After reading the discussion here at TU “what was your last A1c reading,” I began thinking, has anyone here been seen by an Endocrinologist that also has Diabetes? I know there are a few of them out there. Would this make a huge difference to you if your doctor understood first had what it is like to have Diabetes?
Do you think an Endocrinologist with Diabetes would have told Bella a Type 1 Diabetic (poster of the discussion “what was your last A1c reading”), he/she wants to see her A1c at 5.0? Why am I bothered by this? It bothers me the same way as when the couch potatoes every Sunday yell at the TV during NFL football…like they can really do any better than Brett Favre;)?
My previous endo did not have diabetes but she had a large practice of diabetics and I always felt that she did OK with my diabetes management. She always asked about my other health problems as well as advising me about diabetes. I guided my treatment as much as she did, if not more. And she was amenable.
My current endo is a T1 who wears a MM pump, same as me. He also uses cgm but I do not. I do think he does offer something the other endo did not although I never knew it until I got the endo with T1, if you know what I mean. However, I do not think you can lay all the differences to whether the endo has diabetes or not. Their personaiity, character, and diabetes + other health knowledge have a major impact on their management also. I thought my previous endo individualized my care. So does my current one but perhaps more so. Not unlike my previous endo, my current one compares me to me, never to “other diabetics.” If I have not made progress at a visit, his approach is to start from that day, never to look back at “should have done…” The current one with T1, however, has a better grasp I think, on what is doable for the individual and what is not. He really focuses on the positive while challenging me to go another level. Come to think of it, he is pretty darned good!
Re your question: No, I do not think a T1D endo would tell a diabetic he/she should have a 5.0 BUT I also think that the majority of non-diab endos would not do so either. You can’t take one example and make it a generalization! There are a few “bad apple” endo docs just as there are in any other occupation or profession. And are you sure the person understood correctly? I don’t know, just asking. In reading her post, she said she was told 5.0 but all the responders assumed she was told ‘below 6’ or in the 5’s. It is not clear whether she was actually told the whole number 5 or below 6. A big difference.
Read my addition, please. !!! funny!
But I thought your question re T1 endo was very interesting!!
My endo DOES have Type 1! I think she’s the best thing that’s happened to my personal diaetes in the time sine I was diagnosed.
Right after my diagnosis last year, I saw 5 endocrinologists before I found her. She’s been type 1 since she was a kid.
It has made a HUGE difference for me, because when I walk in to the office, I know she’s been through the ups and downs, that she has bad days too, that she understands how hard I am working, because she’s been working just as hard as me for years. I love how when I walk in and tell her I’ve been having trouble with a specific food, she can tell me her personal experiance with it, and usually retaliates with something she’s struggled with…
That being said, I think there are some amazing nondiabetic Endos out there too.
For example:
Will an oncologist who doesn’t have cancer treat his or her patient well? Of course. Will an oncologist who does have/has had cancer bring something else to the table? Of course.
Danny,
Good questions. I just switched from a T1 endo to a non-T1 endo last fall and I’m so glad I did.
I had gone to the T1 endo for several years. But the last few years I have struggled to get the A1c under 7.0 Menopause…who knows. Her response was alwasys the same. “You are harder on yourself than I could ever be”
It wasn’t a matter of motivation. I didn’t need a “friend”, I needed an endo who would get in the trenches and help me figures things out. She poo-poo’d the clinical CGM. There were many problems related to the office management that she practiced out of. Many cancelled or rescheduled appoints. I once made an appt. with the CDE in their office and when I made the 140 mile round trip they told me they forgot to contact the CDE to verify they appt.
The new endo is much more “in the trenches”. I’ve done a round of the clinical CGM and things have improved. She may not know what I’m dealing with firsthand…but I do think she appreciates anyone who is willing to put the required work into this disease.
I have no regrets making the move.
Slightly different spin on the question, but my doctor’s 12 year old son was recently diagnosed T1. At my appointment last week, he asked me more detailed questions & wanted my opinion (!) on Lantus v Levemir & lancet devices.
My Endo is not a T1 but I wouldn’t give her up at this point…Agree with Maia & Brenda that you need to be comfortable with your Endo and I think it’s more like a partnership with all the changes, trial & error things we go thru to get the results that are the best for each of us individually. I’m sure a endo with T1 would have more insight to what we go thru but I’m not sure how that would work as I’m not sure how many of them are out there. I think we each need to be comfortable with our endo and in my case I appreciate how she helps to work out my problems, will make suggestions and let me choose which path I want and help me on that path.
Perhaps the most famous doc who is Type 1, Dr. Bernstein, has what IMHO some of the most extreme unrealistic goals imaginable.
He goes on TV talking about A1C’s in the low-mid-4’s and I’m just astounded. That’s below 99% of the non-diabetic population.
I’m all for tight bg control, don’t get me wrong, and I have observed the goal A1C’s being proferred by docs and eye docs etc. falling dramatically in recent years. That’s overall a good thing, but we shouldn’t have to feel bad if we don’t hit the goal everytime because it really is so hard.
Tim.
As to what Dr. B has achieved… my gut feeling is that he has some easy-to-control type T1 (perhaps some natural insulin production left?) and he cherry-picks his patients such that they are the easy-to-control type as well.
If I’m overly cynical it’s because I’ve seen a lot of hot-shot doctors tell me that any out-of-range individual bg reading or test result I had, was completely my fault because I must’ve deviated from the rules they laid out.
Is there a website or a way to find doctors and/or CDE’s with type 1. I would love to switch to one. I am in Long Island, NY
I guess you turned out ok:)
He doesn’t approve of my diet & he’s given up on that front. He asked me about Lantus & Levemir because I had to plead for Levemir after learning more about it on TuD. The doc said he’s now a carb counting whiz from watching his son’s diet. Nothing like personal experience
David’s endo does not have diabetes and getting a 17 year old, growing teen, down to a 6.4 A1c has been a huge hurdle that David has managed without a whole lot of help from either his endo or CDE.
Instead of telling a diabetic to lower the A1c to a specific amount, it would be much more useful if an endo or CDE would provide suggestions on “how” to get to a lower result, safely. For example, David’s pump wizard needed to be adjusted from the settings that he started with at age 15 to tighten up the blood glucose target that his bolus wizard utilizes with any given meal bolus or correction bolus. Previously he had a fairly loose target of 5.6 to 8.0, based on what the non pumping CDE recommended and never updated. It was only on re-reading pumping insulin and listening to suggestions on this site that it occured to me that the blood glucose target settings for the bolus wizard would have to be lowered to get David where he would like to be. Since then we input two blood glucose wizard target settings, one for daytime of 4.0 to 5.0 and another for the evening and overnight of 5.0 to 5.5. The increased testing alone was not getting him where he wanted to be, whereas the target change has made a huge difference.
By the way, David was supposed to have a follow up pump training class after his initial set-up that just never happened. We never got a call for class. The second class was to cover features such as the bolus wizard and extended boluses. When the class never came up within a few months of pump start, I decided that I would have to read about the wizard details in his pump manual myself and corresponded with the CDE by email to confirm the initial target setting to get him going with the wizard feature. To me, the whole point, of pumping was to provide David with a reliable tool that would reduce the mathwork required to maintain three I:C ratios and reduce the possibility of mathematical errors, by getting David’s role down to simply testing and a good practice of carb counting.
The huge benefit that he got from pumping that we had no advance idea about was how totally great it would be at handling his increased basal needs between 3 a.m. and 9 a.m. I still would like him to get a handle on the dual wave and square wave bolus features. The setting has been turned on and I have read his pump manual a couple of times on how this tool works and looked at a number of discussions on this site for tips, but this is a tool that HE really needs to learn and test as he doesn’t need me over his shoulder checking to see how he handles, how he eats. But he will get there. He has the desire to work at getting his A1c down further than its current 6.4.
I am certain that a pumping endo or CDE would pick up very quickly that certain tools that are built into the pump could be used that are not currently being used. His endo it seems is most focused on encouraging him to move on to a CGM, which he did try, but found very frustrating. If I were the endo, I would work toward getting him to make use of ALL of the existing tools such as the extended bolus before pushing him to move on to a CGM and I personally think that the endo should have caught on a few years back that the targets for his bolus wizard needed to be tightened up. Mom had to figure that out. The suggestion didn’t come from the endo or CDE even though pump downloads are part of each quarterly clinic visit and device settings are clear and easy to see.
I sometimes think the endo’s only concern at clinic visit is with the A1c number itself, with a side concern to watch out for incidents of hypoglycemia and you are right, this very likely is the result of a lack of personal pumping experience. I think that I will make a point of discussing the dual wave, square wave extended bolus feature next clinic visit. Thank you for making me think this through Danny!
Cheryl
So, on a side note. My kids pediatrician is Type 1. I was so excited to learn this, as sometimes you feel you will never meet anyone “just like you”. She’s awesome. I pointed her to TuDiabetes a while ago. But what was interesting is I never would have guessed she was diabetic… and she probably never would have guessed I was either.
Yeah, the T1 down to 5.0 bothers me too. It’s downright RIDONKULOUS. I’ve been with my doc 15 years now and he knows me. I finally said one day “that will never, ever happen no matter what I do”. And he said if I got down to 5.0 his first concern would be HOW I got there and how many lows along the way. At the same time, I’m now 1 month into the pump. It will lower my A1C and I’m very excited. It does help! Heck, I’ll be happy as a clam with anything in the 6’s and NOT be hard on myself with unrealistic expectations to achieve a 5. I’m good enough for me and what I deal with daily and what I have to endure. My doc supports me, encourages me and goes above and beyond to look out for me. It would be crazy to constantly not be good enough to achieve a 5. WOW.
No to your question Danny : ENDO , however I know several MM pumping CDE’s who have type 1 diabetes ; at least one of them ( and she has a son with type 1too ) has given several advanced pump training sessions in my area .We did not discuss one’s A1C ! The purpose to do better , than before the class .
At the last advanced pumping session ( 16 of us were there and believe me, there are many who did not show ) we were told , that several hours drive from here hardly anyone showed up at the last scheduled event . This makes sense to me : BC is a large province and one cannot expect that type of service , if no one shows ; MM Canada will now deliver online sessions we were told .