CDE and Dietitian

To be fair, many Type 2 patients might not change their diets according to test results. I would never say “most,” or even “many,” but I certainly have friends that are Type 2 (and older) who literally would rather not know what their BG is. That way, they don’t feel bad about it. These are folks who can’t seem to get their a1c under control and can’t figure out why the prescribed medication doesn’t work. They often describe to me that they “cheat” a lot.

I’ve heard Type 1s (on forums) talking about the same kind of pattern: they don’t test BGs before bolusing; they don’t bolus; they don’t ever change their basal; etc. They often describe themselves as “out of control.” And their controls shows that. Here’s the thing: most of the people that are on this forum very actively seek good control. We are the type of PWD, regardless of Type, that tend to strive for better control, better understanding of our condition, and ask for help. Some diabetics (many, most, it’s hard to say) seem to not be engaged in their own treatment in the way many of us are.

This all leaves me wondering: my doctors and CDE have treated me like I’m from Mars. My first a1c post-diagnosis was 5.8, my second was 4.8. They literally wanted to throw me a party and said things like: “we’ve never seen anyone get control that quickly or thoroughly.” So…are their other patients not controlling their BG effectively because the doctors, CDEs, and nurses are not giving them enough information and tools, or are the doctors, CDEs, and nurses not offering the tools because other patients don’t want them or won’t use them? I really don’t know the answer to this. I can’t imagine not being as proactive (maybe even OCD) as possible when it comes to managing a chronic, incurable, and fatal disorder (which both Type 1 and Type 2 DM most definitely are, if left to progress “naturally”). But, how many people view/treat this differently?

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Unfortunately I think it’s pretty much the norm to not manage the condition or self educate or arm with tools to do so… I get the same heros welcome every time I see my doc… that’s why the average A1C is so high out there… most people don’t take it seriously, they just eat metformin or whatever else their doc tells them too and keep on doing the same thing they always did… just exactly like how few people actually make permanent changes to their diet and exercise habits when their doctor tells them they’re overweight or their blood pressure is too high… unfortunately about 90% or more of diabetes patients have the same view of blood sugars

IYes, Sam, that is how it is here. I think most T2s think that Metformin or whatever tablet they are on will lower their blood sugars and make them all better without any effort on their part. They are also told not to bother about testing and to eat as normal but less. Preferably Low GI food. I am horrified at the advice my friend was given when she turned T2 a few months ago. T2s here no longer get subsidised test strips.

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Obsessive compulsive is sometimes the criticism asserted by a less successful patient of a fellow patient who does well with a similar condition. I often think its the unspoken criticism of some heath care professionals of a patient who seems “too eager” to do well. I know my propensity to test a lot, up to 14x/day in the past, was often looked at askance from some fellow patients and some health care providers. My results, however, have bolstered my confidence that my proactive attitude has been very good for me.

I’ve witnessed this discussion in the type I parents community regarding the practice of getting up every night to measure their child’s blood glucose. I think it’s human nature.

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My ex-endo decided that ALL my diabetes-related complaints/problems/symptoms were cased by anxiety and were not actual issues. Yes, he complained that I tested too often, corrected too often, worried too much about what I ate, how much I exercised, where my weight was. He dismissed my low-5’s A1c as “expected” from me, but more the result of my anxiety/OCD (your pick), rather than healthy habits. By the way, I think he wanted to cut back on prescriptions for me, but did not because the one person in his office who did agree with what I was doing was his CDE. I only met with her once, but she actively advocated on my behalf that the doctor support my efforts. He went along with that, but was constantly trying to get me to see a psychiatrist about my anxiety. I told him that, instead, I would see another endo…

FYI, both my PCP and my current (soon-retiring) endo emphatically support my efforts and congratulate me on the results. That don’t suggest I have psychological problems (other than the obvious ones, but those are between my wife and me :wink:)

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Might be two different human natures, then :slight_smile: And to be honest, I can’t fault someone for deciding they don’t want to put a lot of time and effort into managing diabetes, or cancer, or alcoholism, or muscular dystrophy, or… etc. Pick any chronic, progressive disease that can be managed (somehow) and put it on the list. Some people will address it; some people will attempt to go on living life as they used to and just deal with the consequences. And then some people seem to get caught up in the “unfairness” of it (and DM, like other chronic illnesses, is unfair in an absolute sense)…

Regardless, I suspect there are multiple ways for an individual to deal with DM “responsibly.” Those of us discussing this here have largely decided to deal with it by aiming for BG control ranging from “good” to “absurdly tight.”

The thing I find frustrating about it is how society treats people dealing with different chronic illnesses differently. If someone has diabetes or alcoholism, and decides they just can’t be obsessive or rigorous in their management, other people (at least in the US) seem to treat it as a moral failing. People are “good” for having tight BG, “good” for being sober; people are treated as “bad” for having complications or out of control BG, and certainly looked down upon for failing to stay sober for a given length of time (or permanently). However, even though we laud people who “fight” cancer, when someone decides it’s time to go, we generally view that as some sort of mature, if difficult, decision. I can’t think of too many people who blame cancer patients for having cancer, regardless of their outcomes.

I wonder sometimes if diabetics and alcoholics suffer from society viewing them as “control” issues: a diabetic is sick because they failed to control their diet; an alcoholic is sick because they failed to control their drinking. This completely ignores the disease processes underlying the disorders, metabolic with genetic roots in both cases. You don’t often hear about cancer patients blamed for being sick because they failed to control their exposure to environmental stimuli…

…and nurses who wanted a day shift job who devoted their career to learning everything they could and want to help themselves and others with it.

My CDE is an RN AND a Type 1 diabetic. The five-leaf clover of diabetic care. He gets extra points for being close to my age and having the same soma type as I do.

cerebro/somato/viscero?

I thought it had gone the way of physiognomy:-)

Soma is Greek for body. We are both tall and lean.

Sheldon’s somatotypes, a theory of physiology from the 40s:

https://upload.wikimedia.org/wikipedia/commons/a/ab/Bodytypes.jpg

cerebrotonic = ectomorphic = tall, thin
somatotonic = mesomorphic = athletic build
viscerotonic = endomorphic = round and short

I have never heard of any of this and have only ever used soma type as a physically descriptive term, with no underlying theory of body physiology behind it. The limits of my physiological knowledge don’t go much farther than a speech physiology course I took as a requirement to get into a Speech and Language Development program. (Circle of Willis is the main term that stuck with me). This type of theory seems like something a race apologist would use. Which I in no way intended. I’m in the Indiana Jones camp:

“Nazis. I hate those guys.”

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“Snakes. Why’d it have to be snakes??”

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“Asps. Very dangerous. You go first.”

“Bad dates.”

What I’ve heard from friends and family members who are doctors, not endo’s, is that they think compliance is difficult therefore they always try to recommend pills first. The assumption is that there is needle phobia.

I don’t mind so much the injections necessary to maintain a tight control. It’s the slow action of the insulin, and the lack of predictability of new foods on blood sugar.

I was told by an endo " I don’t want you checking your BG so often". I was requesting a prescription to test my BG 6x/daily. My A1C at the time was increasing from low 6’s to 7’s. Needless to say, I fired her and found myself another endo. She also considered an A1C of 7 to be acceptable.

Some of the healthcare professionals have low expectations for diabetics. They don’t really set us up for success.

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There are also reputable studies that show a substantial disparity between the amount of needle phobia that doctors think there is, and what actually exists among their own patients. Which means that an unknown number of patients who could really benefit from insulin aren’t even having it suggested as a choice. And the gap appears to be roughly the same regardless of nationality.

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What is “eat to your meter”?

Eat to your meter is based on what Brian says above. Eat what you chose, dose if on insulin and monitor your results by testing after meals, usually 2-3 hours after if using insulin. After repeated results of foods in your logs, you may find that food has varied BG after meal, where as other foods seem to repeat similar BG trend each time.

Brian mentions “if patient took action”… Just testing BGs, bringing to doctor 2-4 times per year doesn’t give actionable changes. But using meter to see before/after BG for common meals and experimenting with portion size, meds, exercise lets you make changes and confirm what makes improvements.

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Thanks for a great discussion. I was lucky ,my first endo ( 10 years) was a type2. He taught me so much, gave classes, and told us to laugh.:smile: I have had a few tiny bumps on this journey, A1C is 6.3 , no complications, and feel great. I do have eye issues , non-=diabetic. But considering 28 years life is good. Nancy50

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This is a good topic. I was just thinking today how valuable my glucose readings are to me and my Endo. Just because someone has credentials, doesn’t mean they are good at what they do. That seemed like poor advice. There are a lot of good CDE’s out there. I hope you can find one.