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My dad is a mechanic, so I spent my formative years leaning over engines and climbing on car lifts getting covered in grease stains and rust. So it’s probably no big surprise that I turned out to be pretty mechanically inclined which helped develop my skills in assessment and diagnostics as a nurse.  I find myself frequently using automotive metaphors for health. When you think about it, the two worlds are not too different. There are all these different size and shape vehicles similar to the different people in the world. Some bodies are specialized and are good at different things, but they all run more or less the same way similar to all the vehicles in the world. Bodies, just like vehicles all need routine maintenance to run optimally and maintain their capabilities over as long a life as possible.

We have all heard the analogies that our body is like a car, we need to fuel it, keep good tires on it, and take it for an oil change every so often. Taking your car to my dad or the guy a hundred miles down the road will provide you with more or less the same oil change.  For people, this is the equivalent of getting our flu shot at the pharmacy, no need for advanced know how or even to know me as an individual. Just do the thing and move on until next time. Rusty old beater, or shiny new racer, we all get the same oil change/flu shot – this is maintenance.

But what happens when there is something wrong? This is where trouble starts.  If you let this problem with a car go on for so long, it may not be fully fixable because you also let it run down and you may leave after getting work done and paying time and money, but you won’t be getting a car back that is more than a slightly less broken old car. ON the other hand, if you brought the same year make and model car in well kept, for regular oil changes, to get the filters replaced and the tires rotated regularly, the mechanic would know that car and the owner pretty well. They would have a record of good maintenance on this vehicle.  So when you brought this car in and said “There’s something wrong, it’s not running as well as it used to” the mechanic’s goal is to get this car back into peak running order. The mechanic is not going to do the bare minimum to keep this car functional and safe, now we are talking performance! We are talking making the sub-optimal optimal!

How does this relate to our own health management?

This is how many of us treat our diabetes team. We don’t visit them until we are a mess. Often we wait until we are in the weeds! We come dragging into their office bleary eyed and barely functional and ask them to fix us. So they take a look at our disheveled sleepless ,  or otherwise beat up selves and roll their eyes.  When you walk into an educator’s office for the first time sick, they are not trying to get you to showroom condition. That team is just aiming for the state of disrepair you are accustomed to. In the medical world we call this the patient’s baseline. The ultimate goal of therapy is not to turn every patient into a physical ideal. The goal of the intervention is to get a patient back to their baseline. But there is a big difference between our level of wellness and function when we are struggling and when we are at our peak! If our diabetes team only ever sees us at our worst (rusty old beaters with little to no maintenance record)  then that becomes our base line. So actually, the fact that you get better at all means that your educator has assumed that your baseline is better than they have ever seen you, which is pretty admirable!

Now, imagine your team sees you routinely, whether you are sick or not. Rather than lamenting to them the list of symptoms and struggles you are facing, you can regale them with stories about your latest outdoor adventures, demonstrate your fantastic logged data and CGm graphs, dazzle with your clear focused mind, reflexes and visage! You are a very different person compared to when you come in sick! Your educator is no longer just aiming you at a baseline of “better managed than when you  came in” Your educator is now aiming you back to a baseline of YOU! (Maybe even a better, stronger, happier you than you even imagined!)

We often become frustrated with our medical support with complaints like “They don’t take my struggles seriously, or, “they don’t believe I’m trying as hard as I am”, when the reality is that they would be foolish to try to get you to a picture of health far better than they have ever known you to have.  No one expects my dad to try to buff the dents out of the fender of every beat up old Olds’ that roles into his shop.

So, while it is important that we get to the doctor for routine labs, and assessment, and flu shots, all of that is only the maintenance part of the picture. We often think to ourselves ‘why can’t they do that when I’m in for a sick visit?!’. The answer is because you need your healthcare team to get to know YOU at your baseline. You are so much more than the person you are when you are struggling, and you need your team to know that THAT is the line they are aiming for with your treatment, not just a lesser state of disrepair.

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