Attitudes of Healthcare Professionals

Why is it in this day and age we still have physicians that think all diabetics are "non compliant" just because your A1c is not what the ADA thinks it should be?
I am NOT that number, damn it! That's what I always want to scream at them in their face.
I am the person who has had T1 for longer than you have been alive, test 6-8 times a day, wear a pump and a cgm, low carb, exercises everyday I am not at my full time job as a nurse, and pay way more money than you will ever have to pay in medical expenses!
I work my butt off to get an A1c of 7.1-7.3, how dare you judge me!
Hmmmmmmmmmmmmm..... now I feel better :)
This isn't the first time this has happened to me and I have changed physicians several times because of those types of attitudes but this was the experience I had today with a locum physician who was filling in for my retina specialist. Hope my regular doc returns before my next appointment.

I hear you. Like most of us, I don't need gushers of sympathy from a doctor . . . just a modicum of understanding and empathy. Sometimes, that's hard to come by. I had a great A1c with my last doctor and he therefore never even bothered to mention it to me. I had to call weeks later and ask about it. "Thanks so much, I've worked three months for that and you can't even let me enjoy it for a second?"

I find most doctors don't really grasp the difference between Type I and Type II much less appreciate the daily effort it takes to manage it. Hang in there, it's not you.

No, you are not that number, but that number will be relevant to your future health... Although I tend to me anto doctor/endo, blood glucose levels are relevant to your health.

I know that endo doesn't understand that you CAN have side effects from 6 different diabetic medicines. Been working with him for over 3 months. Finally decided to give me insulin. grrrr.... I barely eat anything that can increase my levels yet they make it seem like your doing the dirty work on your body...pisses me off

Cannot spell: "I tend to be anti doctor/endo..." Wow. Would it be really a lot worse if I misspelled again? :>)

Management of T1 in particular is NOT an exact science. We are performing the work of an organ (around the clock) that we were not meant to perform. This isn't about compliance, it's about survival. And I absolutely freaking HATE The term "compliance." The last time I had an endo make reference to that word, I asked him if he'd like to do what I do for just 40 hours, to count every freaking carb and take insulin and do all this stuff while trying to hold down a job or go to school or live any semblance of a life. Sometimes I feel like endos think we do this full time or something!!

All the points you make are spot on. Honestly, I'm at the point in my life where if I have an endo pass judgment on me or even hint that I'm "non compliant," I will walk out of his/her office, refuse payment, and find another practice. I deserve to be treated with respect and not judged. And so do you!

I am very lucky to have an endo who seems to really understand Type 1 and she is easier on me than I am on myself.

Sometimes I think you also have to understand where the doctors are coming from. My endo says that she has a large number of patients who won’t even test once a day and it is incredibly difficult for her to try to improve their health when she feels that they don’t listen to her or have much motivation to change. So it’s definitely a 2-way street when it comes to optimal communication and outcomes.

I am very fortunate that my hard work results in good A1c’s. I know that’s not the case with everyone. There is no doubt that with all of our BG tests and A1c’s that we Type 1’s are always “keeping score” with our lives.

I agree with you totally. Most docs who are not endo's have no idea of the different management strategies.

I am totally not compliant, as my doc didn't really give me a "program" or "plan" but just lets me run my show. I'm listed as "compliant" because my #s are ok on my own plan (sic). If someone is listed as "non-compliant", I could see some utility to describe a patient who doesn't try, like that dude on the "Intervention" show who had sort of left the reservation. If you try and it doesn't work enough "for" the doctor, it's the doctor's job to fix it.

Perhaps doctors should be rated suck or non-suck?

In my area of the country, we have top grade hospitals everywhere. However, no endos accept 1.People with pumps, 2. Type 1 patients, 3. New patients, 4. etc.

My Endo retired and it took months to find someone to replace. He is an endo warehouse (mostly Type 2s) and runs folk through like a grocery store check out line.

Another reason I try to doctor myself. I do have a fantatstic PCP but he is a unknowledgeable about Type 1. Tis a conundrum for us all.

You had to go get me started on the non-compliant issue. I really really really hate that term. You know what I think I'll stop with that statement or this might get long and ugly.

As much as I hate the non-compliant term I got to defend the docs a little bit. Not all PWD follow their advice. I can see how a doctor can become cynical. It's like that old saying that 2% of the people screw it up for the rest of us.

It would be great if more doctor would be cheerleaders instead of enforcer of the rules. It would be great if all doctors recognized our efforts even if we didn't achieve the goals the set.

I said I was going to stop at the first statement but I just couldn't.

I am a T2 and we get a bad rep for it. Seems that most doctors think that its your fault. I’ve done everything to change. Whoever heard of eating 10 pretzels and your sugar shooting up to 290. This is crazy. I can’t eat bagels, can’t eat cereal, can’t eat any pastas, can’t eat chocolate, any carbs really. It’s such a bad rap. It’s in the gene’s. They blame other meds, weight gain, no exercise, and everything is blamed on stress and ur capability of being a non-compliant patient. I think it’s the damn insurance as well. If your insurance is not top of the line and you don’t make a huge income your not worthy of their time or the best meds that is offered. No difference than a third world country. I’ve seen both side of the spectrum. I had my own business and payed 1000’s a month for insurance and I was treated like a queen and got the best of all doctors and meds. Now I have medium grade insurance and forget it your just another file.

Hi April, I see that you are experiencing the full blown oral T2 treatment which I know is very flustrating. You mentioned that your doctor has started insulin. I hope it helps you it has really helped me. Eventually we reach the end of the road with oral meds and insulin is the right thing to do.

It is flustrating when we can't eat the carb laden food without spiking. I'm T2 also and share your flustrations. I have sort of made peace with it all and have worked hard to become a compliant patient but you know what I still hate that term.

Yes we do get a bad rap for being T2 whether it's deserved or not. I am long past caring what others think of T2's. I find a lot of non-judgemental folks here at TuD and thats why I keep comming back.

I have a great endo now- after I walked away from the first one. My new endo (the go to guy for T1s on pumps) explained to me that sometimes the A1c is not the most accurate measure of blood glucose control. My CGM indicates that I should have an A1c of 5.8, but my A1c comes in at 7.0 if I am lucky. I worked hard too to get my A1c down and I was a bit disappointed with the test results. He reported the test results and his assessment to my PCP and at my last PCP appointment we talked about it. She said she had a number of patients that also fit the same description- a disconnect between the BG average and the A1c. She had not previously heard a medical explanation of the issue. Both my family doctor and my new endo are very supportive. I guess I am lucky.

Some of the other healthcare professionals can have a bit of an attitude, but I think it is because they are not familiar with LADA and it does not make sense to them.

April–Frankly if I were you, I would demand testing to see if you are an undiagnosed Type 1 or LADA.

+1 great point

Man, you should go to my endo. I keep telling him I want to tighten up my 7.0 and go lower and he tells me that I am doing just fine. I used to be at a 6.2 and then they started to mess with the cholosteral medicine and my A1C of 6.2 that I had for about 3 years went up to a 7.

I have consistently low A1Cs and it's not much better. Everything that happens to me is blamed on diabetes, even though my blood sugar has been in the mid to low 5s for 5 years. The doctor is always trying to get me to take statins "just because" I'm diabetic (my cholesterol levels are also low), and when I refused that I was told to take a baby aspirin every day. The doctor has criticized my obviously successful low carb diet several times. Even though my numbers are great, I'm still called non compliant. So I don't think it's possible to please the docs, you just have to please yourself. I have never been so disappointed in the medical profession, but still it surprises me that as a nurse you can't deal with them either. I'll remember that next time and it will make me smile.

Marypat - The average BG number from CGM data does not match up exactly with the A1c number. CGMs will often not get as low as actual lows and not as high as actual highs. My A1cs usually come in higher than my CGM. If CGMs were lab accurate then the correlation would be very high. As it is, we currently calibrate CGMs with fingerstick meters that are +/- 20% accurate!

I, too, would be puzzled with a CGM predicting a 5.8% A1c and ending up at 7.0%; that's a bit of a stretch. Have you compared the average on your fingerstick meter (90 days) with your A1c?

Being a nurse with diabetes can be good and bad. Good in the sense that I have a medical background and tend to think I am more of an advocate for myself because of it. The downside is that a lot of docs just don't know a lot about T1 (endo's excluded) and just go with whatever I say. Which is great most of the time, but when I really need some help trying to find out what's wrong they're clueless. I'm still in search of a new endo. At my last visit, I offered my complaints, which I rarely have any of, and he just kinda wrung his hands together and said, "well, you have all the technology, you test, you exercise and you watch what you eat, theres really nothing else I can offer you." Yeah, it's totally frustrating!