My most recent visit to the endocrinologist left me feeling both relieved and slightly ridiculous, as if I’m making up my pre-diabetic diagnosis or tending towards hypochondria. They tried their best not to see me at all; as a general rule, they only see patients who have been diagnosed with diabetes.
I understand why. They are probably overwhelmed just taking care of the patients who are already diabetic. I don’t want to take resources away from those people. At the same time, a little bit of support to the pre-diabetic population–an estimated 1 in 3 Americans–could go a long way in reducing the number of new diabetic cases down the road.
“You don’t look diabetic,” said the receptionist, eyeing me over her reading glasses, with the slightest suggestion of “Why are you here?” I wasn’t sure how to respond to such an unscientific comment. Shouldn’t she of all people know that diabetics come in all shapes and sizes?
Once in the doctor’s office, we did an on-site A1C test, and the results were better than I’d hoped. (I subsequently learned that in-office testing can be less accurate.) In the midst of my relief, I began to feel slightly foolish.
“I wish all my patients were like you,” said the doctor, telling me that he sees many patients with A1Cs in the 11s and 12s and tries to get them down to 8 or 9. He explained that, right now, working at the lower end of the spectrum – with the people who have HbA1Cs at 6.0 or 6.3 – is very difficult. The lack of precision in the test means that it’s hard to measure incremental changes.
“Don’t be concerned if you test again in a couple of months and your A1C has gone up a few tenths,” he cautioned.
I tried other questions – could he recommend a nutritionist or dietician? I’ve read differing views on vegan, vegetarian, high-protein/low-carb diets and which is best for diabetes prevention.
Again, he was at a loss. “You’re doing everything right. Most of the nutritionists we work with are taking people with very unhealthy diets and getting them on a path to healthy eating…. I don’t think there would be much value for you in terms of refining your diet.”
In other words, the blunt tools they have available aren’t suited to fine-tuning a pre-diabetic patient. The severe end of the scale is where his office has the most impact, where the tools are most effective. Medication. Dietitians to get you on a healthy eating plan. Counseling to quit smoking or lose weight. There are lots of things that doctors can recommend that will make a big difference to someone with very high blood glucose levels.
For pre-diabetic patients, who may not yet need medication, who don’t have a weight issue, and who understand the basics of diet and exercise, there is not much to do but wait. The science isn’t yet there on exactly when and why a pre-diabetic person progresses to Type 2.
“I can’t tell you whether you’ll progress or not,” he said. “You could be doing all the right things, and still become diabetic 10 years from now, and then we would look at medication or other options.”
Not a very inspiring thought, but he’s right. I can’t possibly control what happens 10 years from now. But I can use the factors that are within my control–diet, exercise, sleep–and be in the healthiest position possible to confront whatever life has in store.
It’s too easy to make choices that seemingly have no immediate consequence–will it really matter if I go off my eating plan for a day? Have that dessert? Skip my workout? Who knows whether that choice matters in the long-term?
Actually, I do. For several years I made some bad choices with regard to eating and exercise. Would I be pre-diabetic now, if I hadn’t made those choices? I’ve moved past having that conversation with myself over and over–what’s done is done. But I definitely don’t want to be having that conversation all over again ten years from now. Or facing it with my kids ten or fifteen years from now.
So… I’m starting with 5 small steps for the weekend and week ahead:
–We’re getting rid of the Halloween candy. Tomorrow. (Side note: my daughter woke up with a massive headache this morning. She may have a cold virus, but I think the over-consumption of Halloween candy is at least a contributing factor. She ate eggs for breakfast and drank some water, which seems to be helping.)
–We’re going to talk about sugar and how it affects our bodies, based on her experience.
–I am going to boil up a bunch of eggs in the Instant Pot this weekend, to help me reach my goal of a protein-filled breakfast every day next week.
–I will stick with my exercise routine both Saturday and Sunday, even though family is visiting.
–I will stick with my healthy eating, even though family is visiting. If I make dessert, it will be a fruit crisp with low-sugar topping.
Starting with small steps is the only way I know to make those good decisions one at a time, one after the other, day after day. And hopefully those steps will lead to where I want to be–diabetes-free–ten, fifteen, twenty years from now! What are 5 small steps you could take today?