Blurring the Boundaries

I've been a pumper for more than half a decade. Yet everyday I deliver more than a dozen injections.

They're not injections delivered subcutaneously, through tiny needles. They're not injections of insulin. Most importantly, they're not injections given to myself. They are local anaesthetic injections, given to  my patients just as routinely as I once gave myself insulin.

There are really few similarities between local anaesthetics and insulin injections. The differences reflect the size of the boundary I like to keep in place regarding every aspect of the relationship between my diabetes and my dentistry. I like to keep them very separate.

I don't disclose to my patients that I have diabetes. Partly because it normally simply isn't relevant. But it's also in part down to fear. Fear of being judged. Fear of people losing their confidence in me, or believing me to be unfit to do my job. I've nothing to base this on, but I don't want to take a chance. As I write this, I realise how crazy it sounds. Anyone of you reading this could in future be a patent of mine and I've no problem discussing diabetes here. But still...

I've repeatedly found myself cringing when I meet a patient with diabetes and I find myself asking "How is your control?"

It's a very important question. Poorly controlled diabetes can increase the risk of dental disease, in particular periodontal disease. Conversely, poorly treated periodontal disease can worsen glycaemic control. I know that people can easily lie, saying what they think I want to hear. And I also know how feel when a perceived uninformed medical professional, or other person, asks me about my control.

Who are they to judge? I think. What do they know anyway?

I've certainly met this wall of defence when I've questioned patients before, no matter how sensitive my approach. I've longed sometimes to break down my barriers, share a conspiratorial smile and say "It's ok, I get it. I understand."

I've also been met with a degree of curiousity before now. People who regard me warily, as if trying to figure out how a dentist would know so much about diabetes and blood glucose values. Some even seem impressed. I wonder now how may might have guessed correctly how close my relationship to diabetes is.

Outside of the professional-patient relationship, I'm very open about diabetes. I'm excited when I meet others wearing insulin pumps, eager to share stories and experiences.

Two days ago, the boundaries blurred.

"So how do you feel your diabetes control is?" I asked the young man sitting in my surgery.

"Well, good, you know. I wear a pump...."

I wonder if he expected me not to now what a pump was. I wonder if he was expecting to be questioned, or to have to explain as we've all done countless times before. In all the time I've been pumping, I've never had a patient tell me they have a pump too.

My reaction was more automatic that considered. I smiled, flicked up the corner of my tunic to reveal my pump, clipped to my waistband.

"Snap."

The world didn't end. The patient didn't leave. Instead he just knows that his dentist really does get it.

Comments

[Jenny]

I'd give a great deal to find a regular doctor with diabetes, because maybe, finally, I'd have a doctor who would understand what I was talking about and know at least as much as I do about insulin, diet, etc.

People with diabetes stay too closeted, which is why we pay 40% more now for strips than we did ten years ago. And why the organization that collects money on our behalf--the ADA--puts the interests of drug companies and corporate sponsors ahead of those of the people who have diabetes.

There are a lot of us out here, but until we lose the fear of going public, we will never take back our power.

[Christine]

I've told a few patients that I have diabetes. One had a pancreas transplant, the other was being admitted to the ICU in DKA. The world didn't end either time ;)

[Jana]

I very much understand your fear. I interviewed (unsuccessfully) for a job last week, and for the first time, I disclosed my diabetes before being hired (usually I wait until after or I don't disclose at all). I didn't really plan to disclose, it just happened because they asked how I felt about transporting blood (this was a research assistant kind of job in a human subjects lab at a hospital) and I said, "Oh, I don't have any problem with blood. I'm a type 1 diabetic."

The interview had seemed to go really well, but I didn't get the job, so now I have this nagging fear that they were faced with two approximately equal candidates, me and someone else, and they chose the someone else because I had diabetes. Or even worse, perhaps they liked me best but chose a slightly less qualified candidate because I had diabetes.