Even if you are looked after by a diabetologist, it is still important that your family doctor knows what is going on as far as your diabetes is concerned. In Britain, and in many other countries, it is the family doctor who is called to your home in the middle of the night when you feel ill, whether your diabetes is the cause of your symptoms or not. Your family doctor cannot look after you properly if he or she does not have all your health details. Most diabetologists or diabetic clinics write to the family doctor every time a patient is seen. Some have cooperation cards kept by the patient on which clinical and laboratory details are written at each visit. If you have such a card, make sure that it is kept up to date and keep it safe and easy to find. If you have out-patient record cards of any sort, keep them where you can find them easily and take them with you whenever you see any doctor, or if you have to be admitted to the hospital.

Whatever arrangement you follow for your diabetic care, it is important that you and those caring for your health are clear who your diabetes adviser is: You must know who you should contact if you need help. You also need to know how to do this during office hours and at night or weekends. If you are unsure about this, clarify it with your family doctor and your diabetologist (if applicable) immediately. You should have on your diabetic card the name, address and telephone number of the person to be contacted in an emergency. Do not wait until three o’clock in the morning on a national holiday to find you have not got them.

When you first discovered that you have diabetes you needed a lot of help and advice. As you became more independent and confident, your contacts with your adviser probably became less frequent. You may have lost touch altogether. But no one ever stops learning about diabetes and even the most careful and expert people with diabetes occasionally need help. It is important that wherever you are, there is a doctor or diabetes specialist nurse whom you can contact if you are having difficulties, or for regular reviews.

You and your adviser may be together for many years, so it is important that you build up a trust and are able to get along reasonably well. Medical and paramedical staff is human and vary in their attitudes and their approach to problem solving and patient care. One doctor’s manner and personality may suit one person but not another. It takes time for you to get to know your adviser and for him or her to get to know you. If, after a time, you really feel that you are not getting along, discuss your feelings with him or consider asking if you can see someone else.

Another factor that may influence your choice of adviser is the framework within which he works. For example, some people prefer to be seen in small local centers, others like to go to large teaching centers. Some just like to see the doctor, others to see all the different specialized members of the health care team. You may not be able to choose exactly what you want, especially in country areas, but if you are unhappy with any aspect of your care and do not ask whether there is an alternative you will never find out about it!

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Your diabetes is also unique to you – no one else responds in precisely your way to changes in food, exercise, treatment and the passage of time. This is why it is very important that you learn all you can about your own diabetes. Armed with this knowledge and with the experience built up by health care professionals, scientists and others (including those with diabetes) you can take command of your diabetes and ensure that it remains well controlled and does not get in your way. Your diabetes is an inescapable part of you, but there is no need for it to intrude on your enjoyment of life.

This all sounds great in theory, but when you wake up in the middle of the night and start worrying and wish that it wasn’t you, that it was all a terrible mistake and you are going to wake up in the morning non-diabetic, then it is not so simple. Being diabetic is not easy all the time. The first, and maybe the hardest, step is to accept that you have diabetes and that for the foreseeable future you will remain so. This acceptance does not come overnight and some people with diabetes never fully accept it.

Jo has been diabetic for ten of her eighteen years. Nowadays she is in and out of hospital with ketoacidosis and mistakes in her insulin dose. I asked her how she felt about being diabetic and the answer was simple: ‘I don’t want to know.’

Being an ostrich is all very well, but if you try to bury your diabetes in the sand you find that the rest of you gets covered in grit too!

There is a tendency to see diabetes in terms of blood glucose levels and the mechanics of insulin injection or pill dose. When you go to your clinic you will be asked all about this and about symptoms of tissue damage. Sadly, in many clinics, there is too little time and too clinical an atmosphere to discuss how you feel emotionally. Many people with diabetes feel that the doctor’. . . doesn’t want to know about my private worries. He is much too busy thinking about my sugar levels.’ If you are worried, then we do want to know. It will help us to help you, and you may feel better sharing your anxieties. If something is worrying you, even if it seems to be nothing to do with your diabetes, the anxiety may upset your glucose balance.

Nellie is seventy-five years old and has been diabetic for twenty years. When she came to the clinic recently she looked tired and had lost weight. I asked her how she was sleeping.

‘I can hardly sleep at all. I’m so worried,’ she said and she started crying quietly.

She told me that because her husband had worked past the official retirement age his pension had been reduced. They were finding it very hard to pay the bills and she could not afford her proper diet.

‘But I’m keeping you from your work, doctor,’ she said. I pointed out that she was my work at the moment. Later, I arranged for her to discuss things with our welfare expert, who found that she was entitled to an additional allowance.

Feel free to discuss how you view your diabetes with your diabetes advisers, your family doctor, your relatives and with your close friends. It will help them to understand. You will be helping your doctor too. I am not diabetic and I do not know what it feels like to have diabetes. I need my patients to tell me how they feel. I learn more from my patients than I ever have from textbooks, and that helps me to look after future patients.

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