Playing At Diabetes

Renza Scibilia blogged last week about her bewilderment at so many professionals at a diabetes conference lining up to get their A1c checked.

Melinda Seed writes

I too have been surprised to see the longest lines at conferences being for the on-the-spot A1c checks. Perhaps all these people are wanting a free diabetes screening because they’re worried about their diabetes status-it would be charitable to assume that. I have my suspicions though, just like Renza’s neighbour who feels it’s about feeling good about their own number whilst judging yours.

I think this checking of A1c is a way in which professionals strengthen their psychological defences against the illness and vulnerability they are surrounded with. I can imagine the need to reassure yourself that you’re different from those who are being discussed at conferences, what better way than by proving you are not ‘diabetic’?

GP Dr Clare Gerada argues that during their training doctors come to believe that they are special and entirely different from patients: patients become ill but doctors do not. This belief defends them psychologically against their close proximity to sickness and suffering. However, feelings of difference can slip into feelings of superiority; …

Charlotte Williamson
British Journal of General Practice 2019;  69 (680): 150-151

I suspect that the A1c check isn’t playing at diabetes, it’s a psychological prop for healthcare professionals. Who am I to judge them for that, but here’s hoping they are led to more empathy and care for diabetes distress, rather than feelings of judgemental superiority about their intact beta cells.

I find hypo simulators more problematic. Diabetes is not a theme park experience. Even if a simulator could come anywhere near the shakes, the extreme hunger, the sweats of a normal hypo let alone the visual impairment and cognitive disfunction of a severe, should they? To what end? There is copious evidence (and isn’t medicine all about being evidence based) of the harmful effects of, and people’s death as a result of hypoglycaemia, why would a very poor imitation of a few hypo symptoms have any impact on professionals? More likely give them a false sense of confidence that they actually understand hypos when they have zero idea.

As for wearing pumps or testing blood sugars or injecting saline, none of these come anywhere near simulating what it is like to live with diabetes. I am reminded of reading Alan Marshall’s excellent autobiographical “I Can Jump Puddles”. Marshall was crippled by polio and permanently relied on crutches-amongst other problems, he was frustrated when people told him they knew what it was like because they had to use crutches for 6 weeks when they broke their leg. It’s nothing like it ok!

Not all attempts to simulate diabetes, however, are necessarily completely useless. Decades ago before there were diabetes communities online, I was at a friend’s extended family gathering. Like all good ethnic families food was piled onto my plate and I was being pressed to “eat, eat”. When I told the GP cousin I hadn’t met before that I had met my carb quota, she said “oh, you have type 1 diabetes, that is really hard. They did a study and GPs couldn’t manage to do all the things diabetics are supposed to do.”

This was the first time somebody acknowledged the degree of difficulty in diabetes and I was grateful. A good diabetes simulator although it can never do justice to the emotional and psychological impact of diabetes could potentially help make doctors aware of the burden of diabetes in terms of the additional tasks that are just piled upon us with no consideration of quality of life or just capacity to do so many things on top of a busy life.

That said, until you have it or you have cared for a child with it (the issues are somewhat different but no less intense) do not ever presume that you know what it’s like because you’ve played around the edges of some diabetes tasks for a while.

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