Diabetes and the patient-doctor disconnect

        I am a huge proponent of almost every diabetic taking full control of their diabetes management.  Learning about insulin and the relationship between it, exercise, and diet is not above most people’s heads.

I’ve had diabetes since age 11 and early on a few doctors encouraged me to learn all about my diabetes and become an “expert” in it.  This is because realistically I would not have a doctor with me throughout daily life and thus needed to have the knowledge to make all of the proper decisions regarding my diabetes.

Who is the expert?

Lately however, I have run into several doctors who do not seem to feel it necessary for me to manage my diabetes.  They believe they should be doing it for me.  With all due respect to doctors, this is absurd.

Decisions need to be made on a constant basis by diabetics and so I don’t know what some of these doctors might expect, that I call them every time I am going to eat or exercise seeking guidance?  They expect me to use the same dose of insulin all the time when I very well know I need to tweak it on a daily basis depending on my daily circumstances.  (I don’t expect a child to do this by the way)

Strict control vs. being “safe”

It has been well documented in many medical journals how important it is for a diabetic to maintain very strict control.  This is one’s best shot at avoiding complications.  Yet, many doctors out there are telling their patients to avoid strict control.

Why?  Perhaps because some studies have come out saying tight control equals a high risk for hypoglycemia.  Personally, I’ve had my share of lows in the past 15 years and have never once passed out or not been able to help myself.  Unfortunately however, other diabetics have passed out-many times.  Telling these people to loosen up their tight control isn’t the answer.  The answer is to evaluate diabetes lifestyle habits and to have a patient check glucose more frequently.  If one is doing the right things and monitoring glucose often, a severe low episode has a much lower chance of occurring.

How much do doctors know about diabetes?

I had a doctor who referred me to a diabetes specialized internal practitioner.  This specialist asked me why I took both lantus and humolog insulin.  Believe it or not I had to explain to this gentleman why both of these insulin types were required  (I use injections, not a pump).  Insulin is a basic thing with diabetes.  If he doesn’t know something this basic I don’t necessarily feel too secure under his “diabetes management”.

Don’t get me wrong, I like doctors.  In fact I love them.  I realize now I should have become one seeing how articles in the New England Journal of Medicine excite me more than shopping, chocolate, and music-combined.

I just feel many doctors are told one thing in medical school when there is a different reality.  They have all the best of intentions about helping people and yet, many diabetics feel as if their doctor doesn’t know enough about diabetes and doesn’t recognize their own knowledge about the disease gained through experience.  Experience does teach and should count for something.  My 15 years of experience taught me things that only recently are being exposed as “new information” about diabetes.  I often read articles and think “I found that out 10 years ago…”


Basically, patients need to come forward to their doctors with confidence about what they know about their diabetes management and doctors need to listen with humility.  Doctors should be aware that their studies did not cover more hours on diabetes than many diabetics have spent studying and living with their disease.

Between patient and doctor there should ideally exist more of a partnership and diabetes will be much better controlled.  It is best diabetics be regarded as the ultimate expert of their own disease and assume responsibility for their actions.  It isn’t fair to expect doctors to give us good diabetes control.  We must do the work.

Only once I became the expert on my body and my diabetes and took full responsibility of for my actions did I finally achieve better control.

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