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Let’s talk about doctors and diabetes

This is a tricky one. Does your doctor understand you? Do you understand your doctor? Let’s talk about doctors and diabetes.

doctors and diabetes

The old-fashioned approach

I think the relationship between doctors and diabetes used to be quite straightforward. The doctors understood diabetes, the person living with it did not. Doctors told us what to do, what to eat, how much to inject, and we tried to follow their advice.

That is all changing now.

There’s a growing awareness that the lived experience of diabetes – actually living with the condition – is far more valuable than book learning, which is what doctors have. Managing diabetes 24 hours a day counts for more than studying it.

If you’re lucky, you’ll spend 2 hours a year with your doctor. The other 8758 hours of the year, you’re managing your diabetes by yourself.

A new way to relate to doctors

So now what? Well, that depends on your doctor and how willing they are to accept that you – the patient – might know as much as they do.

I’ve been going to my endocrinologist (diabetes specialist) a few times a year for the last 14 years, and I love him. He has seen me through two healthy pregnancies, my mom dying, work and life changes, and everything in between. He is respectful and kind, and it feels like a collaboration.

When I saw him last week, I knew my HbA1c wasn’t going to be great. I had some pretty severe diabetes burnout at the end of November, my dad had a stroke the week before Christmas, and the year has been pretty stressful so far. Stress often leads to insulin resistance, which makes diabetes harder to manage.

I explained all this, and we had an honest, helpful discussion about what could make diabetes easier for me to manage right now. As I said, I love my doctor.

But then he said something that surprised me…

Doctors and diabetes: a different approach

I was explaining that many of our community members have bad experiences with their doctors and healthcare workers. They feel judged or shamed, or don’t feel they’re being seen as an individual. Just the week before, a friend had told me about going to see her doctor, explaining that she knew things didn’t look great but she was working on it, and being told her diabetes was a mess. A mess! Can you believe that?!

When I told this story to my doctor, he said: “At least he still cares.” And that floored me.

He explained that the worst thing a doctor can do is be nice and not care. It’s very easy to spend 20 minutes talking about nothing much, tell your patient to keep trying, and then say goodbye. But what good are you doing then?

And then he asked me a question I don’t know the answer to. I’m curious to hear what you think…

How do you motivate people who don’t want to change?

He told me the story of a patient who came in every 3 months with an HbA1c of 14% – dangerously high. Every month, he gave advice, altered medication, talked about why and how their blood sugar was so high, asked them to check their blood sugar more often so he could get a clearer picture of what was going on.

The patient said – as some of our community members have said – that their body doesn’t like going below 8mmol/l. It feels panicky and low if they do. This is actually quite common, as your body readjusts to higher blood sugar, but it can be fixed by slowly bringing blood sugar back into a normal range (under 10mmol/l) over a few days. It really does just take a few days. When he explained this, the patient nodded and agreed, but didn’t make any changes.

Every 3 months, the patient came back with a sky-high HbA1c, one or two blood sugar readings a week (despite having strips) and no sign of making any changes.

“What do you do, then?” he asked me. “Do you keep being nice and understanding, even though it’s not working? Do you get harsh? Do you talk about complications?
What do you do?”

I don’t know. Do you?

The reality is that consistently high blood sugar leads to diabetes complications. But if you’re used to consistently high blood sugar, it’s very hard to change.

Let’s talk about this with doctors

After my doctor and I had debated this for a few minutes, he invited me to gather a group of diabetes advocates to talk to his team of doctors about this. How should they speak to patients? But also, how should patients speak to doctors? I’m very consciously using the word patient here, because it’s in a medical setting: in a doctor’s office or hospital.

What do you think? I’d love to hear – either here or on Facebook. Let’s start the change we want to see between doctors and people with diabetes.

What to read next?

Let’s talk about diabetes education: Sweet Life is all about diabetes education. Since 2020, when we deep dived into the available material and research, we’ve been trying to find the right solution for South Africa.

Let’s talk about diabetes guilt: Diabetes is such a strange condition, isn’t it? On the surface, it looks like it’s all about food and medication and exercise: a purely physical condition.

Let’s talk about diabetes and food: Diabetes and food. Is there a subject more likely to start people arguing? I don’t think so… (Maybe politics? Religion? Money? I think diabetes and food wins.)

What to read next
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Sweet Life is a registered NPO/PBO (220-984) with a single goal: to improve diabetes in South Africa. We are funded by sponsorships and donations from aligned companies and organisations who believe in our work. We only share information that we believe benefits our community. While some of this information is linked to specific brands, it is not an official endorsement of that brand. We believe in empowering people with diabetes to make the best decisions they can, to live a healthy, happy life with diabetes.