When I was a child, my mother always said, "Think before you speak." Have you heard of this before? If not, please digest my words. If you have heard of this simple yet beneficial policy, please reconsider its merit and then implement it into your practice.

You are in a position of extreme power. The title next to your name (MD, RD, RN, etc.) elevates you to a certain status in patients' minds. You are educated. You are powerful. You are specialized. You are respected. Your words can make or break a patient. 

Recently I went to a new podiatrist. I'll be honest. I get a little rise out of being the "good diabetic" and going to see my doctors.  Each time I enter one of their offices, diabetes is with me, and my visits are almost always focused on my disease. I am determined, adamant, and educated. I come across as a confident patient. And for the most part, I am.

However, when I enter an office like yours, I am reminded of what I don't have: a perfectly healthy, normal body.  I am usually in the waiting room surrounded by overweight older men and women sporting walkers, wheelchairs, baggies full of medication bottles, and oxygen tanks. I walk into that waiting room on my own two feet, holding my medical insurance card and toting my 23-pound daughter. You see, I'm one of the young ones, one of the healthy ones. But I'm there, doing my duty, being the good patient.

After I fill out pages upon pages of forms, giving strangers the history of my life, I hand over my co-pay, take a seat, and wait my turn.  I might flip through a magazine or play peek-a-boo with my baby.  I do not have white coat syndrome; however, I do feel the slightest twinge of butterflies in my stomach, knowing that soon I'll be facing you.

I am called back to a patient room, where a nurse asks me why I am there. I tell her that I just want a general checkup. She leaves, and I read my daughter a book and feed her a snack while we wait for the doctor. The room is pleasant enough (large windows, music over the intercom system), as is the staff (doting on my baby girl). I feel ok about the visit. After all, I am there, the good patient, at attention and ready for lift-off into an even better attitude toward my disease.

Then the doctor comes in. He spends a minute or two reading my chart and then asks why I am visiting him. I tell him that I want a general foot check.  He asks me when I was diagnosed with type I diabetes.  I say just three-and-a-half years ago.

The conversation goes like this:

Doc: How is your diabetes?

I smile and say: Pretty good.

While writing in my chart, the doctor says: What was your last A1c?

Me: 7.5%. I'm usually in the 7% range.

Doc, looking over his reading glasses and frowning: Why?

The first word out of a doctor's mouth, a doctor whom I just met three minutes ago, is a critical "why?"!  And once again, like I am after many medical appointments, I am left feeling discouraged, embarrassed, and depressed.   As if diabetes isn't in itself discouraging, embarrassing, and depressing. 

Unless you have type I yourself, there is no possible way you can understand how my life works. But let me try to help you see.

Imagine having type I diabetes. In order for your doctors to give you approval and act like you are a worthy and decent human being, you must do all of the following:

1. Sleep seven to eight hours every night. No more, no less. Too much or too little sleep is bad for blood sugars. This must be quality sleep, whatever that means, or it doesn't count.
2. Be completely stress-free, because stress fluctuates blood sugars. Good luck with this one. If you figure out, write a book. It will be a bestseller.
3. Eat a perfect diet at all times. You do not get any sort of break at major holidays like Christmas or Easter, events like happy hours or picnics, when you had a bad day, when you don't have time to cook, when you are out of groceries, when you are on vacation, when you can't afford to buy the best foods, when you have a craving for a fast food hamburger, when you are at the town carnival, or when it's your birthday.
4. Check your blood sugar eight to ten times per day. You do not get a break if you are driving, shopping, mowing, sleeping, or working. You must stop. Wash your hands. Change the needle. Insert the strip. Test. Then do the right thing. Either eat a snack, eat nothing, or take insulin. Then you must dispose of your needle properly.   If you fail to follow these steps, you fail.
5. Calculate what you eat perfectly and know exactly how many carbs are in every ounce of food you eat. If you don't, your sugar will be too high or too low. Carry a carbohydrate counting book with you. If you are out with your friends for lunch, you still must be on guard.  You must think about how  you are going to weigh the pasta the server brings you, calculate the carbs (and fat---because fat keeps sugars higher longer), and then know exactly how much insulin to take.   If you miscalculate the carbs or eat too much or too little, you will suffer the consequences.
6. Check your feet daily for any changes. If your feet are swollen, too hot, too cold, numb, tingling, irritated, blistered, red, or blue-ish, contact your doc immediately.  And remember, don't stress about it or you will mess up your blood sugars.
7. You must carry these things with you at all times: extra pump supplies, glucagon, glucotabs, batteries, test strips, needles, and insulin. Do not lose any of them.  Do not store them where it's too hot or too cold.
8. You must have a sick day plan. This means emergency contacts, sources of food in the house, ginger ale, and crackers, glucagon, lots of water, and a phone handy because you just might need to call the doctor. If you are sick, you will be scared the entire time. You will miss work. You will test your blood sugars even more than the usual eight to ten times a day. 
9. Change your insulin pump set every three days. If you forget, your sugars will be too high. If you leave it in too long, you could develop an infection. If you forget your pump supplies, you are out of luck. You fail. Again. Oh, and try changing a pump set in a restaurant bathroom stall or while you're riding in a car. Good times.
10. Worry enough, but not too much, because worry because stress (see point two). Worry that you miscalculated your carbs, that you took too much insulin, that you took too little insulin, that your meter isn't calibrated, that your pump tubing is clogged, that you exercised too much, or that you decided not to exercise that day. Worry. Then make the right choices, all the time.  If not, you fail. 
11. Exercise, every day, for at least thirty minutes.  Lift weights. Do cardio. But don't exercise too much or too little. And be sure that you maintain the perfect weight. Do not be fat. Do not be too skinny. Be perfectly perfect.
12. Make constant and consistent medical appointments with all of your medical care team members. Oh, and if you have problems, please increase the number of visits.   You will have to miss work, school, family time, and personal time in order to attend these appointments. 
13. Make lots of money at a good job, never missing work because of your diabetes, so you can give it all to your medical care team members and insurance company and grocery store (healthy foods!) and pharmacy (medications!) and church (spiritual health!). And remember to buy a good mattress (good sleep!) and a gym membership (exercise!).
14. Always have a good attitude, even though you know you could go blind, have your feet amputated, lose a kidney or two, or have a heart attack.

If you can manage to do all these things, you will be approved. Well, until your next appointment.

Please listen to me as a person, not just as another one of your hundreds of patients.  I am doing a damn good job of managing my disease. I am proud of my 7.5% A1c. I do everything I can to do the "right things"---though I'm not perfect and am always pushing myself to improve.

Relate to me on a human level. What do people REALLY need to hear? Not a snide and judgmental "Why?".  Please, take a new approach.  Try encouragement instead of criticism, support instead of scrutiny, and education instead of lectures. 

Please do not forget this lesson that my mother taught me. Please think before you speak.  If you can approach a patient with the right attitude, you will do what you probably set out to accomplish in medical school---make a positive difference in the lives of your patients. 

Rachel