I remember the first time I met with Dr. Gottlieb of the Barbara Davis Center for Juvenile Diabetes in Denver, Colorado (in the intervening years I think they may have changed “Juvenile” to “Childhood”). I had been living with diabetes for about a year or so, having started my journey into this wonderful world under the guidance of an endocrinologist referred through our primary-care physician. I was 15 when I was diagnosed, and so I must have been about 16, maybe 17, when I had that first meeting at the Barbara Davis Center.
It really changed everything for me. My first endocrinologist was a very competent physician, but there was a certain disconnect in the relationship for me. I couldn’t put my finger on what it was, exactly, until I moved to the Barbara Davis Center. Once I met Dr. Gottlieb, it became clear. My learning style, and indeed my overall thinking style, was not matched by my first endocrinologist. He presented diabetes management in a very methodical, step-by-step, sequential way. He started with the practical steps, and only filled in the backstory when he felt it was absolutely necessary. And there wasn’t anything wrong with that. But it wasn’t, and isn’t, the way I tend to think about things.
Let me backtrack for a second. I am a jazz musician, and I tend to think like one. I always have. Jazz is a very complex beast, and it requires a tremendous amount of fluid thinking. It is a style of thinking that looks at a very large picture, and in fact needs to see the large picture to adequately function. It’s impossible to play jazz if all you have is a set of step-by-step, sequential directions. Jazz doesn’t “sit still.” It is improvised music, meaning the music is created in the moment. That means you have to create your part with an understanding of what everyone else in the band is doing, with an understanding of how the chords underlying your melody need to be adapted to the melody, or how the melody needs to be adapted to the chords. When a musical idea strikes you, you have to be able to put that idea in the context of the form of the song you’re playing, and that means you’ll need to adapt to the tempo, the harmonies, and the overall feel of what is happening in that given moment.
When I met Dr. Gottlieb, I met someone who recognized the way I think. He seemed to understand from the beginning that information needed to be given to me in a comprehensive, “whole picture” way that didn’t just lay out the steps for me to take. He understood that for me to really function with this condition, I needed to know the origins of it — what is this disease, why did it show up, what’s the internal physiological process? I didn’t just need to know that I had a correction ratio of 1 unit per 30 over my target blood sugar (or whatever it was back then…). I needed to know how that number was chosen, why that number was chosen, and how it might change in the future. I needed the full backstory, the full picture.
Armed with the knowledge bank that Dr. Gottlieb gave me, I was able to establish a wholly different relationship to diabetes, one that has served me well (for the most part — we all have rough patches, of course) for many years.
But not everyone thinks like I do. I started with the big picture, and worked toward the details, while others need to start with the details, and only later work toward the big picture. It’s not a one-size-fits-all thing. Every person with diabetes has his own unique cognitive style. The real key is not figuring out which style is the “best” way to approach diabetes management, because no one way can be “best.” The key is finding the diabetes team that fits your style.
After all, my first endocrinologist had a thriving practice. For his regular patients, that style was just right. The key is to find the right fit. Diabetes is such a personal journey. While the rest of the world is only vaguely aware of the difference between Type 1 and Type 2, those of us living with diabetes knows that NO two cases of diabetes are the same. There are literally millions of types, one for each soul living with it. And there are just as many ways to approach it.
So find the team that really works for you. Don’t settle, but seek out that doctor and that team that can really match the way you think, and lay out the information in the way you need to see it. And when you do meet with your team, let them know what information you need. If you need to start with concrete steps, tell them that. If you need the whole backstory for their treatment recommendations, don’t be afraid to ask that they share it with you. After all, this is your diabetes. You have to live with it and you have to manage it. So find the right fit.
