At this weekend's annual ADA Conference, I had the privilege to sit for an hour just chewing the fat (or, um, chatting...) about the state of diabetes care with Dr. Richard Jackson of the Joslin Diabetes Center. Dr. Jackson has the dubious title of "Director of Field Outreach, Strategic Initiatives," but his personal passion is talking with patients about how diabetes affects their life. For new patients, his biggest edict is, "You are not doomed. People with diabetes are doing better and better all the time." "When patients come in I ask, 'How are you doing?' Often they slump down in their seats and say, 'I don't know.' So I say, 'NO, how are you doing?'" he told me. The point is: How do you feel? Physically? Mentally? The only way to achieve well-being is to be in touch with your own state of affairs, this doctor says. Here are Dr. Jackson's top tips for getting a handle on your own diabetes and getting the most out of your doctor/educator visits, as he related them to me this week:

• Find Out Where You Are
  Start out by getting your numbers: your A1C (at least every 3 months), and your blood pressure, cholesterol, and microalbumin test results (all annually).  Also, make sure you see an opthamologist annually to be armed with the data on your eye health. Never go in to see your diabetes doctor without knowing what your health starting point is, Jackson says, or the visit will be unproductive. 
  
  And don't get caught up on some stringent number-goals.  Some people do quite well with A1C's of 7+, or even up to 9, he says.
  

• Decide What to Focus On
  It is ridiculous to think you have to tackle everything at once. Look at your health records, and decide which ONE or TWO things you will work on in the coming months. 

  Instead of making vague resolutions like, "I'll eat better," focus on very specific things like lowering your A1C by checking more often so that you can react immediately to highs. Or maybe you'll focus on blood pressure instead of the diabetes-specific stuff.  "If a Type 2 gets his/her blood pressure down from 150 to 140, they can gain as much health-wise as by lowering their A1C," the doctor says.

• Think of Your Diabetes as a Small Business, and Your Care Team as Your Consultants
  Go in to your appointments with information on where your "business" stands, and clear goals and/or questions. Have them advise you on these specifics to get the most "bang for your buck." And remember that these people work for you. Sometimes you might want an A1C more often than every 3 months.  If they push back, insist.

  "If you ask, your doctor will likely do it.  You just have to ask!" Jackson says. (He also notes that Metrika's home A1C testing kit for under $20 at the drugstore is a good option.)

• Make Sure You See the Results
  This is why you need regular testing.  Get your older and newer test results side-by-side and compare your numbers. You can see that you have made a difference!

  Reward yourself in some positive way, and then set new goals for your next triumph. The ability to see the difference you have made is key. It's a rush, like improving your SAT scores or video game scores -- whatever turns you on.

If you do all this, there's no way for nasty complications to sneak up on you, Jackson says.  You'll be on top of it and won't allow problems to progress.  "Remember, nothing ever happens suddenly with diabetes."

Thank you, Dr. Jack, I feel better already!