I really do feel for you. Our endo practice taught us everything, and when they saw that we could absorb more, they loaded on the training, then asked us to call as we were learning and helped guide us. It was honestly the best experience I have had as a customer in the medical area. They employ CDE’s most who either have diabetes or have children with diabetes.
They really get it, and are even willing to discuss out there stuff, like using Type 2 drugs to help manage issues, etc etc.
I realize this isn’t the norm, but it has restored my faith in the medical profession. They even went above and beyond for us as we transitioned to new insurance and got a bunch of prescriptions done in 2 days with insurance approval so we left with fully stocked cupboards.
I think this makes a big difference in terms of experience. Your GP has hours and hours of experience managing diabetes 24/7. Most GPs who don’t have diabetes in their family wouldn’t have that. I think that kind of experience is a big advantage.
Maybe… how much they know or don’t know really doesn’t seem to have much bearing on me as the patient… diabetes is a self managed condition, the doctor doesn’t follow me around and medicate me every time I eat… really I just need someone to fill my scripts and manage my overall health and follow standards of care for screening for complications… I am certain the endo knows more, but that additional knowledge doesn’t really seem to benefit me…
It sounds like it must be a lot more beneficial for pediatric endos
you’re lucky! The last time I had a regular GP that I was able to see with any regularity was in 2007. Here in San Francisco at least, I’ve had a crazy amount of trouble finding a general practitioner that I could see within 3 months for a new intake appointment and within 2 weeks for an acute issue. I don’t know if there are just too few of them or what, but I basically just wind up going to a clinic that has a random assortment of NPs, PAs and a few MDs and just taking the first available. No continuity of care at all! My sons, meanwhile, do have a fantastic pediatric practice they go to.
Well, we definitely have a difficult relationship with our endo, but we have learned tons from our endo clinic, in particular early on, but even now. For instance, recently we got a bunch of information on how the clinic’s patients react to the 670G.
But that’s just a random thing they mentioned to you… that doesn’t affect your own treatment, since you’re not using it, or make your life any easier in any way does it?
I gave you an example. But even then it could have led us to use it. It turns out that the information confirmed what we felt, which is that the 670G would probably not work for us. Negative information is as valuable as positive information, to me. They gave us interesting data that had some statistical value because they have about 20 patients who use the 670G: that’s a good number. This kind of info is difficult to obtain from limited anecdotal reports online.
My single point is that, despite our questionable relationship with our endo, we still get some valuable information from the clinic. I am not saying that it means I believe it is systematically the right thing to use an endo. I am providing a data point
Side note—- I just took part in a conversation on Facebook with Stephen Ponder where he was saying how superior his techniques were to the 670… a lot of his own fan club spoke up to disagree and said it was giving them the best control they’d ever had
II haven’t learned anything from an endocrinologist in years.
I used to see a nurse practitioner that specialized in endocrinology. I think she worked for an endo? That setup worked pretty well for me. She let me schedule appointments every six months and generally just provided support. She wrote any scripts I requested, and things were simple.
When things go wrong, it’s nice to have a really knowledgeable endo though. In fact, it’s always nice to have a knowledgeable endo. When you can’t find one, then it’s nice to find a doc that is supportive and doesn’t get in the way (writes any scripts, PAs, etc.). Whether that doc is an endo or PCP is almost irrelevant in my opinion.
It really does. My previous endo had appointments that were 15-30 minutes long. He didn’t know any of the technology (he only accepted paper logs, no meter downloads). He held off recommending a pump for years until I asked about it because he assumed I wouldn’t be able to use one. He thought an A1c of 7.3% was “perfect” for me and said he’d be happy if 50% of my readings stayed in range. I stayed with him for about 12 years just because he was my first adult endo and I assumed that’s what all endos were like, but I often went for a year with no appointment just because I didn’t see the point (and my year without an appointment was not because I was in great control!). When I moved across the city and got this new one, he was the complete opposite: long appointments of 45-60 minutes, metere nad pump downloads, immediately siad he’d like to help me get a lower A1c, recommended a CGM before the G4 even got here, keeps up on all the latest technology and studies, and I actually look forward to appointments because I’ll always get some useful tidbit out of them. For example at my last appointment he showed me the Medtronic 630G, gave me a sample OmniPod, and showed me the Freestyle Libre, because I’m in this stage of deciding on a new pump. My GP certainly wouldn’t have been able to do that.
I would say I haven’t learned anything from my endo for as long as I’ve seen him, which is a whopping quarter-century. He looks at my recent bloodwork numbers, writes down my current dosages, says vague things about getting my A1c down but not too low, takes my blood pressure, asks if I’ve read any good books lately, and touches my big toes with a tuning fork,. He is, though, the chief of endocrinology at his hospital, a clinician-scientist, “a recognized leader in the field of diabetes,” and a major contributor to the DCCT, so I assume he knows what he’s doing with that tuning fork.
But his nurse educator is absolutely, totally invaluable and if she ever retires I don’t know what I will do.
My family doctor I only see once every two or three years, for little things (thankfully). He of course gets reports from my endo, but does not interfere. He is modern, popular, competent, paper-free, a listener, in no rush to get you out the door, and handsome (though of course that doesn’t come into it). However, I would not entrust my diabetes care to him. He just doesn’t know enough beyond a-bit-more-than-the-basics. At my last visit he had never heard of Afrezza (fair enough, its not in Canada yet) and always wants to look at my latest pump as if he’s never seen them before (which maybe he hasn’t, even in a large city practice).
But that is fine with me, because the role of the GP is increasingly to act as a referral service, not to do everything themselves like Marcus Welby. If a diabetic told me they only saw a GP, I think I’d be shocked. (Of course things are a little different up here, without the insurance and other hassles.)
I’ve been T1 diabetic for 22+ years and STILL wouldn’t say it’s easy I’ve had my share of (mostly bad) endos but dutifully go, every 3-5 months. My most recent one suggested Victoza, really looked at me as a whole person. I miss her since I moved away. My PCP I’ve convinced to let me come in just once a year. Plus my other specialists… so many appointments, it really sucks!
This is key. It also depends on what level you are at on your journey with diabetes.
@Sam it is actually pretty arrogant of you to say that you know more about diabetes than an endocrinologist. You may know how to control your diabetes better than an endo you just met, but if you can put your heads together in many cases you will be able to enhance your control and ultimate outcome.
A lot depends on how you demonstrate your diabetes knowledge and your endo’s willingness to accept that you have this knowledge and utilize it.
It all comes down to the fact that doctors are people too. There are good ones and not so good ones. Unfortunately it’s up to us to weed them out.
I don’t know more about diabetes than an endocrinologist, of course, I’ve never claimed to. But I am saying that I have not found their expertise to be beneficial to me any more so than a primary care doc
Neither one of which had ever actually taught me anything about management —- there’s never been a single conversation in which they transferred a useful management lesson to me… not a a single discussion of the glycemic index for example (although I have had worthwhile discussions like that with CDE)
I think it may different for those of us very connected to resources like this forum. For other folks, at least T1s, I think using a family practitioner is a bad idea. I did it in grad school, and their only response to my elevated A1cs was “well you need to get that down, we should see you back in 6 months” and nothing beyond what I didn’t know. They never expressed any particular urgency about the fact that I hadn’t had an eye exam in years, which turned out to be a huge mistake. Once I switched to an endo, he recommended metformin and a CGM, two of the three major pieces that have helped me get into better control. At this point I suspect I could get by without him, but I wouldn’t want to, because he’s very smart and thoughtful. If I didn’t have a good endo, I might feel differently.
I think it just depends on each individual person and doctor. I had a pretty good endocrinologist at U of M until he moved to another university in another state. The very first endo I saw literally thru up his hands and said he didn’t know what to make of my case and told me to go to The Mayo Clinic or U of M. The woman I saw after my U of M endo left was awful, I saw her once and when I got my records I was shocked to see she had lied obviously to cover her behavior knowing I most likely would not be back to their clinic because of how she treated me. My PCP took over my BG care despite my case being unusual. He’s open-minded, kind, and trusts me to educate myself about my health and healthcare. He recently prescribed Afrezza even though he has never prescribed it before and so far I’m having great success with it. I think the key is to keep looking until you find someone, PCP or endo, who treats you with respect and helps you live the best quality of life possible given your particular health problems.
I’ve had my share of (mostly bad) endos but dutifully go, every 3-5 months. My most recent one suggested Victoza, really looked at me as a whole person. I miss her since I moved away. My PCP I’ve convinced to let me come in just once a year. Plus my other specialists… so many appointments, it really sucks!