There have been many reasons I thought myself to be a well-educated person with diabetes. But education doesn’t always translate into action. The combination of my professional background and my personal experience can sometimes be a problem for me, for my diabetes, and apparently also with my health care providers. This became apparent when I went through insulin pump training a few weeks ago with my new diabetes case manager.

She is coming in to take over the caseload of the retiring CDE I met less than a year ago, but adored more and more with each meeting. The new case manager has had diabetes since childhood and has been working for my health system since the late 1980s. She is well-qualified without a question. That said, she seemed to be more full of opinions than empathy. It came to a head while we were wrapping up the insulin pump training.

“You have ketone strips, right?”

Eagerly, the young lady I’d gone through training with nodded. I sucked in air through my teeth and made my confession:

“Nope. I don’t see the point if the entire box is going to go bad after a month. I can get them if I have continuously high blood glucose levels, but I don’t keep them at home.”

She looked at me as though I’d kicked her puppy.

“Well, you have a choice. You can spend a few extra dollars to keep them on hand, or you can spend a few hundred dollars in the emergency room.” She had a point, but her tone did not at all indicate that she believed this was a choice for me.

“Well, that’s not a choice when you present it that way,” I said, annoyed by her condescension. We stared each other down. She started to reiterate her point. I considered pointing out that the health system doesn’t pay for ketone strips and that I hadn’t seen individually wrapped ones in years.

Instead I just muttered “Yeah, [the other CDE] and I talked about that.” The fact is, the other CDE came from a place of understanding and we agreed that if I found myself in a pattern of high glucose levels, I would purchase some. It wasn’t a big deal. It wasn’t a staring contest to determine who was the alpha dog. It wasn’t challenging me or my well-informed decisions.

At the end of the training session, there were promises of checking in to see how the pump was working out and talk about tweaking basal rates and carb ratios as needed.

Perhaps it’s rebellion, perhaps it’s stubbornness, or perhaps I’m just a bad PWD (person with diabetes), but I have not purchased ketone strips since that conversation. I did, however, call and leave a message with the CDE since she didn’t check in on me when she said she would. It’s been two weeks and I have yet to hear from her,so I’m taking the tweaking into my own hands. And I’m okay with this.