By: Katherine Marple
Endocrinologists are in a funny position when it comes to people with diabetes. We spend so much time with our diseases that we don’t really need them to manage things on a daily basis, but we can’t write our prescriptions on our own.
Doctors are trained to diagnose and assist in the learning curve of new patients. But, once we know as much as they do-or sometimes even more-we become frustrated with the tedious process of meeting with them every three months for an obligatory progress report. It’s a love/hate relationship between us.
Though it pains me a little to say this, as much as we feel we don’t need to see doctors, they are essential to our well being overall.
I hear and read about many accounts where patients find it unnecessary to do these quarterly check-ups. I, too, find myself dreading going into the office most times to not change a thing about my management. We discuss my insulin dosages, carbohydrate exchanges, exercise tasks, and possible complications. Most visits end with a handshake and a nod saying to keep plugging away. There goes a $100 co-pay and two hours of my day. Rinse, repeat three months later.
I’ve thought hard about the point I’m making here. I understand the frustration, feeling like we are being forced to pay into a system that is taking advantage of us, feeling like a number instead of a person at times- I mean that literally, because my A1c is something that is pointedly charted and followed, but my name and who I am as a human being doesn’t seem as important to them.
We go into these appointments because, let’s face it, we are required to in order to get our prescriptions updated. Without an updated prescription, pharmacies wouldn’t hand over the medications we need to live. It sometimes feels like our insulin, pills, and blood strips are being held for ransom.
I’ve heard diabetics say, “I need these prescriptions to live and diabetes doesn’t just go away suddenly. So, why do I need to keep going to see these doctors if all they’re there for is to renew my prescription?” Well, we go in to see them for an assortment of other reasons. They are there to ask questions that we maybe haven’t considered. The appointments remind us to closely evaluate our treatment plans every few months. Doctors see us in a way that we, or anyone who’s close to us, don’t have the ability to see.
When I was pregnant, for example, I had no idea how much or how little weight I was putting on, because I looked in the mirror every single day. My husband also couldn’t say whether I had gained five pounds or 30 over the course of a few months, because he saw me every day. But, looking back at pictures taken throughout my pregnancies, the changes are glaringly obvious: at a few short weeks after conception of each baby, my face swelled noticeably. In that moment, however, I had no idea that I looked any different. When changes happen in incremental amounts, it’s difficult to see that a variance has even occurred.
The Doctors’ Perspective
Doctors are removed enough from our daily lives that they can see from an objective point of view, rather than from so deeply inside our management that minor changes wouldn’t be noticed. It’s like that old saying, “You can’t see the forest for the trees.” As people with diabetes, we are very detail-oriented, managing our lives day by day, week by week. We live and breathe our glucose charts, food allotments, exercise regimens.
But are we able to look at the big picture enough to see that an average daily increase of 30 mg/dl of glucose will raise our A1c by 1%? If we weren’t forced to abide by those quarterly check-ups, would we honestly examine our management that often? Or would we let things slide glacially downhill, none the wiser, surprised when the avalanche is at our feet; in some cases, over our heads?
The 1996 publication of “Don’t Sweat the Small Stuff” started a lifestyle movement where people tried to not let things like workload and family situations fill their lives with anxiety. But when it comes to a diabetic’s health, we do need to observe and search through the details of our lives for long-term solutions. Our end goal: a long and happy life-“long” being the operative word.
We don’t need to do these examinations on a daily basis, I believe, but we do need to be sure that we are making progress on a regular basis. Three or four months seems about right because control can get out of hand rather quickly.
Do I enjoy stepping into those exam rooms and regurgitating three months’ of glucose charts and details about my diabetes life? No. Do I find it tedious to go through the motions of these appointments? Many times, yes. Do I find it necessary to keep me focused on what’s farther on the horizon? Yes. I’ll admit that I become frustrated by the whole process because this disease already takes a lot of time from my life which I could be spending elsewhere. But, if I’m not intimately examining my health choices on a regular basis, I can easily see it going by the wayside. If I’m not in the best health that I can be, what sort of life will I be able to create for myself and for my family?
Aside from the typical diabetes management stuff, I spend my time during these appointments asking about new insulin on the market, fresh ideas about nutrition, and wondering aloud if I really should be seeking therapy for the constant tick in my mind.
My next endocrinologist appointment is in two months. Wish me luck.
Katherine Marple was diagnosed with type 1 diabetes at age 14 in 1998. She is the mother of two small children, has battled insulin resistance, pre-eclampsia, and pump failures, leading to insulin therapy via MDI, using Levemir and Apidra, and sometimes metformin and CGM. She is the author of two diabetes related novels: “Wretched (this is my sorry)” and “Deathly Sweet.” She can be found at www.KatherineMarple.com and www.facebook.com/KatherineMarple