Barriers in mind.

BarrierWe’ve all heard the same story told by someone unfamiliar with diabetes. “He never took care of himself,” they say about a cousin of theirs who died too early from the disease. “Her numbers are always really bad, she doesn’t stay on it” they might say about their friend. And sometimes, this can be a relatively true statement. Maybe that person they know doesn’t take care of their diabetes. But very rarely is this because a person actually doesn’t care what happens to them. That’s a rare – and very scary and sad – scenario. Because most people do care what happens to them, and I’m pretty sure that no one wants diabetic complications or a painful, difficult, laborious disease that never takes a day off. But the reasons behind it are not as simple as “staying on it.”

Barriers to good care are as ubiquitous to diabetes as there are number of people with the disease, and they are complex and layered. Barriers can be financial, educational, cognitive, and emotional. They can be obvious or deeply embedded. When I first started my career in diabetes sales, I learned very quickly that leading with the fact that I have diabetes wasn’t always the best approach, although it might seem like the perfect sales pitch. I’ve had many doctors respond to this by saying “Yes but my patients aren’t like you Alexis. They aren’t motivated like you are.”

Is it that they aren’t motivated like I am or is it they don’t have access to the same information and treatment I’ve had since my diagnosis? Is it that they don’t have insurance that helps them pay the astronomical costs of this disease? Do they feel defeated by the day to day challenges of this disease to the point that they don’t care what the meter says anymore? Do they eat poorly because it makes them feel better, at least for a little while? And actually, I’ve been guilty of every single one of those things I just listed at some point in my disease. So really, those patients are like me. I’ve had the ability to get myself out of those funks that pop up with diabetes, but I also have a phenomenal support system, access to great care, and commercial insurance that pays for most of it. That’s not the norm for everyone.

The bottom line is that we never really know why someone “doesn’t take care of themself.” The reasons can be deeply personal and layered and not even obviously related to the disease itself in any way. There will always be special cases where someone is truly unreachable and doesn’t care what happens to them, but the vast majority of us would prefer to live well with diabetes. It’s all about breaking down those barriers. Easier said than done – this I know for sure – but every day that you push them is a little better than the one before it.

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well said. Your management is very much a complex result of early diagnosis in a very supportive environment, and life choices that have meant financial/insurance support far beyond what most are eligible for. But those were your conscious choices, and you still deserve credit for making them and (most of the time) sticking with the program. I do hear you in how often PWD’s are critiqued or self-criticize that they Are what the meter SAYS. That’s just an instant snapshot of a moment. A new friend who’s also a newly diagnosed insulin resistant (endo still considering if he is T2 or not, has him on diet, weight loss and exercise for now) was so self-disappointed at a morning reading – I had to explain to him dawn effect, how his dinner was not entirely responsible for his BG 12 hours later, how stress, exercise,the phase of the moon,all contribute to this wacky disease.

Thanks Rich – and what a comfort you must be to your newly diagnosed friend. If you don’t have someone explain it to you, you can very quickly feel like you are completely losing it with this disease because it makes no sense!

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