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.
Diabetes Blog - Happy-Medium.net 
Comments
Check out Integrated Diabetes Services. Owned by Gary Scheiner who is a CDE and has diabetes. I prefer my CDE to have diabetes.
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I’m not going to tell you you’re wrong. You make some excellent points. I have switched AWAY from some endos who will see you the first time, but every follow up appointment after that (every 3-4 months) is with the CDE they have on staff. I KNOW the training a CDE goes through. I KNOW they are well educated. But I can’t get over the fact that I am paying a copay to see a specialist on my insurance and I am not actually seeing one. I acknowledge it doesn’t make sense and is a completely old school way of thinking, but if I am paying to see a doctor I want to see a doctor.
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I get it. My experiences with CDE’s have not been fruitful thus far. I believe that if I could remember to write down all of the questions that I need to ask her another appointment it would be helpful. I just have trouble taking the time to prepare for yet another appointment, and they just look at my A1C and ask me where I’m having trouble. Um, if I knew, I’d just fix it myself!
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I think you should see whomever you feel does the best job with/for you. That’s why we’re there. I’ve seen both. I was happy with a CDE and now, I’m very happy with the endo that I see.
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I’ve seen two endos in my 30-years; one recommended by the endo and another requested by me. The first didn’t have much of a personality, and cost me $65 compared to my $35 endo co-pay. I saw that person twice before deciding it wasn’t worth it. The second, with a new endo, I asked for and that CDE had type 1. That person refused to relate and be a D-peep in the way I needed, and so it wasn’t worth it. My endo is fine by me, and if I don’t see the need to see that doc then I don’t. Your reasons are totally 100% legit and understandable to me.
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Scratch that — I’ve seen two CDEs in my 30 years of living with type 1. Multiple endos.
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I don’t have 1000 reasons you’re wrong. I don’t even have one.
To me, I think that for an endocrinologist to recommend seeing an educator is a subtext for saying one or two other things: (1) I’m not good enough to teach you, or (2) I don’t have the time or patience to teach you.
One of my prior endos would have me alternate visits between a CDE and a dietician a couple of times a year (I was 30 when I started seeing him, and hadn’t seen a dietician before that since pediatrics). Those visits served mostly, it seemed, to line his office’s pockets and drain mine. Eventually, I would just cancel them without rescheduling.
Education, to me, is progressive. You learn one thing, and at the next class, you learn the next. My regular visits to these two wasn’t progressive, and it was like taking the same course over and over again. So I stopped.
My current endo has some supplemental staff; some are CDEs and some are not. He seems to make no differentiation, and collectively refers to them as nurses or NPs. They are there for additional help or guidance, as needed.
I think CDEs have an important role when a patient is seeking help, clarification, or coaching. They can engage with the patients in a way that the overworked endo cannot. Their presence and “service” (I don’t like that word, but can’t think of one better) can me mentioned, but it should be entirely up to the patient to decide whether or not they feel they can benefit from seeing them.
Just my two cents…
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I think what ever works for you is what you should do!! If you feel you need to see a CDE then see one. If you feel you are doing find without seeing a CDE, then nobody has the right to judge you. I too have never seen a CDE. My endo has never suggested I see one, and I am doing really well so I don’t feel the need to add one into the mix. At least for now. If things change in the future, then I am open to seeing one for help.
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Your reasons certainly made a great deal of sense. I had never seen a CDE (dx’d in ’74) until this past February when I began outpatient treatment for an eating disorder at the Melrose Institute here in Minneapolis. They are one of the few places in the country that has designed a program specific for Type 1’s.
I lucked out and got matched with a woman who is an absolute gem. She said, “I’ll be your cheerleader”, and my A1C went down 2 full points in the first 3 months. I feel much more comfortable talking to her than to an endo. She considers more the “human” aspect of the patient than most doctors.
I say, “if it’s not broke, don’t fix it”. But I needed fixing, and I’m getting it.
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This is really great feedback… thank you! I’m glad you’re getting the help you needed.
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I’d be open to seeing a CDE who’s a Type 1 and who has a better A1C and less hypos than myself. If not – deal breaker.
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you’re so very right IMHO.
I always feel so much remorse for the US when I remember that you have to pay to see doctors. That’s enough to not see any doctor in my mind.
I haven’t seen a CDE In a very long time. Probably not since first couple years of dx. Why? I just don’t find they offer anything to me and that’s because I don’t ask or feel like I need the assistance. Since I went off the pump I don’t go to my endo anymore either because I’m not forced to see him x times a year to get pump funding. I get my A1C done but he offered zero help to me. Again, because I never really asked or hinted that I needed any help.
In all honesty I feel like the management is on me and only me. It’s my choices that help or hinder my betes. The docs can only say so much but they don’t change anything.
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