In the latest edition of the JDRF online magazine, Countdown, one of the Features is an article titled 16 Self-Care TIPS (Type 1 Positive Suggestions!) and has a few tips from 5 “experts” on living with Type 1 Diabetes.

4 out of the 5 experts actually have some decent advice, but I have to take serious exception to one of them.  Interestingly enough, he was the first of the five to offer his “tips” and he angered me enough that I almost didn’t even look at the other four; let alone the rest of the edition.

I’m taking exception with William Tamborlane, M.D. (read more about him here); he certainly has an impressive resume and has made incredible contributions in the field of diabetes care.  I do, however, have to take serious exception to tips #3 and #4; they certainly don’t seem to fall into the “Positive Suggestions” category.   Let’s talk about Tip #3 first.

Be a “Diabetes Honor Student” by acing your A1C test:
less than 7.0%= A+
7.0 to 7.5% = A
7.6 to 8.0% = B+”

Let me get this straight.  You are going to judge a diabetic based on a single number?  If you were to do that to me, I would explain to you in no uncertain terms why that is wrong.  Those explanations, by the way, are often followed by the words “You’re fired.”

Here’s why its wrong:  It does nothing to recognize what effort that particular individual has put into obtaining that “grade” or what extra things might have been going on that could have affected it.  For example, see my recent post What I Learned Being Sick for a rundown of what high stress, illness and a couple of “dubious” bottles of insulin did to my “grade”.

The combination of all those influences added a full percentage point to my A1c between December and March.  While I still would have been a “passing student”; the impression that I get, from the mere fact that you would recommend such a “grade” system, is that you would chastise me for that increase.

When the fact of the matter is that I was busting my rear to keep things under the best control I could.  I’m glad not all doctors are like that.  Mine certainly isn’t.  At my appointments, my doctor always asks me how things are going before we talk about “grades”.  Her response about my “grade” was basically “I think this X.X A1c is totally justifiable given the circumstances. “, she didn’t mention the full-percent point gain at all.

Overall, I see that type of “system” as simply adding yet another thing to feel guilty about with diabetes.  No one is perfect, we all have “good” days and “bad” days.

I already feel guilty about the worry my condition places on my loved ones, I certainly do not need another layer of guilt added.  Especially when it comes from someone who is supposed to help me manage a life-long condition, not make me feel like I’m failing based on a single number.

I’m the guy who has to walk out the door and do all those things to make that passing “grade” and honestly, it doesn’t really sound like you have the slightest clue what that entails.  Despite your incredible career, it makes me wonder if you actually just sit once in a while and talk to patients.

Now, for Tip #4

Stay optimistic. Getting diabetes is like getting dealt a bad hand in poker. You can cry about it or you can accept it and play it the very best you can. You’ll be surprised by how well it can turn out.

While staying optimistic is certainly an incredibly helpful thing; I believe it is the rare individual who can truly stay optimistic with any lifelong chronic condition.  It is all day, every day.  You seem to know that but don’t seem to have taken it to heart.

Every diabetic I know has suffered from “diabetic burnout”, usually more than once.  Recent blog postings by parents have even told heartbreaking tales of children as young as 5 “not wanting to be diabetic anymore”.

Yes, you have to do the best you can, but there are times when your best just isn’t good enough.   There are times when we HAVE to cry about it; when we have to vent.  Talk to other people who get it, who honestly understand; those who are walking the walk.  You, sir, I believe are merely “talking the talk”.

If we’re not optimistic at an appointment; would you chastise us for it?  Add yet more guilt and feelings of failure?

Overall, you don’t seem to see past the physical aspects of diabetes.  For me at least, the stress, guilt, depression and isolation of diabetes has really been what made me suffer with this disease.

We are more than a grade, Doctor, and I would challenge you to take that into consideration when dealing with diabetic patients in the future.  Especially ones who may be remembering how they were “graded” for a very, very long time.

How about a few tips from those of us out here actually doing it?  Just a suggestion…

Diabetes is nothing like a poker hand.

There are no “flops”, no “bluffs”, no “folding”.

We are always “all in”.

We “ante” with our lives.

©2011 Scott Strange, Strangely Diabetic and http://StrangelyDiabetic.com