When You Care More Than They Do…

I’ve been debating writing this post for a while now. Actually about three months to be exact. It’s been a heavy topic on my mind for the whole time.

This post is all about diabetes, advocacy, education, health and what the hell happens when you care about someone you barely know because they are literally killing themselves.

I’ll start out and say that I’m angry and frustrated. If you read any of my other posts, you’ll already know that me being angry isn’t a common occurrence. I try my hardest to embrace the feelings of anger when they come (which, c’mon, they always do) and then let them go. But in this particular situation, I find myself feeling frustrated and angry all the time. I get irritated when I see the person involved. But I also feel sad and scared. I feel a whole mess of things, and I think, if you were in my situation, you would too.

I met Mandy (*name has been changed) about three months ago at work. In a new employee’s first week, I give several meetings on social media and online representation, so it was in Mandy’s meeting where I divulged my love for Twitter and all three of my accounts. I told her that I keep my most personal account separate from my more professional ones because I tweet a lot about diabetes and am very much an advocate for the education about diabetes (thanks, #DSMA and #DOC!). It was at that point that I told her I had Type 1 diabetes and she said she had Type 1 too.

So, what happens when one Type 1 meets another Type 1? Well, with me, I got excited! I also started asking her about her diagnosis, insulin, etc. After the blank look she gave me, I quickly shut up. She then corrected herself and said she thinks she has Type 2, but she wasn’t really sure.

Huh?

Mandy had absolutely no clue. None whatsoever.

Mandy has Type 2 diabetes. I met her in November of 2012 and she had been diagnosed in March of 2012 and given Metformin to help control her blood sugar. She has (to this day in January of 2013) never owned a blood glucose meter, seen a real endocrinologist, taken her Metformin when she is supposed to, and attempted to eat a better diet. She has however experienced worsening eye sight, extreme fatigue, lots of bathroom breaks and a trip to the ER after she passed out and almost went into DKA (diabetic ketoacidosis= HIGH  blood sugar).

I talked to Mandy pretty soon after she started working in my office about diabetes and what was happening inside of her body because she really had no clue. I explained what happens to the body when blood sugar stays elevated for too long, what happens when it goes too low. I explained the fundamental differences between Type 1 and Type 2. I also explained ways she could manage her diabetes, including better nutrition and exercise. I told her she definitely had to go to the doctor and get a blood glucose meter and emphasized that when I tested her blood sugar two hours after a lunch of Ramen noodles and her blood sugar was pushing 300.

I explained as much as I could about diabetes (of course, there was a lot that I intentionally skipped so as not to overwhelm her) and sent her a bunch of information and resources. The same information and resources that I found when I had been misdiagnosed as Type 2. I explained the DOC in case she wanted to reach out. I sent her a few great blogs that talk specifically about Type 2. I did everything for her that I wish someone had done for me.

She nodded her head and thanked me after we were done talking. I felt good. I felt like I was able to help someone.

That good feeling lasted about two weeks. Mandy said she would make an appointment to get a meter. She hadn’t yet. I also had noticed her diet hadn’t changed and carbs, carbs, carbs seemed to be the theme of the day, every day. I didn’t say anything because I (and every other diabetic) hate the food police. I hate being told from some know-it-all that I shouldn’t be eating a donut or a piece of chocolate. I have Type 1, so that makes things a bit different, but I would never ever want a fellow Type 2 deprived of a delicious and sugary treat every once in a while. I totally believe that moderation in diet is the key for everyone, diabetic or not!

Mandy and I talked here and there and it became increasingly clear that she wasn’t taking her diabetes seriously. I tried expressing just how serious it is and really had hoped my impression had been made.

Fast forward through the holidays. We are finally back at work after the New Year. It was the Friday after New Year’s and I overheard Mandy and her manager talking in the kitchen about the hospital. It had just dawned on me that Mandy hadn’t been at work the day before, so I casually (yes, I’m nosy!) walked into the kitchen. Mandy’s manager saw me and told me I had to talk to Mandy…

Mandy wasn’t at work the day before because she had been in the ER. After a morning where her boyfriend had a hard time waking her up, her eyesight turned completely fuzzy and she passed out as she got out of the car, she landed in the ER where the doctor quite literally asked her if she was trying to kill herself.

As an aside, the thought of going into DKA is terrifying. It’s something I think about a lot and it’s why I’m so vigilant with my health. To have someone with diabetes that I personally know almost enter into DKA is surreal and really grounding at the same time.

Anyway, Mandy and I went into a conference room to chat about what happened. I told her that what happened is really serious and could be avoided. I didn’t want to lay into her too much because it sounded as though the ER doctor and her boyfriend had already done that. What I did do was bring up the emotional side of diabetes. I asked her why she wasn’t taking car of herself. What was preventing her from taking her medicine and making mindful eating decisions?

“I think I’m in denial,” she said.

Denial, I’m thinking. We’ve all been there, I’m sure. Shock, denial, anger, sadness, confusions, frustration. These are all very common and typical reactions to getting life-changing news such as having diabetes. I get that. I’ve also read enough blogs and personal accounts to know that everyone gets the other D word. I told Mandy as much. I did my best to let her know that was a normal feeling.

“It’s time to leave da Nile in Egypt,” I said, trying to lighten the mood with a corny joke. In all seriousness though, I emphasized that there comes a point where you have to get past the denial. Sometimes people can transition into things easily. I was one of those people who got my diagnosis with shock but immediately jumped into a plan of action. I’m not sure I can say I was ever in denial, although I have my bouts with it every now and then. Denial, for me, was never an option. I felt so terrible and unhealthy that I wasn’t going to deny something was wrong with me. I also am a Google fanatic. My friend Liz and I (name twins!) often have conversations about our unhealthy obsession with using Google to find information about anything and everything, from subjects like English literature to current ailments. So, it was in my nature to Google around the internet until I had a bunch of information about diabetes and what I could do to live a healthy life.

Mandy isn’t like me. I have to keep reminding myself of that. Mandy is Mandy and Mandy is going to do what Mandy wants to do, even if it’s the wrong thing to do. And who am I to judge it’s the wrong thing to do? Granted, I’m sure a lot of people think her denial and lack of motivation to do anything about diabetes is the wrong thing to do, but who are we to judge? (See my problem!)

We ended the conversation talking about resources to help with coping. I suggested she talk to a Certified Diabetes Educator and maybe even a psychologist. I stressed the importance of her getting over the denial in order for her to start on the road to a healthier life. We talked about what would happen if she continued down the path she was on. That path would include insulin injections, complications or even death.

I hoped her trip to the ER would snap her out of denial and wake her up to what a life with uncontrolled diabetes can cause. I thought she would take that as a sign to do research for herself and change her lifestyle for the better.

I understand lifestyle change is hard. But I don’t understand at the same time. I’m not sure if that makes sense, but when I was diagnosed with diabetes, I immediately cut out all carbs. I’m serious. My diet became vegetable and protein rich. I stayed away from carbs. I ate cheeseburgers without buns, avoided pasta, gave up pizza. I did all of that (at least until I got my blood sugar under control). I’m not saying that’s the right path for Mandy, but I don’t think drinking a regular Coke is a way to control diabetes either.

A regular Coke, people! This happened about a week after Mandy’s trip to the ER and our conversation. I saw it at lunch and was flabbergasted. I mean, I haven’t had a regular Coke since about 2008 and would only ever drink it now if I was super low (my treatment of a low is usually glucose tabs or something desserty, like a cookie). Even then, just a little bit of that 24oz bottle would be enough to bring a low back to normal. I was stunned that she would drink the whole bottle.

I spent my lunch break walking around like I usually do and kept going back and forth on whether I wanted to talk to Mandy about this or not. Food police, like I’ve said, is not something I’m interested in doing.

But I was so worried about her that I decided to talk to her. This conversation was similar to the last one I had with her. I told her what the Coke was doing to her body right then and there. I told her she has got to start reading labels and looking at carb counts. Things like Coke and apple juice have more carbs in one bottle than a lot of people with diabetes eat in one day. Spending a lot of time reading labels is something she would become used to.

Again, the issue of denial came up in our conversation. She doesn’t want to change her lifestyle. She loves food. I told her that I got it. I understood. I’m a self proclaimed foodie too. But, I said, things HAVE to change for her health. She HAS to do this for her health. If she wanted to have a healthy pregnancy (which she mentioned) she would have to get her blood sugar under control. If she didn’t want to take insulin, she had to get her blood sugar under control. I again mentioned resources and information.

Sensing a pattern yet? Getting frustrated by the same conversations? I was.

I wasn’t only frustrated by the time we had this conversation. I was annoyed.

When I think about Mandy and her diabetes I want to scream. I literally want to pound my fists into a wall and scream. I want to yell at her. I want to do something that will wake her the fuck up. No more denial. Let’s get real here!! It is time to get real!

I know this post is long, and I’m hoping it makes some sense, and I want to thank you for bearing with me. Maybe if I had written this out as it was happening, I wouldn’t be at the point I’m at now. That point is feeling a bit desperate for Mandy. I’m feeling desperate and worried.

The day after the “Coke incident” I saw Mandy drinking apple juice. I bit my tongue. I tried to forget about it.

I keep telling myself (and my mom does too) that people have to want to help themselves. Change only comes about if a person wants that change to come about. I know this. I know that I can have fifty more conversations with Mandy. I can show her pictures of amputations. I can show her statistics. I can give her information about support. I can encourage her to eat better and point her in the direction of great healthy food blogs. I can do a variety of things, but it won’t matter because Mandy has to want this for herself. Many won’t change because I want her to change or her boyfriend wants her to change. Mandy’s health is solely Mandy’s and she can do what she wants with it (which, she is). But I still feel like I have to do something.

I feel a responsibility to do something. Is that normal? I barely know her. I think it’s because I’ve met so many people through social media that are a part of the DOC. It’s that bond that immediately happens through diabetes that makes me feel compelled to help, I think. But would you?

Mandy was out yesterday going to the doctor. I briefly talked to her today about what happened. Her primary care doctor told her she thinks she needs to go on insulin and got her a quick appointment with an endocrinologist who said the same thing. I asked her if either of them gave her a blood glucose meter. She said no and this is where things smell fishy. Why wouldn’t either of these doctors give this poor girl a meter? Why didn’t Mandy ask? She knows how important this is. Mandy went on to tell me she wanted to get a second opinion about going on insulin.

I laughed. Or maybe it was a scoff. I’m not quite sure.

A second opinion? Really? Mandy, dear, you don’t have time for a second opinion. Your blood sugar is out of control. You need to do something! You’re killing yourself. You need to do something to help yourself and right now it might mean taking insulin (I told her this would happen if she didn’t get it down). She’s scared of needles. Scared of insulin. I understand that, but what choice has she left herself with? What other option is there? No second opinion needed. Also, who are these doctors and why didn’t they start her on insulin when she was at the doctor’s office? Some of her story seems a bit fishy, but I’m giving her the benefit of the doubt that she did actually go to the doctors and not just tell the office she did (everyone at work is worried about her now).

Readers, DOC, non-diabetic friends… what would you do? Would you give up on Mandy? Would you feel as frustrated as I do? Is there anything I can do to help her out of denial and on a healthier track in managing her Type 2 diabetes?

I feel an obligation to help. I feel even more of an obligation because I keep failing at helping her. I also don’t know how to go about helping anymore. In the past, when I’ve worked as a teacher, I knew my role and I knew what I could do to help my students succeed. I’m not Mandy’s teacher. I’m not her doctor or her CDE, so what’s my role? I can’t just watch someone with diabetes do this to themselves.

So, I’m asking again. What would you do when you care more about someone’s health than they do? And thank you. Thank you for reading this and for being there for me when I need you. I promise, in return, to always be there for you.

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17 thoughts on “When You Care More Than They Do…

  1. I am wondering whether she has gone to an endo. What I have learned is that most T2s are treated by their GP. With my brother-in-law’s diagnosis they told him over the phone and sent his scripts in without a consultation. Absolutely no betes-ed until 3 months later. I have noticed this gross treatment of 2 other T2s in 2 other states. I am not sure if it is an insurance protocol. Passing on info matters perhaps offering to go to an appt with her. As a former teacher you know the power of mentoring…perhaps a d-mentoring/ apprenticeship? Hang in there! According to Heath’s Switch appeal to her mind and heart and help her make a specific timelined plan. At the very least keep listening. Good luck!

  2. Hi, it’s the first time I’ve read your blog and what a way to start: it was a compelling read. I’m not diabetic but my Dad is t2 and my 12 yo daughter is type 1.

    I think what you’ve done is admiral and although it’s upsetting you I would stick with it. At some point I believe that something will get through to her. There are other angles you could explore, maybe talk to her boyfriend if their relationship is serious, or her parents/relatives if you come into contact.

    On a professional level I’m presuming that your workplace won’t put up with regular days off due to what effectively is her own doing., so could they say something directly to her. If it was my place of work and they understood what was at stake a manager would have a discreet word, explaining potential outcomes depending on the choices she makes.

    On a personal level just before Christmas I was very unsure whether or not to step in call the Police on someone I thought was going to harm themselves. Over the space of an hour I deliberated whether I was overstepping the mark, was it any of my business, what right did I have but chose to do it. I was convinced that the person would never talk to me again but in the end they were pleased for the support, to see how much they meant to others, so it was worth it the end.

    I would say stick with what you’re are doing, as long as it’s not bringing you down too much. She may not like or enjoy what you say but if one word sticks and she changes for the better she will appreciate it in the end.

    Hope it goes well

    Kev.

    • Kev, thanks so much for your advice and kind words. I wasn’t sure how well this post would be received and if people would think I’m a terrible and nosy person for getting involved. I’m not though. I just really care about people in general and have a close office, so it’s hard to see someone at work out sick so often because of her diabetes. I also understand what she’s going through, whereas her manager doesn’t (those diabetes misconceptions). Another commenter couldn’t believe that Mandy’s manager said something about her health, but the fact of the matter is that what you said is right! My office can’t run without everyone being there the majority of the time, so if she’s out too often, the chances of her getting let go greatly increase. I don’t want her to be let go because she’s sick all the time, ya know.
      I did the same thing you did and debated whether I was overstepping lines every single time I talked to her, but every single time she seemed very gracious for the support and resources I’ve given her. It’s that graciousness that makes me want to keep going and, like you suggested, maybe approach it from a different angle if another incident happens. I have to believe that somewhere along the way, the information will stick and a lightbulb will go off.

      Thanks again for your comment! Stop by anytime 🙂

  3. The part about this that really really sucks is that you can’t make Mandy do the right thing. From what you’re saying, you’ve told her, given her resources, reached out and let her know that you’re there. Unfortunately, I’ve known a few people with type 2 who, aside from the regular Coke thing, did the same thing as Mandy for years before realizing they need to get it under control and suffered complications because of it.

    You can only talk, you can’t take her to the doctor or force her to eat right. You can continue reaching out. If I were in your situation, I would be sending her emails on a regular basis of good low carb recipes, giving her the free meter offers I get in the mail occasionally, asking her how she’s doing and if you do some sort of exercise like walking on your lunch break, invite her to join you.

    I was diagnosed in DKA, it’s a bad place to be and I’m on the proactive side like you so I’m frustrated that I already care about her health more than she does!

    • Rachel, you pretty much took the words out of my mouth! Thanks for the advice, especially sending her low carb recipes. Her and I have bonded over the fact that we are both “foodies” and I think one of the things she’s afraid of is that she won’t be able to eat the foods she loves because of her diabetes. Maybe if I send her some good things that I’ve been making she won’t feel so overwhelmed or angry about having to give good foods up.

      I just really don’t want her to be one of those people who waits years before realizing they need to get it under control. It just seems terrible and the complications are devastating.

      I’ve never been in DKA and I’m sorry to hear that’s where you were diagnosed, but glad you’re doing ok today! It’s hard to be such a proactive person and meet someone who isn’t, especially when you know that their quality of life will greatly improve if they make some healthier decisions.

      Thanks again for your comment and advice!

  4. Not in a D context, but in similar situations, I have told people that, “gosh, I remember when I was in your shoes… that was tough, it must be hard. When [whatever] happened to me (diagnosis, hospital stay, coming to grips with dealing with D or any of a number of whatevers), I got a lot of help from [whatever resources] and I’d be happy to send you links (brochures, literature, etc.) if you want. If you have any questions or need any help with anything, I’m available and can help any time.” That puts the ball in the other person’s court, but also lets them feel like they have the control rather than feeling overwhelmed, or judged, by the [whatever] police. It also lets them, if they take you up on the offer, get help with whatever they need help with on their own time frame/schedule. Aaaand, you should be able to rest a little easier because even if you aren’t working with her regularly, you’ve left the door open for her when she’s ready.

    I’m not a regular reader of your blog or contributor to the DOC, but came to this post through a RT by @sixuntilme. I hope my comments are useful.

    • Hey Kit, thanks for the comment and for reading! I really appreciate it. Your advice is definitely spot on and I think she knows that I’m there for her should she ever need advice/resources/etc. I guess the hardest thing for me is sitting back and seeing her not take responsibility for her health when she could. But again, who am I to judge her time frame, ya know?!

      Thanks again for your advice 🙂

      • I was dx’d when I was 8 and when I moved out at 18, I went through what i’ve come to think of as mourning phases (denial especially) and I’m sure there were many around me that felt the same as you in this situation. The way it worked out for me was that I I actually needed to get enough separation from what I thought of as the D police (my parents-my mom especially) for me to take ownership of it myself. I’m certainly not advocating that path for anyone, but I feel like that’s the way it had to happen for me to take on the responsibility for myself. I’m also not sure that’s what Mandy’s deal is, just my experience and another possibility to consider. Good luck.

  5. I think what I might try to do, in your shoes, is invite her into the diabetes world a little more subtly. Do you meet with a local JDRF/ADA group? Maybe invite her to one of the events/dinners/whatever with you. Or a DSMA talk?

    Would your endo (or another nearby DOC member) be willing to give you a meter with sample strips, that you could pass on to Mandy? Maybe drop it off on her desk, or bring it by and suggest that you test with your meter while you walk her through doing a test of her own. You’re already doing a great job of not policing, but she might also be overwhelmed by all the information that you have provided.

    Perhaps be more obvious about your own testing, injections/pump whatever. Maybe seeing somebody else taking care of themselves, and showing that diabetes is manageable, would help ease her in.
    Maybe offer to go the endo with her? Or have her tag along with you once? I could see how that might be a little to personal for a coworker…

    At some point you’ve done truly all you can do, until she decides to take responsibility. Then when she does, she’ll know you and the DOC are here for support.

    I hate to bring this up, but a story awhile back surfaced about someone faking a long-term condition for whatever reason. Though, you obviously know what to look for already.

    • Thanks, Sarah for the comment! I know she definitely isn’t faking her diabetes (how terrible that someone would do that, by the way!) because I’ve tested with her before and it was pretty high.

      Your advice about inviting her to a JDRF is great! I go to an event about every other month, so maybe I’ll throw it out there the next time I go and invite her along. I commented on another comment about the meter and actually offered her one of mine but she declined.

      At this point, I’ve given her a bunch of resources and I know her boyfriend and mother are a great support system for her, so it really is up to her to take full responsibility for her health. I’ve told her all about the DOC and blogs in case she were every interested or ever felt alone in this (because she’s most definitely not).

      Thanks again for the suggestions, and for reading. I really appreciate it!

  6. I don’t even know. I really don’t. From a distance, it’s tempting to tell you to forget about her and let her do whatever she’s going to do. But then, you have to *see* her every day.

    My husband’s BFF was diagnosed about a year and a half ago, at age 39. He lives across the country, but we’d witnessed him dropping a dramatic amount of weight without trying and I had a hunch that it was the big D. When he finally confessed to my husband that he was down to 135 pounds, we begged him to get a meter and test himself. Every result he got was “HIGH”, and still, he wanted to wait and maybe make a doctor appointment later on. I was so frustrated I almost jumped through the phone.

    Thank God, we were able to convince him to go to the ER that night, where he was diagnosed.

    Can you buy her a meter? One of those cheap little tiny ones?

    • Wow, that’s scary that your husband’s friend got down to 135 pounds. For a man, that’s pretty dramatic! Thank goodness he got to the ER when he did! I actually have offered to give her one of my meters and some test strips until she gets one for herself and a prescription for strips but she declined my offer.

      I’ve even gone so far as to walk her through a test when she asked me (after the first time we talked) if it hurt so she could feel for herself that it wasn’t so bad.

      It’s just so important, at least in my opinion, to have a meter because then you can see what’s happening with your blood sugar throughout the day. Seeing that number helps me (and I’m sure other diabetics) make healthier decisions.

  7. As much as it hurts I think you need to back off. This is a coworker you barely know not a personal friend. It’s one thing that you stepped up when she offered that she had diabetes but I can’t believe her manager asked you to speak to her. Do the managers discuss everyone else’s medical conditions? She has to help herself and I don’t think you should give any more unsolicited advice. If you keep it up but eventually she will just try to avoid you at work or get a new job

    • I see where you’re coming from, and definitely have tried to balance out the unsolicited advice vs. friendly advice. I guess I’ve tried to give advice in the same way I wish someone had given me advice. And no, managers don’t usually discuss everyone’s medical condition. I’m very open about my diabetes and work in a very supportive (and small) office where everyone actively participated with me in Diabetes Awareness Month. My intention is not for her to feel pressure or the desire to look for a new job. All the times I’ve talked to her, I’ve constantly told her that if she thinks I’m stepping over the line, to please let me know (she’s pretty outspoken herself). I do agree with you in that she has to help herself, and while I’m not a personal friend, I have been out with her in social type settings and do know a bit more about her than say, a CDE would and unfortunately, she’s not seeking the help of a CDE or even an endocrinologist.

    • In my workplace managers at my level are taught to value a person’s wellbeing, that we have a duty of care to them in the same way a school looks for signs of bullying/abuse in its pupils. We do not discuss it with other managers except up the heirarchy if required but if we can help we should. As a manager I would have sought Liz’s advice and done exactly the same as Mandy’s manager.

      • Thanks for backing me up on this. It’s the same type of environment in my workplace as well (small office of 16). Mandy’s manager is worried about her and came to me because of my knowledge about diabetes. She expressed concern for Mandy’s well being, but also concern that she may not be able to do a good job at work with continued absences because she doesn’t care for herself.

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