It was an ordinary day with a life-changing diagnosis: pre-diabetic. The doctor mentioned it during our visit, slipping it in without any sense of urgency or concern, as he listened to my heart with his stethoscope and then looked into my ears. “Just cut back on the rice, pasta, bread, and potatoes,” he said with a smile, as casually as he might have encouraged me to get more exercise or drink more water and eat more vegetables. I took my cue from him. His demeanor showed me that there was no cause for alarm, no need to be vigilant, and that I didn’t need to worry. I was young and felt healthy, so, I didn’t.
Flash forward to another doctor who read my pre-diabetic diagnosis in my chart and said, “I guess they are monitoring this?”, again with the same casual attitude mixed with little to no concern, not waiting for my response or hearing me say “no”. No advice and no referrals from him. No power for me after he minimized the importance of this diagnosis. None of what I expected from a good doctor, but not unusual for most.
After all, they had places to go and patients to see. No time to entertain my questions. No time for sharing a few words of guidance in staying as healthy as possible for as long as possible. No specific direction for managing my pre-diabetic health concerns that could save or extend my life. No suggestions and no one doing anything about it.
Were they treating this as unimportant because I was Black, female, and poor? Did the white-coated medical professionals as a result consider my health less of a concern because they saw my socio-economic value differently? Or did they consider me as little more than an afterthought to be checked off to get through a mountain of administrative paperwork and other demands for a growing patient caseload?
They passed the buck of diagnostic responsibility from doctor to doctor. They didn’t consider my personal needs and individual situation as their current patient who happened to have a condition that was outside of their specialty area. I was about to slip between the cracks of too little time and an oath not to harm. With all their many responsibilities did they not have time to care? I felt confused and unsure of whom to turn to.
The holidays came and went but I noticed a change. Family and friends in my age category who had received the same diagnosis were vigilant, more proactive, and more informed. They passed on the rolls, sweet potatoes laden with mini-marshmallows, mac’n’cheese, and avoided the sugary sweet, buttery, moist, and tasty desserts.
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Their food choices didn’t remind me that there was diabetes on both my mom’s and dad’s sides of the family; however, we never really discussed family health history when we came together to break bread.
With that background and my response to temptation, it was less a matter of how I would become diabetic, but more about when I would become diabetic or what that could mean, worst case scenario. Nevertheless, I clung to “pre-“ as protection, and loaded up on all of the sweet and starchy, high-carb holiday treats.
The next year rolled in and put the fear of God in me as far as this disease could. One paternal first cousin had multiple toes amputated; a maternal first cousin to whom I was very close was diagnosed with type 2 diabetes; and I became a more active observer of my then boyfriend’s and now husband’s struggles with diabetes for no cause or reason other than that’s just the way the cookie crumbles with this disease sometimes.
How was diabetes manageable especially if one was careful with one’s diet, adherent to medications, and included regular finger prick checks of one’s blood sugar, but healthy actions and faithful diligence still let you down? Maybe manageable did not mean reasonable and unreasonable meant unfair, since, in the end, diabetes would win.
Other than eating a low-carb, non-sweet/sugar-free diet, exercising to lose excess weight, and going in to see one’s healthcare provider for regular check-ups, there were no guarantees, no control, and no reversal once things progressed on the numeric scale from what meant pre-diabetic to diabetic. I have made peace with the possibility that the pre-diabetic stage of this disease has run its course and lab results will confirm me as another poor health statistic in our community.
I wish the doctors I saw had shown more concern earlier and less of an initial casual response. I wish they had given me an action plan to prevent the onset of full diabetes for as long as possible with basic information about type 2 diabetes itself. I wish they did not assume that somebody else was checking my condition regularly as permission to do the least amount that, nevertheless, still had the greatest impact on me. I wish they treated me and my total health as their priority even if they only saw me for ten to fifteen minutes and I was outside of their board-certified area of expertise. Most of all, I wish the doctors had given me hope so I was not eating my way ill while waiting for diabetes to happen to me before they would care for or about me.
I feel that the doctors I had dropped the ball and did me a huge disservice. I did not feel like my health mattered. Practiced neglect as professional distance avoided their use of our visit fully as a teachable moment to educate and empower me about type 2 diabetes, pre-diabetic or not. They did not arm me with serious, comprehensive choices of how best to live with this diagnosis.
They failed to make time to ask me the right questions to be sure that I would treat my diagnosis with sufficient care. Instead, I felt unworthy and not allowed to advocate for myself to have access to information from them that would tell me what to expect. They chose silence and inaction, leaving me to learn about type 2 diabetes through my own research or via hearsay from friends and family. My people weren’t experts, but sadly had all too real lived experience.
One different doctor could have made a difference. A doctor who treated me with answers and respect should not have been a hard to find rarity. Any one of the doctors I saw could have chosen not to dismiss me at the early stages as somebody else’s problem but looked at my being pre-diabetic as an opportunity with viable options.
I needed a provider to take charge of the onset of type 2 diabetes even if it meant a referral to someone who knew more and could create a solid and effective treatment plan. Just one person to follow through. Self-advocacy for better care without being heard gets old quickly. The expectation for pre-diabetes should be at least a satisfactory duty of common care. Whomever you see or however they see you through social lenses should not matter for some more than others. Black health matters, too.
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