Monday, January 11, 2010

Educating T-2s: Pancreas, We May Have a Problem

By the time I was able to see my doctor after receiving my diagnosis in a letter, I wasn't completely ignorant.  I'd done some hunting around the Internet, and I think I'd joined one of the online diabetic communities.  Because I'd called my insurance company to find out if there was anything they needed me to do, I'd received a blood glucose meter and even tested a couple of times.  (The first time had been a bit hard, to tell the truth.)   I knew a bit about the disease mechanism, and I knew some questions I needed to ask.  

I really expected that this first appointment would be when my serious education would begin.  What happened, though, was that I was given a fistful of prescriptions, an injunction to exercise, and an appointment for three months hence.  When I asked about diabetes education, I was told that we'd discuss that at the next appointment.  (At the next appointment, I was told that the education was for people on multiple medications.)

Huh?  Is that all there is?

In my case, being forced back on my own resources may have been the best thing that could have happened.  I'm fortunate enough to have received a good education, I'm comfortable with finding and evaluating the quality of Internet information, and I work in a major public library.   The lack of "official" information probably just caused me to take my own education all that more seriously.

But type 2 diabetes is not a disease that exclusively strikes educated people with a high degree of information literacy.  Here are some of the things I did not learn from my doctor, anybody she pointed me to, or anything she gave me to read:

  • What changes to make in what I eat
  • How the recommended exercise would help, and when it might be dangerous to do it
  • What these medications were supposed to do for me.
  • What range I should be aiming for with my daily blood tests
  • That my metformin might make me sicker than a dog (as it turns out, I was one of the lucky ones on this)
  • What complications I might be facing and that good control would likely help avoid them
  • What to do in case of hypoglycemia or hyperglycemia
  • How and why to check my feet
  • That getting my blood sugar into initial control would initially make me hungry enough to shut down a Denny's 
Seems like some important things to know, huh?  (To be fair -- the test kit she offered and which I didn't need may have come with pamphlets or something.)

Why was my doctor so stingy with information, and so reluctant to get me into training?  Are there so many new Type 2s that there just aren't resources to give classes to us all?  Or was my doctor just more concerned with getting to the next patient than she was with giving me what I needed to improve my health?  Did she have me labeled as a 'hopeless' patient that wouldn't take lifestyle advice anyway?  I understand that patient education takes time and that doctors aren't adequately compensated for it.  But if my doctor had the right resources, another three or four minutes could have made all the difference. 

And here are the most important questions of all: How typical was my experience?  And, if many new patients have the same experience, what can be done about it?

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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.