4 Easy Ways to Talk to Your Doctor About Type 2 Diabetes
- Write down all your questions.
You’ve waited a long time for this appointment. If you’re like most patients you likely waited 3-6 months. While your doc would love to spend as much time as needed with you. The reality is, office constraints limits that time to 15-30 minutes of face time, tops (1). This may seem like a reasonable time. However, when you factor in time for an exam and review of history. You may have a precious 10-20 minutes for actual question and answer session. Use this time wisely. This is not the time to mentally recall and process your questions. Having your questions written in advance, helps to ensure you hit all the major issues. It also demonstrates to your doctor that you are serious about your health and are willing to be an active participant in your care. I have found the simplest way to record all my notes is to write it down on a note app on my smartphone. Not phone smart savvy? No worries, carry a small notebook you may use to jot down your thoughts and questions. Just don’t forget to bring it with you on the big day.
2. Know your numbers- HbA1c (pronounced heem-o-globin-a-one-sea), BMI, waist circumference.
You know, it would be nice if we knew that things are better just because we feel better. Certainly, feeling good about a situation is very much a worthwhile goal to have. It fuels positive action and decreases internal stress. Seeing objective change however, will do even more to bolster your confidence and motivation.
- Your HbA1C is the measure of the average level of glucose circulating in your blood over the last 8-12 weeks (2). Glycemic goals are made on an individual level. Depending on your age and other factors such as the presence or absence of other chronic illnesses, the target number for your HbA1c will vary. Determine with your doctor your targeted HbA1c level.
- BMI (body mass index) is a number that reflects your weight in proportion to your height. It is a very practical measure of body fat. The numbers are categorized as underweight, healthy weight, overweight and obese (3). Granted these are rough estimates and in rare situations the categories may not be one hundred percent accurate. For instance body builders may have a BMI that inaccurately assign a category of overweight, when in fact they are of healthy weight. Their high muscle mass leads to a higher weight which drives the BMI into the overweight category. But, if you are not a body builder or someone who has far more than average muscle mass, then chances are your estimation is accurate. Play with the number in our BMI calculator so you may see what weight is needed in order to reach the desired BMI [http://www.uptodate.com/contents/calculator-body-mass-index-bmi-for-adults-patient-information?source=search_result&search=bmi&selectedTitle=1%7E150].
- Our waist circumference is the measure of what’s called central adiposity. It tells us how much fat surrounds our internal organs. It is a great indicator of our cardiovascular risk. Persons with a higher waist circumference are at an increased risk of heart disease, abnormal lipids (high cholesterol , LDL etc), and liver disease. Waist Circumference of 40 inches (102 cm) or greater in men, or 35 inches (88cm) or greater in women, is abnormal and puts you at an increased risk of heart disease (3).
3. What are the things I can change?
The vast majority of our health concerns are within our control. There are a few aspects that are genetically driven and therefore unable to be modified. But let’s focus on what we can control. There are many things we do that alter our state of health. Such as choosing whether or not to smoke or consume alcohol, our diet physical activity and stress control. If your doctor is concerned about your type 2 diabetes, ask him what are the things I can do to help control this. For most chronic illness, the management options will be varied. Some of the top options include medication compliance, weight reduction and stress management. Review your options with your doctor, then decide on one of these factors that you would like to focus. Handling one goal at a time will increase your likelihood of success. This will motivate you to tackle additional goals.
- What is the one thing you can do to reach your target goal?
Having a goal is a start to achieving that goal. But without the activity, that goal becomes as elusive as the unicorn. Now that you have established this goal together, you have to determine what activity is needed in order to accomplish this. For instance if the goal is to lower your HbA1c, the activity may be to no longer add sugar to your coffee or to instead use a sugar substitute. Focusing in on one activity 1) helps to determine if this is an effective way of meeting your goal, 2) decrease the sense of being overwhelmed, 3) makes it more likely for your goal to be achieved.
- Time and the Patient-Physician Relationship. Dugdale, David C. MD; Epstein, Ronald MD; Puntilat, Steven MD. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869]
- Estimation of Blood Glucose Control in Diabetes Mellitus. McCulloch, David MD. [uptodate.com]
- Obesity in Adults: Prevalence, screening and evaluation. Bray, Geoge A. MD [uptodate.com