Endocrinology, diabetes, and choosing a provider.
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
January 2009 — When I mention that I see an endocrinologist for my type 2 diabetes, it raises some eyebrows. I have to explain myself each and every time this happens, as not everyone seems to see the value in an endocrinologist treating people with type 2 diabetes.
First of all, the primary care physician who diagnosed me was much too insistent that I couldn't control my condition with diet and exercise alone. She wanted to prescribe metformin, but didn't mention anything about a blood glucose meter. Given that my A1C and fasting blood sugar were both borderline, it didn't make sense to pop a pill and call it good. I needed a second opinion and wanted an expert to guide me.
Added to that, I had been diagnosed with hypothyroidism only a couple months before my type 2 diabetes diagnosis. It did make sense to see a doctor who was knowledgeable about endocrinology, diabetes and the thyroid condition.
Most importantly, I knew that for years, my husband had been under the care of specialists in endocrinology—diabetes was first diagnosed when he was eleven. How could I deny myself the help he'd received from the doctors who knew diabetes well?
It's been nearly four years since I started seeing the endocrinologist. He knows all the latest news and trends for not only type 2 diabetes and thyroid disease, but also provides some insight into my husband's type 1.
We both wonder if his endocrinologist, who is board-certified in both endocrinology and internal medicine, is the best fit for Greg. This doctor treats those with diabetes and thyroid conditions as well as those who do not have abnormal processes of the pancreas and thyroid. I suspect that most of his diabetes patients have type 2 and he may not be entirely helpful with Greg's type 1. Time after time, I hear Greg complain about being rushed through appointments.
One of the major differences between our endocrinologists is the way they handle laboratory tests. Mine asks me to go for tests before each appointment so that we can discuss the results at our visit. Greg's doctor gives him a lab slip at the end of each appointment and then receives a letter in the mail letting him know the results. This has been another complaint of his – not being able to discuss possible changes in his insulin regimen at his doctor's visit.
On the other hand, Greg can usually call his doctor's office and get an appointment less than two weeks out while I'm usually looking at a two-month wait. (I have to wonder if this is why he often feels rushed through his visits though…)
There have been some structural changes in my endocrinologist's practice and Greg is starting to seriously think about making the switch. He knows how informed and assured I feel after each visit with my doctor. He is also aware that the practice is open to technology such as insulin pumps and continuous glucose monitoring systems, both of which have begun to interest him. The practice will be closer to our home, which holds even more appeal.
Changing specialists won't be easy if Greg does choose to do so. Since he relies on his current doctor for both primary care and endocrinology, he would have to find a new primary care physician. It seems like it may be a good time to switch, with the promise of better control without the fear of hypoglycemia.
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dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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I had a work dinner last night with some leadership from my office. I always find diabetes etiquette at these things to be kind of tricky. It was a four course meal, with salad, soup, entree' and dessert and coffee. There was also a selection of gluten free and non-gluten free dinner rolls. I felt way too full of questions for waitress... "Could I get my dressing on the side? How much sugar is in it?" A course later...