New endo, disappointed

[gambi]

I recently changed treatment facilities and been seeing the PAC at the office, who was absolutely wonderful. She answered all of my questions and was very open to trying new things. She suggested that I see the doctor, ok fine. She is brand new just out of school. So I thought ok, she's going to be very cutting edge. Wrong. Did not like her.

1. She criticized by current treatment plan and is convinced that Byetta in conjuction with the pump is not going to work for me in the long run. Well whatever does end up working in the long run? How often do people have to change their diabetes treatment plan.

2. I approached the SUPER BOLUS from the pumping thread and she thought it was ridiculous - still going to try it anyway.

3. She told me I shouldn't be taking metformin at night, well guess what? If I don't take it my fasting is 160-170 if I do we are looking at 85-115.

4. She told me my AIC of 7.4 is goood!?!?!?! That's horrible, I am newly diagnosed and still working on things, just started the pump in October.

5. She told me I need to go back to Symlin- well gues what? I took Symlin from September to about 2 weeks ago when I switched to Byetta, my last AIC was 7.3 and it's 7.4 (taken on Dec. 28) So no change in the AIC with Symlin oh and I gained weight!! With the Byetta I lost a few pounds and have cut my insulin down to 15-17units from 20-22units.

6. AND she told me I was exercising too much and wasting a lot of time - uhh like I have so many better things to do? I have a lot of stress right now with my wedding, my parents fighting, and I'm about to change jobs. I NEED TO EXERCISE to keep sanity and it helps my BGs. I don't think 45 minutes 2x per day and weight lifting for 30 minutes is excessive - most body builders do 50x more than that! Sorry I want to stay in shape and get stronger and improve my mood.

7. She also had no idea about this new insuling coming out Vioject by Biodel, I have been watching it pretty closely. Do these doctors ever research anything?

8. She also thinks the islet transplant is a BAD idea. Whatever. I would do it in a heartbeat if I was selected. When I saw the PAC, she was very receptive and even said she would start looking into studies for me.

She did tell me my numbers for the last month looked good, so hopefull since I've been using the CGM and havng sucess with the Byetta and the pump my AIC will improve.

I will stick with the PAC, sorry to vent. I guess I was just expecting so much more.

[davef]

Gambi,

That's an awful way for a doctor to behave! Geez, she should have sat, listened and learned something from you. As an old saying goes (think it was Oscar Wilde) "if only I was young enough to know everything". She really needs to realise that she does not yet know everything and can learn from people who have been living with an illness. I'm really happy with my own GP, he is honest, he is in his late 40's early 50's but has no problem admitting when he does not know something, but will always say "I don't know, but I'll find out".

Stick with the people you are happy with, listen to you and are willing to work with you and not against you.

[Funnygrl]

In her defense- Byetta isn't suppose to be used with insulin and Symlin is, and islet transplants are far from perfected so who knows, they may still be a bad idea, but you're too newly diagnosed to be accepted to any trials anyways.

[Cyborg]

Sorry you didn't like your new endo. Perhaps things will go better next time.

With regards to your fasting numbers, it appears you don't have your basal set correctly to offset your DP. Your pump would be much more effective than the metformin and you'd be able to drop another medication. Good luck.

[kgm0612]

Geesh........the new endo sounds like a real "downer". Stick with the PAC from now on.....she seems to know more!

My last A1c was 7.3 (up from 6.8) and my endo was NOT happy. Said it was way too high and that he wanted it below 6.5. I'm working on that, but like you, I have major stress going on right now and it's doing a number on my blood sugars.

I've been on 500mg Metformin twice a day, along with insulin, for the last 5 years. Endo claims the combination helps maintain weight control and so far, it has worked for me.

As far as exercise goes........I walk at least 3 miles almost every evening, whether it's outside or on the treadmill. It helps keep my blood sugar from spiking too high after dinner, and it also relieves some of the stress in my life.

Keep doing what you're doing.......it's working for you!

Karen

[Jan B]

Gambi,

Just curious . . . what did you say, or do, while she was being so critical of your current plan?

7.4 isn't (really) horrible (just not great); many doctors still think 7 is fine -- they think we have too many lows when going for the 6 or better. (My goal is 6 & my doctor wants 6.) Your treatment plan is unusual. Did she have a conversation with you about your "unusual" ways, or keep dictating to you?

[xMenace]

2. I approached the SUPER BOLUS from the pumping thread and she thought it was ridiculous - still going to try it anyway.

3. She told me I shouldn't be taking metformin at night, well guess what? If I don't take it my fasting is 160-170 if I do we are looking at 85-115.


I tend to agree with much of your endo's assertions.

While I implore type 2's to take their metformin, it's not something I would do or recommend anyone do that doesn't need to. There are cardio-vascular related concerns with it. Why add another risk factor to an already elevated case?

You claim you need met to get your FBGs down. I don't disagree this gets them down, but I disagree about it being the only or best way. You are on a pump. Pumpers can easily tame their dawn phenomenons or any other variances. It takes a bit of work, but it is easy to do. With a CGMS it should be a snap. Read the links below for the basic concepts.


Integrated Diabetes Services - Diabetes Management (http://www.integrateddiabetes.com/pump_bt.shtml)

Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals)

[Alice]

Try to stick with her through the "getting to know" each other...I've had do this a lot...and sometimes it works out great in the end.

Truthfully, you are taking an unusual combination for a Type 1 which you know already. I think she might be trying to get you back to basics to figure out basals, etc....

Low 7's on A1C? She has seen a lot worse...that range just means that a little work/tweaking has to take place...not the major drop she needs to see on many people.

I'm getting to know new doc's this year too...it's always an adventure, but keep an open mind. Good luck!