A few years ago, I was introduced by my endo for I talk I was about to give. I was there to do a bit about how I like to be treated by HCPs, and there was a whole bit in there about how I was more than my numbers. We’d chatted about how I would like to be introduced and I suggested she should read my bio and then say ‘And Renza’s last A1c was…’ before I would cut her off. It was a good lead into my talk.
My endo is one of the very few people who actually does know what my A1c is. As a matter of course, I don’t share it. It’s my data. I own it. Sure, I may post a screenshot of a recent CGM trance because right there and then it contributes to how I am feeling. But it is my own and my decision to put it out there for others to see. I understand that there may be judgement from others, or they may want to share their opinion. That’s fine. I can take it.
I would never, ever ask another person with diabetes what their A1c is. Or what their blood sugar is in the moment. In fact, I deliberately look away if someone pulls out their glucose meter or checks the CGM app on their phone. Of course, if someone wants to tell me what their numbers are, I’m happy to listen.
But I would never, ever ask. And would very pissed off if someone asked me. Imagine if someone asked you your weight? How would you feel about that?
Why is it that even though there are so many different aspects to our health that are measured, it is glucose levels or A1cs that are the ones that get shared around – by ourselves and by others. Get onto any online diabetes group and you will see this happening. I have to sit on my fingers and keep them away from the keyboard when the data being shared does not belong to the person doing the sharing. Some groups have regular ‘roll call’ threads where they ask for most recent glucose results. People sharing their own numbers is one thing – sharing someone else’s is another thing altogether, especially when it is annotated with what the person ‘did wrong’ to ‘cause’ the out of range number.
How can we truly believe that people see us as more than our numbers if that is what is shared? That was the point my endo and I were making during her introduction…she read my bio outlining all the things that I do believe go towards defining me. Yet there she was at the end focusing on a number that I refuse to believe does.
Imagine participating in a ‘current weight’ thread. How comfortable would anyone feel doing that? Or would they even consider sharing someone else’s weight online? (Step down now if you’re a Kardashian and that’s just regular Insta fodder.) I know that there are weight loss groups who do online weigh-ins. While I would never do it, they’re adults making the decision to do it.
I have a number of adult friends who use CGM share apps so that their friends, HCPs or loved ones can keep an eye on what’s going on with their glucose levels. (I’ve done this in the past, but don’t do it now.)
I asked some of them if they set up rules around how this sharing works. Some do. For example, they share only at certain times; they are clear about when they want the person they’re sharing with to get in touch, (one friend said that her partner is allowed to call her if she is low and hasn’t messaged within 20 minutes to say she’s on it – if she messages, he leaves her alone); they do not want to hear any judgement calls from the person seeing their data (and that goes double, triple, quadruple if that person has a functioning pancreas), they do not want to be asked if they have bolused as their trace inches (gallops) higher.
I guess what everyone is trying to do is make sure that they don’t feel as though they are under surveillance.
I asked these friends if there had been a conversation about ‘on-sharing’ – that is, the person who had access to their CGM data sharing it with others. No one had. I never had that conversation when I was using share apps because I knew that no one would think for a moment that was okay. They knew that flashing what they could see on their app to anyone around them was not okay – the information was not theirs to share. My friends said they knew their data was safe too.
Some people may think I am making too much of a deal about nothing. That it is just sharing a number in the moment and that is it. Or it is a moment of pride, sharing a loved one’s A1c they have worked hard on or CGM graph for the day, or snapshot showing how much time they’ve been in range.
But actually, I think it is more than that. I see it as saying that in that moment, that person with diabetes is only about a number and data. That is never, ever the case.
POSTSCRIPT
I wrote this piece a while ago and have been reluctant to publish it but changed my mind after seeing a conversation about this online earlier this week (that I stayed well clear of).
Please see my musings through the lens with which I am writing: I am an adult with diabetes. I was diagnosed as an adult. My perspective is my own and I don’t for a moment claim to understand anyone who is not a woman in their mid-40s, diagnosed with T1D at 24, living near the middle of a large city, who drinks too much coffee. And is called Renza.
3 comments
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March 22, 2019 at 5:16 pm
Jen Ridley
I have had T1 for 53 years. What I object strongly to is my GP not allowing me to get a copy my pathology results including my HBA1C. He wants me to return to him so he can “interpret” them (and pay another consultation fee). So I deliberately don’t ask for them, it is a power game we play. My cardiologist tells me anyway, so I eventually find out. Grrrr!!!
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March 23, 2019 at 10:03 am
George
I’ve always been asked about my height because I’m very tall, so I guess I just feel like humans are inquisitive. I happily tell anybody who asks. Judgy people will be judgy anyway and will find a reason.
I publish my data on an open nightscout and have a number of HCPs access it. I like this because I have good control, so Ill often get questions like “What are you doing? It seems to work well?”, which gives me an opportunity to advocate for different techniques.
I also like that they can play around with the system, browse data, run reports, etc. This gets them familiar with it so that if another patient comes in then they don’t freak out at new stuff because they think “aaah yes, I’ve seen one of these”.
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March 24, 2019 at 12:52 am
alexsilverstein1987
Fantastic blog and important topic (as always).
It inspired me to feel that quantitative measurement in healthcare has pros and cons.
CONS: The cons are that we risk being judged by our numbers. What Adam Brown very nicely highlights is that there are at least 42 different factors that affect HbA1c (https://diatribe.org/42factors), as you alluded too, sharing your HbA1c can lead to judgment from HCPs and others about parts of our life that we may have no control over and that they might not understand the root causes of, which doesn’t feel very fair.
This is worsened by the phenomena that when humans are put in positions of power (e.g a doctor, manager, etc) it has been shown that more often than not we end up telling people what to do. This strategy kills ownership and
growth and isn’t a very useful strategy at inspiring people to take leadership or make improvements within their diabetes self-management.
PROS: The pros are that measurements have the potential to show progress, whilst also identifying where more support is needed. There is also strong research that highlights lower HbA1c reduces the risk of complications, which I feel is a shared outcome for both people and professionals.
OTHER THOUGHTS: I have heard anecdotally, that in conditions like Autism, where there are not quantitative measurements to the same extent as diabetes, it is often felt that it is harder to diagnose, treat and highlight progress.
It is also a lot easier to measure things quantitatively than qualitatively and healthcare commissioners/insurers like to show impact with numbers, which can lead to less funding for things that are less likely to be measured This can be useful for diabetes, as it can be more attractive to fund new research, and interventions (projects/programmes) where you can show progress.
SUMMARY: Both the pros and the cons highlight that what is important is why the measurements are being taken (is it evidence-based? what are the limitations?), and who are involved in the decisions being made from those measurements (is it led or at least a shared decision by the person that data is about)?
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