I don't think I'd want to be an endocrinologist or a diabetes educator treating type 1 diabetics.
I'd want to be a doctor with answers.
I imagine the job has moments of satisfaction. Guiding those newly diagnosed through those very difficult first years must be rewarding. But eventually the insight the endo provides plateaus. What can you possibly suggest to the diabetic who's been in the game for 5, 10, 20 years? What can you tell them to do that they haven't already tried on their own a million times?
How many times must I say, "yes, we bolus prior to the meal" and "yes, we rotate the infusion sites every third day."
Maybe your experiences are different. Maybe you learn new tricks upon each visit. Maybe in your life with diabetes, a doctor is still a doctor. Maybe yours is the endo of the world and you know it. I do like the CDE that we see. She's very nice. Though, I must say, the silence is getting awkward.
Over time, the roles change. The patient becomes the doctor. Diabetes is unique in that way. I'm in no way an expert in different fields of medicine, but I don't think there is another disease quite like it; one in which the patient or caregiver has so much autonomy over it. The patient determines the dosage of medicine and makes adjustments on the fly. All this based not on blood work or CAT scan, but instead observation, trends and gut feelings. The patient is in control of the sharp objects. The patient even begins to sound like the doctor:
"We've noticed recently that his blood glucose levels have been increasing at 3 am, so we've increased his basal rate to .25 until 6 am. We've also reduced his sensitivity to a ratio of 1:130."
The doctor nods his or her head and takes notes.
What? Is that me talking like that? I sound so ... so ... scientific. If I could zip back in time to before November of 2003, half of those words would not be in my daily vocabulary.
If I could zip ahead to the not-too-distant future, I pray those same words are never mentioned again.
