Ah, diabetes clinic. Also known as The Day of Judgement. Today as I sat in the dank corridor of Sir Charles Gairdner Hospital (SCGH), I pondered my lifetime of diabetes appointments.
It all started at Princess Margaret Hospital (PMH). I attended diabetes check-ups at PMH every 3-4 months for 12 years. The itinerary for a PMH check-up differed greatly from adult clinics. First of all, they were immensely more stressful. At younger ages (keeping in mind I started attending clinics from 6 years of age), I was mostly unaware of the stress a clinic could induce. I noticed sometimes that my mum would be a little on edge. As anyone who has met me knows, I’m a blurter. I blurt things out without thinking, pretty much all the time. It composes about 80% of my daily speech. Now and then at PMH clinic, I would blurt something. Usually it was something along the lines of “I DRINK 250MLS OF FANTA” when the endocrinologist or diabetes educator is asking my mum how we treated my hypos (low blood sugar). Unbeknown to me, I actually drank 150mls of Fanta. The endo/educator looked at my mother with judgement while she hastily corrected me. She would occasionally snap at me for something small later as a result of all the pressure on her, leaving me mortally wounded and oblivious to the reason why. I get it now. Constant judgement for over an hour on how you care for your child. It’s anyone’s nightmare!
Clinics at PMH in general (special occasions omitted) went like this. Arrive at PMH. Go to clinic, say my name. Sit and wait. A diabetes educator would come around and call me into a room. There, I would have my height and weight taken. They would also take blood from a finger prick to measure my HbA1c. HbA1c is a tool used to get an idea of the amount of sugar in your haemoglobin over the previous 6-8 weeks. This enables the diabetes team to evaluate your overall control.
Back to the waiting room! We wait a little more. Stress over the fact that we didn’t bring my blood glucose record book (eventually they stopped asking- some people just don’t have the brain space to remember things). Then, we get called into the endocrinologist’s room. The one we always went to had a portrait of cut up oranges in it, and for some reason I loved it. The endocrinologist would usually just chat to my mum while I sat in my own world (as a child) or sat in broody silence (as a teenager). I would usually beg for my blood pressure to be taken. Mum and the endocrinologist (almost always Dr. Price for the past 6 years of my care- a living legend!) would look over my insulin regime, discuss any hypos or issues with sugar control. Then I’d be set free and taken straight back to school.
Occasionally we would see a dietitian or social worker at the clinic. Social workers helped organize healthcare cards and the like- nothing too exciting for me to remember. The longer we went to clinics, the less we saw dietitians. While at the adolescent clinic, I refused to see them altogether. Now, I work alongside dietitians for my career, and I admire them. I believe that they are a complete necessity to the patients I treat, and I commend their work. But my personal experience with dietitians has been bleak. At first they were a great help, along with diabetes educators, at teaching carb-counting and what kind of foods were low GI etcetera. But soon after, they pretty much only talked about my weight. As a (normal-sized, I might add) seven year old, it wasn’t very pleasant to have adults discuss my weight and tell me I was overweight every 3 months!
(Me blowing out the candles at my 7th birthday party. Definitely not overweight!)
So, from paediatric clinic at PMH, we move to SCGH. In the public system, you go from roughly 3-monthly visits at PMH to 6-monthly (if you’re lucky!) visits at SCGH. I started off in the young adults clinic at SCGH, with an amazing educator named Gwen Babel. Unfortunately, it takes more than a great educator to keep a supportive system in place. I was soon placed into adult clinics at SCGH, once they noted I was already in control of my diabetes and able to manage it. Adults clinic is… unpleasant. It’s a mix of type one and type two diabetics. At my appointment today, I was the only person under the age of 65. Usually, being with a bunch of senior citizens would make my day! Unfortunately for me, senior citizens don’t like me with bright pink hair when I’m not in my nursing uniform :~(
My usual visit at SCGH takes 20 minutes, compared to the usual hour or so at PMH. I sit in a corridor. I get called into a room. My weight, height and HbA1c are taken. I sit back in the corridor. I see the endocrinologist. I go home. I have to specifically request to see a diabetes educator, and sometimes the closest slot they have is 6 months away!
Due to the immense pressure on the public system, my last visit before today was 14 months ago. During my last visit the doctor informed me that since I was so well controlled, I could go a year without seeing them. A pretty great system! Here’s your reward for taking care of yourself- you are stripped of your support! As a health professional I understand why this is the way the system works. I don’t mean to criticise any of the people who work at the diabetes clinic, they are an amazing team. However, the stark difference between the support in paediatric and adult clinics still mind-blowing to me after all this time. All those advertisements aimed at type twos to exercise and eat well… how about giving them access to the services they need? All this pressure to maintain a HbA1c below 8%… but no guidance on how to get there?
ANYWAY, that’s me done. I turned a little ranty there, my bad.
Until next time!