Are primary care physicians really hopeless?

[binnieman]

I hope this does take precious time away from the more important posts. The ADA, or whoever, came up with defining pre-D but there seems to be a gross lack of knowledge and interest in the primary care doctors with respect to this condition. It is a very confusing concept to begin with, to me anyway, and yet doctors have no clue. My doctor, as of yet, has not ever mentioned that word. Right now, I would really not be surprised if she never heard of it as you will see in the next couple paragraphs.

The title for this thread is based on this email exchange with my doctor. I don't think she means any harm. In fact, she is a very nice woman but I just wonder...

My email to her goes as follows:

"I have been monitoring my BG at home for many weeks now. I wake up over 100 mg/dl almost invariably. My post meal numbers are generally quite good specially if I eat smaller portions. The other good news is that I do very well with all the fruits I have tested thus far.

Given that I am well within the normal weight range and fairly young, I would really want to rule out the possibility of LADA or type 1.5. Would you please order a C-Peptide test for me or whatever test is appropriate?

Also, I have adjusted my diet by lowering my carbs rather substantially and taking more proteins and lean meats, cheese, nuts etc. I want to make sure that does not adversely affect my cholesterol. I would like to see where I am with that as well some time in the fall."

My doctors reply:

"Fortunately, you do not have diabetes, just glucose intolerance. I am so glad that you are taking steps to work with your diet. That will make a big difference in your long term health. No genetic testing for type of diabetes would be appropriate, as you do not have diabetes.
All my best to you..."

I know my wording was probably vague but she should have understood that I meant to say "I would like to see how much insulin I am producing." I might be missing something here.

Sorry for the interruption again folks. I just had to vent and now you all know I don't have a better place to go.

[EeyoreButterfly]

General practitioners are just that- general. You can't expect them to know the finer nuances of every single disease. I can honestly see where she is coming from. She probably has limited knowledge of LADA and based on your e-mail, you are doing great! So to her, there is no reason to test you.

Even though I am "only" pre, I quickly made an appointment with an endo. Doctors are individuals. I am sure there are many pcps who are wonderful about diabetes because they are very knowledgeable in some way, shape, or form. By the same token there are many who simply do not understand it. You have to decide for yourself whether or not you are comfortable with the care your doctor is providing.

[binnieman]

I completely understand what you are saying Jessi but diabetes is an epidemic in this country and they had a really good reason to come up with Pre-D so that you and I can take all precautions to prevent the onset of T2. Given the ever rising numbers of children and adults with diabetes, I would figure every doctor would be on top of the ins and outs of this disease. That is my take but I realize they do have a difficult job. But this forum is a great alternative for information for me. Most of what I know about Pre-D came from you and the members here. I hope to be one day a senior Pre-D member for a really long time without crossing the aisle to the T2 section and I am taking measures for that.

[jps]

I think primary care physicians should know more about T2 diabetes than any other sickness because not only is it an epidemic, all indications are it's becoming even more and more frequent.

I don't think you can lump all PCP's together though. There is going to be some good, some bad.

As for your doctor possibly not knowing about LADA or 1.5, that's understandable. For her not to be over-concerned about a FBS just above 100 is understandable too.

However, if you cannot find a PCP that will give you a little more wiggle room with your health, you might want to find another one. Either that or go to an endocrinologist, who will obviously be very aware of diabetes.

[sorka]

What's sad is that she apparently doesn't know the difference between "impaired fasting glucose" and "impaired glucose tolerance".

Two very basic terms and concepts that any PCP/GP/Internist should understand.

[ADSOFT]

I completely understand what you are saying Jessi but diabetes is an epidemic in this country and they had a really good reason to come up with Pre-D so that you and I can take all precautions to prevent the onset of T2. .

Yep, and people are showing up here more confused about their symptoms. It appears that many are Pre-D but are being told they are ok. But, they know something is definatly wrong, they just don't feel right or their FBG is just not under 100 on a regular basis.

I mentioned this before, and I'm going to mention it again, maybe it will motivate more Pre-D to come on board.

I was reading lots of pamplets about Pre-D when I would take my mom to the hosipital and I would all be screened as Pre-D and high Risk for D. ... but I didn't know what to do.

1. Overweight by 25lbs
2. Over 40
3. Parents with D
4. Sedentary Lifestyle.
5. High blood pressure
6. Tired a few hours after meals

Of course, even without High blood pressure, and the over 40 thing you are still high risk.


I was just going to keep my fingers crossed. I was definatly going to get D if I didn't come here, ... I might still get it according to the stats, but I think I have a fighting chance. And hopefully have a few more years without full blown D.


If the pamphlets would have mentioned to check your glucose in the mornings to make sure you are under 100 then I would have taken action earlier but they didn't mention that.

Anyhow Biniman, at this point I wouldn't trust you future health to that GP get an endo.

FWIW, losing weight and lots of cario have been working for me. I'm no expert, but I keep reading that High Fiber diets are your best defense and Cardio helps lower Insulin Resitance because the blood develops more insulin transporters (or something like that, G???-4's).

I snack alot of Carrots and Broccoli, walk for 1 hr a day.

It was taking me 2 1/2 hrs to get back to under 105-103 after meals, I got is down to 1 1/2 hrs.

My FBG has come down to around 93-95 from 99-101. However, I do drink Miller Lite at night, and I did notice an FBG drop when I started drinking Miller Lite. Two 12oz beers are acceptable from what I have read.

I'm not saying that it is what you have to do, It just seems those things are working for me.

Get and Endo, and keep reading is what recommend.

Glad you shared that with us.

[davef]

I think JPS is right to say that not all PCP are the same.

Certainly I have been very happy with working with my PCP, at present I don't have they need for an Endo.

It is good that you are taking action now as a pre-D, it's only in the last 12'ish months that pre-D has been recognised here in Ireland. prior to that you either were or were not D.

If you have difficulties working with your PCP, then find one you can work with.

[fgummett]

I hate to even suggest this but perhaps you would get more attention from the Doctor if you were not taking such good care of yourself... by testing, limiting carbs etc... you are giving the impression that everything is fine, as evidenced by your reasonable BG control so far. All too often, even with a firm diagnosis of Type 2, the attitude is still "wait and see"... "let's retest in 6 months and see how you are doing"... the "wait and see how bad it can get" attitude :mad:

[Kosmo29]

I know mine is, he says all my numbers are normal when they are clearly not. Good luck!

[foxl]

Get referred out to an Endo and they will get a C-peptide for you!

I suspect for my PCP it was a relief to send me out!

[ADSOFT]

I know mine is, he says all my numbers are normal when they are clearly not. Good luck!


Hey, Kosmo

Have you tried 30g or carbs/meal and test you bg's yet?

[Kosmo29]

not yet, sorry I need to get some more strips. I run through them fast! I will though!

[ADSOFT]

not yet, sorry I need to get some more strips. I run through them fast! I will though!

I kow what you are talking about, I can go through 25 in two days.

I try plan my tests now.

When I run a test I do.

0min, 45min, 1.5hrs, 2hrs. thats 4 strips. (sometime 3 hrs, long tests, if I don't reach my base line or very close to it in 2hrs)

If I try to make my strips last 1 week,

7 strips for fbg, (25-7) = 18

18/4 = 4 + 2 strips, for spot tests. (short tests)
18/5 = 3 + 3 strips,.... (long tests)

That might help your stips last you longer :D

I got those ideas from a lot of the Diabetic studies I have seen. Of course some of them go out to 4-5 hrs.

[themarquis]

My PCP (who is actually a nurse practitioner) is much better than my current endo. :)

I go to a nurse practitioner clinic that mostly serves low income folks and people with little access to care. I initially ended up there a few years back due to an insurance gap, but I loved them so much that I still go even though I have excellent insurance now. It is staffed by four women, all NPs with a decade or more of experience, and they consult with an actual doctor as well (who I have never met). They have been able to get me treated for sleep apnea, beat my depression into submission :) and now chase down the blood sugar/diabetes issues.

My NP freely admits she doesn't know everything about diabetes, but she takes a lot of time with me and goes over my endo's notes and test results. Anything she doesn't know, she talks to people about and does research and gets back to me.

She has tentatively diagnosed me as t2 diabetic and basically said "whether or not you are pre-d or d, you need to be treated the same way with diet, exercise, and medication". She listens to my concerns and wants me to improve my blood sugar, whether or not it's technically "over the line" into diabetes.

My endo, on the other hand, seems to be diagnosis chasing at the moment. I've had every test she can think of (GTT coming up) and she's very diffident about the whole thing, as if she won't really give a **** until some number reaches a magical threshhold or something. And until that happens, she's just going to test me over and over again. Sigh.

[binnieman]

I have now switched doctors but I am not going to raise my hopes too high up. But one way or the other I will do a C-peptide and OGTT because when it comes to foods I get rather surprising post meal numbers. A huge bagel or any pastry or even some drinks loaded with sugar don't raise my BG by more than 10 mg/dl but foods that are cooked too much or that have a lot of spices even with very limited carbs raise my BG to the 130 range. In a nutshell, anything that I have trouble digesting and that makes me feel too full raises my BG. I guess that is to be expected. I don't feel like I am at any dangerous BG levels at this point but I am in agreement with this forum that if your blood sugar is not normal then you have to do something about it lest you become diabetic prematurely. But to most doctors, either you are diabetic or not, there is no gray area in between. That is what is frustrating me the most.

[Ronin]

Hi Binnieman!

You are learning the lesson that we all have had to learn -- the only person who is going to watch over your health is you!

Primary care doctors are an important part of the process of health care. However, they are the underpaid and overworked in the industry. Hence they double and tripple book their fifteen minuted appointments (Translation: five to seven minutes per visit) and cannot hope to keep up with the changes in the health care universe for all diseases or conditions.

Your experience is not at all unusual. You have to be a demanding client (I hate the title "patient") and come into the process with a lot of knowledge. Then you have to overcome the organizational arrogance and get them to respect you (which is why I prefer to call myself their client -- it levels the playing field and acknowledgs the fact that I'm paying them).

Good luck with the new Primary Care.