1. < Diabetes & Endocrine System

When is an endocrinologist necessary over a Primary Care Physician?

Posted by Retired Teacher @retiredteacher, Sep 4, 2017

I was diagnosed with diabetes 2 about one year and a half ago. My PCP sent me a letter that I had diabetes 2. She didn't have any information and never being a sickly person, I had no idea what to do. The PCP admitted diabetes was not her area. Where we live there are few specialists and a hospital like a clinic. I found the one endocrinologist (ready to retire) who sees patients one day a week, maybe. He had no answers since my numbers were not high, but I guess he felt obligated to do something so he asked about throwing medicines at the problem. I told him I didn't see the reason for meds when I was just barely over normal. I told him I decided not to take anything, but to control with diet. I have read too many horror stories about Metformin and ads all over TV about other meds that have horrid side effects. So that's what I have done for the time I've had this disease. I haven't seen any change in numbers---higher in the morning and dropping during the day is typical. Blood checks in A.M and three hours after lunch. Sometimes higher; sometimes lower.

I'm wondering if I need to keep seeing the endo. when he's doing the same thing the PCP does. For all practical purposes I am my own dr. There is no changing doctors where I live. One won't take another's patient. Since the elder endo. has basically retired except for once a week, he's not available for anything except on Monday, if he's in the office.

I know other people don't have such poor health care available, but it's that way where I live. I am thinking that since the endo and the PCP do the same tests and know the same that there is no point in seeing the endo. Seeing the PCP is enough, and she can run the numbers.

Any opinions? Thanks.

retiredteacher

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JK | @contentandwell | Sep 7, 2017
In reply to @contentandwell "@retiredteacher I think whether you see an endo or a PCP is really dependent on how..." + (show)
@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

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@retiredteacher oops, I meant to say from when I was inactive to now, being active. They so say activity helps to bring your A1c down.
JK

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jeya | @jeya | Sep 7, 2017

An endocrinologist should be part of your team. I see one every 3 months, she's the one that does the dosing, makes sure you don't have neuropathy. The primary care physician then follows the treatment of the endo doctor. When this happens, you may only see your endo about once every 6 months, unless there's a problem.

REPLY
4 replies
Retired Teacher | @retiredteacher | Sep 7, 2017
In reply to @contentandwell "@retiredteacher I think whether you see an endo or a PCP is really dependent on how..." + (show)
@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

When I was young, working, and going all the time, I also was taking aerobic classes, swimming, riding my horses, walking, and generally on the go. I was skinny all my life and never had any fat. As I got older and had to deal with a number of personal problems, I gained weight. Since I retired, I do not do any organized exercise. I have a bad knee, so I use a cane and the exercise I get is what I do walking around in the house or going to the grocery store and the like. I have a tread mill, but the knee gets worse when I walk on it. I walked on the tread mill every day for one month, to see if I could tell any difference; I didn't see that it helped and I gained weight! I thought I would lose, but it didn't happen. So that's about as active as I get. I know I should have a schedule for exercise, but I don't. I count the walking I do as enough for someone my old age. I don't drink alcohol of any kind; I don't smoke. I try to eat as healthy as I can and monitor my blood. Except for being labeled a diabetic, which I hate, I feel pretty good for someone my age. My A1C is at 6.0 and my average blood draw for A.M. and P.M. is 120. So unless something catastrophic happens, I am doing what I can and what is okay for me.

retiredteacher

REPLY
dolo | @dolo | Sep 7, 2017

I was diagnosed T2 about a year and a half ago and haven't seen an endo. I feel fortunate that I am doing well with my PCP, pharmacy therapist (insulin dosage) and hospital educators. I do understand to expect changes with time. My insulin is 10 units twice daily. I'm hesitant of Metformin because I previously had acute kidney failure and although I'm told kidneys are normal now, very concerned about those side effects of Metformin.

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3 replies
Retired Teacher | @retiredteacher | Sep 7, 2017
In reply to @jeya "An endocrinologist should be part of your team. I see one every 3 months, she's the..." + (show)
@jeya

An endocrinologist should be part of your team. I see one every 3 months, she's the one that does the dosing, makes sure you don't have neuropathy. The primary care physician then follows the treatment of the endo doctor. When this happens, you may only see your endo about once every 6 months, unless there's a problem.

Jump to this post

@jeya, in an ideal situation I would have a team, but there is no coordination or cooperation between the PCP and the endo. I don't have a team; there's nothing like that where I live. It's a strange situation, but my team is my husband, the internet research I do, the books I read about diabetes, and me. That's why I always say I am my own doctor. The medical people don't exchange info. from what I can see.
With my endo. getting ready to retire, I have just about decided to see my PCP; she can do the blood panels, and that's all I need her for. If I had anything more, I'd have to travel to get to a specialist. Sad but true.

retiredteacher

REPLY
Retired Teacher | @retiredteacher | Sep 7, 2017
In reply to @dolo "I was diagnosed T2 about a year and a half ago and haven't seen an endo...." + (show)
@dolo

I was diagnosed T2 about a year and a half ago and haven't seen an endo. I feel fortunate that I am doing well with my PCP, pharmacy therapist (insulin dosage) and hospital educators. I do understand to expect changes with time. My insulin is 10 units twice daily. I'm hesitant of Metformin because I previously had acute kidney failure and although I'm told kidneys are normal now, very concerned about those side effects of Metformin.

Jump to this post

@dolo I don't see that my endo. has done anything except to say, "Everyone is different." He's right about that. I take no meds and plan not to have to take any. I stay in touch with my body and as long as I've lived in this old skin, I know myself fairly well. I don't blame you for avoiding Metformin. It has horrible reviews and ads everywhere say not to take it. But, there are people who tolerate it very well. So not all things apply to all diabetics. With my A1c at 6.0 and my average blood at 120, I think I'm okay without any meds for now.
I do know that the American Diabetes Association says the A1c is acceptable at 7.0 and the Endocrinologists say 6.0. They don't even agree, so who knows? It just depends on who is giving the information.

retiredteacher

REPLY
Lucie | @lucie2 | Sep 7, 2017

Retired Teacher, you may be able to control things with diet and exercise. I did at first (now many years ago. ) and your numbers are low still. You look like you are maybe on the border between prediabetic and diabetic.
You might want to exercise 20 min twice a day. Have a sensible diet --mediterranean type maybe, and stay away from most sweets and soda.
But also, you do not need to be afraid of metformin if you ever find you need it --. I am not sure what you are reading... but metformin has very few side effects if any. I think it is the one safe diabetes drug.
I don't think you need an endo at this point. An endo is good when the diabetes is more serious and difficult to control.
You should have a glucometer and test strips so you can keep track of your glucose level.
Best wishes!

REPLY
4 replies
Retired Teacher | @retiredteacher | Sep 7, 2017
In reply to @lucie2 "Retired Teacher, you may be able to control things with diet and exercise. I did at..." + (show)
@lucie2

Retired Teacher, you may be able to control things with diet and exercise. I did at first (now many years ago. ) and your numbers are low still. You look like you are maybe on the border between prediabetic and diabetic.
You might want to exercise 20 min twice a day. Have a sensible diet --mediterranean type maybe, and stay away from most sweets and soda.
But also, you do not need to be afraid of metformin if you ever find you need it --. I am not sure what you are reading... but metformin has very few side effects if any. I think it is the one safe diabetes drug.
I don't think you need an endo at this point. An endo is good when the diabetes is more serious and difficult to control.
You should have a glucometer and test strips so you can keep track of your glucose level.
Best wishes!

Jump to this post

Thanks, @lucie. I am going to one more appointment with the endo. and then I think I'll leave it to my PCP. I've only been to the endo two times, and he looked at my numbers and looked at me as if he was wondering why I was taking his time. I wondered that too. He doesn't call me prediabetic, but a controlled diabetic.
There is bad press on TV ads as well as articles on the internet and people on this forum have reported really bad side effects from Metformin. Again, we're all different, but I am not willing to risk it. I've already explained the exercise and my situation. I am a senior, senior citizen, and strenuous exercise is not on my schedule. I'm doing the best I can with what information I have researched over the last 16 months.

retiredteacher

REPLY
JK | @contentandwell | Sep 7, 2017
In reply to @jeya "An endocrinologist should be part of your team. I see one every 3 months, she's the..." + (show)
@jeya

An endocrinologist should be part of your team. I see one every 3 months, she's the one that does the dosing, makes sure you don't have neuropathy. The primary care physician then follows the treatment of the endo doctor. When this happens, you may only see your endo about once every 6 months, unless there's a problem.

Jump to this post

@jeya @retiredteacher From what I know a PCP can easily handle it if he or she is well informed about diabetes. I know my PCP has many diabetic patients for whom he is their diabetes doctor. If you are at all not typical though I would definitely seek an endo. You mention that your PCP is not very familiar with diabetes. In that case i think I would seek out a different PCP who is.

Also, you mention not being active. If there is a facility close to you where you can do pool exercises I recommend you try that. I go to them very frequently and the people range from under 60 to in their 80s in class. It really helps. Also many hospitals have things like chair exercises for seniors. I have not done that but I would imagine that would help too.
JK

REPLY
JK | @contentandwell | Sep 7, 2017
In reply to @contentandwell "@retiredteacher I think whether you see an endo or a PCP is really dependent on how..." + (show)
@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

@retiredteacher it sounds like you are doing well but I just want to say, I too have two compromised knees, one is having a TKR in October. Since getting a lot of exercise, primarily in the pool, my knees are much better than they were and my limp is not really noticeable to most people. My ortho told me the more exercise I could get, the better because if you strengthen the muscles around your knees that really helps, and it definitely has for me.
JK

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