“All patients are liars until proven otherwise.” Meredith Grey
Wow. Can you even imagine how my blood boiled when I heard that quote? Yes, I realize it was said by an imaginary character on a TV show, but it still made me a little crazy. It reminded me of all the things we hear about people with diabetes: non-compliant, non-adherent, lazy, don’t care, in denial, and so on. Oh boy does that stuff make my head spin.
The thing is, some people with diabetes do lie. They sometimes make up numbers, or give the wrong weight, or say they quit smoking (when they didn’t), or that they exercise regularly (when they don’t). What??
Actually, there may be a perfectly good reason for this.
I recommend stopping for a minute the next time we suspect someone isn’t telling the truth. I recommend stopping and thinking about why they might not tell the truth. What’s really going on? Were they shamed into hiding the truth? Are they afraid of how their provider will respond if they tell the truth? Do they feel it’s safer to give the “right” answers? Do they lack trust in the health care professionals they see?
I would suggest that what’s really going on is much more important than the “lie” itself. Most likely we can approach people in a way that establishes trust, which in turn gives people space to open up and communicate honestly. It can even improve care and outcomes.
As diabetes professionals, I hope we can listen to and accept anything a patient has to say.
Two weeks ago I had the honor of taking part in the Glycemic Outcomes Beyond A1C meeting in DC. There were many smart, well-informed diabetes professionals in the room and it was fascinating to hear their thoughts on this important topic. It was abundantly clear that CGM is an important part of diabetes management and it would make sense to use it in diabetes research across the board. It was also clear that consensus has been reached regarding CGM metrics and now it’s time to get them published and into practice.
I really like the idea of CGM being the next EKG. How cool would it be for clinicians, researchers and patients alike to understand the language of CGM and the numbers it produces and then use it for improved outcomes?
One thing that stood out to me was a comment about focusing on “time out of range” instead of “time in range” (blood glucose between 70 and 180). My heart sank when I heard that. Why would we ever focus on something negative when we have something positive to look at? I thought, “wow, that takes us back to the dark ages.” Focusing on time out of range is like marking highs and lows in RED and only talking about them.
What about focusing on strengths (see last week’s blog post) and what is working, and then figuring out how to duplicate that and make it happen more of the time? What about asking, “what did you do here” when looking at in-range numbers, rather than “what did you do wrong” when looking at highs or lows?
I think of diabetes management as closing the gap – spending as much time in range as possible. While I’m ok with using blood glucose data to make changes, I don’t agree with focusing on time out of range.
“You never know how strong you are until being strong is your only choice.”
Managing diabetes every day takes strength. It actually takes a lot of strength – in many different areas. It takes diligence, perseverance, math skills, a sense of humor, acceptance, the ability to trouble shoot and let things roll off, the ability to start over (and over and over and over and over…).
Diabetes is not for the weak. So even if you think you are weak because your A1C is higher than you’d like, or you don’t get enough sleep, or you forget your insulin every now and then (or more), I’m going to guess that you are actually an incredibly strong person. You have more strengths than you know.
By focusing on your strengths, rather than your weaknesses, you can figure out ways to build on those strengths and improve your life. Find something (anything) that you are doing at all (or doing well) and see how you can apply that strength to living better with diabetes.
You might amaze yourself.
You’ll never guess what has been found to increase happiness, and we already know it’s not money…sleep!
I’m a huge fan of sleep – good quantity and quality sleep. I’ve written about the benefits of sleep in the past. Now there’s a study out that showed regular sleep leads to happiness. This study looked at college students, and I’m guessing the results will cross over to those who aren’t in school as well.
So in addition to improved blood glucose levels, higher energy, less weight gain, banishing under-eye circles, improving mood, and lowering risk for illnesses like the common cold, getting good and regular sleep can make us happier.
Does anyone else out there cringe every time they see a Facebook post with type yes if you agree at the bottom? (I’m not on Instagram, so I don’t know if it happens there as well.) I have been experiencing this phenomenon for weeks – maybe even months – now, and today I think I figured out why.
Type yes if you agree – to me – is like asking someone to be “compliant.” Rather than presenting some cute quote or phrase or inspirational message and letting people get what they will out of it, type yes if you agree is like saying, “you do agree with me, right”?
It’s like the whole compliant/non-compliant message people with diabetes get all the time. The health care professional delivers some nugget of wisdom and then expects you to follow it. If you do, you’re compliant (good, etc.); if you don’t you’re non-compliant (bad, etc.).
What if you simply don’t agree? What if you have a different or better idea? Couldn’t those posts say let’s discuss or enjoy your day or nothing at all below the cute saying?
Maybe the whole type yes if you agree thing really just reminds me of a chain letter. Remember those? Ugh. I’ve even found myself looking for those annoying words on every post.
It’s making me a little crazy. Type yes if you agree.
Today is Diabetes Alert Day, your opportunity to check your own risks for diabetes and alert others as well. Diabetes affects millions and millions (and millions) of people in the U.S. and in the world. Knowing the signs, reducing the risks, and being aware can help everyone.
Type 1 diabetes: an autoimmune disease where the immune system mounts an attack on the pancreas cells that produce insulin. Signs/symptoms include fatigue, extreme thirst, losing weight without trying, frequent urination (peeing), hunger, moodiness, dry mouth, vomiting, labored breathing, or even loss of consciousness. Type 1 diabetes can occur at any age. While there’s no way to lower one’s risk for type 1 diabetes, it is important to know what to look for. Catching it early could help someone get care sooner and may even allow someone to take part in research studies.
Type 2 diabetes: at least eight factors contribute to one’s risk for type 2 diabetes. Genetics plays a huge role in type 2 diabetes. If any of your family members have type 2 diabetes, get checked! If you gave birth to a large baby (more than 9 pounds), get checked! If you have slow-healing wounds or tend to get infections easily, get checked! The American Diabetes Association has a type 2 diabetes risk test you can take. While there is no guarantee that type 2 diabetes can be prevented, it is possible to lower your risk and possibly even delay the onset of type 2 diabetes. Being informed and aware is the first step.
Diabetes alert day – take it seriously!