Three reasons why I don’t see a CDE.

I’ve enjoyed reading about the recent American Association of Diabetes Educators meeting in Orlando. Wil Dubois at Diabetes Mine has written thorough recaps of many facets of the conference, and thoughtful viewpoints of the conference and of Certified Diabetes Educators in general have either been posted or will be posted at ThePerfectD and Diabetesaliciousness, as well as on blog posts I haven’t seen yet (If you’ve seen a good one, feel free to link to them in a comment below). There’s no doubt Certified Diabetes Educators do an amazing job of providing education, encouragement, and ongoing information for people living with diabetes. Metaphorically placed end to end, their numerous success stories could stretch from here to the moon and back, and probably back again. They are an important and vital part of the diabetes community.

So why haven’t I seen a CDE since my diagnosis 23 years ago?

The reasons are many. I’ll give you three right now. I’m not saying these are good reasons; in fact, they might be downright ridiculous. I’m not saying you shouldn’t see a CDE. If it will benefit you, you should. But why haven’t I seen a CDE in 23 years? It’s more than just a simple “I don’t wanna see a CDE”. Here we go:

A doctor has never asked me to see a Diabetes Educator.
This is true. I saw a Diabetes Educator in the hospital after my diagnosis. She taught me how to inject insulin, gave me the lowdown about the exchange diet (it was 1991), and she even warned me about certain parts of my anatomy not functioning properly if I didn’t take care of my diabetes (creepy, but true). Since then, not only have my GPs and endocrinologists not suggested that I see a CDE, they haven’t even mentioned it at all. Ever. I never thought about it either, until reading online about how much people love their CDEs. Since then, I’ve thought about discussing it with my endo. But as you probably know, time with our primary healthcare professionals is precious and short, so I never got around to it. But this whole paragraph makes me think: Are doctors not recommending CDEs to their patients enough? Are they only recommending them where there aren’t enough doctors or nurses in the first place? I don’t know the answers to those questions. I’m just asking.

It’s one more person to make an appointment with. And pay.
I already need to visit my endocrinologist every 90 days (no complaints about that… it just is). Then there’s my GP, whom I don’t see often, but still. I also have to keep regular appointments with the eye doctor and the podiatrist. I have to see a dermatologist every now and then. Now I need to schedule time with a CDE too? I’m already forking out over three grand per year in out-of-pocket expenses for my diabetes. Like it or love it, it’s one more appointment and one more expense.

On the other hand: If a CDE could help me get to a better state of diabetes management, they would be worth their weight in gold. Just sayin’.

Side note: I can see where people on an insurance plan that still requires referrals would just say no to this outright. Why pay an out-of-pocket expense to get a referral from the primary or endo, then pay another out-of-pocket to go see the CDE? This is why many plans have done away with the idea of referrals for everything—it’s too expensive for them too. In fact, some plans are probably saying that they won’t cover visits to a Diabetes Educator at all, though I don’t know how prevalent that is. Again, my view on that is: If it helps, it’s more than worth the cost.

It’s one more person to answer to.
This is probably the dumbest reason, and yet the easiest to write out. Why do I feel this way? Because I like my endo. I trust my endo. I want my results to make my endo happy every 90 days. If my results are less than stellar, I feel a little like I’ve let her down. I do not want that responsibility every 90 days with an additional person. To change this would probably require rewiring my brain, so I see a CDE as an additional member of my team, there to help me rather than be another person telling me what to do. But right now, while things are going okay, I’m worried that an additional person added to the mix might make me less likely to want to listen to their advice, no matter how helpful it may be.

Now… go ahead, leave a comment and give me the 1000 reasons why I’m wrong about all of this. I know I deserve it. But please be respectful. I might deserve criticism, but not hatred. Thanks.

Disclaimer: As I said above, these are NOT reasons why you should not see a CDE. Everyone has a right to seek the best help they can find.

Happy Halloween! It’s a Peep®.

File this one under the category “Things I never thought I’d write about on a diabetes blog”.

If there’s an e-mail I’ve received this year that made me laugh really hard, it had to be the one from a representative for Marshmallow Peeps®. If you’re someone in the ‘States who celebrates Easter, you may have received a peep or two in your Easter basket prior to diagnosis. Or maybe after too… YDMV.

Now the Peeps® people are rolling out marshmallow treats with Halloween in mind. Marshmallow ghosts, pumpkins, and chicks with different flavors and colors. Also, and the reason they wrote to me: They are now producing sugar free Peeps®.

What made me laugh was the fact that someone who makes something so sugary wanted me to write about their sugar free options. And most important… I absolutely hate marshmallow. Marshmallow invokes an almost immediate gag response in me. And they wanted to send me free samples!

So of course, I said yes.

I told them that I just can’t stomach marshmallow, but my wife used to love Peeps® as a kid, so if they wanted to send a few sugar free and non-sugar free selections my way, she would try them out and I would report back.

In fact, we took it a bit farther and waited until we had a big party (Maureen’s dad was visiting), and we handed them out for people to try. These were all people not living with diabetes, so their opinion on the taste of sugar free and sugar laden marshmallow would be important for this taste test.


The verdict: The overwhelming majority of our guests said that the sugar free pumpkins taste just the same as the sugary versions. No difference. Of the sugary things they tried, they really liked the chocolate mousse-flavored cats. They thought those were the best by far. Opinions on everything else was mostly met with “Well, it tastes like a Peep”.

So I’m going to give you the link for the sugar free and the Halloween selections for Marshmallow Peeps®. Here they are:

Honestly, I wouldn’t usually write about something like this, but it just seemed like a fun thing to do, and we can’t always be super serious. With September just around the corner, whatever your options are for Halloween or for stubborn bouts of hypoglycemia, I hope your upcoming autumn is very nice indeed.

Disclosure: I was given some free samples of Marshmallow Peeps® to try. I did not promise to write anything about it. All opinions belong to me (and my guests).

Hitting the benchmark.

I was thinking the other day about some things I’ve written over the last couple of years. Things that said, essentially, “I’m going to do something”. I started listing those things in my head, then started assessing whether I had met each goal, and whether I had met the goal within the spirit that was intended when I wrote about it.

What I’m finding is that I am completing most of the things I’m starting. Almost all of them. I’m completing them, and as a result I’m able to feel good that I did something I felt was important enough to write about in the first place. What’s disturbing is the feeling that I’m often not as successful as I think I could have been when I first started out on these goals. This kind of thing is really gnawing at me right now.

Did I run that 5K? Sure. Cross it off the list. In a quiet moment of reflection, however, I lament the fact that I didn’t really train to run it hard; I just trained to be able to finish it in the first place. Big difference. It leads to the feeling that I’m not doing things big enough, or with big enough success.

You might think it’s good that I completed the 5K in the first place. Not completing it is the alternative, and that’s definitely not good. And hey, we’re all busy, and blah blah blah. I so appreciate the sentiment, but there are times when hearing that sounds more like a reminder that I didn’t do well enough, rather than what it should sound like, which is support, which I so desperately need. I want to hold myself to a higher standard. And it’s not about trying to be as great as [fill in the blank]. I don’t generally compare myself to others, because I find I feel better if I celebrate what others accomplish instead of comparing my accomplishments against theirs. Plus, I know there’s a good chance I’ll feel like I don’t measure up anyway, and feeling like I’m not measuring up is enough to make me hesitate to try anything new. Insert recipe for inertia.

Yet I have to root myself in the knowledge that much of our success in life comes from trying, not necessarily succeeding, in every new venture. And I must admit to giving in to the feeling that if I write about it, I’d damn well better do it. More than once, that’s kept me from giving up on something entirely. Maybe you think that’s a poor way to go about achieving things. But I don’t feel this way about everything. And if the end result is positive, who cares?
As in all things, I think there has to be a balance.

I need to hold myself accountable. I need to give myself a break once in a while.

I need to keep trying new things. I need to not be disappointed if it doesn’t always go perfectly the first time.

I need to try for the best possible result every time. I need to be happy that there is a result of any kind, even if it doesn’t always meet my expectations, which are generally pretty lofty anyway.

Side Note: I need to learn from every experience, and be open to learning from everyone else’s experiences.
What I most want to remember is:

1. Celebrate the success of others
2. Look for opportunities to make a positive difference, even if the difference only affects one person
3. Take advantage of those opportunities and actually make a positive difference
4. Never stop learning
5. Never stop trying

I might also add: Keep some perspective. In reality, it’s been a good year so far, and the future looks brighter all the time. I could have done more, or done what I’ve already done better perhaps, but it’s only okay to feel that way if I stop short of regret, self-pity, and future inaction. I’m not perfect. I will keep trying to be helpful, in as big a way as I can muster.

Wordless Wednesday. Make a list.


I’ve got the day off today. After checking my desk drawer before I left yesterday, I realized I need to take a little time to get replacements for the juice boxes I’ve been going through lately. And maybe some peanut butter crackers. Maybe some candy too.

And where did that plastic knife come from?

Innovation is good. Innovation WORKS.

My co-workers and I were talking the other day about our recycling, and one of them mentioned that they now put out more recycling every week than they put out actual garbage. I’ve actually lived in places where a couple of decades ago, there were people arguing that recycling pickup wasn’t worth the cost to have it picked up on a regular basis. Now many of us are throwing out less than we’re recycling. Where would we be if we were still throwing everything away?

Just like when there was no such thing as recycling newspaper, plastic and glass bottles (heck, I can remember when all bottles were glass), cardboard, and metal, there was a time when performing a blood glucose check at home was a pipe dream. There was a time when an insulin pump (no injections? get out!) was something out of a sci-fi novel.

But lo and behold, over time, those devices not only became a reality, they’ve become a fixture in our diabetes lives. New things do get developed. New technology emerges. New therapies are perfected.

That’s why I get a little sad when I hear people say bad things about the artificial or bionic pancreas. It’s disheartening to hear someone dis remote monitoring of their CGM.

The reality is that these two ideas are coming to fruition at a rapid pace. We already know that artificial/bionic pancreas technology, when filtered through an appropriate algorithm, functions far better, with far less effort, in a safer way, than the average patient does on their own. Side note: Can I just refer to it as artificial/bionic pancreas now? Even now, after years of development and testing, this technology is changing further to include a bihormonal (insulin and glucagon) solution. Can you tell me you were thinking about that ten years ago?

And what about remote monitoring of your CGM? We know that Nightscout has already rolled out a solution that can allow parents to send their children to school or to sleepovers with a little less apprehension. Adults can use the CGM In The Cloud to keep their family members in the know, on a real-time basis. Was this on your list of cool diabetes ideas six or seven years ago?

I know it takes a long, long time for products to come to market. But I know that with the help of technology and some extremely smart cookies, new diabetes devices and software are going from concept to go live faster than ever before.

I know that there is still so much about diabetes that will remain dangerous, even after the latest innovations come to our doorstep. But I also know that fear of what still exists is not worth not taking steps to erase some or all of the fear of dangerous nighttime lows.

I know that a cure is still out of our grasp. But I also know that I am willing to live with incremental improvements in care and delivery systems until a cure becomes reality. And I am not willing to wait on everything until a cure is within reach.

I don’t believe I’ve ever written this before. But for the record, I am 1000 percent behind the #WeAreNotWaiting movement. Where last year there were only a few isolated pockets of innovation and collaboration in diabetes technology, there are now visible signs that collaboration and innovation are occurring and are at work right now. And that leaves me thinking that with the speed of technology, #WeAreNotWaiting will soon go from a fringe idea of faster implementation of new ideas, to an inventive steamroller that eventually leaves non-believers thinking #WeShouldn’tHaveWaited.

I was not prompted by anyone to write anything on this subject, but I was inspired by this blog post, and this one too.


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