3 month check up advice

Type 2 New to Type 2 diabetes
#1

I was diagnosed with T2 11/15/13, so about three months ago. I had a A1C of 10.8 at diagnosis. My PCP has done a lot of things that make me think incompetence/lack of knowledge about diabetes, so I am hoping to gather some information before I go into my appointment on Thursday.

I just got a blood test yesterday, and the results showed up this morning. My A1C is now 6.1%. I know my doctor has talked about how if I just work hard my diabetes might be cured. On the other hand, googling forums doesn't seem like that's the case. Well-managed, not cured. Where does this A1C leave me? What should I expect her to say at the appointment? Are there any questions or points I need to keep in mind? How often should I expect to need to return to the doctor?

#2

How often would I return to a doctor who said my diabetes would be cured? Never! I'd get a new doctor. Unfortunately your diabetes won't be cured. But the good news is you are doing great! Congratulations on doing what you are doing and keep up the good work!

#3

Congrats on such a great A1C. I'm glad you are doing better. However, I agree with Zoe. Getting cured of a T2 like yours (at a young age, not severely overweitght, as far as i remember) is, in my opinion, not very likely. therefore, i doubt the sincerity (not sure if word is ok) of your doctor. what i would recommend:
go to your appointment and check the doc out, then see if it is worth returning, if not, go and look for a better endo. because, a "usual" diabetic returns every 3-6 months to regular checkups with their endo.
what do you do at your endos office:
talk about your bloodworks, your medication (possible changes in medication like adding insulin to it, and so on), prescriptions, etc.
your doc is there to answer questions and to guide you. however, diabetes is mostly managed by the diabetics themselves, so your doc usually does not give you a regimen for 3 months and you stay on it, you usually change it on your own (i am not sure about dosage of T2 med like metformin though)
if the endo notes any insecurities, he should make appts for you with dietitians, CDE's or other specialized personnel who can educate you more in their own areas, so that you can manage your D in the best possible way
wishing you luck, take care and tell us if you need further help and how it went!
SC

#4

Hahaha XD I can see your point. Yeah, she has failed, a lot. She didn't give me any information other than a diagnosis and told me to maybe try eating less sugar and take metformin and to come back in a month (no meter, no dietary recommendations, no referral). I sent an email insisting on education, and she *was* willing to send me to a diabetes educator (3 weeks later), who actually knew stuff and was able help set some goals meal-wise. At my second appointment (1 month in, armed with information from the internet along with this board) I insisted on getting a prescription for glucose strips, though she felt like most people don't even bother testing. The pharmacy never received the script from her (they send it electronically) even after several days of my calling. I called and it took days to get it straightened out. Unfortunately, she said she was writing them for a specific brand so I could get a $50 discount, but then she didn't. So I emailed her, she said she would fix it. After all was said and done, by the time the prescription was actually filled, it was 3 weeks *after* that appointment--a total of 7 weeks after diagnosis--before I was actually able to test! She just doesn't seem to think testing is important at all, but for me, it meant flying blind. So yeah. As soon as this appointment is over, my goal is to find a new doctor. At this point, I don't really respect her judgement on anything diabetes related. Can I ask for a referral to a endocrinologist instead? I feel like the hardest part of this so far has been dealing with the doctor =/ the diabetes educator was great, but insurance only covers that once (per year?) so I don't want to waste it.

#5

Thanks :) I am glad too, although I am really missing real food :( I am working on a more sustainable diet plan, that is somehow healthy but has foods that I like--I am picky! I am 22, but I *am* fairly overweight--my BMI is 34. More than that, I exist at the corner of PCOS and Diabetes--not sure how that impacts my prognosis, but it doesn't seem like my doctor thinks they're related at all. I feel like it is quite unlikely--that's part of the reason I want to get into a endocrinologist. It all has to do with hormones not working how they should, so theoretically someone who specializes in that could help me understand how it is all related. However, it seems like regardless of the circumstance, diabetes is never really gone.

And I'm in the Portland, Oregon metro area, so any recommendations near there are welcome :) thanks for the advice!

#6

Honestly? If you can (like no insurance hiccups) and are willing, switch to an endocrinologist. I just feel like diabetics should go to one...I mean if you had a doctor that sounded like they knew their stuff it'd be a different story and I'm aware there are internal medicine doctors and family practitioners that know their stuff about it, but it's probably best to go to an endocrinologist if you can. I had a negative experience with an internal medicine doctor soon after dx so I might be biased/burned by that experience. Diabetics should see their doctor every 3 months, at least ideally, to get their A1C and to make sure their blood pressure is good and their treatments are still good to go.

Regardless, 6.1% is an amazing A1C! Congrats! I got a 6% a1c last time (No idea what it'll be on Friday lol) and it was goooood news. It means you have a regular blood sugar around 126 mg/dL which is a great number itself. If you can maintain a good a1c without frequent hypos that's really good too.

#7

If you are not under the care of an endo, get one. a GP can not help you in the same way as an endo can, that needs to be said. GP's are general doctors, who are supposed to refer you to a specialist if needed. and you definitely seem to need one, so fight for it!!
good luck!

#8

Before discussing what your doctor said, BIG congratulations are in order for your A1c! Great job!

Now then. There is no cure for diabetes. Anyone who tells you there is, is just simply wrong. I won't speculate about why someone would say that -- people have their own reasons for what they do -- but it is not true. Period, full stop.

Did your doctor actually use the word "cure"? If so, my choice would be the same as Zoe's: find a different doctor. There's enough misinformation spread about diabetes, we don't need more. More to the point, you need good, relevant information on which you can base a realistic and effective management plan for yourself.

Diabetes can be managed and controlled with spectacular success; the growing number of people living with it for 75 years or more is sufficient proof of that. But control is not cure. A cure is something that makes the disease go away, e.g., you get your penicillin shot and your pneumonia is cured. You can walk away and never think of it again -- it's gone. Nothing like that exists for diabetes. Not yet.

Anyway, congratulations again on your terrific results. Please come back and let us know how you're doing!

P.S. I wrote the above before seeing your answer to Zoe. A doctor who thinks you don't need to test? I am speechless.

I am about an hour south of you so I'm just too far away to recommend anyone. You might consider OHSU.

Good Luck!

David

#9

Thanks :)
I'm not 100% sure if she used the word cure, but at the 1 month appointment she said that if I could keep my numbers down, it would be completely fixed--and although it may come back in 10+ years, I wouldn't have to deal with it until then. So yeah, from what she told me my understanding was a complete reversal with it possibly never coming back, and not having to monitor, that I just needed to work hard to get healthy. With the information I have now, that doesn't sound realistic or even like a very good understanding of the data on her part.

Does a complete reversal, not control, happen to some people? At a point where they could eat a gallon of pasta and cheesecake and be back to 100 two hours later?

After I talked to her about how I felt clueless without testing and how I had talked to the educator about a meal plan, but I needed to know how my body in particular could handle it, was willing to write a prescription for 4 strips per week. Oh well. After all that angst, even with the insurance, I am pretty sure the Walmart brand is cheaper (without having to mess around with a prescription).

I don't know how picky my insurance is, and I'm not financially in a place where I can invest $$ into going off plan when it comes to an endo, but we'll see--I'm going to request one next time.

Anyone have ideas on how I should present it? Like "I want a referral to an endo" what should I reply when she asks why, other than "I don't trust you as far as I can throw you"

#10

Thanks! I was hoping that because my A1C was good I would get to not go to the doc for a while :/ guess that's another thing that I need to get used to. I hope my insurance will be good about it.

#11

Regarding your "reversal" question: not that I've ever heard, claims from food fad quacks aside.

#12

Yeah insurance can be a bit of a pain in the butt when you're a new diabetic . I have no idea if I'll be able to get more test strips on my insurance, because I need more than 4 now (I've been using like 6-8 a day lately without having enough which is hard on me but I have to test D: ) that's my problem , supply crap. I also have issues with getting my dietitian covered when she's covered by my insurance? wtf? Insurance is such a headache.

#13

Honestly I'd say if I were you, either call your insurance company or go on their website. Find an endocrinologist that way. Don't have to bother talking to your doc, I didn't lol. I found mine with a service from the local hospital, but I'd say insurance website or call them and see what endocrinologists they cover. Pick one and call one and see what you like?

#14

I think in some places, it's hard to get in to see an Endo if you are Type 2. If you can do it, great. If not, there are some good internists who understand out there. What you really need most from your doctor if a prescription for strips. I can't see why she is withholding them. It's best to get some education and guidance from your medical pros, but this is stuff you can research yourself. But insurance won't pay for the strips without a prescription. Find a better doctor quickly; you may have to do it again in a while, but this is a place to start.
You should also be aware that no matter what you do, your disease may progress in a lot less than 10 years. Your doctor sounds entirely too cavelier about your health.

#15

This is an interesting idea, I'll definitely pursue it!

#16

Meh, I hope my insurance isn't one of those places =/ I am planning on changing doctors regardless of if I can get into an endo though.

And that's depressing. I do think that my good numbers etc are in part just a honeymoon, and am kind of terrified of when real life kicks in =/ I hope it progresses slowly =(

#17

Whether you can be cured or not is a matter of definition. You may be able to be free of symptoms and be free of meds, If you accept those condition as a cure then one can consider them selves cured. But we all know here that is not cured. To be cured you must be told that this disease will never come back. I doubt you will find a doctor willing to say that.

Doctors use the cured phrase as a motivational tool. I wish they would say managed rather than cured because that is what is possible.

Whatever you call it your last A1c is an excellent improvement. You are doing a superb job. Even if its not possible to be cured in the true sense managing your diabetes to the point that BG is normal and no meds needed is just as good in my book.

Like I said before, no doctor is going to say you are cured forever and continued follows-ups are likely to become a part of your life from now on if you chose to follow medical advice, I strongly urge you to do so. If it were me I would give this doctor a chance, I'll bet he or she know the score and is just wanting to motivate you.

#18

If nothing else, that surely sets me up for disappointment though =/ I'm glad it is improving, but I think just the fact that I want to aggressively treat the condition/prevent damage from diabetes (create meal plans, check BG regularly, figure out how to tailor my workouts) and she doesn't seem to want to work with me or thinks I'm too lazy to peruse it (didn't give me any meal suggestions or even carb recommendations, when pressured was willing to prescribe 4 test strips per week, said she was surprised I worked out at all but that whatever I did was fine [because obviously fat people don't work out]). It is hard to be told your condition is chronic and you'll deal with it the rest of your life. It is even harder to be told that it can be cured and learn that that is at the least, a half-truth and at most a bold faced lie. It is nice that it is likely that she knows the score and just wants to motivate me, but her tactics damage the trust necessary for that type of relationship.

#19

It was an interesting doctors visit. She basically said that I was more or less reversed, and if I kept doing what I am doing I don't need to worry about having diabetes for about 10 years. She said I don't need to come in for another check up for about a year unless something else comes up. She told me there is no point in seeing an endo. It was really nice to hear and I would really like to believe it is a good idea... I would be happy with not having to go to the doctor for a year. I think I'm going to buy a Walmart mail-in A1C test in 3 months just to keep an eye on it for myself along with testing in the meantime.

#20

That's great. I'm glad she is happy with your success. I have rarely seen a doctor that recommends yearly check-up to a person with or suspected of having diabetes, mostly they recommend every 3 to 6 months. She must have been impressed with your improvement.

If you are an over achiever like a large part of our membership it would not hurt to continue to learn, our community is here for you. If you don't already you might consider doing regular BG checks. A meter can teach you what food does and doesn't cause problems with your BG. There are general principle for good meal plans but a trial and error approach identifies what works for you.

I wish you good luck with your continued success.