By Jan Chait | January 8, 2008 12:27 pm
"Your A1C is up a bit," said the voice on the answering machine. "Watch what you eat."
Wow! Was that helpful or what?!
The voice belonged to a nurse in my husband’s primary care doctor’s office, and I can think of a few things she could have said instead:
“Your A1C is up a bit. Please call the office so we can set up an appointment for you with a dietitian.”
“Your A1C is up a bit. Perhaps we need to reevaluate your medications.”
“Your A1C is up a bit. Have you been sick or stressed lately?”
“Your A1C is up a bit. Can you increase your exercise some each day?”
I have some of my own such as: “Honey, I know you love pasta. Maybe you could eat it for breakfast instead of for a bedtime snack.” It would, at least, give him a chance to exercise the blood glucose levels down instead of sleeping on them.
Anyway, I think there are some problems with the message. First of all, what is his A1C (or HbA1c) up to, and from what? I pondered that, with the understanding that care does have to be taken when releasing private medical information. Then I decided that the fact he had an HbA1c was private in itself. After that, what would have been wrong with giving the numbers? And how much is “a bit,” anyway?
The message assumed that the problem was food-related. We all know that food isn’t the only culprit. Stress, illness, lack of physical activity, hormones, the amount of sleep you get, medicines taken (or not), the alignment of the planets and phase of the moon… One or any combination of those can raise havoc with your diabetes management.
Many doctors don’t understand the nuances of Type 2 diabetes and don’t seem to understand that it’s often a case of progressive beta cell destruction resulting in a need for changes in therapy. I recall being chastised for “noncompliance” when what I really needed was insulin.
Heck, many don’t seem to understand diabetes—either type—at all. They seem to believe high blood glucose levels are all food-related. Exercise is a given—it mostly reduces blood glucose levels. As for nuances, ask any woman about the effect of her monthly cycle on blood glucose levels and you’ll realize there’s more to it than food!
My husband was diagnosed with Type 2 diabetes several years ago. He has yet to be referred to a dietitian or to a diabetes educator. Yeah, yeah, I know: He lives with me. Like he listens!
Instead, like many of us, he makes excuses for why his HbA1c level is high: It was just after the holidays. He wasn’t fasting when the blood was drawn. He’d eaten pasta the night before (like that’s unusual!). Yada, yada, yada.
The cold, hard facts are that, in the beginning, he was able to manage his diabetes doing what he was doing in terms of food, physical activity, and the like. Now he can’t. The diabetes, as Type 2 is known to do and as I’m not sure many doctors understand, is progressing. Changes need to be made—in drugs, in food, in exercise, in all three.
I think it’s time I sit him down and have a little—no, make that a major—talk with him. I kind of like him and would like to keep him around.
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