Don’t Bring Up Diabetes, Doctor

Dear Mom,


Well, you wanted to know about my trip to the dermatologist today and how things turned out. So let me tell you…

First, I was the youngest person in the waiting room by a good 30 years.

Second, it’s amazing, but there was nothing said about my diabetes. No mention of it. No questions that incorporated my self-management or my diagnosis or blood glucose levels or anything whatsoever to maybe trace my care of myself alongside what was going on with my skin. Maybe it doesn’t matter, but then again (and this is based solely on generalized hearsay about dermatologists), maybe the doctor didn’t consult my chart. She only asked generalized questions about the issues I brought up. So maybe they don’t feel it’s necessary to look into my medical history?

Could diabetes not really be on a dermatologist’s radar? That’d be strange, because I find that everyone in the medical community to this point, from primary-care physician to endocrinologist (obviously) to podiatrist, even dentist to psychiatrist to phlebotomist, has asked about the diabetes. Not a visit to date (except for today) has been diabetes-discussion free.

Anything that’s anything to do with my body has in some way involved the diabetes.

But the derm? Diabetes wasn’t breached.

Third, I learned, during the examination, that the little things on my forehead that Kathryn was worried might be basal-cell carcinoma, these two or three little (2-millimeter) blips were instead what I thought they were: sebaceous hyperplasia.

I can’t blame Kathryn for worrying, because she’s had skin cancer and is very tuned into anything amiss with her significant other’s skin. But when we — Kathryn and I — first discussed my forehead abnormalities and I agreed to see the doctor, I did some online research and self-diagnosed sebaceous hyperplasia.

So, yesterday, when the medical resident came into my room first, alone (to pave the way for the doctor), I told her straight up that I suspected the lesions were sebaceous hyperplasia. I told her this because (a) I want to establish that I’m an informed patient, but also (b) because it’s just a fun condition to say out loud. Suh-bay-shuss hy-per-play-sha.

The resident seemed uninterested in my diagnosis — in fact she didn’t really acknowledge what I said, although I know she heard me. That’s fine. The only thing that irritated me was that when the attending and the resident returned to the room ten minutes later, and the attending looked at my forehead under the lighted magnifying glass, she said, “Well, I agree with Dr. Marks’ diagnosis. This is sebaceous hyperplasia.”

“Hey!” I wanted to say, “Didn’t Dr. Marks tell you that that’s what I thought it was, too? Come on! At least give a nod that I was correct.” But no. The resident had to be all “I’ve got all this medical schooling and I’m earning the points with my attending.”


Sebaceous hyperplasia is, according to most definitions I found online, a common, benign condition of sebaceous glands in adults of middle age or older. Yes, sadly, I guess at 35 I have to start thinking that maybe I’m nearing — or at — middle age. Time is happening to me.

The lesions, of which I have three — which are pretty minor and hardly noticable unless you’re right in front of my forehead, and then only one’s visible, and that only if you look very closely — well, they’re typically basically soft, small papules on the face, particularly the nose, cheeks, and forehead. This condition is something that won’t go away on its own, but I don’t think there’s much to worry about. The “effective treatment,” I was informed, was to have them removed via laser. However, in the same breath the doctor said that to do so would be considered cosmetic surgery and therefore wouldn’t be covered by my insurance.

Really, two or three hundred bucks for something minor like this? I’m not that vain. I’m not worried about this unless it becomes pervasive sebacious hyperplasia and marks a more noticable constellation on my forehead.

For now, its just a wee glitch (very wee) on my forehead. I’m going to leave it. Or maybe I can find a way to see if my endocrinologist thinks that this condition, these lesions, are affecting my diabetes and therefore need to be removed, which would therefore make the procedure covered by insurance?

Oh, and fourth (I almost forgot [OK, no, I didn’t almost forget]): I’ve been diagnosed with rosacea and got a prescription for something called Metrogel (metronidazole gel) (and yes, the name: sounds a bit kinky!). So you can add rosacea to the long line of diseases I keep finding out I have. That bit of splotchy ruddiness on my cheeks and nose that has flared up on and off for the past few months wasn’t simply due to a few wayward days with too much oily food. The good news is that it’s early enough that I can manage this condition with the Metrogel, and in fact and it’s too early, or not pronounced enough, to even allow me to participate in the university’s rosacea clinical study, in which I’d get to fill out a huge questionnaire and then have a few of the rosacea pimples (of which I have none at the moment) biopsied.

I’d totally do that, though. More time off from work to wander around in the university hospital. Which you know I love.

Anyway, that’s news from Michigan.

Love, Eric

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  • I

    I was diagnosed with rosacea a couple of years ago and Metrogel works a treat. I use it every night and very rarely have a flareup now. Good luck with it.

  • Carol

    Glad you got good news from the non-d-discussing dermatologist. Maybe she did miss it in the chart, but it’s actually kind of refreshing to find a doctor that doesn’t immediately relate everything to “D” or decide how your overall control is based on one fingerstick.

  • Sarah Jane

    That is nifty, I usually find overbearing drs want to make sure my numbers are under control. i have to tell them to shut up, explain i have an endo for that.

  • Erik

    I’m not a dermatologist and don’t even play one on TV. In fact I was appreciative of your pronunciation guide for sebaceus hyperwhadyacallit, but I do believe in the theory that basically no cell in the body is immune to effects of diabetes. I’ve read that Diabetics have increased dermatological issues, so I’d say that the dermatologist should be interested in the diabetes.

  • Deirdre

    Anyone know if there is any connection between Diabetes and Rosacea? I too have been diagnosed with both – T1 diabetes diagnosed in Apr. 2006; Rosacea diagnosed 2003 – just curious as I find more peopls with both…

    I actually take an oral med (doxycycline) for the Rosacea as well as use the Metrogel and have occasional flare-ups generally when the rest of my hormones are going wacko each month ;-)) but otherwise do pretty well with the two…

    One suggestion I do have for new users of Metrogel – it seriously does affect sun exposure – be very careful about using sunscreen when in direct sunlight…

  • Lindsay

    I also recently went to the derm. and they did not check my chart! I had a reaction to a bug bite on my elbow and he was about to give me a cortizone shot before I mentioned I had type 1 diabetes. Everyone be aware and make sure EVERY Dr. checks your charts.

  • Leanne

    I am also diabetic T1 and have been diagnosed with Rosacea. I have had antibiotics and am using salicylic acid products on my skin. These really help! I can be seen in public again! Woohoo.

  • Ann

    First of all Eric, you write very well. And second that doctor should definately have discussed your diabetes in your skin condition, as diabetes as you know can effect all areas of your body.

    Also when you told the Doctor about your sebaceous hyperplasia, she should have given you credit for it..DOCTORS ey!
    Anyway I am sorry that you have been diagnosed with Rosacea, and metro cream is very common treatment that does work, the only trouble with it is that it will be needed long term due to it only treating the symptoms of rosacea.

    I wish you well
    Take care Eric

  • Scott Morgan

    I’ve been using Metrogel for over 10 years to control rosacea. If I don’t take it my forehead, nose and cheeks breakout terribly. Metrogel is very effective. However, over the last 2.5 years I have switched to a low carb / high fat diet to keep my insulin and glucose levels down for the purpose of avoiding diabetes (I have a number of symptoms of pre-diabetes), and several months ago started eating only twice per day within an eight-hour window, again to allow glucose and insulin to recover and stay low most of the day. Last week I went out of town for a few days and forgot my Metrogel. Except for a very slight pink colour, my rosacea has not returned.
    It has been hypothesised that rosacea is due to hyperinsulinemia (too much insulin in the blood) and my experience seems to confirm that. So, if you have rosacea, you are very likely pre-diabetic. You should have yourself checked for diabetes, and note that the fasting glucose test will mis-diagnose those whose fasting glucose levels are low and yet their insulin levels are starting to take off due to insulin resistance.