American Association of Clinical Endocrinologists (AACE) blood glucose targets, hoping that as an endo, that would hold some sway or unlock her “informated patient mode”. Err, not so much. Instead I was rewarded with a wry look and lecture that the ADA and AACE targets are the same… le sigh
Then I reminded myself why I was there, to get a prescription for a CGM, and decided to shut my trap so that I didn’t ruin my chances. After waiting two months for this appointment, I was not going to blow it with this new doctor.
So I doggedly steered the conversation back to the CGM, over and over, until finally she agreed to write a prescription, if I first met with a CDE to learn more about it. I promptly agreed, letting her know that I had taken the entire day off, and that I would be happy to meet with the CDE today.
Back in the waiting room, the receptionist promised to “squeeze me in” and I cooled my heels for 2 hours. Reflecting back on the less-than-stellar first impression of this new endo, I found myself becoming bitter. Afterall I had chosen this place, the Kovler Center for Diabetes at the University of Chicago, because I had naively hoped that they would somehow be “enlightened” and more up-to-date on diabetes technology and treatment. Yet here I was getting the same frustrating, canned advice that I have gotten from GP’s past.
Now, everything I’ve written so far isn’t worth writing about. Anyone who’s spent 5 minutes talking online with other diabetics has run into this. This mind-bending disconnect between what we see as ignorant, or willfully harmful, outdated advice guaranteed to keep us diabetic, progressively more sick, yadda yadda yadda. Conspiracy theories abound. What is interesting is how I decided to react. Instead of going down that well-trod path, allowing myself to become upset, I made a decision to look at it differently.
I would view their advice not as a way to keep me sick but instead as a way to set expectations on what they will give me grief over:
- 45g carbs per meal became she promises to not scold me about a meal unless it’s MORE than 45g carbs.
- 7% A1C became she promises to not give me the third degree unless my A1C is greater than 7.
- 2hr post-meal blood sugar of 180 became she promises to not get on my case about how I’m managing my insulin boluses as long as I don’t go over 180 after 2 hours.
Essentially, rather than looking at everything she recommended in a negative light, I chose to accept it as a contract with my doctor. If I am achieving these targets, then I don’t have to worry about what she’ll say at my next appointment.
I have such a poor relationship with the medical profession, and this was a revelation for me. A huge weight was lifted from my shoulders! I now know exactly what I need to do in order to not dread my next appointment. No more indecision about what to share with them or how they would react. I am hopeful that this will save me a ton of anxiety and help me maintain a healthier relationship with my new doc.
By the time the CDE called me back, I walked her through yesterday’s meals and boluses, asked a few questions about the CGM (to not look like a total geek who has already read 3 books about them in preparation) and left with a CGM prescription. It’s still winding its way through the doctor/insurance/pharmacy obstacle course. But I will be getting one; I’ve earned it.