Wednesday, August 21, 2013

Please don't shoot me.

Please remember the thoughts and opinions expressed here are solely my own, not NASA's, the American Diabetes Association's, or the cookie monster's.
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The difference between a fairy tale and a war story is the opening line. A fairy tale begins, "Once upon a time..." and a war story begins, "There I was...". As of today, my count is 2/2 for new endocrinologists offices.

But I realized something today that hit me like a brick wall. And please don't take this personally if you or someone you love has Type 2 Diabetes, but I think the increasing population of Type 2 Diabetics is exponentially decreasing the quality of care we, as Type 1 Diabetics, receive. Adult endocrinology clinics, in general, do not specialize in one strain or the other. So, as a Type 1 Diabetic I am funneled through a clinic where 9 (or more) out of every 10 patients are Type 2 Diabetics. And yesterday this fact was blatantly obvious. 

I don't think it's important to focus on the details of this visit, rather the growing need for a workable solution to the problem of adult Type 1 Diabetes clinics. My last endo, at Vanderbilt, was a hybrid - she worked in the pediatric endocrinology clinic 3 days/week, and the adult clinic 2 days/week. Presumably, she saw a high number of Type 1's in the pediatric clinic and was able to effectively care for her adult Type 1's as a result of being in practice. I never had to explain the physical devices and tools that I use to manage my disease, she never tried to convince me that a certain type of insulin works differently than how I experienced it (hey new endo lady: I'm pretty sure I'M the one taking the insulin and that I know how it affects ME and since you didn't even know that you can't fill an insulin pump reservoir from a pen, youaredeadtome), and so many other instances that let me know, as the patient, that she truly understood the disease and my management struggles as a Type 1.

There are many ways to slice this cucumber: Type 1 only clinics, Type 1 focused physicians within adult clinics, CDE-run appointments, virtual Type 1 appointments, etc.

I'm afraid as the number of Type 2's continues to rise, Type 1's will continue to be marginalized in adult endo clinics and many of us will experience moments like yesterday when we realize doing the right thing is a frustrating waste of time and money.

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Friendly public service announcement: if the doctor comes in and asks to see your pump, don't hand it over unless they are going to download it. At yesterday's appointment I made this mistake and noticed her aimlessly pushing buttons. When questioned what she was doing her reply was, "I have never seen one of these One Touch Pings before, how do you get to the settings?" As the pump was still attached to my body, I swiftly took the pump out of her hands, "If you don't know what you are doing, then you shouldn't be pushing buttons randomly that could deliver insulin." Ugh.