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Are You a Noncompliant Diabetic?

When we don’t get our blood glucose levels low enough or take the diabetes medicine that our doctors prescribe, they often complain about our noncompliance. Particularly when we follow a very low-carb diet and are unlucky enough to have a nutritionist on our medical team, she is almost certain to give us a hard time.

When doctors and nutritionists do that, they are forgetting their place. The doctor-patient relationship is a status thing. While medical professionals usually earn more money than we do, they work for us. We are the ones who make them well off, if not rich.

We hire our doctors. We can fire them too. Several years ago when Byetta first came on the market, I knew that taking it would help me control my blood glucose and lose weight. The doctor I saw at the time had never heard of Byetta, so he had to read up on it. When he did, he refused to give me a prescription for it because he was sure that I would lose only a few pounds. I fired him and proved him wrong after I hired a compliant doctor.
A compliant doctor is one who not only talks at his patients but who also listens to them. Nowadays, many doctors are too busy processing insurance paperwork to spend much time listening to us. But when our doctors are not on the same wave length as we are, they often blame the victim — us — when we don’t do what they want us to do.

It’s our body, and we are responsible for it. One of the ways in which diabetes differs from other diseases is that between rare visits to our doctor’s office, we are in control. We have the right to set our own goals and decide how we will manage our diabetes because we have to live with the consequences.

We go to our doctors because we want them to help us. I’m not writing about those unfortunate people who are in denial and don’t see their doctor or go only under duress from others. Nor am I writing about misguided people who seek quack cures from so-called natural remedies.

But I know that almost all readers of my articles are trying their best to control their diabetes. I know too that our doctors try during the few minutes we have with them to help. Why then do we so often fail to communicate?

With most doctors those of us with diabetes have to take the lead to change our relationship. It has to become a partnership, as Jane Jeffrie Seley writes so well. We need to be firm with our doctors to disabuse them of their view of themselves that they are the experts whose job is to get us to behave in ways that reflect that expertise. If these experts fail to work with us, we have the duty to our bodies to find someone who will.

For most of us, to be labeled noncompliant is a worse slander than being called a diabetic. This is particularly true when health care people criticize us for not doing things that they haven’t clearly explained or which we think are wrong. An endocrinologist friend wisely says, “The ‘noncompliant’ label always grated on me — it’s assuming a model of health care delivery that the doctor is the captain of the ship and the patients are chained to the oars.”

Update October 27, 2009:
A new article on the website of The Los Angeles Times Jessica Bernstein beautifully illustrates out this problem of communication that we have with our doctors. The address is Diabetes may create a chasm between patient, doctor.”

This article is based on an earlier version of my article published by HealthCentral.

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  • Sarah at

    Not to blast the individual doctors, the problem in such environments is that they are overworked, and must follow ‘cookbook’.

    If you do not empower yourself, educate yourself, and stand up for yourself, you will be ‘cookbooked’. Some of this ‘cookbook’ reaction is liability issues, some is ignorance, some is ‘*I* am the Doctor!’ These people are running scared.

    But YOU will be labeled as ‘non-compliant’, and passed around, buck passed, when you show yourself to be correct, or die from their miss-service. (I can tell some stories!!!)

    Bottom line, educate yourself, have the cites, and references, and a means to present complaint over the ‘dud’. Eventually you will find somebody who will work with you.


  • Art Seaton at

    I define “expert” as one who is more knowlegable about the current paradigm than most. However, if the current paradigm is wrong, then being an expert is as meaningless as being able to pass a third grade math test, unless you are a third grader, that is.
    Most experts invest years of education into becoming an expert. Because of that, there is a natural tendency to resist paradigm shifts. Consequently, when a nutritionalist told me that the Zone diet is bad for diabetics because it is a low carbohydrate diet and therefor increases either the protien or fat to make up for the lost calories. If you are familiar with the Zone diet, you can easily see how wrong she was – all the way around. And that is before she went into the once held belief that high protien will cause kidney disease in diabetics and that high fat clogs the arteries and only increases the risk of heart disease. She also told me that while she is familiar with the glycemic index, she doesn’t use it because it is “just too complicated” for most diabetics.
    Because of her, I will have nothing to do with the nutrition department of my local VA Hospital. She is head of the department because of her expertise.