This is my first post on Diabetically Speaking in a really, really long time. The last thing I published here was on October 23, 2015. 988 days ago. It’s not that I haven’t been doing diabetes things, I just haven’t been doing them here. So what inspired me to post now, after all this time? Well, I had an appointment with my endocrinologist today and…
I lied a lot.
I didn’t mean to. The lies just started, and they kept falling out of my mouth, and I couldn’t stop myself.
The nurse called me to the back and we went through the usual rigmarole of height, weight, and other fun basics. No problem there, except I remain confused why they measure me for height every time I’m there. Are they trying to pinpoint the moment when all of the hours spent hovering over a keyboard and glaring at a computer screen finally leaves me with a hunched back and and a driver’s license that needs updating? Why can’t they just accept that I’m 7 feet tall like I tell them? (I’m 5’8″.)
Then the nurse and I sat down together, which is cool, and we started working our way through all the little dings that the electronic medical record wants updated.
Are you still on Novolog? Yes. (Honest answer.)
Are you still on a pump? Yes. (Honest answer.)
Is your insulin to carbohydrates ratio the same? Yes. (Honest answer.)
Are you still using approximately the same daily amount of insulin? Yes. (Honest answer. I’m on a DIY closed-loop system, so it varies. But overall, sure. Let’s go with that.)
Are you still using OneTouch strips? Yes. (Honest answer)
And then it happened…
Are you checking your blood sugar at least 4 times a day? Yes. (Honest answer.) And no. (Also an honest answer.) *cue the awkward Nurse pause*
I have the Dexcom G5 continuous glucose monitoring system. I check my blood sugar dozens of times a day. Some days, maybe even 100 times a day. I can do this because I wear a sensor, and I can see my blood sugar on my phone and whether it is trending up or down or holding steady in near real-time at any given moment. The G5 systems requires me to calibrate it twice a day. So if we’re counting fingerpricks, I do that twice a day. Rarely more than that simply because it’s unnecessary unless something weird is happening (like if I feel low, but my Dexcom says I’m not… I have trust issues).
My health insurance wants to know that I am pricking my finger at least 4 times a day. To them, that means I’m staying on top of my diabetes and all the silly and incessant decisions that it requires every single moment of every single day. So, I lied. Yes, I prick my finger 4 times a day. If you ask me for my logs, I’ll lie then too. BECAUSE IT DOESN’T MATTER HOW MANY TIMES YOU ARE PRICKING YOUR FINGER WHEN YOU ARE MONITORING YOUR BLOOD SUGAR 24/7 WITH A CGM.
Are you still taking your statin? Yes. (Total lie. I should be. I’m just not. Mainly because I forget. In my defense, I did walk that lie back a little and confessed that I need to do a better job of taking my statin regularly. Small victories.)
Are you exercising regularly? Yes, when I can. (Liar. I work at a university, and take classes, so I walk across campus almost every day. Is that exercise? I mean, it’s better than sitting on my duff and not doing anything. But I’m not getting that heart rate up and pushing any boundaries. So definitely room for improvement.)
Are you in any pain right now? No. (Why are you doing this?! You literally can’t write with a pen and pencil anymore without having to shake the pain out of your carpel tunnel riddled hands!)
Have you felt down, blue, depressed in the past week or two? No, I’m fine. (Help me! I am literally seeing a therapist (recent occurrence) to try to figure out how to manage being overwhelmed almost every moment of every day, figure out how to be happy more consistently, and how to unpack and process things in my life that I do not have the tools to know how to deal with. I’m a picture of success on the surface, and an absolute mess underneath it all. I’m highly productive, and I keep most of my problems inside. I feel extremely vulnerable even sharing this paragraph. Ugh. Gross. I’ll probably just keep lying about this one.)
The visit was relatively uneventful. Mainly because I lied. A lot. But the thing is, why did I feel like I had to lie in the first place? Shouldn’t I be trusting these people to help me, to make me the best I can be, to guide me toward living to be 400 years old? I’d probably be Hobbit-sized by then if they keep checking my height, but at least I’d be as healthy of a Bagginses as I could be.
This sounds like I’m assigning the blame to someone else, but hear me out. I’ll own my lies, but it is important to realize that there is a reason for them. The reason is a systemic problem in our healthcare system. We are encouraged to lie to our healthcare professional partners all the time. The lies are even incentivized!
If we don’t lie, then we admit that we are imperfect humans, and our health insurance then has reason to deny our claims, charge us higher premiums or additional fees, or even cancel our coverage altogether. Bagginses don’t like punishments. That doesn’t happen in ever case, and shouldn’t happen in ANY case, but it does. So many of us have been denied coverage of some necessary medical device, medication, or treatment, and had to fight an uphill battle to appeal to a name without a face that we truly do need whatever it is to live with or overcome our condition.
If we lie, we can sleep at night, resting assured that we have insulin, strips, needles, pens, pump supplies, CGM sensors and transmitters, and the infinite recipe of other medications and supplies that go along with our living well with diabetes and any other chronic condition the world may throw at us. Sometimes, many times, lying is easier than being honest.
I really wish our healthcare system would stop making us lie to them. I wish these electronic medical record systems would stop trying to quantify what it means to be well and be sick. I’m a researcher, so I get it, data is important. But data is useless when it is so blatant that you are simply collecting metrics. That is when you get rote answers, and lose the humanity that should be paramount to everyone’s participation in healthcare.
Recently we all lost Anthony Bourdain, and he was a master at asking very simple questions that allowed the people he interviewed to open up to him. I want my healthcare people to do the same with me. Sit down with me, away from the computer, and ask me very simple questions. How are you doing? What brings you in today? What is one thing I can do to help make your life better today? As Anthony Bourdain did with the people he met, ask me, directly and compassionately, what makes you happy?
I promise I won’t lie.