When is an endocrinologist necessary over a Primary Care Physician?

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

@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.

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@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

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!

@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!

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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

Liked by dolo

@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.

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@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

@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 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

@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.

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No pool, facilities, or classes in my area. I don’t know if I am not typical. I am just different like everyone else. People on this site have all kinds of problems and other diseases besides diabetes. So we are a mix of people who share one problem—diabetes. I can’t speak to anything else.
It must be great to live in an area that has all this help for exercise and changing doctors or doctors to choose from, but it’s not that way in my area. There is one endo. who sees patients one day a week; he’s getting ready to retire. The hospital is like a clinic. If anything serious happens, it’s off in an ambulance to a city with a hospital that can handle the problem. So that’s another way we are different—-not everyone has the luxury of facilities to educate or work with different illnesses. I have to deal with what I have and do the best I can. The pat answer is usually, “Everyone is different.” I do believe that from what I’ve read and hearing it often.
So far, I am okay except I am a controlled diabetic, whatever that means.

retiredteacher

@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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Bless your heart. I hate to hear when anyone is having to have surgery. Good luck and hopefully a fast recovery. Hospitals scare me and I avoid them, even to visit people who are in the hospital. I’m rather squeamish; I guess that would be a mild way to explain it. The pool would be wonderful; I’m sure, and I’ve always owned a home with a pool, but the last time around, we bought a home and hubby said no pool. There are no pool facilities in my area, and I am not comfortable being in a pool with people I don’t know. I guess I have germ phobia. I went to physical therapy after seeing an ortho. He sent me to PT. One time with this knee and the guy almost broke my leg! I couldn’t walk at all the day after he finished his routine, so I never went back. I think walking around in the house and going up and down stairs since I live in a two story house and doing other errands are good. For my age, I’m doing the best I can.

retiredteacher

@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.

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@retiredteacher If my A1C was like yours, I would not take pills or insulin either. I have been reading your posts for a few months and it seems like you are doing fine. We all require something different and you sound like you have figured it out for yourself. My best to you.

@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!

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Well, metformin is a moot point for you right now, as you do not need it. I surely do not get side effects from it… though years ago, when I was first diagnosed I was afraid of it as well. I have actually even read “good” things about it now. Did you know that metformin has anti-cancer and anti-aging properties?
https://www.ncbi.nlm.nih.gov/pubmed/28258677
As far as exercise, I think at our age (I am quite senior myself), just activity is good… I do go to a gym that has classes for older people, and I really enjoy their “yoga on a chair”. I should go more than I do.

@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!

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I enjoy reading ur post, I’m on metformin were also on glipizide with it but the doctor took me off glipizide bec it was working against my kidneys,

@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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@contentandwell @retiredteacher. Oops, typo. Carbs should be 150 for the day. I also 2 snacks of 15 carbs or less. Sorry about that, I didn’t mean to scare anyone. LOL

I wish my A1c was as good as yours are everyone. Mine is 7.0, even w/Lantus Insulin. And I had gastric bypass surgery 3 years ago to help with my diabetes. I lost 85 lbs but I still have diabetes. Dr said it’s genetic for me. I can only eat 1 cup of food at each meal, which I do. I have 2 snacks a day and I take lots of vitamins everyday. I had back surgery last December, So I haven’t been as active as I used to be which doesn’t help my blood sugar levels. Just so you know some background. I don’t know why I can’t get my A1c down but my endo and I keep working on it.

@dolo

@gailb I am T2 and also follow a diet much like yours. My blood sugar tends to spike easily with any higher carbs. My A1C has been 5.5, 5.6 for the last 9 months or so and I generally do not feel deprived by these foods. It is all a balancing act, I figured that out early on. Thanks for your input.

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@dolo I think you don’t have diabetes with a 5.5 or 5.6 blood sugar. Why do they say you are?

I imagine my A1c will be higher this time because of summer and holidays and vacations. I am not going to a nice restaurant and order a piece of lettuce when everyone else is having a steak supper with all the trimmings. I’ll take the consequences, but that’s my age attitude. If I were younger and still working and still kicking up my heels, I’d be more selective. I should lose fifty pounds and I’d feel a lot better, but if I cut out food, my blood goes up; if I eat right I gain weight but my blood is good. So who knows? According to the Diabetic Assn. 7.0 is an acceptable A1C. Again, it’s all about everybody being different, even the doctors!

@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.

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I guess I’m not fine because I have diabetes. I asked my endo. if my numbers were always in range and my A1C was 6.0 if I would NOT be a diabetic. He said, “Once a diabetic; always a diabetic.” So I have this frustrating disease which drives me crazy and which I resent since I’ve never been sickly. Now I have to stop and think about everything to be sure I choose to follow the rules or not. When I first learned I had this, I had no idea, and my PCP never even mentioned it until it was too late. She claimed she was watching it trend to see if I would be a diabetic. How about preventative measures? I doubt she knows what that is. I don’t have much faith in her, but she’s it unless she moves. The few doctors in the area don’t switch patients. At least her nurse can take the blood and send it to the lab for a computer print out and she sends that to me in a letter. I wish I did have this figured out, but I learn something new every day. It’s ever changing.

I hope things get better for all of us with this disease.

retiredteacher

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