The Power of the Physician-Patient Relationship in Diabetes Care

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🎙 Episode 1 | Endocrine Matters Podcast

In this episode of Endocrine Matters, we explore the transformative impact of empathy and collaboration in diabetes care.
Dr. Vidhya Illuri, a renowned endocrinologist and type 1 diabetes expert, joins diabetes advocate Mila Clark (The Hangry Woman) to share Mila’s journey from misdiagnosis to receiving proper care, the systemic barriers within healthcare, and how strong physician-patient relationships can lead to better outcomes.

This episode is a must-listen for:

• Patients navigating the healthcare system

• Caregivers looking for guidance

• Healthcare professionals striving to improve patient interactions

Listen to the Full Episode

🎧 Press play below to listen:

Key Topics & Timestamps

⏳ Skip to specific parts of the episode:

• 01:31 – Celebrating women in medicine and their contributions

• 09:36 – Dr. Illuri’s transition from traditional practice to direct care

• 18:30 – Mila’s experience navigating systemic barriers in healthcare

• 31:13 – Understanding LADA and its distinction from type 2 diabetes

• 38:28 – The importance of empathy and trust in patient care

• 51:00 – The critical role of female physicians in fostering compassionate care

• 58:01 – Addressing the shortage of endocrinologists and its impact on diabetes management

• 01:18:27 – Recognizing and addressing diabetes distress

• 01:22:34 – Empowering patients through advocacy and validation

Episode Highlights

💡 Key Takeaways:

• Mila’s Misdiagnosis → After four years of being misdiagnosed, Mila finally found the right physician who listened and provided a proper diagnosis.

• Endocrinologists’ Role → Dr. Illuri explains why frequent, patient-centered care is crucial for effective diabetes management.

• Women in Medicine → The unique way female physicians bring compassion and understanding into patient care.

• Advocacy Tips → Why self-advocacy matters and how patients can take charge of their healthcare.

• Expand for Full Transcript

  1-Mila Clarke & Vidhya Illuri -Audio

  Arti: [00:00:00] Welcome to today's episode where we dive into one of the most critical aspects of healthcare, the physician patient relationship. I'm thrilled to be joined by Dr. Vidya Aluri, a dedicated endocrinologist, type 1 diabetes expert, and most importantly, my bestie and business partner. Mila Clark, known to many as the hangry woman, is a vocal and passionate diabetes advocate and a patient living with latent autoimmune diabetes of the adult, aka LADA.

  Together they bring their unique and uniting perspectives to this conversation. Too often people living with diabetes feel dismissed by their healthcare providers. They receive substandard care and sadly important diagnoses get missed. This was the case for Mila, who struggled with autoimmune diabetes for four years before finding the accurate diagnosis.

  Mila's journey navigating her condition paired with Dr. Illuri's [00:01:00] clinical expertise underscores the vital role of endocrinologists in providing the nuanced care needed for people with diabetes. At the heart of this episode, we'll explore how a strong empathetic physician patient relationship can profoundly influence diabetes care and outcomes.

  Mila will share her personal story of advocacy and perseverance, while Dr. Alluri highlights how endocrinologists like herself strive to balance medical knowledge with patient centered care in a system that often challenges the time and attention such relationships require. Additionally, we'll celebrate the unique value that women physicians bring to medicine.

  Women like Dr. Alluri embody not only clinical excellence, but also a deep commitment to understanding the lived experiences of their patients. This ability to lead with compassion and insight transforms care, particularly in chronic conditions like diabetes. As endocrinology becomes a female dominant field, it is important to stress the value women bring to the care of endocrinology patients.

  Join us as we [00:02:00] discuss how endocrinologists and patients can work together to overcome barriers, the power of advocacy, and why fostering trust and communication is the cornerstone of effective diabetes management. Whether you're a healthcare professional, a patient, or someone interested in advancing the physician patient dynamic, this conversation promises to inspire and inform.

  I hope you enjoy the show. And if you're looking for links to anything we discussed, check out the show notes.

  Well, Mila, thank you so, so much for being on our show today. We're so excited. to have you. You have been so inspiring to me as an endocrinologist who, you know, I, I am such a diehard patient advocate, but sometimes when you are trying to be an advocate, You don't know the problems and, and [00:03:00] having our patients like you who are openly discussing the, the issues that you're facing helps guide us so much.

  And I'm so grateful for your story. And your willingness to share that story because it is such an important one and it really helps us become better and and that's what we want to do. And with me today is my partner in crime, my bestie, Dr. Iluri, um, She is one of my favorite human beings in the whole wide world, so much so that I decided to live next door to her in San Antonio after I'd already bought a different house, and then I tried to get her to join my practice for years until I finally convinced her to say yes, and now we get to hang out all the time, and um, she has been such an asset to my life and our team here, And is just an [00:04:00] incredible doctor and person.

  So I'm so excited that we get to let her shine here today in this very important conversation regarding diabetes, people living with diabetes, different types of diabetes, and how we can really come together as doctors and patients to make a difference. the experience better for our patients. Because when the experience is better for the patients, guess who else benefits?

  We do. And so does everybody else. So, um, first of all, let me start with Mila. Mila, will you introduce yourself, uh, tell everybody a little bit about you and perhaps what connected the two of us? 

  Mila: Sure. So thank you both for having me also. I am just such a big fan of both of you. You're such amazing physicians and.

  I feel like the world needs more yous out there. But my name is Mila Clark and I am 35 [00:05:00] years old. I live in Houston, Texas. And I was misdiagnosed originally with type two diabetes when I was 26 years old. And four years after my initial diagnosis, I was tested for autoantibodies and eptide levels, and then I was rediagnosed after four years with type one diabetes.

  Um, I run a food blog called The Hangry Woman, and it's really about all of my food adventures with diabetes and a big joke among my friends that when I have. Low blood sugars. I am the hangry woman to be avoided at all costs. And, um, the thing that connected us was that I share a lot of my, my journey with diabetes online.

  And, um, The big purpose for me in doing that was because I wanted to find and connect with other people who understood what was happening, who understood the struggles I was going through, and also because I didn't [00:06:00] really know anybody else in my actual life who wanted to talk about diabetes, and I wanted to find other people who did.

  And so, Through sharing content and through just telling those stories, you and I connected and we were able to work on an education campaign together, which was really awesome and just kind of showed that there is so much power in, Doctors and their patients working together and that there is space and room to do that both inside an appointment and outside in a specialty project that maybe educates others or shares the realities of living with diabetes.

  Arti: Yes, and I think, um, to take a step back to Mila's diagnosis story, Mila had a situation, that situation is a never, never miss moment. for an endocrinologist, we should never, [00:07:00] ever miss that. Like that was a huge, huge miss. That is an easy mistake not to make. Um, that's a funny way of saying it, but, um, There, there be several physicians hopefully listening to this episode and we need to be checking a C peptide in all our patients when they're first diagnosed.

  It's, it's basic guideline based care that is being missed and leading patients to suffer and it's, it's not okay. It, it's just not okay and, um, that is one of the reasons that I, I started on social media is because we live in a setting where healthcare is fragmented and patients sometimes aren't getting to see the specialists that they get to see, especially endocrinology is very difficult to get into.

  And so there's like 38 million people living with diabetes in the United States. And if every endocrinologist was [00:08:00] to see patients. 20 patients a day, 5 days a week, for 52 weeks a year, that's taking no vacation. They still wouldn't be able to see every single person living with diabetes in the United States, not to mention all the other conditions that we treat.

  So this endocrinologist shortage is, is horrible, but it also translates to situations like this, because while LADA or latent autoimmune diabetes with the adult is, and type 1 diabetes are things that we know like the back of our hand, only 15 percent of people living with diabetes are ever going to see an endocrinologist, and I hadn't even heard of that.

  Lada before I became an endocrinology fellow. So it's not even on a PCP or generalist radar because you don't know what you don't know and it doesn't make them a bad person. It doesn't make them a bad doctor. It's just not in the training. And so I feel strongly that it's [00:09:00] important for people living with diabetes to to see an endocrinologist sometime in their life, especially early in in diagnosis.

  But in this current setting it's it's frankly impossible. But But these problems are avoidable if we live in a system that can actually do what it's supposed to for our patients, which, um, it doesn't. And that's a huge reason that we're all here today to talk about it. But, but this was a never miss moment that we missed and it happens way too much.

  Okay. Let me get off my soapbox and move on to our next guest and host, uh, Dr. O'Leary. Tell us a little bit about yourself, your journey in endocrinology. I actually don't even know this, like, why did you choose endocrinology and, um, tell us about your journey from a more traditional practice setting to direct care and how you made that switch.

  Vidhya: Absolutely. So my name is Vidya Lurie and I am an adult endocrinologist. [00:10:00] I'm actually originally from Chicago. I did my medical training there at Northwestern. And that's when I first started to get really in, in, interested in endocrinology, and it really was type 1 diabetes, um, that I found, um, super exciting because there was just so much technology, and also it's generally young folks are getting diagnosed with type 1 diabetes, so it was really great to work with young folks to get, uh, to get their diabetes under control and treated and to see them And that's really what brought me to endocrinology.

  So after I finished my training, I joined, uh, uh, academic practice here in San Antonio. Well, not here, but in San Antonio. And, um, I was there for eight years. And I loved it, but it was busy. I mean, it's, it, it was a very busy academic practice. You know, it was hard to see my patients as frequently as I [00:11:00] would have liked.

  And, you know, it, it's standard to at least see patients living with diabetes every three months. And even in that practice, we couldn't do that. We were spacing out patients four to six months, and it was just impossible to give folks the care that they deserved. So, you know, my neighbor, Dr. Arthi Thangadu, had started a direct care practice, you know, and we are just very good friends and our kids are friends, so that all worked out.

  Um, but watching you, you know, Right, the, you know, grow your practice and just be able to have that close relationship with your patients with frequent access and patients were getting better, it's inspiring. So basically you asked me and I was like, yes, you know, and it's, you know, we've been working together in this practice for a year now and it's been wonderful.

  I [00:12:00] love that. I can see my patients frequently. I love that when they're having. You know, or particularly stressful time or there's like a lot of changes, we can talk about it. We have access. They have access to me and we can make those changes. And here's the thing. And like, you know, this, like folks with diabetes, especially folks with LADA who are on Insulin.

  Like, we change insulin doses on a week to week basis, depending on what's going on. And if there's some particular stress, we, we change doses. So like, having patients every three months, it, it just doesn't make sense. Yeah. And I think 

  Arti: that people living with diabetes are living with it every second of every minute of every day.

  It impacts every single decision they make, whether it be about food or exercise or, you know, Just so many different factors go into minute to minute decision making for our patients [00:13:00] that when we think about that and then we think about the fact that sometimes they get to see us a handful of times a year, less than that, once, twice a year with some endocrinology practices, it really makes you wonder like What are we even, what are we even doing and are we providing the level of care that, that we could and are we really, you know, there's all this talk about working at the top of your license and more than that, it's am I working at the top of my capability and my intellect and my compassion and all of those things and I think that it's, traditional model where we don't get to see our patients often for enough time.

  We don't get to support them between visits. As an endocrinologist, it just feels like we're, we're able to, to deliver care here. That's what we're capable of. But, We're delivering it here because that's what the system allows for, and [00:14:00] it's just very unfair to both sides of the table. Um, Vidya, you and I were talking last night about some of the specific changes that you saw, even, you know, eight years of practice is, it's a long time, but it's also not that long, but you also already, in that short amount of time, saw changes in your practice.

  that were worsening that physician experience and patient experience. Can you tell us a little about that and, and that feeling of loss 

  Vidhya: of control? Absolutely. So, you know, when I first started my practice, I was building, so it, It was easier for me to see patients a little bit more frequently and bring people in and add new patients to my schedule, but after eight years, there were just There had been different management changes, you know, in my clinic, and [00:15:00] you know, it became increasingly harder to have any control over my schedule.

  So it came to a point where I wasn't able to add new patients to my clinic, and I wasn't able to, you know, bring patients back when I thought they needed to see me, whether it be one month or two months or a couple of weeks in some situations. So, you know, as a result, my patients didn't have access to me.

  And I also felt as an endocrinologist, I should be serving other physicians, right? Like so if another physician. sees a patient living with diabetes or another endocrine issue, I want, wanted to be able to help in a timely manner, and I couldn't. So, after being in that practice, I lost, I felt I lost control over how I could practice and deliver care, and it just did not feel good.

  And I felt like, Without having any control over my own practice, I couldn't [00:16:00] be the best doctor I could be. 

  Arti: And I think that, um, we as physicians intrinsically understand this loss of control over our own schedule, but what it comes off as sometimes is when we say we don't have control of our schedule, it sounds like, oh, I can't take off, you know, when I want to.

  That's not what we're talking about here. We're talking about being able to schedule patients in a way that we think is right for them, giving them adequate time, getting them in in a timely fashion, getting new patients in. You know, when I first started my direct care practice, of course, there were patients that I previously was seeing, um, that wanted to continue to use their insurance.

  And since I was out of network, I was referring them to Dr. O'Leary because she was the best endocrinologist that I trusted my patients with. And then came a time where I could no longer refer my patients out to her because not only was her practice full, but she wasn't allowed to take referrals from outside of that system.[00:17:00] 

  And systems want to keep patients within their system. So, they want their endo there, their PCP there, their labs, their imaging, their hospitalizations, everything to be managed by that hospital system because that is a lucrative patient. That's a patient that makes that system money. But if the patient is seeing all these doctors from multiple different systems and they just come to Dr.

  Uluri for a one off, then the system doesn't find that patient as valuable anymore. Because. They're not a recurrent stream of income, and I think this mentality is absolutely grotesque to physicians, um, and we have gotten to this situation where the patient is just, uh, It's a profit module, right? It's, it's no longer human that we're taking care of because the people who are making the decisions are not actually the [00:18:00] ones providing the care and the customer is actually not seen as a patient.

  The customer is the insurance company. So it's like the hospital system is the Yeah. The business and the insurance company is the, the customer and they're making decisions that benefit them because that's what businesses do. They do things for their, their clients and the doctors and the patients are just pushed around between to, to make decisions.

  To enable them to profiteer off of them and, um, really leads to some major challenges and Mila, I would love to kind of hear more about your story and how perhaps getting lost into that system led to some of the challenges that you face. 

  Mila: Yeah, absolutely. I think. What you said is so interesting because it feels like it mirrors the experience that I [00:19:00] had as a patient where I was only allowed by insurance to see a primary care physician, um, where If I wanted to see an endocrinologist or any other specialist, I had to get referrals for that, which meant having to set up more appointments just to get the referral that I needed.

  Um, and then also just in terms of the way that I was treated by physicians within the system, um, I was like not an obvious case of LADA. I had a very strong family history of type 2 diabetes. No one in my family, except for me, has type 1 diabetes. Um, I walked in, I was overweight, and then walking in also as a black woman, it was kind of like, well, these are the normal puzzle pieces that fit together, so.

  This is what you're dealing with. [00:20:00] When I was diagnosed, I had an A1c at 14 percent and I had also had DKA twice and I let my primary care doctor know that and he kind of said Well, DKA can happen in people with type 2, and really we just need to work on your eating and your exercise to get those blood sugars down.

  There's like no talk of medication, no talk of insulin, no talk of really a plan forward aside from make these lifestyle changes and you'll be fine. And if you're not fine in three months, will evaluate what we need to put you on to get you to a place where your A1c is good. Um, at the time also, I think CGM were, was emerging as this technology and, you know, as a patient in the U.

  S. you get advertised [00:21:00] all of these different devices. And so I saw a commercial for a CGM. And at the time I was pricking my fingers seven times a day. That's what my primary care doctor wanted in terms of my blood sugar log. and it was frustrating. My fingers hurt. I was exhausted. I Would make up numbers in my log because I was like, I just can't do this all this time.

  And then I walked in and I said, okay, well, I'm not really pricking my fingers. And like, some of my numbers are accurate. Some are not. I'm not really checking them all because I am exhausted and it's painful, but I saw this commercial for this device. And I think that it would actually really help me. And the conversation to me was that's going to be too much information and too much data for you, and that's not really for patients with type 2.

  And a lot of those decisions and the ways that those kinds of things were, like, denied for me were because of the decisions made at the top that were saying, OK, [00:22:00] CGM. Can only be covered by insurance for people who are insulin dependent and I wasn't at the time or, um, you know, going back to like the referrals.

  I asked, well, can I go see a specialist or a diabetes educator or someone that I can get more information from and I had all these roadblocks trying to get there. Um, I think maybe what was most frustrating for me in the process was. It's kind of within the first year of me not seeing very much improvement in my A1C.

  It had gone from 14 percent to 10%, um, which is, I think like a significant change, but it's not enough to be the healthiest you can be. Um, and when I had talked to my doctor in that first year, the message that I got was you're just obviously not working hard enough because if you're, if I'm putting you on all of these oral medications, [00:23:00] you should be improving and you're not.

  And so you're either not telling the truth about what you're actually doing. You're either not taking the medications and adhering and doing it as prescribed. And that was kind of like one of two things. It was either, it was like, Either you're at fault or you're at fault and it was really hard to swallow that knowing that I was still having these terrible symptoms and that I still wasn't seeing this improvement in my blood sugars, even though I was working really, really hard at the lifestyle change aspect.

  Um, and something that I think about all the time now is just in that experience, um, of dealing with that for four years and feeling like, At the end of that four years, I was kind of like, I, like, I, I'm just failing and I don't really even know what else to do, except for seeing someone who [00:24:00] looks like me and maybe will be willing to listen to me a little bit more than all the experiences that I had had.

  Um, And the first time I went to go see a different doctor, um, she was a black woman, and I sat in her, like, in the chair talking to her, and I said, I just, I want you to listen to me for, like, five minutes. I just want to tell you what's been happening to me for the last four years, and I, I need help. Like, I, I don't know what else to do or what else to try.

  Um, And after I had that conversation with her, she said, well, let's try a few things over three months. And if we don't see any improvement for you, then I want to refer you to an endocrinologist. And I think that was like the first time someone offered a referral. It was the first time that, um, I actually had somebody listen to me and take me at face value and not just look at me and say, I know the answer for you.

  And then I think the other [00:25:00] thing that kind of was so Remarkable to me in that time is that when I finally did meet an endocrinologist, he told me, you know, tell me about you and what's been going on in your story. And I told him all of these things. And he, the first question he asked me was, have you heard about LADA?

  Do you know what that is? And I was like, no, I don't think that's what's going on. But tell me more. And when he told me that the confirmation was a simple blood test and I had been getting my blood drawn for three or four years every three months at that moment, like it just made me break down because I was like, Oh my God, like the answer was here the whole time.

  And I just needed somebody who knew that that was the way to find the answer. And then sure enough. Within, you know, another week after that appointment, I'm finally re diagnosed with LADA, and started on insulin immediately, and I feel [00:26:00] so much better, and I'm not this, like, zombie and shell of a person, and I'm actually, like, I feel alive for the first time in so long, and it made me wonder if other people encounter that same thing, and if that experience is, you know, Um, and if it's so common for it to go on for so long, and I'm just glad that I finally had that moment where I was like, I have to find somebody who's going to listen to me because I don't want to live like this anymore and I can't, and I'm not going to be alive if I don't do something.

  And so it was really nice to not get to that point of frustration, but to finally find somebody who could say. Okay, I'm not quite sure what's going on, but let's try some things out and then if we don't get the answer that we want and we don't see the improvements that we want, we'll take you to the next level and have you work with a specialist to get it straightened out and fixed.[00:27:00] 

  And, um, Just thinking about that process, like, for me, it was, it was so long ago at this point, um, like being diagnosed in 2016 and then, um, 2020 being when I got my re diagnosis, but I think back to all of that time and just how uh, Potentially, like my health could have been even worse. Like I could have had really awful complications of diabetes because I wasn't on insulin.

  I was at risk for going into DKA again because I wasn't on insulin. I was just kind of like trying to make it through every day with no energy, with no, like, I couldn't think. I couldn't like do anything. I didn't want to do anything because I just had no energy to do it and thinking back to that time and how that how much that's changed because I have a really supportive endo who listens to me like hears me out when I come to him and I'm like oh I just saw this research that was [00:28:00] published and like I think this might be really interesting in terms of my treatment and having like being able to have those conversations openly you Um, has been such a, a life changing experience because I like, I feel like a human being sitting in that chair, but I feel listened to, I feel cared for, and I feel the autonomy that I need to be able to manage diabetes every day when I'm not in the Endo's office.

  Arti: So, Vidya, thank you so much. Are you dying from her story? Cause, cause I am. And Mila, one thing is, when you, in your early days, did you have like, excessive thirst, excessive urination, unexplained weight loss? So, you started that story by saying that you were like, an atypical case for LADA. You were 

  Vidhya: not. 

  Arti: You were a slam dunk.

  You were a slam dunk diagnosis. I had two 

  Vidhya: episodes of diabetes 

  Arti: ketoacidosis. Yeah, it's, it, that is like, [00:29:00] I mean, I wouldn't even have had to check your C peptide to know what you had. You know what I mean? Like, I would have checked it and your antibodies and GAD and all that stuff, but I think that It was a massive failure, uh, of the system, of, of that clinician, you know, I think that, I think humility in medicine is incredibly important because We don't know everything, right?

  Like, I didn't know what LADA was when I was an internist, either. And so we can't really blame people for not knowing everything. However, when your patient isn't getting better for three, four years, like, Let's say two weeks, right? Like, two weeks your patient is doing all this stuff and their blood sugars aren't vastly improving.

  And anyway, you should get a C peptide on initial diagnosis [00:30:00] on every single person with, with newly diagnosed diabetes. That's basic, basic diabetes care. That's not even like, uh, That's like ADA standards of care, like that is extremely basic. So the reason I say that is because I think sometimes we make excuses for other people to help us wrap our heads around a situation or understand that, oh, maybe this person was, maybe it was me, maybe it was me.

  I was atypical, right? But it was not you. It was not you. It was your disease was presenting like a disease that we treat all the time presents and That that clinician did not get you to the expert that you needed to see within a reasonable amount of time That's that's it I mean, you were 26, A1c of 14, DKA, [00:31:00] blood sugar's not getting better with dietary intervention, polydipsia, polyuria, unintentional weight loss, like, it's a slam 

  Vidhya: dunk diagnosis.

  Slam dunk. Easy peasy. Like, 

  Arti: yes. And so, before we get too far, Dr. O'Leary, will you tell us what LADA is? We've been 

  Vidhya: throwing the term around. Sure. So, LADA stands for Latent Autoimmune Diabetes in Adults. It's a type of diabetes that develops in adulthood, so usually after the age of 20. And it's caused by an autoimmune destruction of the pancreas.

  So it's actually really similar to type 1 diabetes that we see develop in children. Um, and it's an antibody mediated disease where the pancreas gets destroyed. So this is not due to diet, this is not due to weight gain. These patients who develop LADA stop making insulin. And You need insulin to live, so if you [00:32:00] don't get insulin, you get these terrible, life threatening diseases like diabetes, ketoacidosis, and that's what you went through, Mila.

  But it's so important to differentiate LADA between type 2 diabetes because the treatment is completely different, and if you don't get it right, your patient will die. 

  Arti: Yeah. It's actually like a miracle that, um, that you didn't have worse complications and, um, you know, I think that perhaps it was divine intervention to bring you here to educate more clinicians about this and more people to advocate for themselves if they're not getting a diagnosis.

  And even in the diabetes space, I think there's this idea of management and that patients are noncompliant. And we have seen way too many times that patients actually do get better. When they get excellent care and we've, we've seen so many patients who were doing poorly in different care settings and then they come into [00:33:00] our clinic and voila, we are, you know, at goal at our, our glycemic goals.

  People are doing better and it doesn't happen slowly. I think there's this misconception and, um, a lot of doctors have this that And I've been asked this question multiple times, well, how fast should an A1c change? And, you know, if you ask a lot of doctors who perhaps aren't, um, in endocrinology or they don't see their patients as frequently as we do.

  Um, they often think it should take, you know, six months, 12 months, a couple of years for the A1C to go down. And physiologically that doesn't make sense. An A1C is, uh, three month average of blood sugar as measured by sugar attached to the the red blood cells and the the reason it's three months is RBCs have an average [00:34:00] lifespan of three months, so they change out every three months So that's why it's checked every three months And so if your patient isn't improving with their A1c in three months Like not not just improving from like a 14 to 10 But like they're not at at their goal in three months, that means your therapy is probably not working.

  And you need to change your therapy or escalate care to a specialist or something. So if you're going more than six months, not well controlled, and your doctor, is out of tools in their toolbox, then you need to see a specialist, because we might have more tools in our toolkit. But people don't know that, and it's really, really hard to get into an endocrinologist, especially when we have these insurance restrictions that say you need a referral, and if your primary care doctor is not willing to make that referral or unable to make it for whatever reason, then you're kind of, but, you know, [00:35:00] that's the point where like, we, we are here, and you're here to help people advocate for themselves.

  Because, you know, it's, it's, It stinks, but it's true. Like, if you keep barking about it, like, then, then things happen. And yeah, nobody wants to be that annoying patient, but nobody wants to be dead either. Or like, nobody wants to not get the care that they need for themselves or their loved ones. So I think we need to just think about it in that way.

  Because in the healthcare environment that we're living in, like, Unfortunately, patients have to advocate for themselves a lot to get what they need. It's hard to be a patient as a physician. I can, you know, it's not that I can't imagine. I do see what my patients go through when they're trying to get, get the care that they need and deserve and that is evidence based and all of those things.

  It's massive [00:36:00] loopholes. But when they do advocate for themselves. Even with me, like, if I'm thinking along one track and my patient advocates for themselves, it even helps me, you know? It's, it's not a bad thing to have a patient who advocates for themselves. It's actually a good thing. You want, you want that.

  Um, it just gets kind of turned inside out and upside down sometimes. What, 

  Vidhya: Mila, is when you said at the end of your year, the end of two years, you felt like it was your fault. Like, it was your fault you're not getting better, it's your fault the therapy you were given didn't work for you, how dare you ask for a CGM, it's not for you, like, I, I just can't believe that, but I hear that all the time from my patients when they're coming in for care.

  Like, they were told that they weren't doing good enough or they weren't trying hard enough. There was never a, well, maybe we got this diagnosis wrong or maybe you need different [00:37:00] treatment. Or maybe I'm the problem. 

  Arti: Yeah. You know? You know? And. I think we have lost this extreme ownership over our patients and in medicine and if my patient isn't doing better, it's my fault until proven otherwise.

  That's how I see it because I'm the one who's supposed to be helping them get to their goals and if they're seeing me and they're not getting to their goals, well, Either I need to try some of my other tools or recognize that this isn't in my tool toolkit and maybe I'm not the right doctor for them and, and help them get to that right, right place to get the care that they need because I don't have all the answers, but it is my duty to help, help that patient, um, get what they need.

  Mila, you mentioned that once you saw a Uh, a clinician who was a woman of color, you are finally heard. Tell us a [00:38:00] little bit more about that. Um, you know, how did that female connection, that cultural connection change the quality of your experience? And how How, what was the impact of, of that connection that, that was more than just a doctor patient relationship?

  Mila: I think for me it really felt like I, if I can find somebody who I identify with, maybe looking at me, they'll have more empathy and they'll have a desire to want to help rather than just kind of shut me down when I ask questions. And so it took a long time. It took some digging. It took figuring out who's actually in my network to be able to do it.

  And the [00:39:00] doctor that I found was an hour and a half late. Commute from my house. And so that's how deep in I was like, I am willing to do a three hour round trip just so I can see someone who I think will get it. Um, and you know, it was really important to me also to, just because of the experiences that I had.

  Um, I kind of had to be a bit of a consumer about it. So I went and I googled my doctor to see like where she had worked and what kinds of specialties she had worked in, even though she was in primary care, um, to see other patient reviews that said, okay, this is a compassionate person. They listen. Here's how I felt when I left my appointment like those things all mattered to me before walking in because I knew I didn't want to see someone else who was going to fight me at every step or be like your intuition about your own body is [00:40:00] so very wrong.

  Get out. And so, um, I think for me, I mm. One of the, one of the things that kind of led me to find a doctor who was also a black woman was talking to my mom. Um, my mom lived, I think honestly that my mom had LADA, she was never tested. Um, she passed away a few years ago, but I had this conversation with her and I was like, I'm kind of at my wits end and I really don't know what to do.

  And you seem to really. Like your doctor, like how did you find them? What kinds of questions do you ask when you go in and how do you approach it when you feel like you're being told the wrong thing and you, but you can't prove it? Like you can't. You have no evidence that you're right about what you're feeling, but you know that something isn't right.

  And the one thing that my mom told me was. Sometimes like somebody who's looking at [00:41:00] you has to feel like they're looking in a mirror to give you a little bit more empathy. And so maybe you need to find somebody who is willing to do that and who really aligns with similar values that you have in terms of your health and approaches to your health.

  And I think that gave me like such confidence that I was doing the right thing by seeking out someone who looked like me to move forward. everything forward. Um, and what I got from that experience was somebody who looked at me as a blank slate who didn't have preconceived notions, who was willing to let me just share why I was frustrated, what I had tried, what I hadn't tried.

  Um, what I was thinking, what I was feeling, and then also offered that compassion and that support and saying, we're going to figure this out, and maybe it's not me who figures [00:42:00] it out for you, but somebody is going to figure this out, and we're going to get you to the right place, and I think, um, really what it came down to for me was that aspect of self advocacy, because I told myself even before I had found this doctor, I am not going to another person who does not listen.

  I can't do it. Like, I can't take another appointment where I feel like I'm not heard and I can't take another blood sugar reading that's 400 and not being able to figure out what to do about it. I can't exercise for two hours a day every day anymore. I'm exhausted. And so it was really, I think, the position that I was in that was so motivating for me to feel like, Okay, no one else is going to do this for me.

  And I have to like, put on my big girl pants and just like move forward as hard as I know how and [00:43:00] also don't stop until I find somebody who hears me out. And so I just got lucky that the first person that I saw after thinking about all those things was willing to hear me out and that she eventually, um, like you talked about humility, had the humility to say, I can't help you that much more from here.

  I've given you everything that I feel like I know how to do, and now you need to go see someone who is, who has the depth of knowledge to be able to help you. And, um, That's when I got referred to the endo that I work with now and it's been great ever since. Rough in the beginning trying to get used to insulin and the fact that I would be on insulin forever.

  That was something that was always told to me throughout my experience with my misdiagnosis was that you know, I would hear all the time, if you get on insulin, that's going to be awful for you, because it means that you are way too far into the [00:44:00] process of diabetes. It means that you're probably going to gain more weight, which is going to hurt your insulin resistance, which is going to do this, this and this.

  And so I had this mindset also like, okay, I don't want to get on insulin because that's going to be terrible for me, not knowing that, like, that was the best case scenario all along. Um, and then having to, like, go back and cope with the fact that, oh my gosh, I've been told over all this time that, like, if I stay off insulin, I'm in a good place.

  And now they're telling me that I'm going to be on insulin for the rest of my life. And I have to deal with that now. And so I think, um, really just having that ability to gain that confidence to be able to say like, all right, I'm, I'm kind of sick of everybody ignoring what I'm saying. And I really have to figure out how to get someone to listen.

  Um, it's probably the most frustrating process of my life, but I think that it also gave me the ability to be here [00:45:00] today and to have an A1C that's in range and to. Now have switched over to a pump finally and getting comfort more even more comfortable with diabetes technology And none of that would have ever happened if that first you know, first primary care doctor that I saw who looked like me, didn't take me at face value and really understand that I was in a position where I needed a lot of help.

  Arti: You manifested her, you manifested that doctor for yourself. And I do believe that, that we can do that. Like we, we can get ourselves together. that we envision by, by first envisioning it. And, and that's amazing. Big girl pants are so annoying. I, half the time I don't want to wear them and they, they aren't the most comfortable, but you know, when we take ownership.

  Um, that's when we, when we make the magic happen and I'm so grateful you did [00:46:00] that, proud of you for doing that, and also grateful and proud of you for, for sharing with us and, and everyone else who you share with because this is such a common scenario, sadly. But, um, it is common, and so if we can show people that when, when they, a success story of, uh, advocating for themselves, um, hopefully it will encourage them to do so.

  Um, you spoke a lot about the relationship that you had with, with your new PCP. And The, the similarities between you two that, that enabled that and augmented that, um, I think that demonstrates a really important piece of the puzzle. Many women patients prefer women doctors, um, and I think we're all women.

  I think it's obvious [00:47:00] why that, that connection is there and, and oftentimes women physicians more empathetic or listen more than, than some of our male counterparts. Obviously, that's not true for everybody. Um, but being a woman physician has its own challenges. I would love to kind of talk about that, though.

  Like, a lot of this podcast talks about challenges women face in healthcare and how Healthcare is now a female dominated space, 54 percent of medical students are women now. Um, and of course in nursing professions, women have dominated that space for a long time. And in a lot of other healthcare settings, um, it's, it's a lot of women.

  Um, particularly for physicians though, as [00:48:00] we engage in a more, um, female centric workforce, especially in endocrinology. 70 percent of endocrinology fellows are women now. Um, I think that it's important for us to highlight the importance of keeping women in the game. Because, you know, not too long ago, medicine was dominated by men.

  And women had to dress like men, act like men, work like men to, to, you know, Survive, essentially, and now it's a female dominated field, and I think there's still that mentality of we're held to a standard of men, but we're not men, right? Nobody's asking men to have babies, right? They aren't, they aren't picking up the slack there, [00:49:00] but women have risen to the occasion in a lot of ways.

  We contribute to our families. Finances, we contribute to science and new discoveries to lots and lots of things more and more and more. And I think this experience that you shared with us, Mila, demonstrates that we have a valuable place here. We're important here and it's important to keep us in the game to help patients like you, who, who clearly I wouldn't have gotten the care, probably, without seeing a woman physician.

  So I would love to kind of hear y'all's thoughts about, about that and, um, yeah, just anything. 

  Vidhya: Yeah, I, I think it's very interesting that our field especially is becoming so female dominated [00:50:00] and I think that I can think of a lot of reasons why, um, but one of them I think is. It's actually pursuing this relationship with patients and how important it is in endocrinology.

  And you know, like you said, Arati, there's definitely male endocrinologists that are wonderful and I, I would see them, I would have my family see them, right? But I, I think in general, women physicians are more compassionate and I think they listen. Um, and with a lot of endocrine diseases, especially diabetes.

  Diabetes is just so, I mean, it affects our patients daily lives, minute to minute, every day. It affects them when they're eating, it affects them when they're awake, it affects them when they're sleeping. Um, but I think that this is why endocrinology has become so dominated by women, because women are better at it.

  They [00:51:00] just are. They're, they're, they're, and this is why a lot of my patients, will tell me when they meet me that they specifically sought out a female physician and they were happy that they did because they actually feel heard and they actually feel like they can ask questions and, you know, previously with a male physician, they weren't able to or they, they would just, feel so shut down, they wouldn't speak up for themselves or share their experience or what their concerns were.

  Arti: Mila, in your experience, what do you think it is? What do you think, how do you feel about the importance of keeping women in the game as far as healthcare, primarily in the physician space? 

  Mila: I think it brings a certain mindset into the entire system, which is that your patients are people. [00:52:00] And the person that is sitting in front of you is struggling with something that they don't know how to deal with, and that they need help with, and they need someone to be there alongside them that is compassionate, and patient, and willing to explain things, and not willing to make them feel dumb.

  And, um, I, like, I will say in my experience, you know, I can't speak to every male physician in the world because I haven't seen every male physician, but every male physician that I have seen has not had compassion for me, has not made me feel like there was space and that they were holding space for me to share with them.

  what I needed to be able to get better. Um, I constantly felt shut down. Like I'm a very confident person and I'm willing to speak up for myself, but there were some moments where I was just like, I'm not going to get anywhere. So I'm just, I'm just going to nod my head and say yes. And then I'm going to leave.

  And I know I'm going to be disappointed because I'm not moving anything forward. [00:53:00] And so I think there's just this like really beautiful difference sometimes in The area of compassion of seeing your patient as a person and also making it feel like you are holding that space for them to be able to share.

  They're, they're probably their most embarrassing things that they ever have to say out loud about themselves and their bodies and giving a space that feels comfortable and compassionate to do that. Um, I think that's so important and it's something that every patient deserves to have, like, regardless of what.

  doctor they see, um, but it's something that is lacking and I don't think that's always the fault of clinicians. I think that like the system being set up the way that it is to kind of like move patients out and like maximize the most time possible, um, means that you're not always going to get to have the time to be the most compassionate and the most, um, [00:54:00] you're not going to maybe have time to.

  build that deeper relationship. But I think it's so important because Just speaking from the patient perspective, like once I found somebody that I was truly comfortable with, it made my care so much better because I was willing to be open and honest and really talk through what I was struggling with without feeling.

  any sense of, um, I would say judgment in that room and in that space or without feeling like, Oh my God, I just asked the dumbest question and now I'm so embarrassed because I, I put this out on the table. And so I think, um, really that compassion is something that just seems like a part of our fabric and a part of our nature as women.

  But I think it really shows through in those care settings as well. Um, especially when we're coming with our deepest, darkest, like, health issues, and we need someone to listen, [00:55:00] and somebody that we know we can be honest with. 

  Arti: Yeah, and you know, you can be confident, but also be vulnerable, right? And I think we have this immense privilege of having patients walk into our door.

  They don't know us. We don't know them. And they just like spill their guts, right? Like they, they tell us everything. They tell us, you know, I have patients cry with me. And the first, Five minutes I've seen them, you know, and there's this immense vulnerability that we have the opportunity and privilege to hold space for that.

  I think, you know, this is a generalization, but women by nature are tend to be more nurturing and I think that is a place where. We shine and I know like my husband's a very compassionate doctor and his he deals with patients Crying with him too. So it's not like [00:56:00] there are No, compassionate male physicians.

  We're not trying to say that in any way, but there's something different about a woman, and there's power in that, you know, there is a space for us. There's things that patients and people prefer about women in certain spaces, and instead of trying to work like a man, think like a man, you know, prescribe like a man, I think we really need to hold space and lean in to.

  Um, the things that we bring to the table because, you know, Harvard published a study where patients were less likely to die if they had a woman physician. These empathy and these softer characteristics that are kind of looked down upon throughout training might help. Be what [00:57:00] enable us to sometimes have better outcomes.

  I mean, your story is a great example of that. Your, you know, empathy and all of these nice soft words, they make people feel very warm and fuzzy, but often are written off, um, as unimportant. But here we are talking about empathy leading to a tremendous change and improvement in outcomes. And we see that in data too.

  If If you listen and you're empathic, your patient is going to have a better outcome. And so I think that we have to just know what we're good at and go for it and get after it and and do it and find spaces where, where that's valued. Um, because we have this incredible gift. Um, not all women, but many, many women physicians do.

  Let's, let's use it for, for the betterment of [00:58:00] our patients. Um, Mila, I would love to hear your perspective as a patient because I'm constantly harping on the importance of an endocrinologist, right? I'm an endocrinologist, obviously it's self serving for people to recognize that an endocrinologist is important, um, for Myself and my team and all of that and I get that like that's what people might hear Um, that's not really where i'm coming from to be frank I'm i'm coming from a patient perspective because I hear stories like this way too often but from a patient perspective We have this massive shortage of endocrinologists only 7 000 endocrinologists in the entire country to take care of so much diabetes and metabolic and hormonal disease.

  And we're shrinking. We're like a, an endangered species of a specialty. And there's a lot of forces going into that that we discuss in depth in some of our other episodes. Um, [00:59:00] but as a patient, what is your thought? Do you think that people with diabetes would do better If they had better access to endocrinologists 

  Mila: from my own experience, the answer to that is yes, but I also feel like primary care is sometimes the first line of.

  diagnosis. The first place that you might be checked out where you may get an answer about a health outcome or you may have testing done to confirm what's going on with your body. And so I think that Because endocrinologists are in short supply and that you are kind of an endangered species, knowing that primary care can kind of [01:00:00] understand at least the surface level basics of what's appropriate to test a patient on before maybe they make that referral or before they say, this is.

  Um, I think that kind of solves two issues. One is that patients are more accurately diagnosed and they know more about their condition overall. Um, and they're also maybe spending a little less on care because they're able to get the answers that they need in primary care. But I think, um, especially for people who have gone through a diagnosis journey like mine or maybe people who are, you know, in that process now and they're like, I've tried all of these things and like these care plans aren't working for me.

  Um, I think it's really important to know that endos are out there and that it might take a long time to be able to get in to see [01:01:00] someone, but it's absolutely worth it to do the deeper dive if you can. And if you have these concerns that like your care overall isn't getting better. Um, I feel like when I saw an endo, it unlocked so many different pathways of treatment that I just didn't even know existed and that I wasn't even offered when I was sitting in primary care, even down to not having my C peptide and antibodies tested on my first, like, a week.

  Diagnosis A1C is something that is like I think about and I'm like, Oh my gosh, like I, it's, it's crazy to me that my doctor didn't have either like the knowledge or the resource to be able to say, okay, her A1C is this high, her, this is how old she is, this is what her symptoms are looking like, maybe we should also do this additional testing just to confirm.

  And I think like those tools in [01:02:00] primary care are so important. Because that's kind of like the first line where people are finding out that they might be living with diabetes. Um, but I do think like everything that I have learned and gained and just become informed about has come directly from my endo and has come directly from those conversations.

  And it's been, I think, so eyeopening for me because it was almost like the, when I walked into endocrinology, the world was presented to me as It was like, we have so many things we can try because you have a lot of so be prepared that like, you might be a little bit of a like, you know, like, test, test case for a little while and we're going to try out things and see how they work.

  And, um, but like, it was never a conversation of you can't have this or [01:03:00] no, that's not what's going on with you or, um, um. I remember one of the things that my initial primary care doctor said to me was, you know, I see hundreds of patients with diabetes a year exactly like you exactly in your same spot.

  And it was just kind of like this mentality of like. You are a cookie cutter version of every other patient that I've ever seen. You're not an individual. And so I'm going to treat you in this way because this is how I always treat everyone. And this is how it works. And I never felt like that in endocrinology.

  Like I felt like, okay, I'm being understood as my own person. I'm being understood based on what's coming up in my labs. I'm being understood in a way where, um, um, You know, I resisted an insulin pump for a while because I was really scared of technology. I just, I couldn't see myself wearing a pump [01:04:00] and having my endo have that patience with me to say, Okay, well, you are doing multiple daily injections and you've told me that that's really exhausting for you.

  So let's try an insulin patch, and maybe that's going to be the thing that helps you adhere, that helps to work with you, and that minimizes the amount of injections you're doing. Um, but having someone who was really conscious along the way of listening to both my concerns and then understanding the tools that they have in their toolbox, and also looking at it as, We have so many possibilities here and I'm open to trying those possibilities.

  Um, I think made such the difference and that's just something that you can't get by going to primary care. You don't get that depth of care and that depth of, um, Um, your, your clinician really seeing you as a whole person and then figuring out what your needs are, what your access [01:05:00] is, um, what you can afford, like what you just want preference wise overall, and I think that takes such a special skill that I have seen an endocrinologist and that I think makes the specialty so valuable.

  Um, It makes me want more of you, so more people can experience the, like, the good parts of what I experienced. 

  Arti: You know, I think that, that the shortage is, is such a massive problem, but, um, I just want to talk a little bit about endocrinology and how we train with regard to blood sugar, because the, the truth is, we have a massive Toolkit for for diabetes and we have this crazy relationship with blood sugar We are obsessed with blood sugar.

  I don't know how else to put it [01:06:00] and also Stepping back one second. I'm judging that doctor so hard right now like hundreds of patients that look just like you What? Diabetes does not have a a look. Diabetes looks like so many different things. Babies, 100 year olds, white people, black people, brown people, like women, men are trans friends.

  Like diabetes does not have a face. It, it is everybody. And I think And nobody's experience is exactly the same in anything in life, but certainly not with diabetes. So, I can almost guarantee that Vidya and I, individually and collectively, have seen way more diabetes than probably, uh, That, that PCP and I think that you don't know what you don't know and you feel [01:07:00] more confident the less you know and then as you know more, the less confident you become because you're like, holy crap, this is really complicated.

  And I remember graduating from internal medicine fellowship and that was When I was studying for my internal medicine boards, that was the most confident I have ever been in medicine, peak confidence, not the most knowledge, and then I entered endocrinology fellowship, and I was like, holy smokes, there is so much to this field that I had no idea after, you know, a grueling three years of residency and studying for my boards and passing, I was a board certified internist, and There are all these other fields.

  There's cardiologists. There's gastroenterologists. There's ENTs. There's all these other people that know their field in the depth that I now know exists for endocrinology. I was like, I don't know anything about anything. Like I And I still, like, I still feel that humility because I'm [01:08:00] like, okay, well, I know this space very well, and there's a depth and breadth to this that many people don't, don't grasp, not that they shouldn't, because they're not an endocrinologist, but, um, I think like that humility piece was, was, you know, lacking and extremely, extremely profound.

  It's extremely dangerous in your case, and it terrifies me to think about all of those other other patients or the other potential misses, and I'm not saying that we're perfect by any means, but, um, yeah, that that scares me. But going back to what I was talking about, like how we think about blood sugar is sort of insane, like when you think about it.

  So, and. Vidya, tell me if your experience was different, but we would, um, have clinic as well as inpatient rounds. I had a very inpatient [01:09:00] heavy fellowship, so pretty much every day for a whole year, except a handful of weekend days off, because that's how fellowship works, I was rounding on 20 plus patients, almost all of whom had Diabetes, and we would have these little booklets that we would print off and track the patient's blood sugar.

  Every single blood sugar. You want to know what my patient's blood sugar is from December 8th at 11 a. m.? I've got it for you right here. I also know what they ate before that. I know what medications they were on. I also know what um, IV fluids were running for them. I know what, what other conditions they were dealing with, what, why they were admitted.

  Um, I know their insulin sensitivity factor, I know their insulin to carb ratio, if, if they're a person with type one or type two diabetes in the hospital, I can tell you what one unit of insulin will drop their blood sugar by, and how much [01:10:00] insulin I need to drop their blood sugar by a certain number of points, like, every single patient, every single day, for several years, you know, for like two years of fellowship, we are a Like, micro, like, we look at it with a microscope, with a fine tooth comb, and we learn so much from patterns.

  Like, we, we just, you know. There are things that when you do them over and over and over again, so many times, you just get this very deep understanding and respect for the human body. And I had never experienced anything like that in, in residency, where you're looking at something so Closely, so many times on, on the same [01:11:00] person and really, really learning them, like it would get to the point where, you know, you'd be rounding on a patient and you'd be like, the first thing you do is look in their trash can because you're like, okay, the nurse didn't report what they, that they had dinner, but I, I saw their blood sugar and I know that they had pizza.

  Nope. There's the pizza box. You know? Like it's. It's so intense that it would be impossible to ask another type of physician to understand blood sugar in the way that we do. And like, we're emotional about blood sugar, right? Like we care so much about it and we're like obsessed with it. The fluctuations and what could be causing it and we talk about it all the time and it's Fascinating to us and it never gets old But Vidya, what was your experience?

  Vidhya: It was similar, you know and [01:12:00] and I think it's really funny to see how I would manage blood sugars before endocrinology fellowship and it's like you laugh at it, but it's also so horrible and what we would do and what unfortunately a lot of Internal medicine docs, and hey, I did this too when I was in internal medicine residencies.

  You just kind of, no matter who they are or what kind of diabetes they have, you just, you just like start them on a sliding scale, which is like the worst thing. So we, we didn't think about, well, does this person have type one? Do they need basal insulin? Does this person have type two? Are they just on metformin?

  Like what are their insulin needs? Like how much do they weigh? Like what's going on? What are they, what are they eating? So it was. It's crazy how little we thought about blood sugar management in the hospital as internal medicine residents. And then you go to endocrinology fellowship and just [01:13:00] like you said, you interview the patient, you figure out what they're eating on a day to day basis.

  You calculate their insulin needs based on their weight and what else is going on in the hospital, right? Like if they're getting chemotherapy, if they're getting steroids, if they're unable to eat, Um, all of that influences what their blood sugar is going to be, and you calculate something, but you may have to adjust that four hours later because the patient got a different medication.

  And then, so, so, with the intensity that we are managing blood sugars for folks in the hospital, we are looking at things minute to minute. We might even change things a couple hours later, depending on what's going on. Um, so, to train for two or three years, depending on which endocrinology fellowship you go to, to just assume that anyone can help folks with their diabetes, and not anyone, like any physician who didn't undergo that intense training.

  It's laughable. [01:14:00] It doesn't make sense. So when you have that experience, That's where you had a physician, unfortunately, oh, I've seen a hundred diabetes and they're all the same. That's crazy. They are not all the same. Everyone couldn't be. It's nuanced and everyone is so different. And if you don't look at the details, you are not going to get it right.

  Arti: Yeah. And I think, I think diabetes is so common that it's just like, oh, it's just diabetes. Like I got this. It's just diabetes. It is never just diabetes. It's a human being living with a chronic condition with. The own their own nuances to life and also their disease process is different. They're in different stages They've had it for different periods of time.

  It's it's different and and if we start to think that way We're we're already three steps behind and I'll tell you another thing thing that is very particular to diabetes, but I think it tells the story quite well. And it's that when a patient is admitted to the hospital [01:15:00] and they're on tube feeds, like they can't eat.

  So they have either, um, a feeding tube where they're getting their food or, um, parenteral nutrition through an IV. we actually calculate exactly how much insulin they're taking. to give, like, it'll be like nepro, and then we'll calculate how many cc's they're getting, and then how many carbs they're going to get in a certain period of time, and then calculate a carbohydrate ratio for that patient, and then dose their insulin with, to be given at the same time if they're getting bolus feeds, um, differently if they're getting continuous feeds, and it is, like, the most incredible puzzle to me because we nail it, right?

  Like, it's amazing. Like, you're like, Oh, I do all these like voodoo calculations. It's not voodoo at all. It's math, but it's, we do [01:16:00] all these calculations. And then the blood sugar is like fantastic. And then, you know, my husband is an ICU doc and he, I have been the free consult service for several ICUs around.

  All over the place because there's no endo in the hospital and he'll be like, Hey, um, can you help me calculate this tube feed? And then the next day all the nurses are like giving him high fives and they're like, how did you fix this patient's blood sugar? There were 300 for the past, past few days. And like, what did you do?

  Like it's magic. And, you know, obviously it was me, but, but, um, But it's amazing how when you look at it so closely, and Mila, I'm sure you've had this experience too, when, when you understand what you're doing, because I would say most people [01:17:00] living with LADA who are well controlled or people living with type 1 who are well controlled probably know more about diabetes than a general lay person.

  Primary care doctor. I talked to a surgeon the other day who was taking care of a patient who of mine with type 1 and I was guiding him on what to do with with the insulin pump of pre operatively and He was like, oh, I'm so happy you called because I've only this is my only second patient with type 1 diabetes.

  I've ever Operated on ever. Okay, so like I think It isn't, it's not even trying, I'm not trying to be mean, but I do think that patients living with, with diabetes often know more than, than their primary care provider, and even sometimes us, right? Like, they, we can guide them and they can, Help us guide them with the information that they have about their own body.

  So, um, I think, I think that's an important thing for us to talk about because endocrinology is so cerebral, right? It's, it's an intellectual [01:18:00] specialty. We're, it's pretty black and white for people to understand. Okay, ortho fixes my knee, whatever, like they do a surgery, but with endocrinology, it's hard to understand something that you didn't even know existed.

  There was a world of that didn't exist. So, um, but that's how we, we think about diabetes in a very microscopic way. Mila, I'm curious. Did anyone ever talk to you about diabetes distress in this whole process? 

  Mila: No, it was something that I learned, um, after I decided to start therapy because I was feeling like it This has all been really heavy and I don't think that I've processed it.

  And now I have this condition that like I truly will be living with for the rest of my life and I don't know how to cope with that. And, um, so it wasn't until I talked to a therapist, um, and I kind of said, I really want [01:19:00] to talk about, Like my life changing diagnosis, like this is going to change everything about my life.

  And then we had this conversation of, well, I'm going to send you some resources about diabetes distress in some ways that you can cope. And I had no idea that there was such an emotional component to living with diabetes. Um, and. Um, and it's just really keeping yourself alive on a daily basis. It's a lot of responsibility.

  And I think we live in a time now where, like, we have technology at our disposal. And it is probably easier now to live with diabetes than it ever has been. Um, But when you think about it on the granular level, you're like, Oh, wow, I'm in charge of handling this medication that if I take too little is going to be harmful to me.

  And if I take too much, it's going to be harmful to me. And that's my responsibility. It's my responsibility to do that every day. So, Um, it's my responsibility to wake up [01:20:00] at 3 a. m. when my pump runs out so that I can make sure that I'm still having a basal dose of insulin. It's my job to make sure that I'm carb counting so that I can accurately bolus so that my blood sugars stay in range.

  Um, and so it's this really interesting puzzle piece and I think it's exactly what you were talking about is, um, You know, we have such granular data about ourselves, about every move that we make. And then we have all of this technology that tells us like, you slept poorly last night, and that's why your blood sugars might be higher today.

  Or, you know, you, um, ate 50 grams of carbs, but you only bolused for 40. So you have to do this mental math and make this correction. And I think that, um, It's just really, it's interesting to kind of be pushed into. That life. And then I think it also causes a [01:21:00] lot of emotional instability when you're not ready for it because your whole life changes overnight.

  Everything that you now have to do in life is compounded with making sure that you're alive every day. And so, um, it was a conversation that I didn't get to have and I didn't realize that I was going through until I had talked to a therapist and they said this is what you're dealing with right now and having that ability for them to explain it to me gave me the ability to give myself so much more grace because every day I was looking at a high blood sugar as a pass fail and not like an opportunity to learn something and to be able to tweak in the future.

  I was just kind of like, I'm, I'm terrible. I can't get this right. I can't figure it out. I can't do the math. It's not working. Um, and then I would be really frustrated and just not want to do anything. And so being [01:22:00] able to know that there was like a term for that and there, like, it was an actual feeling was so refreshing because it gave me the ability to.

  Kind of like step away and just say, okay, you're going to be fine. Like just take this one step at a time, take a deep breath. It's frustrating right now, but you'll get it and it'll be okay. Um, but also like, it's okay to say that you are feeling these feelings of distress and you're feeling anxiety around your diabetes management and what you're responsible for.

  Arti: Yeah. And I, I think that, um, The terminology gives validation to those feelings, like, oh, okay, this is, this isn't a me problem. This is part of this. And now that I have the language with which to understand this part of it, now I can, I can cope with it. And I always think about the importance of [01:23:00] validating our patients.

  It's, you know, I think all of us have gone to the doctor and had this experience of like, It's all in your head or like that's not that's not what's going on or or just feeling like Invalidated what if we've had it from a doctor or any all of us have experienced that in life And I always think about the massage therapists.

  I know this sound this is like Sounds very off topic, but I always think about the massage therapist because they're always like, oh my gosh, you are, you must be so stressed. You have so many knots. And like, how does that make you feel? Right? It makes you feel validated. Yes, I should have gotten this massage.

  I should have shown up here to take care of myself. And. They have got something right, you know, like, I think I probably don't have any knots, right? Like, I don't have that stressful of a life, but they tell me I do, therefore, I, the experience is that much [01:24:00] better. So I think that if we give ourselves a grace, sure, but also as physicians, if we give our patients the grace by doing something so simple, like, yeah.

  It sucks that you have diabetes. Like, I, yes, it makes sense that you are not excited to have to dose yourself with insulin before every meal. Like, I think those small touches of understanding and validation can go really far. Like, don't you think, Mila? Don't you think that would be helpful? 

  Mila: Yeah, absolutely.

  And I have such a great example of this with my current endo in that whenever he pulls up my ambulatory glucose report, he doesn't just say, Oh, I see this pattern in this pattern, in this pattern, in this pattern, he'll turn his screen and he is like, tell me what you're seeing, tell me where you feel like you might be struggling or where you feel like you're doing really, really well.

  And let's talk [01:25:00] through it. And that is another. piece of validation, because I know that my clinician knows that I am the expert in my diabetes and they're not going to make assumptions about what I know or what I don't know, but they can learn from me how I'm managing and what ways that we can enhance what I'm already doing or change what I'm already doing.

  And so I think you're so right when it comes to, um, Just like, again, that compassion. I think validation is such an important part of it because it really does make your patient feel heard and it makes us feel like, okay, I might know what I'm doing and I can take the driver's seat when I leave and I don't come back for three months.

  Um, Because like in that three months, we're on our own and like we can message or we can call or we can book another appointment if we can pay for it. But [01:26:00] we're also figuring it out as we go and having to kind of like test and tinker and tweak every day. And so, After having an appointment like that, where I walk out of the office and I'm like, okay, my endo said, I know what I'm doing.

  Cool. Like I've got this for the next three months. I think it also just helps us build that confidence, which is so important when it comes to living with diabetes. 

  Arti: Yeah, yeah, for sure. Um, Vidya, was there anything 

  Vidhya: that you wanted to add to that? Yeah, I loved how you, you said Mila, building confidence when it comes to your own management of your type 1 diabetes.

  And I think that's huge. I, I think, you know, And just like kind of going back to diabetes distress, like, I'm an endocrinologist, but I don't have diabetes, and I think that we, you know, we do have to think about that, like, yes, we can sit here and say, hey, I've seen hundreds of patients with diabetes, you know, I've been doing this for this many years, [01:27:00] but our patients know all about it.

  Because they are looking at their own blood sugars every day, all day, every night, and then they see what changes their blood sugars, exercise, their menstrual cycle, stress, you know, whether it's holidays or sleep or whatever it is. So, You know, I think, thinking of the patient doctor relationship as like a team, it's not, you came to the doctor, you're sitting there like nervous, and your doctor tells you, you're doing a bad job, increase your insulin, see you in three months, like that's horrible.

  You know, and it's not going to work, because your patient leaves feeling like, okay, well I guess I don't know what I'm doing, I have to increase my insulin, I just feel scared, and I feel like I did a bad job. So, Yeah, I think one of the things that helps with diabetes and distress absolutely is calling it something, recognizing it, validating your patient, and then also like helping your patient gain [01:28:00] confidence with managing their day to day.

  Diabetes and their lives. So yeah, I mean I thought I think that's all I had to add But yeah, I really appreciate you saying that like getting the confidence, right? And I mean we can kind of think of ourselves as like diabetes coaches like really like it's you know when you're a coach It's not about you, it's about, you know, your patient being able to fly, right?

  Being able to live their lives in the best way that they can. So, we have to give them the tools to do that. I think that's great. 

  Arti: Yeah, I think giving, giving our patients the tools is important. is absolutely the key in, in diabetes, especially type one and, and lotto where, where there is a lot of management at home, self management.

  Um, and I think that when we do that, that that's how we succeed. We're not magicians. We're just kind of like the Magellan to guide you, you know, [01:29:00] through these rocky straits and to support you when it gets hard. And, um, I think that, um, That's really how we should be seeing our roles as a, as a partner in, in this as, as opposed to like your, I know a lot of people on, on Instagram kind of like see their appointment with their endo is like judgment day, you know, like they, they're like terrified or like, there's like memes and threads on like, guess what my endo said to me today, like, And it's always ridiculous, like I, I get it from the patient's perspective, like you're like working super hard, your A1C drops from like 8 to 7 and the endo's like, well, still not good enough.

  You know, it's like, okay, um, that, that's not useful or helpful. So I think, yeah, a partnership is so important. And the, the other thing is like people living with diabetes, type 1, type 2, LADA, [01:30:00] all All the plenty of different types in between can have a wonderful, thriving life and career and family and all.

  There are no restrictions. There's nothing that You cannot do because you have this diagnosis and I think when people are disempowered about their diabetes it may disempower them about everything else and It's unnecessary and it's unhelpful to to do that to a person, you know And this is, this is not a death sentence, it is, it's not ideal, it's, it's not, like, no one wants it, but at the same time, there are people doing great things, I mean, Robin Arizona is pretty cool, and she's living with this, and, um, Justin Jonas, and, um, Winona Ryder's daughter, [01:31:00] right?

  Like all of these people are doing cool stuff. And also like some, some people have used a diagnosis of type one to launch their career in, in coaching others or things like that. It, it could be used as a tool. tool to get you somewhere. And also, people living with type 1 diabetes have a skill set that they've been managing for a long time that's really hard.

  And if they're doing a good job at that, can you only imagine how many other things that they could do a great job at? So I think that validating our patients and their concerns, but also Building that confidence and empowerment goes so much further than just diabetes numbers. It goes It, it can spread to their whole, their whole life and their whole sense of self.

  So that word confidence, I [01:32:00] think, struck a chord for both of us in a very positive way. So thank you for, um, for, for saying what you said, but, um, as we close up, is there anything we didn't talk about or anything that anyone was like dying to say that, that they didn't have a chance to, um, before we wrap up?

  Vidhya: Yeah, I think, you know, What we've gained from this conversation is just, like, a couple of things. First of all, diabetes management takes time for our patients and for the doctors and the nurses that are helping and coaching our patients. It takes a lot of time. And it's not easy. time every three months.

  I mean, it's time depending on life stress stressors. And for our patients, it's every day, every minute of the day. So there's nothing simple about diabetes. It's incredibly complex, and it is very different. on everybody. So I think it's just [01:33:00] important to recognize how complex and important this disease process is.

  Um, and then the other thing is just the current healthcare system doesn't support good care for folks who are living with diabetes because there's barriers to get to an endocrinologist and endocrinologists also don't have the time that they need to learn about and, uh, form like a good partnership.

  with their patients. And this has got to change. And I think we saw that today. 

  Arti: Yeah, 

  Mila: absolutely. 

  Arti: Anything you wanted to add, Mila? 

  Mila: I think just reinforcing the message of self advocacy. And no matter how hard it can be to speak up for yourself, it's in your best interest. And it's going to help your clinician help you in the most positive way.

  So the more that you can be open and honest and speak up even when it feels really hard, the better it will be for you going down the [01:34:00] road. 

  Arti: Absolutely. And Mila, where can people find you on social and are there any projects that you're working on that people should look out for? Yeah, 

  Mila: so I have an Instagram.

  It's at the hangry woman, which is all my, um, fun recipes and reels about living with diabetes and, uh, funny conversations that. We tend to find in the humor of our disease. And I also have a mobile app for iOS and for Google Play, and it's called Glucose Guide. I'm a board certified health coach, and so I work with people on habit change and also, um, Really working to build a community of people who understand.

  And so it's a great community with over a thousand members. It's completely free. I offer recipes there that you can't find on my website or Instagram. Um, and I also offer free short coaching sessions to anyone who joins the community. so that they [01:35:00] can get their questions answered. They can get help with their overall goals.

  Um, and then they can understand diabetes a lot more. So it helps with that confidence aspect of learning how to live with and self manage your condition. 

  Arti: That's amazing. See, using diabetes as a launch pad. That's what we're talking about. That's so awesome. I'm so proud of you and thank you so much for your time and sharing your story so openly and honestly and having this incredible discussion with us.

  We really hope that we can bring endocrinologists and our, and our patients closer together by delivering these messages together. And, um, Your story was just so powerful. And thank 

  Vidhya: you, Mila. You're an inspiration. And I, I love your platform. And you just inspire so many. So thank you for all your work.

  You're amazing. 

  Mila: Thank you so much. And both of you are [01:36:00] also. So amazing and so wonderful. And like I said, I hope that one day we figure out cloning so that we can have way more of you being our excellent and 

  Arti: amazing endos. Oh, thank you. Oh yeah. That should be our next project. Cloning. We're on that.

Resources & Links

Follow Mila Clark (The Hangry Woman):

• Explore Mila’s Diabetes App: Glucose Guide →

• Instagram: @thehangrywoman

• Website: HangryWoman.com

Follow Dr. Vidhya Illuri:

• Instagram: @dr.illuris.pantry

Connect with Dr. Arti Thangudu:

• Instagram: @drartithangudu

• LinkedIn: Arti Thangudu, MD

• YouTube: @drartithangudu

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