I see a lot of discussions on the board where people mention seeing their Endocrinologist. After 30 years of living with diabetes I have seen an Endo all of "1" time. Part of that is probably because when I was diagnosed we lived in a small town that didn't have Endos, so my Pediatrician oversaw my treatment. Once in adulthood I only saw my PCP and they never pushed the Endo issue.
So at my last check-up I asked my PCP if I should be seeing an Endo and pretty much said based on my A1C he thought I would be wasting my money. He said if I was having control issues or some of my other numbers started coming back out of wack he would then send me to see the Endo.
One thing I like about my current PCP is he doesn't hassle me about anything. For example for both my Pump and Dexcom he wasn't a road block in getting those items. Granted in my 20's I needed someone to smack me around a little, but those days are gone.
Am I missing out on something by not seeing an Endo?
When I was first diagnosed I did not see an Endo, my numbers were pretty good and I felt I did not need to because I had a doctor that knew how to treat the disease. (I too live in a ruel area without a lot of healthcare options) After I could no longer see that particular doctor and I could not find one that knew more than I did about diabetes is when I started to travel 4 hours to see an endo. I think if your numbers are good and you feel comfortable with the care and knowledge your PCP is giving stick with it. But if they cannot care for you or your numbers are out of control I would recomend it. If you find a good one it is so worth the money and time to see one. Just my opionion.
I agree completely with your PCP. You're doing great! Especially for someone who has had Type 1 so long. When I returned to the states, my niece expressed concern that I wasn't seeing an endo. I basically told her what your doctor said: If I had any issues I couldn't handle myself I wouldn't hesitate to get a referral.
Having said that I think we're all different. Some people have more difficulty in regulating their Diabetes and an endo is certainly the medical go to person for this. Also, I think some people look to their medical "team" more than others. I'm like you, Jim, by idea of a good doctor is "one who doesn't bother me too much". I'm only exaggerating a little, but I do see a definite continuum of care. Some people wouldn't tweak their dosages at all without talking to their endo; some manage their Type 1 on a day to day basis but like checking in with an endo every few months, and some, like us, just know we can't write our own prescriptions! (At least in the U.S.; when I lived in Guatemala you just went to the pharmacy and got what you needed, no prescription needed)
Like they say, "if it's not broken, don't fix it". Congrats on your great A1C!
I am not allowed to see an endo at Kaiser because my A1Cs are "too low" for them to be bothered with me. I was told that all they do is attempt to lower your blood sugar if it's high, then they kick you back to your PCP. I wanted to see someone because I've had all sorts of complications with my feet and with neuropathy. I see a podiatric surgeon a lot, but he sees only the effects of diabetes, he doesn't deal with causes. He tells me I should count myself lucky I haven't lost a foot. OK, so I'm lucky. But what can I do, when my blood sugar has been under control since 2007 and there's no evidence it was very high before that, to keep from having more foot problems? It's especially frustrating, now that I've read other people's stories here on TuD and have found that most of the people here still have all their toes. Maybe I just don't know what an endo does? What should I be asking for? Like Jim, I wonder if I'm missing out on something by not seeing one.
I've got an appointment with a new one though quite frankly I am probably wasting my time and money. You do need one initially to understand what you need to do to try and keep the sugars running ok but once you do that you become your own doctor for it anyway. Even though they specialize in diabetes the reality is they can't do anything more then any other doctor in better regulating it. Insulin the way we have to use it is a totally inferior treatment. Its a rollercoaster of hell but its the only thing we have to stay alive. As Ive said many times I would trade for non terminal cancer any day of the week.
I don't think you can summarize your health status by simply looking at your HbA1c. You have had D for 30 years and you are commended for maintaining good blood sugar control and presumably that has enabled you to avoid complications.
But I have to tell you, it would be naive to think that you could go through your entire life and not be at risk for some problems. And while your PCP may well be a great doctor, he isn't a specialist, he isn't likely to know how to look for early complications and guide your proper diagnosis and treatment. In many cases, early detection of problems is important to effective treatment.
Personally, I have good insurance and I already spend a lot on my health. If you are in the same position, wouldn't it be reasonable to not neglect this aspect and get the best treatment? Why not get an endo and make sure you have a specialist keeping an additional eye on you.
You are not missing out on someting. I don't see an Endo, my doctor is knowledgeable about diabetes and continues to be educated in it. Along with keeping an eye on my diabetes, she sees after all of my health issues. It's one stop doctoring!
When I moved from my endo who prescribed a pump for me decades ago, I would have liked to bring him with me. I did look for a doctor who specialized in diabetes when I needed a new one.
Jim, your PCP sounds like a good doc. He is not afraid to refer you if necessary, and sounds like he trusts you to maanage and control.
I see my endo or his nurse practitioner EVERY TWO WEEKS right now (I'm pregnant), and frankly it's a waste of my time and $20 copay. Basically they look at my numbers and say, "doin' great!" and that's about it.
BUT. I do think it's been great for me to be hooked into their practice in general. When I was first sent there, he immediately ran a bunch of tests for other autoimmune diseases. He caught my Hashimoto's before it was a real problem, and now I know that I'm genetically permissive for celiac, though I don't yet (or hopefully ever) have the antibodies. He keeps an eye on other conditions, related to but distinct from my diabetes, in ways that I don't think a PCP would.
Thanks everyone. A lot of the responses confirm what I was thinking and I will probably stick with what is working for me. I would say I am lucky that I am linked into the right PCP because I've been to a couple who are pretty clueless about Type 1.
