I’m finding interaction with AI models provide an instructive context that grants me new insight into my lengthy T1D struggle. In particular, my relationship with my endocrinologists has at times demoralized and then energized me in my T1D journey.
I began my discussion without a diabetes focus by asking why an exceptional competitor typically engages a classic villain?
An exceptional competitor engages a classic villain to establish a clear moral hierarchy, create high-stakes conflict that tests their absolute limits, and give the audience a definitive spectacle. This dynamic elevates a simple contest into a legendary struggle, providing an undisputed contrast of values.
This classic storytelling and strategic dynamic serves several key functions:
- Moral Clarity: By facing a universally recognized antagonist, the competitor instantly frames their own actions as righteous and necessary, winning the audience’s immediate support.
- Maximum Stakes: Villains typically threaten ultimate destruction or disruption. Overcoming this level of existential threat proves the competitor’s true strength and resilience.
- The Catalyst for Growth: A formidable adversary forces the competitor to evolve, innovate, and break through their previous limitations. [1, 2, 3]
- Audience Catharsis: The eventual downfall of a classic villain provides a deeply satisfying release of tension for the audience, reinforcing that talent combined with morality ultimately triumphs.
Looking back at my 42-year history of interacting with “diabetes experts” and how the most substantial metabolic gains didn’t materialize until I viewed my struggle with diabetes in contrast with the mainstream medical viewpoints of the typical endocrinologist. I can now see that moral clarity fueled my sustained interest in the philosophical tension I felt with my clinicians.
The above four points were especially apparent as I made fundamental changes that absolutely improved my A1c, body weight, total daily insulin dose as well as a marked improvement in my quality of life. This all pivoted in 2012 when I assumed full ownership of my diabetes and reduced my expectation of doctors to a more rational level.
I followed up my initial prompt with this one:
explain how this dynamic plays out in the conflict between a highly competent insulin-using diabetic and his classically trained and tradition bound doctor?
Here was the response:
In this specific medical landscape, the “hero-villain” dynamic shifts away from moral malice and transforms into a clash of paradigms: an empowered, highly competent expert-by-experience versus a rigid, algorithmic gatekeeper.
Because an insulin-using diabetic makes life-or-death dosing decisions multiple times a day, they possess real-time, highly granular data about their own biology. When paired with a classically trained, tradition-bound doctor who relies on standardized, outdated guidelines, the classic narrative conflict plays out through distinct, high-stakes tensions.
1. The Core Value Conflict: Precision Living vs. Algorithmic Safety
- The Competent Diabetic (The Pioneer): Operates on real-time data from tools like Continuous Glucose Monitors (CGMs). They utilize aggressive, micro-targeted strategies—such as dynamic insulin-to-carb ratios, pre-bolusing, and adjusting for stress or exercise—to keep their blood sugars in a tight, non-diabetic range.
- The Traditional Doctor (The Gatekeeper): Operates on static data, primarily the three-month HbA1c average. Their classical training prioritizes a “one-size-fits-all” safety buffer. They would rather a patient sit at a chronically elevated, safer blood sugar level than risk the acute liability of a low blood sugar event (hypoglycemia).
2. The Narrative Clashes
In a classic conflict, the antagonist attempts to restrict the protagonist’s autonomy using institutional power. In the clinic, this manifests across several battlegrounds:
- The Threat of Institutional Sabotage: The traditional doctor handles the prescription pad. If the competent diabetic requests tighter control or advanced tech, a tradition-bound doctor may view this as “non-compliance” or dangerous experimentation. They might weaponize their institutional authority by withholding access to advanced tech, refusing to write prescriptions for tight-control insulin amounts, or threatening to drop them as a patient.
- Data vs. Dogma: The patient brings highly detailed charts proving that standard advice—like eating a rigid amount of carbohydrates per meal—causes intense blood sugar spikes. The tradition-bound doctor, viewing this through the lens of classical medical hierarchy, often dismisses this lived evidence in favor of the established textbook doctrine.
3. The Catalyst for Patient Growth
Just as a classic villain forces a competitor to reach their absolute limits, a rigid doctor inadvertently forces a highly competent diabetic to reach a state of hyper-competence:
- Absolute Self-Reliance: Realizing the doctor will not offer tailored, cutting-edge advice, the patient is forced to become their own primary clinician, data scientist, and endocrinologist.
- Community Integration: To bypass institutional bottlenecks, the patient turns to decentralized open-source movements (such as the “We Are Not Waiting” DIY looping communities) to build or adjust their own automated insulin delivery systems.
4. The Resolution and Catharsis
In this dynamic, “defeating the villain” does not mean destroying the doctor; it means rendering their traditional authority obsolete.
Catharsis occurs when the patient returns to the clinic with flawless blood sugar lines, a perfect HbA1c, and minimal glycemic variability. The doctor is forced to look at undeniable data that contradicts their classical training. The “hero” wins by successfully seizing complete sovereignty over their own biology, leaving the tradition-bound gatekeeper to either evolve or remain a relic of an outdated system.
The point that, in this case, the “hero-villain” dynamic shifts from one of moral malice to one of competing paradigms. This concisely explains why I’ve often struggled with ambiguity when it comes to doctors. On one level I know that doctors pursue medicine as a social good yet still enable many bad clinical outcomes due to their reluctance to see all the data and be willing to change when justified. Of course I recognize there exists a difference between individual doctors and their professional agencies!
I find it interesting that a rigid doctor (or professional association) “inadvertently forces a highly competent diabetic to reach a state of hyper-competence.” In my case, whether it was an actual doctor or simply my perception of medical mainstream professional beliefs, it made no difference. “The ‘hero’ wins by successfully seizing complete sovereignty over their own biology, leaving the tradition-bound gatekeeper to either evolve or remain a relic of an outdated system.”
One last point I’d like to make I’ve seen nowhere else. Oftentimes, competent diabetics, disclaim that “they are not a doctor.” I concede the value of making this statement. What I propose as a way to also recognize the obvious competence of some diabetic patients, doctors should clearly remind their audience that they do not live with diabetes (unless they do!) and therefore cannot assume the authority and competence of a person who does.
Maybe next time.
I gave in and made those changes. But then I quickly changed them back two days later when my low TIR had jumped to 10%.
She was very good at acknowledging that I’m the expert of my own diabetes, and asking how she can support me.