Leadership 101a: Managing Your Care Team
Good diabetes care is in your hands.
with Amy Tenderich
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
February 2006 —Are your doctor and educator appointments really helpful? Or do you walk out of the office feeling deflated, maybe even resentful? That's how I felt during the whole first year of my diabetes -- until I came to the realization that I am the leader of this team. That is, everyone else is there solely to support me, the person with diabetes, so it's up to me to set the agenda.
This is quite a departure from the way we traditionally think about dealing with doctors: they're the professionals, right? So we should sit passively and listen, i.e. wait for the doctor to tell you what to do, and then do your best to follow orders. But no! Diabetes is a whole different animal. Only you can really control it, and the fact is, your body will react very differently to various foods and activities than the next guy with diabetes. So forget "one-size-fits-all" doctors' orders. You need customized help. And I've discovered that you can get it just by changing your approach to interacting with your care team.
Small Business Values
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.
The essential goal is to take a proactive, step-by-step approach to managing your diabetes –- rather than being constantly at war with yourself over all the things you "ought to" be doing. Viewing your diabetes as a battle will make you miserable and unmotivated. And you will hate your care team, because they're part of the enemy front, imposing all this impossible stuff on you.
It dawned on me that we need to stop walking into appointments clueless, hoping the doctor will do something to improve our diabetes care. Instead, we want to go in to our appointments armed with information on where our "business" stands, and clear goals and/or questions. Then we can have our endocrinologist, diabetes educator, or nutritionist advise us on these specifics to get the most "bang for our buck." You're steering this ship, so it's OK to proactively ask to try new medications or devices, or request lab tests, if you believe these things can make a difference.
"Remember, these people work for you," Dr. Jackson says. "If you ask, your doctor will likely do it. You just have to ask! And if they push back, you can insist." He also notes that if you'd like an A1C test more often than every 3 months, Metrika's home A1C testing kit for under $20 at the drugstore is a good option.
Know Your Starting Point
The first thing to do is find out where you are. That is, you can't get very specific help if you have no idea where your diabetes stands. Before you walk into the appointment, be sure you know your current numbers: your A1C (at least every 3 months), and your blood pressure, cholesterol, and microalbumin test results (all annually). Also, make sure you see an ophthalmologist annually to be prepared with the data on your eye health. Never go in to see your diabetes doctor without knowing what your health starting point is, Jackson says, or the visit will be unproductive.
And don't get caught up on some stringent number-goals. I was surprised to hear Jackson say that "some people do quite well with A1C's of 7 , or even up to 9." These numbers aren't for everyone, but the point is: How do you feel? Physically? Mentally? The only way to achieve well-being is to be in touch with your own state of affairs.
Focus is Everything
Here's a bit of wisdom that ought to be obvious, but we all get caught in the snare of trying to tackle everything at once. Maybe you do need to lose weight, and also reduce salt in your diet, and test your sugar more often, and start a new exercise regime, and, and, and… But trying to launch all these efforts at once is ridiculous, and a recipe for disaster.
What you can do is to look at your health records (the aforementioned test results), and decide which ONE or TWO things you will work on in the coming months.
Instead of making vague resolutions like, "I'll eat better," you'll want to focus on very specific things like lowering your A1C -- by checking your blood sugar more often, so that you can react immediately to highs. Or maybe you'll focus on blood pressure instead of the diabetes-specific stuff. "If a Type 2 gets his/her blood pressure down from 150 to 140, they can gain as much health-wise as by lowering their A1C," the doctor says.
Note your specific goal should be behavioral. "Not a number, but something you can actually do physically," says Dr. Larry Fisher of UCSF, who helps many diabetics hone their self-care. "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 you'll stick to a 1500-calorie diet, for example."
And please, 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 5x/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 appointment with highfalutin idealistic goals you can't possibly achieve.
Results, Baby, Results
This is why you need regular testing. Without some kind of "report card" you'll likely feel like your efforts are in vain. 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. You can see that you have made a difference! Hooray! It's good to know that your actions, not just your doctor's, are effective and make a big difference in your overall health.
Now reward yourself in some positive way, and then set new goals for your next triumph. The ability to see the difference you have made is key. It's a rush, like improving your SAT scores or video game scores -- whatever turns you on.
If you do all this, and think of yourself as the leader of your own care team, there's no way for nasty complications to sneak up on you, Dr. Jackson says. You'll be on top of your health status and won't allow problems to progress. "Remember, nothing ever happens suddenly with diabetes."
Read more about Amy Tenderich.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...