Not long ago, I attended the American Diabetes Association’s Diabetes Expo here in New York City. Personally, I didn’t expect to get much out of the event because I knew that the Diabetes Expo (and ADA as a whole) is skewed toward the predominant type 2 diabetes population. But still, I wanted to bring along a friend who’s been struggling with her diabetes, and I wanted to say hello to a few other friends who were also attending.
So we went, and the experience of watching some food presentations on healthy eating by people who don’t look like they’re necessarily following their own advice got me thinking about an issue that’s been on my mind through the years: judging the diabetes “experts.”
It began with Charles Maddox, actor-cum-chef, nephew of Bob Marley and type 2 PWD (person with diabetes) who’s dubbed 
himself “The Poor Chef.” He presented about healthy cooking on a budget, which was particularly relevant to my friend and I since we’re both young and broke. While he demonstrated a cilantro salad with olives, sunflower seeds, garbanzo beans and feta (it was delicious!), he asked a woman next to him to explain a bit about what garbanzo beans are. I had assumed she was his simply his assistant, but Charles introduced her as being a Registered Dietician.
This is where the rubber meets the road — the part that’s difficult to admit and even a little embarrassing. But this is important to talk about, since it’s actually an issue that I’ve seen come up repeatedly over the years.
Once this registered dietician came out from behind the stage, I could see that she was overweight — an overweight dietician talking to a group of type 2 diabetics about healthy eating. Even though I battled thinking it, I would have guessed she was a type 2 PWD.
I know, I know! So judgmental of me, right? All those stereotypes that we wage war against were clouding my own head! But I couldn’t help it. The RD, who was espousing healthy eating information, didn’t appear to be following her own advice. That got me thinking about how many other people I know who judge their healthcare professionals by how they look…
This conversation came up many years ago with a friend who mentioned he couldn’t stand appointments with his dietician because she was so overweight. Who was she to tell him what to do and how to eat? And that dietician isn’t alone in the world of healthcare providers. I’ve attended two annual American Association of Diabetes Educators (AADE) meetings, and let me tell you the truth: they are not all athletic Mediterranean Diet-eating educators. Many appeared to be a “healthy” size, but many were also overweight and some were downright obese. So I know that this isn’t an isolated incident.
If it’s so tough for these educators and docs to practice what they preach, then what right do they have lecturing us on what we’re supposed to be doing? Or presenting it under the guise of “Well if you just did this, this and this, everything would be fine”? As if it were all so easy!
Makes you wonder.
For me, the most guilt-inducing part of this whole situation was that just days earlier, I had read a wonderful post by fellow type 1 Abby Bayer, who’s a registered nurse and fellow D-blogger. She talked about why PWDs aren’t as qualified in health matters as CDEs. She noted in her post that sometimes, she doesn’t even mention to her patients that she has diabetes. In the comments, she elaborated that this is because she doesn’t want to risk having her patients judge her, or have outrageously high expectations that she’ll be the “perfect diabetic” — because we all know that’s impossible.
Here’s the Catch-22: do we have unrealistic expectations that our healthcare professionals will be perfect, while simultaneously expecting them to let us off the hook because being a “perfect diabetic” is so damn difficult?
What I saw myself doing at that ADA Expo was judging this RD based on the highest of standards because she is standing before us as an expert. She’s supposedly the role model for all these patients. So, shouldn’t she be setting an example? This is something I am trying to do, actually. I often think about how I want to be healthier so that I can be a better role model for my future patients once I finally become a diabetes educator. If I can show them that I lost all this weight (I’m about 50 lbs. overweight, FYI) and got my A1C into the 6s all while going to nursing school, then I’ll be more deserving of respect. Right? Maybe they will look up to me and I’ll be a better teacher because I can show them just how it’s done.
But really, I’m doing a disservice in thinking this way. I am essentially discrediting the more practical mantra of striving to simply “do better” in small steps, and instead seem to be putting this imagined perfection on a pedestal, where neither I will nor my future patients will ever reach it.
So I have to change my thinking and face the music. Hey, I am not a “perfect diabetic,” nor will I ever be. And there’s nothing wrong with that! I’m doing the best I can — I test my blood sugar regularly, eat mostly healthy foods and get regular exercise. Bad habits take a long time to break, and just because someone outwardly appears to be overweight doesn’t mean they aren’t trying to be better. And we can’t see how many times a day they are testing or exercising, so it’s not fair to judge them without knowing those details.
At the ADA Postgraduate Course that I also attended in late February, the AADE’s past president Sandra Burke acknowledged this point about diabetes educators, saying: “We are the most knowledgeable people about diabetes, and we don’t necessarily do what we need to do. It’s hard to do what you need to do.”
While I find it debatable as to whether or not CDEs are the most knowledgeable about diabetes, I do agree that it’s very hard to do what you need to do. So maybe while we’re cutting ourselves some slack over not being perfect, we need to cut the educators and dieticians some slack too? Maybe so.
All of this was a great wake-up call for me. This observation and self-reflection made me realize that, despite my best efforts, I still have a double-standard for people who are in the medical field versus those of us who are “regular patients.” We are all educated in how to be healthy, but sometimes the knowledge is more difficult to put into practice than we think. Sometimes despite our best efforts, obstacles get in our way.
At the end of the day, what I’ve gained from this experience is that I need to be more understanding of others’ situations, just as I struggle to be understanding of my own. No one is perfect. Not even the “experts.”
I have no respect for RD’s or Diabetes educators for that matter as I have encountered horrible ones in my journey with T2.
My current Endo who is very good, wanted me to take a course from a Diabetes educator at his office, I refused saying that there was nothing new they could teach me. He finally got the hint after a year seeing that my HBa1c’s were in the 5.8 – 6.2 range.
Two points:
1. If the CDE has the perfect body and the patient is obese, the patient might think, “Well, what does she know? She doesn’t understand how hard it is.” An obese CDE is not a good role model, but maybe someone slightly overweight would be the best.
2. Maybe those overweight CDEs *are* following their own advice. Maybe it’s their advice that is wrong.
BTW, garbanzos have a very high GI.
Oops. It’s fava beans (broadbeans) that have the high GI, not garbanzo beans (chickpeas). I should learn to proofread before I hit Send.
Allison – Your account is a good lesson in humility. Understanding, compassion, and forgiveness are sometimes difficult but they do reward you by connecting you with others on the basis of our common humanity. We all could use more of it.
Nevertheless, I still hold medical professionals (and diabetes advocate organizations) simply to the high standards that they themselves endorse. Case in point: the medical/nutritional establishment’s reluctance to seriously consider the health benefits for persons with diabetes in reducing their carbohydrate consumption to blood glucose sane levels.
Their continued reluctance to consider the benefits of a low carb diet, merely as another option, harms our community. It costs lives and creates needless suffering as secondary diabetes complications.
I don’t care if my dietitian is overweight or even obese. I care much more that s/he gives me the straight story on what is healthy for me. Continuing to tell me that I should consume half or more of my daily daily calories as carbs harms me. That should stop.
I’m really hard on myself that I’m not perfect when it comes to managing my T1 daughter’s care. This makes me feel a little better – we are making small steps do try and do better all the time. I can try to judge myself less when I see no one is perfect – not even our experts.
Our Pastor touched on something like this during Bible Study – read the passage in Luke where Jesus advises about the Pharisees and teachers of the Law – “Do as they say, not as they do”. These elites were holding themselves up as perfect paragons and moral authorities, but He called them out for their failings and hypocrisy. This seems to happen in every system and government.
I have had experiences with judging physicians, off-kilter diabetes educators, as well as some who were human and caring. My primary care provider dismissed the possibility of my severe gut pain and distress being a rare side-effect of an ACE inhibitor I was taking (Lisinopril, intestinal angioedema) , and objected when I discontinued it. Months later, asking if I had any more attacks, I shrugged “no”, and the doctor agreed that it must have been the medication, after all. Rather than hold it against them, I forgave.
IMO we have to remember that medicine is an art as well as a science, and that its practitioners can be all too human…
For all you know, she’s an athlete. Maybe she does triathalons. I’m obese, and do long bike rides. The last CDE I saw clearly did not believe me, so I stopped seeing her. It’s a matter of perception.
I have a lot of thoughts about this (shocking, right?).
First – as people we need to try to stop judging everyone. Even ourselves. We need to live for our own health and well being and help others, not judge them.
Second – you also missed my point in the post I wrote about how some people will be defensive if I tell them I have diabetes, which leads to their criticism of themselves and that’s a bigger reason I don’t tell them. You will learn this in time.
Third – a lot of HCPs don’t have diabetes, so why should they live the way we do? If I were an allergist, I wouldn’t stop eating peanuts just because my patients do. The bigger picture is that PWD NEED to live a healthy lifestyle or we have immediate consequences, and others don’t, necessarily. If HCPs are choosing to be over weight or eat a poor diet or never exercise or – heck – do drugs – what does it matter? They know the risks and benefits and us judging them isn’t going to help anyone in the end.
My point is that we need to stop with the judging. PWD need to lay off the HCPs unless they are one. And even then it’s going to get you nothing but stress and self doubt if you’re judging others.
@Abby – the point that Allison was making was that “to judge is human,” but it’s one of those negative things we really need to keep in check.
Also, of course it’s silly to expect an HCP to “pretend” to have an allergy or other ailment…
BUT people who have chosen to spend their lives “preaching the gospel of general healthy living” — as dietitians and CDEs do — should most certainly practice what they preach in order to be taken seriously. Otherwise, it’s like a Pastor committing all the sins he/she is telling others to avoid. No credibility!
True. I hear you, completely. I also appreciate someone who will admit to me that they also aren’t perfect. Guess it’s all about balance.
I understand your point — and I think we could all benefit with more humility and understanding that the struggle to achieve good health is not an easy one for any of us, but especially for diabetics.
I am 65, and was diagnosed with Type2 Diabetes 6 months ago with an A1C of 12.7. My doctor and I were both shocked. I searched all over for good information. And what I learned is that the best way to control your blood sugar is to not feed your body those foods that convert easily to glucose. I eat healthy fats, most meats and seafood, especially salmon, and lots of eggs.I eat a lot more vegetables and berries, but far less wheat and potatoes and rice. I test my blood sugar often, at first as much as 6-8 times to learn which foods spike my blood sugar. I have learned how to make delicious foods, and can even enjoy treats like LC pancakes or chocolate mug cake made with almond flour.and healthy ingredients.
In 6 months I have lost 40 pounds and brought my A1C down to 6.3, My doctor has been very happy with my progress, and we spend a lot of time each time I see her just talking about the steps I have taken to control my diabetes. The only medication I am taking for my diabetes is Metformin.
The big problem I have with the current diabetic advise most often given by the ADA, their publications, and many dieticians — is they promote a low fat diet that is high in carbs. And then blame the patient when s/he is unable to control their diabetes. Like the other Gretchen said above, maybe the problem with the “expert” is that she was taught and is promoting the “wrong advice”. My daughter has a close friend that is very interested in nutrition and working towards a degree as a dietician, and was appalled at the really unhealthy information being taught by her nutrition professor.
I am also upset that Medicareand other insurance providers will only pay for enough testing strips to test once per day,, unless one is taking insulin. There is no way you can adequately learn to control your blood sugar without testing several times a day until you know how your body reacts to various foods. I now do a fasting BG in the morning and test prior to the evening meal and after the evening meal, as it is usually the meal with the most carbs, and varies a lot more than my breakfast and lunches.
I am dumfounded when I get a diabetes magazine in the mail and see recipes with as much as 23 g (or more) carbs per serving. I try to eat less than 15g per meal, and certainly at most under 50g per day!!
I see too much advice given to avoid all saturated fats, with no distinction made between the very harmful transfats and the very natural and healthy fats such as butter and coconut oil.
I do not understand why the current “standard of care” for a diabetic is to prescribe a statin drug, even if their cholesterol is within normal ranges. The statin drug pushing is downright scandalous. I had headaches and very disconcerting memory issues the one month I was on a statin drug and refuse to take them any more. I am instead taking krill oil now to help lower my LDL, which may be totally unnecessary because — my doctor’s lab does not have the capability to do an LDL particle size test to determine if one has harmful small particle LDL or the harmless large particle LDL. Yet we are told to reduce our cholesterol without even know this important fact! Btw my HDL did go up, and my triglycerides have always been in the normal range.
And then the thing that bothers me the most, is the ADA seems to more into pushing harmful drug treatments, and that their is not a single diabetic on their board of directors. They should ALL being diabetics that know how best to control the disease.
So good luck to you in your studies. Just be aware that there is more wrong information out there about treating diabetes, than there is truly helpful good information.
As a medical professional, you need to be aware 50 grams of carbs per day are too low. You need a minimum of 100-130 grams of carbs per day for brain function period! It all comes down to potion control. I have seen a lot of vegetarians in my day that have high TG, Lipids. You can overdue nuts, avocado, and other healthy fats. Portion control, balanced diet…period!!
I have some interesting fatcual statistics, regarding diabetes, my father was incharge of a bindary in the 60′s he worked there all his life, he doens not have diabetes, but in those day’s I say again diabetes was rear, out of a workforce of 2,000 there were only three diabetics on insulin, none he noted none on medication, It’s proven fact these people are living normal lives, he still sees them on occassions, they are now in their 70′s and enjoying retirement, many people live very long lives with diabetes, even if contracted at an early age, with porper management the condition can be kept under control, with limited effect.
The commetns on obesity are interesting, I have noted a number of diabetics are indeed obese and over weight, but at the same
time there are very large numbers of people who are extremely
thin and under weight with the condition, when I encounter diabetics and I do meet many, there seems to be no golden rule. to say a thin person couldn’t develop the condition what
not be true in any contex.I bumped in to an old work associate
last year, he has alway’s been seriously under weight, he was
suddenly diagnosed type 2 and put on insulin. Mind you he had lived on a chinese takeaway and fast food diet for years.
As an endocrinologist without Diabetes, I find many patients and people on diabetes forums feel I can never know what they feel, think , and need. While I do not have the experience of having Diabetes, I have studied the science of Diabetes for many years and have met thousands of people with Diabetes and other chronic diseases who have described in detail the emotional as well as the physical pain of their disease. I try to be as empathetic to every person I meet and never thought to expect for empathy and understanding in return. Thank you so much for this post.