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

@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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@gailb I was found unresponsive and rushed to ER. I had a glucose reading of over 900. I also had pancreatitis, acute kidney failure and delirium. (I thought I had stomach flu before I faded out). I have about 6 days of no memory. I would have slipped into a diabetic coma if my son had not found me. I had not been sick or on meds before then. So, 10 units of insulin twice daily works for me. My Dad passed from diabetes complications many years ago. I take this desease very seriously now but didn’t understand it before as my parents never discussed it with us children and I guess alot was unknown back then. From all I read, I think I’m doing well.

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@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 @gailb My A1c has been as low as 4.9! When that was the reading my endocrinologist chuckled and said it was lower than his and he is not diabetic! If you really stay away from carbs it can go that low, if your insulin resistance is not as severe as some people have. Not only am I not as “good” as I used to be, but I also thinks my insulin resistance has increased.
JK

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@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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@lucie2

I’m glad that you brought up “chair yoga.” There are a lot of chair exercise programs available for us these days. There are even on DVDs that you can order that have chair exercises. They can be done at home and any movement is helpful in dealing with diabetes as well as the arthritic problems related to aging.

Teresa

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@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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@retiredteacher I’m not sure if I commented on this before, it was still in my inbox.
You probably live in a beautiful, country area since you obviously do not live close to a metropolis. There sure are pluses and minuses to each. I know a number of people who have moved closer to the city as they aged so they could be close to better facilities but that’s not for everyone. I personally am a city person so given my druthers I would be right in the heart of Boston but I cannot afford that so I will have to deal with being in a nice town in NH, about 55 miles from Boston.
I wish you did have more things closer but the important thing is that you are happy where you are.
JK

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