Endocrinologist and Other Stuff

[belyro]

Some of you may remember that when I first joined DF a little over a month ago I was pretty unhappy with my endo, was frustrated that she hadn't been as helpful in giving me useful suggestions as I'd hoped, and was planning on asking for a referral from my family doctor for a new endo.

So, today I went to my family doctor (who I love and trust 100%, for the record...best doctor I've ever had), and she suggested that perhaps I don't really need to see an endo anymore - at least no more than once a year. The new plan is that she has given me a "standing lab request" to go get bloodwork and urine testing done once every 3 months. The results will go to her (my family doctor) and she will contact me to let me know how they are. If there's a problem, she'll call me in to see her.

That's part one. Part two is that she's going to try to find me a diabetes educator in my city (my doctor's in my hometown, which is a bit of a drive from here, so I'd rather see a DE in my own city) that I can meet with on a more regular basis to really strategize. So now I'll be able to have a DOCTOR who really cares about me and wants to help me and CHEER me on, instead of making me cry, plus I should have some real hands-on help as soon as she can get me hooked up with a DE. VERY exciting!

Also....I asked her about low-carb diets (some of you may have seen my "how many carbs in a day" thread), because I was getting conflicting responses from people. She said they're really good for Type 2s, but she also doesn't see any reason why they couldn't be good for Type 1s. She acknowledged that there are people out there who believe that it's not healthy to eat low-carb (and I'm talking low-carb, here, not "no-carb"), but really, the most important thing for me as a diabetic is to keep my HA1C down......end of story. The other stuff is peripheral. I've never really looked at it that way, but it's so true. So if low-carb makes it easier to manage my bloodsugar, then that's the way to go! If it doesn't, then I don't have to stick with it. So I've got some thinking to do...but I might give it a try.

Anyway, sorry to ramble, but there's my update.

[Gangrel]

You know, I'm not sure if I would go endo-less....... I currently see my endo every 6 months, get my A1cs and everything else checked by her, and have access to the Nurse, Dieticians, etc at the hospital.

I'm sure your doctor is very good, and the Educator would be too, but how "expert" are they on D? Or at the least, how much do they stay on top of treatment options, theories, etc? I know my endo is very involved with that sort of thing, and she is usually the first i hear of something, unless I read it online.

Now, I could be wrong, and my perception of an "educator" is wrong.... in which case, ignore me.... But an educator to me seems to be someone who only teaches you the current practice... but doesn't help you tweak, or help you get involved with future best practicies... (wow, i stole that term from work!)

Again, maybe i'm just too old school.... maybe i'm wrong. Feel free to ignore me as I am heavily medicated this week.

[belyro]

You know, I'm not sure if I would go endo-less....... I currently see my endo every 6 months, get my A1cs and everything else checked by her, and have access to the Nurse, Dieticians, etc at the hospital.

I'm sure your doctor is very good, and the Educator would be too, but how "expert" are they on D? Or at the least, how much do they stay on top of treatment options, theories, etc? I know my endo is very involved with that sort of thing, and she is usually the first i hear of something, unless I read it online.

Now, I could be wrong, and my perception of an "educator" is wrong.... in which case, ignore me.... But an educator to me seems to be someone who only teaches you the current practice... but doesn't help you tweak, or help you get involved with future best practicies... (wow, i stole that term from work!)

Again, maybe i'm just too old school.... maybe i'm wrong. Feel free to ignore me as I am heavily medicated this week.

That's kinda what I thought too....but she assured me that the eductor she will find for me will be very "on-top" of this stuff, and that she actually is as well. It was one of my first questions b/c one of the things I DID like about my endo is how quickly she put me on Levemir after it came out. My family doc assured me that I wouldn't be lacking that kind of information, as long as I dealt with an educator.

I'm sure some educators are really just all about what's "current", but that's not the kind of educator she's trying to find me. She's trying to find a "tweaker" (geez, I hope that's not a bad term in any international dialect on here.....) for me, and someone who will give me the heads-up about new stuff. There's an educator in my hometown that I've known all my life and would be GREAT for me - she's on top of EVERYTHING....but she's got way too many clients already and she's too far for me to drive on a regular basis, so we're trying the "my city" option first.

[BlueSky]

.... So now I'll be able to have a DOCTOR who really cares about me and wants to help me and CHEER me on, instead of making me cry, plus I should have some real hands-on help as soon as she can get me hooked up with a DE. VERY exciting! .......

It sounds like a sensible approach. As long as your control is stable, there is no need to experiment with the latest treatments anyway. Endos, in my view, are too specialised and busy to add much value to the day-to-day managment of a chronic condition. And you get much more mileage out of working with a DE who helps you get the best results from your insulin regimen.

I have a similar arrangement with my GP. She gets copies of 3 monthly tests and I see her at least twice a year to get new prespcriptions. She likes me to see an endo annually to keep a watching brief on what is going on, which is fair enough. :wink:

[belyro]

Endos, in my view, are too specialised and busy to add much value to the day-to-day managment of a chronic condition. And you get much more mileage out of working with a DE who helps you get the best results from your insulin regimen.


This was my doctor's point exactly.

[valc3]

At the time of being dx'd, I was seeing my Internist(family dr)He said he would refer me to an Endo, if that's what I wanted, but if there weren't any complications or problems, he could continue my treatment. The treatment I received was current and he also referred me to a Nutrionist and a CDE. I stayed with him for almost a year and when problems started happening, he immediately sent me on my way to an Endo. He said it was time for a specialist.

I think if you have a good relationship with your family doctor and are not having complications or problems, then you can continue seeing her. The most important thing is, your Dr. knowing when it is time to send you to a specialist.

Good luck

[grace girl]

Sounds like a good plan, to me. If you have a doctor that you trust, and a good up-to-date cde, plus 2x yearly with an endo, I think you'd be quite well covered.
As to the carb thing, being type 1, I think it's like everything else with this mess, you just have to find what works best for you personally. I totally agree with your doc, the important thing is keeping the a1c on track.

[seacomp]

and she suggested that perhaps I don't really need to see an endo anymore - at least no more than once a year.
...
So if low-carb makes it easier to manage my bloodsugar, then that's the way to go! If it doesn't, then I don't have to stick with it. So I've got some thinking to do...but I might give it a try.
That's the conclusion I came to regarding my own endo; all I was getting of out the appointments were new free meters!
On the low carb approach, I think that's what a lot of people have been saying. That is, it works to manage your Bg easier, no more, no less. Not a religion, a creed, or a point of honor, just a workable approach to Bg control.

[rzrbks]

I've had 4 (count them) F-O-U-R CDEs tell me that unless I'm having problems, that going to an Endo isn't worth it.

Now, granted, the Endos in this area are mostly ButtHeads and Beaveses, but if you and your family Dr. are doing ok controlling your Diabetes, why change?

[Amanda_Jo22]

I had an endo like that...I would cry when I would leave his office. I finally found an endo whom I love, and I saw how important it is to have a doctor you like and respect. I think it sounds like a good idea...why not try it for 6 months and see how your bg control goes.

[gettingby]

I see a CDE at my family doc's office. She is very up to date on everything and she once worked under a highly respected Endo up North. She's thinking that I will have to see an endo soon but she will still be a part of my treatment plan. She's wonderful !!! :)

[Funnygrl]

I go to a diabetes center with endos and CDEs. I like being able to see the endo and cde all in one place.