Sunday, August 01, 2010

Dear CDE...

(Saturday afternoon, I put out on Twitter a request for Type 1s to make suggestions about anything they might like to see a Type 2 address. Sarah, who is working towards becoming a Certified Diabetes Educator (CDE), responded "Everything!" I've chosen to write this post to the CDE I might work with someday.)

Dear CDE --

I don't know you yet, nor what circumstances caused me to need your services. But I'd like to tell you some things about me and my diabetes to give you the best shot of helping me. Because Type 2s rarely have Certified Diabetes Educators, your availability to me suggests that I'm having real problems.

First, I am a man in full. I am more than my metabolism, more than my BG log, more than what they scale says, even (despite the saying) more than what I eat. I have a sense of humor and am an incorrigible punster. I've read an awful lot of books. I have some hopes and a lot of fears. I am cranky and often inwardly judgmental, but my compassion and overriding desire to treat all people well are easily aroused and overcome the crankiness and judgment. I'm happy to live alone, but I am sometimes lonely. These details are not important for you to know. What IS important for you to know is that I, like all your patients, am a complete person.

Second, I need you to start with questions about who I am and what I already know about diabetes. If you start with a standard informational spiel, you're going to be wasting time for both of us. I don't doubt that there are many things you can teach me, but none of them would come up in your first session with a newly-diagnosed patient.

Third, you're not going to make me skinny. I've been seriously obese for four decades. In all likelihood, I've worried about my weight since before you were born. It's no longer a healthy goal for me. I need to you to assist me in my efforts to live a healthier life. If substantial weight loss happens as a result of that healthier life, that will be wonderful. But that isn't, and can't be, my goal.

Fourth, if I need changes in my treatment and your role includes making suggestions to my physician, I suspect that my needs as a Type 2 may be a little different than for your Type 1 patients. An experienced Type 1 may be able to be at least your equal in deciding changes in basal rates and so forth. However, it's not possible for me to really understand all the types of medication therapies that are available. However, I do expect you to solicit my strong participation in decisions about tradeoffs among alternatives.

Fifth, it's often said that insanity is doing the same thing over and over and expecting different results. Given the miniscule percentage of people who are able to make sudden dietary change, and the even smaller percentage of those who are able to stick it for the long haul, just what would be sane about your reaching into your desk and handing me a one-page meal plan? If I could make a "meal plan" work for me, it's overwhelmingly likely that I wouldn't be meeting with you. What I do need is information about smaller changes I can make or suggestions as to how I can circumvent the barriers I face. I also need help in sorting out which pieces of medical research I should be paying attention to.

Finally, don't try to "scare me straight" or scold me. Fear does enable to make some people to make changes. But my diagnosis was a long time ago, and I wasn't ignorant for long about what it meant. Frightening me won't make me skinny, it will just make me fat and scared. I don't consider that progress. As for scolding, I assure you that all the scolding that might be helpful, and more, has already happened within my heart. From you, I need respect and a little kindness.

Thank you for meeting with me. I respect you and your very significant attainment of education and training. I'm likely to be a little reserved when we first meet, but I do hope you can help me. I hope that very, very much.

Your patient,



  1. *thumbs up* Sir Bob, thank you for writing this. It allowed me into the mind of a T2 for a minute.

  2. I wish the DOC universe would all write letters like these, and then we could send them off to the AADE - wouldn't it be something if our future CDEs could read what goes on in the minds of their patients? Could learn what their patient actually needs to be healthier?

  3. I love this, for the obvious reasons and also because not only are you reminding me of things I need to remember as a CDE but also reminding me of why I wanted to pursue this profession - because I want to change the way "healthy lifestyles" are approached by the health care providers. I've had my CDE (who I love) hand me a meal plan before - I almost laughed in her face!

  4. hehe, good post Bob

    I can usually tell what type of CDE/Endo I have within the first 5 minutes based on what they ask me and their answers to what I ask them

  5. So well said! You have written it from a T2's perspective, but I think with very little tweaking it could serve well for even T1s like myself. Meal plans? Yeah, been there. Plastic food in appropriate portions on a plate? Yeah, been there too. I have my first meeting this coming Tuesday with a new CDE. It's hard to go in there with an open mind, and ready to hear the real gems that one might have for me.

  6. You know, I was trying to choose my favorite point. I couldn't do it. They are all great points.


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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.