Carla Cox, PhD, RD, CSSD, CDE starts
off her blog on the American Association of Diabetes Educators (AADE)
website with something that truly surprises me. All I can say is
thank you Carla. I have been fortunate never to have a provider
(doctor) say what makes her want to scream. Believe it or not, it
was a certified diabetes educator that said, “If you cannot control your diabetes better, you will have to be put on insulin.” This was in
the month following my diagnosis and I was still figuring out what I
could eat and my numbers were still generally above 250 mg/dl. When
this was said, I got up, and said that may be necessary, but your way
of stating this sounds like a threat from someone that does not
understand diabetes as I went out the door. I did not understand
then how correct I was, but I found out over the next few months that
this person did not really understand diabetes and was terminated for
her attitude.
I did call my insurance company when I
got home and explained what had happened and how long I was in the
room with her. I was told that I was not the first to complain and
payment would reflect the short time and lack of education. October 2003
was the month of diagnosis and this was about mid-November. I did
see my doctor mid-December and he was concerned that I had not
reduced my blood-glucose readings more. He had me rescheduled for
late January. He suggested that I do some research on insulin. No,
there was not order, just a very polite suggestion.
I knew by the middle of January that I
would be better on insulin and had read two books and done a lot of
Internet reading. I had the blood draw and the doctor was ready to
see me. I said the test results would probably be late and he said
yes. I said he was welcome to look at my recorded results for blood
glucose readings and that I should be using insulin. My readings
were still generally over 150 mg/dl. He said he still was not sure,
but that he would talk to the person and get me started with some
education while waiting the test results. I said I would not meet
with the person I had before and he said she is no longer part of the
office and he felt that the RN would be able to gain my confidence.
I must admit he was right. The first
question she asked me was what I knew about insulin. I opened my
briefcase and showed her the two books and said there were many types
of insulin and I wanted to stay away from any mixed insulins. I
would probably need a 24-hour insulin and a fast or rapid acting
insulin. At that point, the doctor entered the office and had the
test results. My A1c was 7.1% and my lipid panel was within range.
The doctor said I should probably stay on oral medications for a
little longer. I said I am tired of being overly hungry and fighting
to bring my blood glucose levels down and being even hungrier. The
RN spoke up and said that with the knowledge I had already that I
should be on insulin. We talked for a few minutes longer and he
pulled out his prescription pad and wrote several prescriptions. He
instructed the RN to give me one of the better meters and for me to
stop using the one I had.
The next 45 minutes with the RN were
intense and rewarding at the same time. She gave me the starting
dosage for Lantus and Novolog after doing some calculations. She
anticipated my questions and showed me how to calculate and refine
adjustments over several weeks as needed to get me to the levels I
had expressed wanting to reach. Then we covered the correction ratio
for correcting readings that were higher that desired before a meal.
She carefully wrote out all the calculations and what to do to
adjust the dosage to get near the readings I wanted. Then she had me
walk through several calculations. This was a great learning
experience for me and I still have the calculations. This fit my
learning style – observe and then do – and I remember how to do
this today.
Then she said it was time to scare the
dickens out of me and I said like hypoglycemia. She did a double
take and asked where I had read this. I pulled out the book (the
second in my list here) and showed her the tabs I had created on
post-it paper. She looked at the area I had marked and stated, “You
do know then.” I said she had not read far enough to read some of
the tips to correct hypoglycemia and what not to do. She said if you
know that now, I don't need to cover this. She did take time to look
at many of the tabs I had marked and then she went to the copier and
copied the cover of the book. I told her where I had purchased both
books (including the first on the list) and she said she had not
seen either of them and wanted to read both now that she knew of
them.
Next, she wanted to talk about reading
labels and I hauled out my third book and a cookbook. She asked what
I had learned. So I showed her the labels I had put in the book from
different foods and explained that I had a scale to weigh things if
necessary. Next, I opened the cookbook (Betty Crocker's Cookbook,
ninth edition – ring binder)) with the nutrition information with
each recipe and said I look at the number of servings in the recipe
and multiply the carbohydrates by the number of servings and divide
by the number of servings I would be using. She said I understood
better than most and I thanked her. She did suggest a carb counting
book that I had not heard about and we covered a few other pointers
she wanted to cover.
She commented how much she wished
others would work to understand diabetes and investigate insulin like
I had. I said that not everyone has an interest and many do not want
to talk about diabetes. I said I had gone to several bookstores and
several places on the Internet looking for books, especially after
the doctor had politely asked me to learn about insulin. She made
sure I had the telephone numbers for my doctor and how to contract
her or her associate if I was having problems. We did exchange
emails a few times and she would give me new book titles that she
thought I might be interested in.
About a year later, I lost contact. I
have met a few CDEs outside of an office setting and had enjoyable
experiences. In an office setting, I have not had an experience I
wish to repeat. I am very surprised and appreciative that I had such
a pleasant experience with a registered nurse.
I have to wonder as most of the
cookbooks since then no longer have the nutritional information
included especially the hardbound editions. In looking through the
bookstore a week ago, all of the hardbound and paperback cookbooks do
not have the nutritional information included. This store does not
carry any of the ring binder versions.
No comments:
Post a Comment