Thursday, March 13, 2014

What Does That Mean Anyway?

"Are you in control?"

Four little words that have the power to make me cringe.

Especially when asked by a medical professional.

Latest example:

I went to my GP's office a few days ago for my physical and to get a few prescriptions refilled.

Before I saw the doctor I had to meet with a young lady (a nurse?) who goes through the usual things. She checks my weight, my height, my blood pressure and asks what medications I'm taking.

Then she asks the dreaded questions:
"Do you check your blood sugar every day?" and "Are you in control?"

"Do you check your blood sugar every day?"

I forced my face into my best impression of a pleasant/patient smile and responded in my calmest voice "I have Type 1 diabetes. Of course I check my blood sugar every day".

(I wanted to add - I check it 10 times a day AND I have a continuous glucose monitor - but I didn't. I also wanted to say - even if I didn't, how are you going to know if I'm lying? - but I didn't.)

"Are you in control?"

Again, using a picture-perfect look of patience, I responded "I have Type 1 diabetes. It's impossible to be 'in control'. My blood sugar is constantly going up and down. I just do my best to limit those ups and downs. My A1C was good though if that is what you're asking."

"Great!" was her response. End of discussion.

Seriously though - I don't get it. When someone in the medical profession asks "Are you in control?" I always wonder what they are really asking.

Is my blood sugar between 5 and 7 all the time? Of course not.

Do I have lows? Of course I do.

Do I have highs? Of course I do.

I have an A1C of 6.5, my diabetes team is pleased with everything I do but every day, and I mean every single day, my Dexter graph looks like a roller coaster. Sometimes I stay between 4-10 all day long. Other times it's a bit wilder and I go from 3-18. But it's always always always up and down and up and down.

So what does 'in control' mean?

I really don't know what they are asking but I never ever answer that question with a yes or a no. I always answer it with some version of "I have type 1 diabetes, there is no way to keep my blood sugars 'in control'.".

That usually either ends the discussion then and there or, as in the case of my optometrist last year, starts a conversation about my idea of control versus hers. I had no hope of convincing her that I could have highs and lows and still get a gold star from my doctor. She was extremely concerned when she heard that, of course I have lows and of course I have highs, and cautioned me on all the awful things that will happen if I let that craziness continue.

You can imagine how hard it was to keep my 'patient' look going that day.

"Are you in control?" feels a lot like greeting people with "hi, how are you?" We don't really truly want a long drawn-out answer to that question. We just want them to say 'fine thanks, and you?' so that we can get on to the real stuff we want to talk about.

"Are you in control" is supposed to be answered with a simple "yes".

I refuse.

Because I feel that it is important to gently teach people that questions like that are silly. And useless. And insulting. And, in my opinion anyway, tells me that the person asking the question does not really understand what Type 1 diabetes is anyway.

1 comment:

  1. Two things about those two questions...

    First off, I think you definitely *should* answer the "Do you check your blood sugar?" question with what was in your head: "Yes. I test 8-10 times per day, and I use a continuous glucose monitor," is my standard answer when someone asks that question. Those details often end up in the medical record seen by my doctor, which is important for my care and a subtle form of advocacy, too.

    And, on the rare occasions when a healthcare professional asks about my "control" I always feign ignorance. "What do you mean by control?" This makes them explain exactly what they're interested in knowing. Do they want to know my A1c? How many highs and lows I have? How much trouble do I have influencing my BGs to go where I want them? Do I have any other issues? These are all legitimate questions to ask, and much more useful than asking about some kind of mythical "control." More often than not, I'll also let them know (politely) that "control" is out of favor in the endo/patient community mainly because it doesn't really mean anything and is too often associated with judgment (real or perceived).

    I actually got one of my doctors, whom I see regularly, to change his office staff's procedures. We shouldn't keep these thoughts about these questions to ourselves.