A Tale of Two Meters
The "tsk" of an endocrinologist.
December 2010 — Dear Endocrinologist:
We so appreciated you the day you taught us how to handle type 1 diabetes. You taught us how to use glucose meters, how to count carbs, and put the first pump on. But somewhere over the years, we stopped trusting you.
In a recent conversation I had with grown men and women—all of whom are star athletes in the world of diabetes—I learned that all of them keep separate meters at their disposal. One is for the bad blood sugars that loom and lurk, and a second is the golden meter—the one they take to show their endocrinologist.
You see, the golden meter is used when a person feels their blood sugar is in a good range, pokes their finger, logs a 90, and poof! "I'm a good patient! I'm a good patient! All my blood sugars are pretty!"
The other meter—the naughty one—is used when a person is having a bad diabetes day, blood sugars are all over the place, the inexplicable high, a series of lows. They wouldn't dream of letting you see those numbers!
Any rational endocrinologist would now ask, "Why on earth would you lie about your numbers? You are only hurting yourself! We are here to help you."
Ask yourself why they would lie. Better yet, ask yourself what you can do to help them feel good, and go to you for help and reassurance?
The psychological news of a fluctuating A1C can be devastating. Any mom who has been in the room with the A1C announcement knows the wincing all too well for both parent and child. In this case, the patient wants to do well, but define well, I ask of you.
My friend Laurie recently took her daughter, Shannon, to the pediatric endocrinologist. Shannon's A1c was up to seven percent. "Tsk, tsk."
"Shannon, what are you doing differently? Are you not bolusing? Are you snacking when you shouldn't? Are you sneaking food?" asks the well-meaning endocrinologist.
"Tsk, tsk." And while Shannon sits feeling naughty, mom is equally as embarrassed. Instead of scheduling the next appointment in three months, she drags it out to five…out of sheer dread of the "tsk, tsk." Or worse, the endocrinologist's staff who tells a new family: "DKA? At our hospital we call that ‘dead kid already.'" Unfortunately, yes, statements like these are made to families who are already scared.
I don't know what would be the best way for you to talk to your patients, their parents, and their families. Maybe its just time to brush up on your bedside manner and remember that diabetes is a relentless disease, that many times blood sugars roam all over the countryside for no explanation, that scientists all over the world still scratch their heads at the crazy numbers. That every child—and adult—would pay $10,000 for 24 hours without this disease. And that is a testament of how hard is to be them.
Most people agree that positive reinforcement works better than negative. So I ask you, dear endocrinologist, what will you be doing differently with your patients? I mean, if athletic-minded adults with diabetes are dreading the "tsk, tsk," what is going through the mind of a 9 year old?
That's my point.
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.
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