A big win with my new Doctor of Internal Medicine

Type 1 & LADA
1

I’ve read a lot of the comments about non-endo doctors. People have commented on having Internists, General Practitioners, etc., instead of an endo.

So I wanted to look into getting a non-endo to prescribe everything for me.

I had an appointment and it was a lot different than my endo experiences!

I brought a printed list of all my prescription needs. It had the dosages on there, so he didn’t ask anything about how much insulin I took, he just read if off the list and entered it directly into the computer right from the list I had printed out for him.

He did say a few silly things. He asked me my A1C, and when I told him, he said “Have you ever considered taking less insulin?” And he also asked if I ever had low BG. :rofl:

Those were the only silly things he said. The rest of it was very easy and with absolutely no nonsense.

They weighed me and took my blood pressure. My blood pressure and heart rate was a lot lower than it usually is at the endo office, because they were not irritating me like the endos always do!! :grinning:

No BG test, and no request to download a pump or BG meter!! No blood draws, no checks of my feet to see if they still had feeling. No questions about how much insulin I take or IC ratios or any of that goofy stuff.

Absolutely none of that. :+1:

Basically a few questions, and I got every single script request filled except for two.

I tried to get my omnipods through pharmacy, but my insurance will only provide them through durable medical. And the Dexcom G5 is not available through pharmacy, only the G6.

So I will go to an endo and only need scripts for pods and Dexcom, nothing else. Those are super-easy scripts to get because you don’t have to haggle over amounts, dosages, etc. And those are generally written at 1 year, so only 1 endo visit needed per year.

All the other stuff I need - test strips, Armour thyroid, syringes, NovoLog (vial and pens!), Levemir, and Lisinopril (for kidney protection) - I got scripts for all of them and all of them were written for 1 year!!!

At the end of the appointment, he actually said, “See you in a year…”

It was very easy. I am super happy with this experience. :+1:

15 Likes
2

Lol…get use to the silly questions, but worth it. My pcp actually writes pump and dexcom scripts for me, so maybe yours would warm to the idea.

I don’t have an endo.

3 Likes
3

Bet they’ll prescribe your pods and Dexcom just as smoothly if you just have the paperwork sent to them instead.

2 Likes
4

The problem with that, from what I have seen before with the endos, the supplier says that the insurance company requires an A1C and clinical notes. So there are 3 different players at work there - provider, insurance, and doctor.

That is a bit different than when he only needs to send an electronic request over to the pharmacy and not submit any other documentation.

This guy has probably never prescribed Dex or pods. Pretty sure he has not, because when I showed it to him when it was stuck to my back, he seemed like he had never seen it before.

I am not sure he would know how to navigate that whole process of providing the supplier with the stuff they need so they can get insurance to process it.

Endos at least know that part of the process.

I can try. But I would probably need an A1C at least. It seems that the insurance requires that in order for them to approve it.

5

Yeah but it’s not a big deal to track your A1c and have chart notes, any doctor you’re seeing for primary care would be doing those things anyway, and the insurance would just request it from them instead of the endo. Really not a big deal.

Always has been bizarre to me how everyone thinks they need to see an endo… in alaska there were no endos except for in one city and even there primary care docs managed all the diabetics… it works just fine

2 Likes
6

Yeah but the way it works is you call dexcom or whoever the supplier you’re going through and tell them you have a new doctor and they send The paperwork to him with the “sign here” part highlighted. It’s pretty idiot proof

2 Likes
7

Well, I can certainly try it. :+1:

Would be nice to get it all from that one guy.

2 Likes
8

totally doable. It’s a rubber stamp world. He doesn’t need to know how to prescribe anything special he just needs to be responsive and efficient at processing the paperwork that comes across his desk.

4 Likes
9

@Eric - I am one of the out of the lane drivers without an endo. I have seen my PCP for a long time and came to an agreement for my diabetes care to go through her after my pregnancies. I do the same stuff with prescriptions as you describe – keep a list with dosages and make it easy for her to read and keep track of. I am guessing I am her only patient with a Dexcom. The process of getting it was no big deal - I did have some back and forth with the medical supply house (3rd party DME supplier, not Dexcom directly), but just to clarify what they needed from my dr’s office so I could smooth the path for them. It was pretty straightforward. Worth a try.

I will note that my agreement with my PCP for her role in her “mgmt” of my diabetes is that I do bloodwork with her office every six months. Which, I guess falls nicely with what appears that Dexcom probably behind the scenes requests from her anyway.

Let us know what you decide to do! Jessica

4 Likes
10

I guess I should be even more grateful that I have an Endo that I absolutely LOVE. I see the PA at the Endo clinic where I work and she is fantastic. She does check everything but being a nurse and older, I am glad she does. I like to see what my A1c is as ai compete with myself to try to keep it down. I only have to go every 6 months, but can communicate with her any time through my MyChart. She is fantastic and I would not do it any other way. I guess as a nurse, I want to go to the most knowledgeable person I can. I know too many newly diagnosed Diabetics that continue with an Internal Medicine doc and are mis-managed. The trick with finding an Endo is finding one that you like. I do not go back and have walked out of appointments with jerks who do not listen. Once again, I am older and I just do not have time to go see someone who will not actually listen to me. If any of you are in New York, Dr Peter Goulden moved there from here. He was my first Endo and is fantastic!! Great accent too…LOLOL

3 Likes
11

I wanted to update this after I got all my scripts filled by a non-endo doctor. It took a couple of months to get them all filled by the pharmacy since I had filled them previously with the old endo, and they are all on 3 month refill. So I had to wait out the refill time from the previous fill.

But anyway, I filled the last one a few days ago. So now I have gotten every single script written and filled non-endo!!

It was nice to check them off one by one, and see the non-endo doctor’s name on the prescription form when I picked them up from the pharmacy.

And not just pharmacy stuff, I also got my sensors and pods sent to me too, also non-endo.

I asked the GP if he had ever done a prescription for a pump, and he said no. He said he has many diabetic patients but they all get those scripts filled by their endo. But he said he would be willing to write them for me. So I was his first!

To get the scripts and the supplier to send me the OmniPods and Dexcom stuff, I printed and filled out the prescription forms you can get from Insulet and Dexcom and brought them in to the General Practitioner. I had them completely filled out, so all he had to do was sign them. Made it easy for him.

Feels good to be endo-free!

Anyway, I plan to stay endo-free for maybe 6 years. :grinning: If your endo tells you something useful, please pass it along to me, because I won’t be getting any of that info for a while!

image

10 Likes
12

Having lived in rural areas until lately it’s really surprising to me that this doesn’t seem to be common knowledge. Even where I live now in fairly large city area, virtually nobody sees endos for diabetes… most see primary care docs for all their diabetes needs here too… And there are a couple NPs and PAs who specialize in diabetes… who are really great… but I think most GPs where I’ve lived are completely comfortable managing insulin dependent diabetics—- typically they just prescribe whatever diabetes stuff the patient asks for, which is nice, plus just general medical care and monitoring, which certainly doesn’t require specialized training.

Where the idea came from that diabetes requires an endocrinologist is lost upon me…

4 Likes
13

I think it is useful when you are first starting. There is a lot to learn, and figuring it all out by yourself would be difficult, unless the GP really knows their stuff.

Like they might know about insulin and diet, but all of the new pumps and new CGM and new insulin’s - they might not be able to keep up with all of that. The GP I went to had never seen an OmniPod! So they certainly would not have prescribed it on their own!

But at some point if you have spent enough time working on it yourself, and you are able to keep up with new things, that’s where I kind of feel like it’s possible to break free from it.

For my stuff, I handed every single script over with amounts and names and NDC’s. I did not ask a single question, I already had my list.

1 Like
14

To be fair, you are still living in a small town. Most would consider the tri-cities to be rural.

1 Like
15

That’s where CDEs have came to play in my experience… no doctor has ever had time to educate me to any meaningful extent at appointments, but I spent quite a few hours sitting down with cdes and going over the basics early on

3 Likes
16

Yeah but the important thing is they sign the rx request when it lands on their desk

I get what you’re saying that if this is all brand new to someone that maybe a GP (st least one who doesn’t have a cde) is not the best place to start… but after someone is up to speed a little bit I can’t imagine why someone would feel strongly about it

1 Like
17

That is a bit unlucky, or maybe we have been lucky, but my son’s appointments with his endo is a full 30 minutes and she reinforces the CDE’s classes and really digs deep. I have always enjoyed our endo appointments when we have the insurance that lets us see her. She also goes to conferences and frequently updates my son on the latest literature if we ran out of topics.

4 Likes
18

I’d speculate might tend to be different for pediatric patients and clinics… practicing pediatric medicine of any kind demands a whole different skill set and personality to be good at it…

2 Likes
19

I still remember when first Dx, by a family practice doctor in ketchikan ak (who thought I was type 2). He ordered my labs referred me to a cde, who told him— nope this guy is almost certainly t1 / LADA…

Labs came back, she advised him I need to start insulin right away… he called me and explained how it was going to work, I was going to see the cde every day for the next few days and she was going to teach me about insulin therapy, how it works, how to count carbs, etc etc, she was going to write up a treatment plan he’d review it and approve it, how readily I was able to understand what she was teaching me would dictate the complexity of my treatment plan, whether simple sliding scale, carb counting, or possibly pump therapy once I got home and followed up with my regular doctor… which he was going to fax al my documentation to…

Worked out quite well…

Just a regular small town family doc but well equipped, when paired with a good cde to manage t1 and T2 diabetic needs

1 Like
20

@Eric I think I might be qualified to know a little something about controlling my diabetes, but it has really been my experience that general docs usually know just enough about diabetes to kill me.

Case in point, I just moved to rural East Texas with no insulin rx refills. So I went to the local GP to get prescriptions, told him exactly what and how much I needed, and he transmitted the prescriptions to the pharmacy.

I went to pick up it up and discovered that he wrote me for kind of what I told him. I told him I:C of 3, up to 100 units/day. I got I:C of 9, up to 60 units a day. I think he got it wrong because he just didn’t know what those numbers meant.

I also got the endo referral, but Covid-19 kind of put that off. And I’m almost out of G6 sensors-- oy vay!

3 Likes