Amy Tenderich was diagnosed with type 1 diabetes in May of 2003. She is the founder and editor-in-chief of Diabetes Mine and co-authored the book Know Your Numbers, Outlive Your Diabetes. You will frequently find her speaking at diabetes, health, and social media events across the country.
Many people feel frustrated or even disheartened by interactions with their doctors, but your interaction really depends on how you approach your appointments. Simply believing “it’s all the doctor’s fault” is unproductive, and it distracts you from what you need to do yourself.
Larry Fisher, MD, a clinical psychologist at UCSF who treats numerous people with diabetes, puts it this way: “Passive dependency is bad news. When things don’t go well, patients get really upset, and they don’t know what to do. It’s never a good choice to think, ‘I’ll just have to wait three weeks to see my doctor.’”
He says folks who are proactive and take an active role in their management are always going to do better than those who are passive and follow the party line. After all, YOU are making many more decisions on a daily basis than your doctor is.
Keep in mind that you are the leader of your diabetes care team. Everyone else is there to support you. You’ll get more out of your visits if you go prepared with specific questions and action items.
It was Dr. Richard Jackson, director of outreach programs at Joslin Diabetes Center in Boston, who first introduced me to the idea of thinking of your diabetes as a small business and your care team as your consultants.
It’s a proactive approach to no longer walking into doctor’s appointments clueless, hoping the doctor will do something to improve our diabetes care. Rather, we want to use this valuable time with experts to get the most “bang for our buck!"
So think of your diabetes as your own small business, which you want to succeed, of course. You’ve got these high-value consultants (doctor, educator, nurse, nutritionist, etc.) who can give you some really good advice. But you only get to see them for a few minutes every few months. You’ll want to go in to your meetings with these people armed with information on where your "business" stands and clear goals and/or questions you’re ready to discuss with them.
The following checklist will help you prepare to make the most of your time with your endocrinologist, diabetes educator, or nutritionist:
1. Prepare a list of specific questions to bring along with you. Address things that may confuse you and ask about how to achieve your short-term goals.
2. Look at your health records. Check your latest glucose readings and lab test results, and decide which ONE or TWO goals you will focus on in the coming months.
3. Note that your specific goal(s) should be behavioral. Not number targets, but rather something you can actually do physically. As one expert endo says: “Lose 10 pounds in the next three months” is not an achievable goal, because you cannot control your weight. But you can control your eating. You can say, “I’ll stick to a 1500-calorie diet,” for example.
4. Be realistic. Communicate with your care team about goals that will work in your real everyday life. If you have a 10-hour workday and are the primary caregiver for several small children, then exercising for an hour five times a week is probably not going to happen.
Maybe you could focus on careful eating, taking your pills regularly, and walking for a half-hour on your lunch break whenever possible. It’s important not to walk out of any doctor’s appointment with idealistic goals you can’t possibly achieve.
5. Insist on regular lab testing of five key measures. These include A1c, blood pressure, cholesterol tests, microalbumin test for kidney damage, and an annual eye exam. These five simple tests are currently the best and only indicators of each person’s own individual diabetes health risks. They also provide you with a kind of “report card” to see that your efforts have made a difference. The idea is to get your older and newer test results side-by-side and compare the numbers. Just by focusing on an area for a few months, you will no doubt bring the test results closer to ideal range.
It’s good to know that your actions, not just your doctor’s, are effective and make a big difference in your overall health.