The following post, dating back to June 2005, was one of the first expert interviews I ever published here at the ‘Mine. It was originally titled ‘Surprising Interview with a Joslin Researcher,’ although that title seems quite dated to me now, because the good doctor’s recommendations are so basic (yet still so relevant, and with some great reminders for refreshing your approach in this New Year). I think I was mostly surprised at what he said about A1C levels.
btw, this is the interview that launched the book that Dr. Jackson and I eventually wrote together: Know Your Numbers, Outlive Your Diabetes (currently on 2 left in stock on Amazon – he, he!), which is now the basis for a new interactive ‘Diabetes Care Plan’ on Keas.com.
Wisdoms From My Favorite Joslin Doc
At this weekend’s annual ADA Conference, I had the privilege to sit for an hour just chewing the fat (or, um, chatting…) about the state of diabetes care with Dr. Richard Jackson of the Joslin Diabetes Center.
Dr. Jackson’s personal passion is talking with patients about how diabetes affects their life. For new patients, his biggest edict is, “You are not doomed. People with diabetes are doing better and better all the time.”
“When patients come in I ask, ‘How are you doing?’ Often they slump down in their seats and say, ‘I don’t know.’ So I say, ‘NO, how are you doing?’” he told me.
The point is: How do you feel? Physically? Mentally? The only way to achieve well-being is to be in touch with your own state of affairs, this doctor says.
Here are Dr. Jackson’s top tips for getting a handle on your own diabetes and getting the most out of your doctor/educator visits, as he related them to me this week:
* Find Out Where You Are
Start out by getting your numbers: your A1C (at least every 3 months), and your blood pressure, cholesterol, and microalbumin test results (all annually). Also, make sure you see an opthamologist annually to be armed with the data on your eye health. Never go in to see your diabetes doctor without knowing what your health starting point is, Jackson says, or the visit will be unproductive. And don’t get caught up on some stringent number-goals. Some people do quite well with A1C’s of 7+, or even up to 9, he says.
* Decide What to Focus On
It is ridiculous to think you have to tackle everything at once. Look at your health records, and decide which ONE or TWO things you will work on in the coming months.
Instead of making vague resolutions like, “I’ll eat better,” focus on very specific things like lowering your A1C by checking more often so that you can react immediately to highs.
Or maybe you’ll focus on blood pressure instead of the diabetes-specific stuff. “If a Type 2 gets his/her blood pressure down from 150 to 140, they can gain as much health-wise as by lowering their A1C,” the doctor says.
* Think of Your Diabetes as a Small Business, and Your Care Team as Your Consultants
Go in to your appointments with information on where your “business” stands, and clear goals and/or questions. Have them advise you on these specifics to get the most “bang for your buck.” And remember that these people work for you. Sometimes you might want an A1C more often than every 3 months. If they push back, insist.
* Make Sure You See the Results
This is why you need regular testing. Get your older and newer test results side-by-side and compare your numbers. You can see that you have made a difference!
Reward yourself in some positive way, and then set new goals for your next triumph. The ability to see the difference you have made is key. It’s a rush, like improving your SAT scores or video game scores — whatever turns you on.
If you do all this, there’s no way for nasty complications to sneak up on you, Jackson says. You’ll be on top of it and won’t allow problems to progress. “Remember, nothing ever happens suddenly with diabetes.”
Thank you, Dr. J, I feel better already!
Great advice I particularly like the treat your diabetes like a small business idea it really brings everything into perspective for me.
We are after all professional diabetics and treating diabetes as such brings a whole new level of commitment.
Amy, I usually love your articles, and although this is an older article, I think these quotes from Dr. Jackson are just feeding the $1.00 per strip and “go see your doctor, even if you don’t need an A1C test” fanfest. We shouldn’t be raping diabetics for testing, a task that is already taxing on us personally and work-wise, and taxes our healthcare system…while I need those friggin’ test strips, I can’t believe that the pharmas can’t recoup that with the 13 billion AMERICANS alone…never mind A1C tests…not trying to sound like a conspiracy theorist, but who gets all the money while we struggle to survive, (PHARMA), and who gets most of the $$$ when we die (GOVERNMENT)…
“Sometimes you might want an A1C more often than every 3 months.”, Umm, I live 80 miles from my primary endocrinologist…why would I want to travel to Portland, Maine from Rockland, Maine if I don’t have to…it would cost me more to do so than staying home.
“focus on very specific things like lowering your A1C by checking more often so that you can react immediately to highs.”
Whoa xim, “raping” is strong language there. Please note that Dr. J works mostly with Type 2s who don’t test very often at all. He’s constantly trying to get his patients to simply pay attention to their BG levels.
And as far as the A1C goes, I think his point is that it’s OK to insist on a test you feel strongly about having – don’t let your Dr. put you off if it’s important to you. He deals with patients whose Drs (believe it or not) have previously blown off patient requests for A1C or cholesterol tests.
Great reminder – Thanks !!