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How’d He Do That?

Jan Chait

February 28, 2012

So, as I was telling you earlier this month, my blood glucose was all over the place and running high for the most part and I was in the throes of filling out an intensive log listing blood glucose, number of carbohydrates consumed, amount of insulin taken, times, phases of the moon, which tarot card surfaced, etc.

When the endocrinologist’s nurse called, it was to tell me Doc wanted me to change my breakfast ratio.

“What about the REST of that mess?!” I asked.

But you know what? Sonuvagun worked. Pretty much. I’m still having problems with dinner and overnight, so I’m filling out another intensive log. I’m anxious to find out what he recommends next. I mean, who knew just changing one little insulin-to-carb ratio would darned near straighten out an entire day’s worth of numbers?

But it points out the importance of having a good doctor; one who is knowledgeable, responsive, and who cares about his patients. Or, at the least — well, me.

Admittedly, I didn’t want the one I have now. But the knowledgeable, responsive and caring endocrinologist I had at the time was moving to another state, so the CDE gave me another doctor in the practice. He’d always seemed cranky to me, so I fought the decision…and lost. Now, I’m glad I did. I’ve been seeing him since…well, I remember taking my granddaughter with me once when she was 4 years old, and I’d been going to him for a while at that point. She’ll soon be 19. Turns out he’s knowledgeable, responsive, and caring.

How do you find a good doctor if you don’t have a CDE choosing one for you that you don’t want, then planting her feet firmly on the ground, crossing her arms, and resisting all of your pleas? Ask your friends. Ask your other doctors who they’d send their family member to. Interview doctors. In fact, interview them even if you’ve asked around. I chose my family practice doctor because he knew nothing about insulin pumps, but demonstrated a willingness to learn.

Me: “What would you do if I had to be hospitalized?”

Him: “Put you on injections.”

Me: “Why?”

Him: “I don’t know anything about pumps.”

Me: Raising eyebrows.

Him: “I guess I’d better start learning.”

That I made a good choice was demonstrated when I attended a diabetes information meeting where he spoke. The man knew his stuff. Even about insulin pumps. (I like to think I had a hand in that.)

When it comes to asking questions, is it best to ask open-ended ones or to be specific? It depends. For example, a doctor once suggested to me that an open-ended “what’s happening with my body?” is the single-most important question to ask. Why? It sets up a dialogue that can lead to more questions and tells you if he explains things in a way you can understand. More importantly, will he take the time to make sure you understand what is being said? We all have different learning styles.

Say things like: “I understand you to say ____. Is that correct?” to make sure you’re getting the message. Or try to understand what is being said by using something you’re familiar with. Once when I was interviewing a person about the closing of a plant that made glass bottles, I didn’t understand why it could only make one color of glass. “I can make cookie dough in a bowl, wash it out, and then mix up a cake batter in it.” I said. The person explained that a glass plant needs a different bowl for each color because they can’t wash it out well enough, at which point the little lightbulb went on over my head.

Think about how to ask a question. For example, don’t ask, “Are you going to send me for education?” Rather, ask, “Where are you sending me for education?” You’ll need that education. You weren’t born knowing how to get through life: You had to be taught. You’ll also need to be taught how to get through the rest of your life; a life with diabetes.

Places to get down to specifics may include topics such as meal plans and choosing a blood glucose meter. This is where your doctor may INSIST that you go to education, where those kinds of questions are handled.

My favorite registered dietitian and CDE asked me what I ate, when I ate, what my favorite foods were — down to the brands — and worked with me to come up with a meal plan that fit my lifestyle. If you are sent to somebody who gives you a predetermined “diet,” run! Run as fast as you can!

I count carbohydrates and find I can maintain control best if I don’t eat a lot of carbohydrates at a sitting. Well, I do sometimes. My favorite food groups are potatoes, pasta, and bread, and sometimes I have to indulge. My intensive log does include some higher-carb meals (albeit not from the Chinese restaurant my husband and I went to in between logs).

You may want to eat differently than I do, and that’s your choice. Just make sure the dietitian works with you to find a plan you can live with. You’re more likely to follow one like that.

Don’t let the educator hand you any ol’ blood glucose meter and say: “Here. Use this.” How much blood does it need? Are the strips large enough for you to grasp? Can you read what’s on the screen? Can the data be downloaded to your computer (if that’s important)? Will it give you averages? Is it self-calibrating, meaning you won’t have to physically enter a code each time you start a new vial of strips? Can you recommend an inexpensive brand of test strips?

Another question should be “how often should I check my blood glucose?” If you’re told you don’t need to check…find another doctor. You need to check to find out how different foods affect you. You need to check to find out how exercise affects you. You need to check to see if your overall blood glucose is rising, which means you may need to change, increase the dosage of, or add another medicine. If you don’t check, you have no idea what your control is.

The natural follow-up to “how often should I check” is “what should my blood glucose levels be?” The doctor who told me to check ended with just that. “You have to check your sugar.” Yep. That was it.

I didn’t have a clue! I dutifully wrote down numbers…when I checked. They were all in the 200s and 300s, so I stopped checking. They seemed pretty steady to me! (For the record, the American Association of Clinical Endocrinologists recommends levels of no more than 110 mg/dl before eating and no more than 140 mg/dl two hours after eating.)

My next question for my endocrinologist? Why was my 3 AM glucose in the 200s when I ate a cinnamon raisin English muffin after having a baked potato but 99 at 3 AM the following night when I had a cinnamon raisin English muffin after eating barbecue? I’m still scratching my head over that one.



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