Dear CDE – A Guest Post from Bob

I met Bob on Twitter like I met most of my diabetes online community contacts, but Bob is special because he was one of the first DOC-ites that I met in person. Bob and I attended a World Diabetes Day event held in Kansas City last November. Bob has type 2 diabetes, and we find it interesting to converse on the differences in taking care of our similar-but-different conditions.

One day, Bob asked what topics his readers would like to read about on his blog, T Minus Two, and he and I had a conversation about what a CDE would want to know about his or her type 2 paitents. The following blog was posted here on his personal blog at the beginning of this month, but it was so good I wanted to share it with you as a guest blog as I trek my way across the Rocky Mountains today. Thanks to Bob, and enjoy!


(Saturday afternoon, I put out on Twitter a request for Type 1s to make suggestions about anything they might like to see a Type 2 address. Sarah, who is working towards becoming a Certified Diabetes Educator (CDE), responded “Everything!” I’ve chosen to write this post to the CDE I might work with someday.)

Dear CDE —

I don’t know you yet, nor what circumstances caused me to need your services.  But I’d like to tell you some things about me and my diabetes to give you the best shot of helping me. Because Type 2s rarely have Certified Diabetes Educators, your availability to me suggests that I’m having real problems.

First, I am a man in full.  I am more than my metabolism, more than my BG log, more than what they scale says, even (despite the saying) more than what I eat.  I have a sense of humor and am an incorrigible punster.  I’ve read an awful lot of books.  I have some hopes and a lot of fears.  I am cranky and often inwardly judgmental, but my compassion and overriding desire to treat all people well are easily aroused and overcome the crankiness and judgment.  I’m happy to live alone, but I am sometimes lonely.  These details are not important for you to know.  What IS important for you to know is that I, like all your patients, am a complete person.

Second, I need you to start with questions about who I am and what I already know about diabetes.  If you start with a standard informational spiel, you’re going to be wasting time for both of us.  I don’t doubt that there are many things you can teach me, but none of them would come up in your first session with a newly-diagnosed patient.

Third, you’re not going to make me skinny. I’ve been seriously obese for four decades. In all likelihood, I’ve worried about my weight since before you were born.  It’s no longer a healthy goal for me.  I need to you to assist me in my efforts to live a healthier life.  If substantial weight loss happens as a result of that healthier life, that will be wonderful.  But that isn’t, and can’t be, my goal.

Fourth, if I need changes in my treatment and your role includes making suggestions to my physician, I suspect that my needs as a Type 2 may be a little different than for your Type 1 patients.  An experienced Type 1 may be able to be at least your equal in deciding changes in basal rates and so forth.  However, it’s not possible for me to really understand all the types of medication therapies that are available.  However, I do expect you to solicit my strong participation in decisions about tradeoffs among alternatives.

Fifth, it’s often said that insanity is doing the same thing over and over and expecting different results.  Given the miniscule percentage of people who are able to make sudden dietary change, and the even smaller percentage of those who are able to stick it for the long haul, just what would be sane about your reaching into your desk and handing me a one-page meal plan?  If I could make a “meal plan” work for me, it’s overwhelmingly likely that I wouldn’t be meeting with you.  What I <b>do</b> need is information about smaller changes I can make or suggestions as to how I can circumvent the barriers I face. I also need help in sorting out which pieces of medical research I should be paying attention to.

Finally, don’t try to “scare me straight” or scold me.  Fear does enable to make some people to make changes.  But my diagnosis was a long time ago, and I wasn’t ignorant for long about what it meant.  Frightening me won’t make me skinny,  it will just make me fat and scared. I don’t consider that progress.  As for scolding, I assure you that all the scolding that might be helpful, and more, has already happened within my heart.  From you, I need respect and a little kindness.

Thank you for meeting with me.  I respect you and your very significant attainment of education and training. I’m likely to be a little reserved when we first meet, but I do hope you can help me.  I hope that very, very much.

Your patient,


3 thoughts on “Dear CDE – A Guest Post from Bob

  1. Sarah

    Thanks for guest-posting this. I especially loved the final point – “don’t try to ‘scare me straight’ or scold me”. Fear doesn’t work for some of us D’s. Sometimes, it can put us in more of a depression than what D already does. To me, a CDE or endo that does that really doesn’t know their patient. If they knew their patient, they wouldn’t do it, but rather work with them to get to the source of the issue.

  2. sisiay

    I like this. I’m glad Bob’s an incorrigible punster, makes him fun to have around 🙂 I think the one thing I’d say is that a CDE is probably not the person to look to to help you make incremental changes in diet/lifestyle. There may be the rare/gifted one who speaks that language, but that’s more likely to come from someone else. CDEs have so much knowledge they want to use, but they also see soooo many people, that unless they’re diabetic themselves, it’s really, really hard to appreciate the personal nuances/needs of the disease, no matter their intentions. If you want to make incremental changes, the best way to do it is to just try a tiny change, something you know you’re up to. You obviously know all the science, and know what would be better/worse for you. That’s the lesson we all learn (and unlearn and relearn etc): ultimately, drugs come from doctors, the rest has to come from us.


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