Emotional Diabetes

I had to go to a walk-in clinic the other day. Like many these days, I don’t have a family doctor. The one I saw previously, and only had for a couple years, retired.

My old family doctor never really knew what to do with me. Any reference I made to an emotional element in my glucose responses was deferred to specialists. “You’ll have to speak to the endocrinologist about that.” And so when I finally got an appointment with an endo — and this was by phone — he ignored my claims and stuck to the script:

• I need to take long term insulin, despite the problematic problem of weight gain.
• I need to lower the A1C, a blood test diabetics should take every three months. It shows average glucose levels.
• I should watch my diet. When I told him I eat low-carb vegan, he ordered up a blood test for a B vitamin (can’t remember the number) to ensure I’m getting enough nutrients. Turns out I was.
• I should get exercise. Despite the fact I told him that exercise does not bring my glucose down. I get 10-15,000 steps a day. The only time insulin helps is to accelerate a drop after I’ve injected a shit-load. Normally I have to correct the overnight spike (called the dawn phenomenon) with a ton of glucose. Then I walk the dog(s), and occasionally I get an alert via the Dexcom that my glucose is dropping rapidly. Never a concern. I usually need to inject again to get it down to a number I can live with.

Lots of “shoulds.”

So I was in my usually bitchy mood when I arrived at the mall where the clinic is located. I got there at 7 a.m., when the mall opened. There were two others already in the line-up. I set up my camp chair and and settled in for the two-hour wait until the clinic was set to open, at 9 a.m.

These are tough times for patients. During those two hours, the people in the line-up maxed out the clinic’s capacity for patients that day. I sat in the waiting area as those behind me were told to come back later in the afternoon or get in the line-up another day. It’s brutal that people have to wait in a long line-up just to get turned away.

I had already tried the online Telus Health, having had luck previously with same-day cancellations. But all I saw were appointments two weeks away. The only sure way I could get a special authority request for my Dexcom and prescriptions for glucose strips and needles for my insulin pen was to make sure I got in line early. It makes me wonder about moms with babies and the elderly, who simply can’t endure the long waits.

After a short wait in the office, I saw the doctor. I probably had my defences up, as I usually do with medical professionals, but he turned out to be lovely. He introduced himself as a physician who has a practice at another Nanaimo clinic.

“Have I seen you before?” he asked, scanning the computer screen.

That question earned points from me. The question was from a place of caring and empathy. He had not seen me before, but the question indicated that when I see him again, he will remember me.

I explained that the main reason I was there was to get a renewal for my Dexcom. I’m on my last sensor, which will last 10 days. I was unaware, until I went to get a new batch of sensors, that the special authority required for the prescription had expired in October. I asked if he knew how long it would take BC Med to approve my next stint.

“I had a terminal patient and they got their special authority in two days. But normally, I understand it takes six weeks. I’ll see if I can speed it up for you, since you’re diabetic and your situation isn’t going to change anytime soon.”

Six weeks would mean I’d have to buy at least one box of sensors on my own. They’re priced at $300 per month. I get 50% off my prescriptions at the retail outlet where I work (now only Sundays) because of my benefits, and another 10% off with my employee discount card. According to my calculator, that makes it $120 per box. That equates to a couple bags of groceries.

I also needed more glucose strips. I recently asked the pharmacist about them and he said a box cost about $70. I also need sharps so I can inject the insulin. These things are all available on prescription but I haven’t ordered any since my last prescription ran out. I get my insulin for free — it’s covered by a current prescription.

I know others have it much worse. Diabetes is a chronic, expensive disease. It’s difficult to do the right thing when you’re working for minimum wage. I hear horror stories from the US of parents short-changing themselves on insulin so they can feed and house their families.

Back to my doctor of the day. I asked if it’s possible to get sleeping pills. I described the little blue pills and orange/red capsules I’d had in the past.

“There’s a problem prescribing those now because they’re addictive,” he said.

He asked about my sleep and I told him I cannot keep my eyes open past 8:30 p.m. and then wake up at 3:30 or 4 a.m.

“That’s an unusual problem,” he said. “You’re getting enough sleep but you’re going to bed too early.”

I was thinking out loud when I said I could try to stay awake an hour more and see how it goes. With my new job, I’ll be working (from home) until the end of a shift, which is 9 p.m. So for the last couple nights, I’ve rewatched The Handmaid’s Tale on Prime (which has very few dull moments) and the first night I went to sleep at 9:30 p.m. and awoke at 5 a.m. Amazing. Last night I stayed awake until 9:45 p.m. and awoke a few times in the night but managed to get back to sleep. I awoke at almost 6 a.m. That’s my version of sleeping in.

I don’t like taking needless medication so I was happy to have solved it on my own, with a little advice from a friendly doctor.

A couple other things worth noting. He didn’t bother to take my blood pressure — maybe seeing in my records it’s always in a good range. And he didn’t ask about my A1C, which was due in early October. I’m an adult and I choose not to subject myself to the endo waiting in the wings who will chastise me for not taking long-term insulin. I know my glucose is well out of range, but I feel healthy.

Not all doctors are assholes. I’m happy to have met a good one. I only wish a guy like this would take me on as a patient.