Last night, I was the ‘here’s one we prepared earlier’ on a panel discussing CGM technology. The audience was all healthcare professionals – mostly DEs, but some dietitians, RNs and also a GP-in-training (so much yay to him for coming along!).
I love being in the room for these events! I wrote about my last experience giving the same talk here. I cannot speak highly enough of the two experts on the panel last night. Dr Peter Goss – who spoke at the last one of these events – is what I would call a disrupter in the diabetes healthcare space and, honestly, all the power to him. He may ruffle some feathers with his sometimes unorthodox approach, but it is undeniable that he is a champion for kids and teens (and young adults) with type 1 diabetes. Also on the panel was A/Professor David O’Neal who is best described as a truly awesome endo (I have heard that from every single person I know who sees him as their endo) and an absolutely brilliant mind. His expertise in diabetes tech is second to none and he is genuinely interested in how the technology can safely, efficiently and effectively be incorporated into the lives of people living with diabetes.
I know that all sounds rather effusive. But I need to point out that they are remarkable. And that they are the sorts of HCPs you want on your side if you are a person with diabetes.
Because now I am going to talk about language and why I pulled them up a little bit after we all did our presentations and sat on the stage ready to answer questions from the audience.
As happens frequently when I am in the room with a group of healthcare professionals, the conversation turned to language. Okay, I made that happen. In fact, the words I used were ‘I’m going to hijack this conversation because we really need to talk about language here.’
One of my biggest pet peeves is the jokey, and somewhat snide, comments made about people with diabetes making up numbers in their diabetes log books. Because, it’s not a joke. It’s not something for HCPs to roll their eyes over and dismiss as ‘non-compliant’ behaviour.
The word that was used for PWD who make up numbers in their books was ‘fakers’. I cringed the moment I heard the word. And cringed even more at the audience’s response – laughter, heads shaking from side to side and knowing looks. I looked around the room and knew that we would be talking about this later on in the evening!
As I pointed out when the panel was seated on the stage, I absolutely did this. And I was incredibly good at it – different coloured pens, splotches of blood on the pages, dog-eared corners of the book. Once, I even splattered a few drops of juice, because on that particular page, I was having a lot of lows and I thought the juice would make it look more authentic.
Now, let’s all just remember for a moment that I was diagnosed as an adult. This wasn’t insolent teenager behaviour. This was a woman in her mid-twenties who was terrified of disappointing and being judged by the HCP to whom she would be handing the grotty book and its made up numbers.
I told the room my story of this last night and there was laughter – because the way I spoke about it was amusing. It was a cheeky anecdote. But at the time, it wasn’t funny. I was scared, I hated checking my BGL, I was paralysed by numbers that didn’t make sense and I didn’t know what to do about it. So I lied. Of course my HCPs knew that. And I knew my HCP knew.
But the question is about WHY people do this. The discussion needs to stop being about diabetes at that point, because really, managing BGLs and most other diabetes tasks is not the issue here. The issue is distress, anxiety, fear. And, in my case, I felt desperate.
One of the panellists made the point that the reason that he brought it up was because HCPs need to know what to do when someone is ‘faking’ their numbers. He’s right. I completely agree. And then there needs to be understanding of how to approach it, which is likely to be different with each PWD.
For me, it took until I found a HCP who I felt I could trust – one who wouldn’t judge the numbers that were out of range (which one HCP always circled in red pen, making me feel even more like a delinquent adolescent) – and was interested in knowing what was stopping me from feeling able to check my BGL.
When we worked through that, I was better equipped to not only regularly check my BGL, but also to deal with the numbers and act upon them. I came to understand that a number was nothing more than a piece of information that I could use to make a treatment decision – not an indication of me being a good or bad person.
Language does matter. And words count for a lot. Using the word ‘faker’ in this context is loaded with judgement and accusation, and even if that is not the intention, it made me – a person with diabetes – feel very uncomfortable. But mostly, it fails to consider the real problem at hand which is not that a PWD is making up numbers in a book. It is why they feel the need to do that.
9 comments
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July 28, 2016 at 6:41 pm
Ashleigh
Very true! So happy that you hijacked that panel, at least there’s now at least one room full of hcps that are a bit more informed.
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July 29, 2016 at 8:58 am
RenzaS
It was a really good – and very respectful and open – discussion! Thanks for reading.
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July 28, 2016 at 7:26 pm
Pam oka
Hail Renza….spot on! As a newly diagnosed Type1 I felt exactly the same trepidation everytime I visited my endo. And I was 42!!! I even stopped filling my book in or conveniently ‘forgot’ to take it.
Love your voice Renza…Thanks for speaking up.
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July 29, 2016 at 8:58 am
RenzaS
Ah yes – I ‘forgot’ to take my book. Or left my meter at home so it couldn’t be downloaded. Thanks for reading, Pam!
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July 29, 2016 at 1:02 am
Annabelle Leve
Wow Renza, again you’ve raised a point I’ve never heard from another diabetic – I used to do urine testing, and then had one of the first machines to trial. No quick pricks, I had to manually prick my finger with the needle to get the blood, and I just couldn’t do it! That, combined with exactly the fear you mention, not wanting my endo to be disappointed with my results that just never seemed to respond the way they should, I lied and lied and filled in my book just as you describe. But nobody every actually sat down with me to talk about why I would do that. Thank god I grew up and they invented those quick and easy pin prickers!
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July 29, 2016 at 8:57 am
RenzaS
So many of us have done it. And our HCPs usually know. We need to find ways for us to safely have the conversation. Thanks for reading, Annabelle.
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July 29, 2016 at 3:15 am
Karen
Thank you so much for helping them to understand us all better!!
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July 29, 2016 at 8:46 am
Blood Sugar Trampoline
Renza, Thank you, thank you, thank for writting this. About 6 weeks ago, i was at a research conference where the top of the diabetes hcp food chain opened with a similar “fakers” story. I was so mad that I couldn’t form words. And it wasn’t a conference where open discussion was encouraged. But boy will I let him have it next time!
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July 29, 2016 at 8:56 am
RenzaS
Sometimes it’s tough to come up with a response at the time – especially when angry! I’m sorry that you had to deal with that. Every time I think we are making real headway in this space, I hear stories that make me wonder why people don’t get it. Thanks for reading.
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