When you know better of course.

Well, that raises a lot of questions!

Let's first consider them in the context of a non-diabetic example. My
mother and all her children suffer from ulcerative colitis (UC). Some
time ago it was all of them except me. Then I developed the familiar
dreaded symptoms after a campylobacter infection. I called in a
doctor. I told him that I was the only one in my family without UC,
and described to him my typical UC symptoms.

"Probably not," was the diagnosis. "Probably just residual
campylobacter. Take these antibiotics to make sure it's really cleared
up and we'll see how it goes."

I rang my sister. "The lunatic!" she said, "The antibiotic will make
you worse! And the fool didn't even take a stool sample for testing to
confirm his speculative diagnosis! Complete moron! Think of an excuse
to call in another doctor tomorrow. Time is very critical!"

Well, to cut a long story short in three days I went through three
doctors from that practice, all of who told me I probably didn't have
UC, I should take the antibotics, and we should wait and see. The
third was the head of the practice, who brought along a student doctor
to see how she dealt with this now notoriously troublesome
patient. She did back down from the antibiotic after I asked her to
tell me what effect it would have on me on the remote off-chance that
I did happen to be suffering from UC.

"There's a nasty tummy bug going round", she said. "And it could also
be a resurgence of the campylobacter. Let's wait and see what the lab
comes up with from your stool sample. We'll hold off on the antibiotic
until we get the results and we'll see what happens while we wait."

After having been stonewalled by three doctors, including the senior
head of the practice, I was inclined to take their unanimous medical
advice. But my sister was still going ballistic about medical morons
on the end of the telephone. No, she's not a doctor, nor does she have
any medical or biological or even scientific educational
qualifications at all. She's just an intelligent patient who's
suffered the disorder for decades, and has taken the opportunity to
learn as much as she could about it. So should I listen to her, or to
the three medically qualified doctors?

I don't judge the opinion of an expert by his or her qualifications
except in an emergency when nothing else is available. I judge it by
how well they can provide me with a good explanation of their
diagnosis. If I don't have the educational background to understand it
all they should be able to explain what's missing and why a simplified
analogy won't work so I can do the appropriate homework. In other
words they have to convince me that they do know what they're talking
about.

None of the three doctors could do that. None of them could fit all of
my symptoms into a convincing explanatory diagnostic model. Whereas my
sister could. What's more, she had been right about the error
committed by the first doctor which the other two had admitted, and the
error commited by the first two which the third had admitted. I didn't
take her advice over theirs because she was my sister, I took it
because she could provide a more convincing explanation of my symptoms
in terms of a diagnostic model than they could.

So I called in a fourth doctor. He put his hand up to stop my standard
recitation of my problems after about twenty seconds. "Have you a
phone?" he asked. I pointed to it. He picked it up and booked me
straight into the hospital as an emergency case of suspected UC.

I was very lucky. He had booked me into a GI research clinic run by a
professor whose research speciality was UC.

"We're *so* lucky to have caught you this early," she told me, "Most
people who arrive here have been faffed around by their doctors for at
least months and sometimes years before they get to us. We've been
trying for ages to alert them to the critical importance of getting
people in here fast before they've suffered too much damage. They
shouldn't be waiting to be pushed into a diagnosis by irrefutable
exclusion. They should send people to us as soon as there's a
suspicion. That may possibly the most critical factor in a good
prognosis, starting treatment as early as possible. The risks of
wasting time while irrecoverable damage progresses are far too high
not to act on the first possible suspicion. But we can't just talk to
the local GPs, we have to to go to the top and fight our way through
the national bureaucracy. These things aren't medical problems any
more unfortunately, they've been turned into political problems."

In fact I managed to get treated so early that I joined a very select
club, so select that officially it doesn't exist -- those people who
have been cured of UC. The professor told me that she suspected that
with early enough diagnosis and modern treatment it might even be
possible to cure rather than just control UC. I had been caught so
early that she was very interested in how I was going to fare.

Very sadly she died of cancer before discovering just how well her
treatment worked on someone who had been caught as early as I had
been. The last time I saw her I thought to myself "Why are you talking
to me like a woman whose life is over? You're the same age as me!" But
I didn't know her well enough to ask if she was dying.

So in sum you should ignore your doctor's advice when you have good
reasons to suspect that you know better. Notice the "you"
there. Notice I did not suggest that you sould ignore your doctor's
advice because you know someone *else* you think knows better. That's
simply shifting the authority from your doctor to someone else. That's
playing the childish "who is the best authority?" game.

It's *your* disease. It's *your* life. The relationship between you
and your doctor is not a child-parent relationship. The doctor is an
expert whom you, a grown up autonomous adult, consult. You ask for
their advice. You ask them to justify their advice to you if they have
failed to do so. You compare their advice and justification with that
of other people you consult, such as other doctors, relatives,
friends, or strangers on the internet. Then *you* take the decision
about whose advice to follow, if any.

If I had taken the unanimous advice of the first three doctors I
consulted about my UC then I might have ended up by now with a
colostomy bag instead of an a.shole.  Fortunately for me my sister had
had plenty of experience of ignorant doctors mistreating UC
possibilities, and was able to guide me past them.

Is this relevant to diabetes? Of course. It's how I got diagnosed.

For years doctor after doctor had been telling me "Nothing to worry
about, you're not diabetic yet". Then one day I saw a really cheap BG
meter on offer in a supermarket and bought it out of curiosity. I
tested my BGs, looked up diabetes on the web, found this newsgroup,
and took complete graphs of my BG response to various typical meals
along to my doctor. He agreed. He also agreed that by the standard
recommended UK NHS testing procedures if he hadn't seen those graphs
he'd still be telling me "you haven't got diabetes yet". He apologised
for the UK NHS diabetes diagnosis rules, and said they were a bit out
of date.

Incidentally, I tested my sister, and suggested she might like to
suggest to her doctor that she might be diabetic. She was later very
pleased to be able to tell me that her doctor had told her there was
nothing to worry about, she wasn't diabetic yet. All I did was a
"whatever" shrug.  I didn't say another word. She's an intelligent
woman. "Let's see how long it takes her", I thought.

It was several weeks before I saw her again. "I've been looking into
this diabetes business," she said, "and I think my doctor might be a
bit of out date."

You go girl! That's my sister!