FUDiabetes

Bad endos

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Worst Endo of the Year Contest!!!


This is just a small sampling of some of the comments I have seen on our forum about endos. I know I am forgetting many other comments.

Hearing things like this about endos really bugs me, because I know that for every well-managed person on this board, there are thousands who do not know how to research for themselves, and bad endo advice is all they will ever get.


Are there any other bad endo quotes anyone would like to share?

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Our endo 9 months ago:
“I don’t want you to treat a high when you go high. Wait until it peaks so that you find out if it will go down on its own.”

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Non D horrible endo story.
I had Hashimoto’s and a thyroidectomy 35 years ago. From the beginning I have been maintained on 150mcg of levothyroxin.

About 12 years ago after a low TSH my internist decreased the levothyroxin to 137mcg. Within a few weeks my TSH went way up and triglycerides went over 1000. I was in thyroid crisis.

My endo immediately got me back on 150mcg and things got back to normal in about three weeks.

Now my new endo on my first appointment says my TSH is low. I said I knew that. He said he was reducing my levothyroxin to 137mcg. I explained to him what happened the last time this was tried and told him I wouldn’t go through that again.

A week later he sent me a divorce letter for non compliance!

All I can say is I’m glad this happened on my first appointment with him because I wouldn’t want to continue seeing a doctor with that kind of god complex.

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Well it’s kinda D. And it’s horrible!

uh, what?? How would the high “go down on its own” if you have Type 1 Diabetes? That makes very little sense.

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C’mon Tia, we all know that there are Type 1 Dia-Fairies that can sprinkle bg down dust on you at any time. That plus hope is a valid strategy in my book.

https://www.amazon.com/Fairy-Dust-Tiny-Royal-Request/dp/B00E4WSXLI/ref=sr_1_10?ie=UTF8&qid=1501623390&sr=8-10&keywords=fairie+dust

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The endo must have thought we would mistake meal peaks for highs that had to be squashed. That’s the only way I can even make sense of this “rule.” Of course, we never paid attention to it.

Regrettably, we still have the same endo: there are very few endos affiliated with the local Children’s Hospital, and, from reviews we heard, the others are no better. We are thinking of moving in a year, so I figure that changing endos at this time may be counterproductive, as we get a long really well with our NP.

Endos write prescriptions, but knowledge and knowing what to do comes from experience and places like this forum.
:wink:

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I’m not so quick to throw doctors under the bus… each of us brings to the table 100% of the life’s experience of one person with diabetes. There is a lot of value to that. However, these doctors each bring to the table a small percentage of the experience of thousands and thousands of patients… plus a ridiculous level of education and experience in managing health outcomes of tens of thousands of patients over their career-- that also has a lot of value even if there is sometimes a disconnect in the perspective…

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are y’all near Wauwatosa by any chance?I remember interviewing people at the Medical College of Wisconsin and at least some seemed to be solid and doing interesting research – of course, that was way before I had kids and cared about endocrinology so no idea if their practicing endocrinologists are any good.

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our endo is still fairly young and while I don’t think she always gets it right (i.e., she doesn’t necessarily always know the answer and her pump setting corrections don’t always work), I do think she has a kind of intuition about what types of general changes and profiles seem to lead to good results. I see this as useful information that shouldn’t be discounted off hand. For instance, I remember when Samson was newly diagnosed, we read “Think Like a Pancreas,” which is huge on basal testing and ensuring a person stays “perfectly level” in the absence of food. Well, we basal tested Samson and he clearly needed a much lower basal rate than we had. But when we talked to the endo, she said they seemed too low – in her experience, the kids who were better controlled seemed to have higher basal rates.
Her actual numbers were not ideal but over time we realized that yes, having those higher basal rates just does seem to even things out more. Is it canonical? No. Does it even make logical sense? Probably not. But that clinical experience certainly was relevant.

We are super close! Both my wife and I have PCPs from there. Great people there. And Children’s saved my kid’s life when he was in DKA at diagnosis, the other emergency rooms weren’t willing to take him on. So I am very thankful to Children’s Endo’s for that.

They also have great family classes. But they don’t like sugar surfing.

Interesting. We don’t currently have access to an endo, just a diabetes trained gp, and they are fascinated by us. They must see so many kids without proper control. While they admit they don’t have the answers for everything, they make sure we are safe, and have been trying to convince my son to teach others in their practice, since they don’t often run into young men that are taking the bull by the proverbial horns.

I have detected no malice for any of our treatment plans, and my son even had a bet with them on the last visit. He bet them that he could lower his A1c and the number of lows he was having at the same time. (my son won). Now they have even given up the objection to lowering his A1c past 6.5.

I am sorry for people whose medical team don’t buy into their diabetes management plan.

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Some of them are great. I have much more experience with good doctors than with bad, because the bad ones I will only see once, and never return. The good ones I will return to.

There are many endos that do not take the time to establish what each patient is capable of, and just lump them all into the same category of “dumb helpless diabetic, unable to safely maintain normal BG’s”.

Not everyone can safely have a target of 100, but for those that can manage it safely, they should not be discouraged from pursuing it.

Sometimes endos do not explain things well, and the patient leaves with a complete misunderstanding of what was meant.

Sometimes endos will say things like “you only need to test 2 times a day” because the endo does not want to spend the necessary time to do the PA that the insurance company will require. So they take the easy road.

No, of course not all of them suck, but there are some who are really bad.

There are many endos that do not take the time to establish what each patient is capable of, and just lump them all into the same category of “dumb helpless diabetic, unable to safely maintain normal BG’s”.

Not everyone can safely have a target of 100, but for those that can manage it safely, they should not be discouraged from pursuing it.

Well, to be fair, I think part of this comes from the diabetes community itself. The thing is, when my son was first diagnosed, I heard a lot of comments about how diabetes is just so chaotic and indecipherable that you can never predict and preempt most trends, and a lot of defeatist statements about how it was impossible to a) avoid spikes b) avoid A1Cs below a certain number c) manage diabetes in a toddler. For instance, whenever I would try to figure out why a certain spike happened, the answer was always “because your son has diabetes!” – as if there was no point or benefit in trying to figure out the cause. I also heard a lot of “well, I tracked and analyzed everything at the beginning but in the end realized it was impossible to predict what was going to happen.”

I think those comments are meant to be encouraging for those who are taking on a ton at first and maybe blaming themselves for not being able to rein in their kids’ numbers. And maybe it’s because people learned a lesson early on about avoiding self-blame and burnout and have come to a specific detente with their own diabetes care that works for them. But I found those comments really discouraging and depressing.

And so I can imagine that if you had an Endo who started out thinking it might be possible to lower A1C to say, non-diabetic ranges, and then they get a parade of people saying “I’m trying as hard as I possibly can and nothing works and there is no way I can get my A1C lower than 7.5 without having a lot of lows,” then it’s actually a sign of a good doctor that they listen to their patients and sort of internalize their experience. They don’t want to make all those struggling patients feel worse by telling them to aim lower than they routinely see is possible in their clinic!

I also can say that when I spoke with my Endo at first diagnosis, I asked her if it was possible to get our son down to below 6.0. She basically said she had very few patients with such low A1Cs and none of those patients had healthy CGM traces – they were having hours and hours of lows! So maybe you need to see 500 child patients before you find one that is both in non-diabetic range and not having excess lows. It’s possible, and I now know it’s possible from speaking to others via the Internet – but the internet is the perfect place to find all those “long-tail” people – they might be 0.1% of the population, meaning some endos never even see that percentage.

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Actually, THE sign of a good doctor is that they treat their patients like the unique individuals that they are.

I have no interest in a doctor who develops solutions he thinks are best for the majority of his patients. I want a doctor who can work with me, developing solutions for me as an individual.

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I have the same tolerance level.

My last “first visit = last visit”.
[NP] “You need to get the basal and bolus to balance at 50% each”.
WTF ??

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This has been a fascinating thread (along with the many other threads here that are wonderful) in that the questions that come to mind are : what is best for the individual patient, what is less risky as advice for the medical practitioner to give, and what protocol may be less risky for the “group” of diabetics.

If an endo wishes his patients to target 100; perhaps too many of his patients may suffer hypoglycemia and the doctor may fear being sued, or termed a bad endo because so many of his patients suffer low BG. While the endo does treat each patient during the visit, their protocol is generally based on what works for the masses. That’s why they push the pills always first. One doctor told me that he was taught that patient compliance is usually poor amongst the population with diabetes. Many have needle phobia. It also takes much more time and effort to explain the details of insulin usage - everything that we discuss in great details here in the forum. Unfortunately, mass healthcare would tend not to be individualized/customized - it attempts to treat many, quickly, not necessarily the best for each individual.

As a ski instructor, when I teach a group lesson my focus and aims are slightly different from an individual lesson. With a large group of varying abilities, safety and making sure that there are no runaways are important. During a private lesson, I can take a little more risk in that I can push the limits of the student because the feedback would be quick, there is constant dialog between us. For a large group where everyone is at similar capabilities, I can also push the limits a little more.

The bottom line is whether the doc wishes to take the time to individualize the care or views all diabetics in the same way and thus has 1 speed. Sigh…when did doctors stop making house calls?

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That is one of those metrics that is frequently misused. A perfect example of clumping individual patients into a mass.

The basal/bolus ratio can be used to evaluate an individual’s insulin usage, but a particular ratio number should not be given as a gold-standard that everyone should target.

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Heh. That is the truth. I would be in bad shape if I did that. Amazing the garbage some of these docs learn in school.

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