I was having a discussion with my veterinarian (she’s type 1) and she asked me what meds I was on (I’m type 2) and I said that I was on Lantus,metformin and Byetta. She asked why if I’m T2, am I on Lantus? What is my Endocrinologist prescribing that for? I said that I was seeing a GP, not an Endo. She said every type of PWD needs to see an Endo. Is that true? I thought my current healthcare team was doing a pretty good job. My last A1c was 5.6 and my BG history is reflected by the A1c. So, is there any real benefit in me seeing an Endo? I read all the posts here and really appreciate what I’ve been able to learn. Thanks for any input.
if you’re happy and you’re getting good #'s i don’t see why you would need to
Hi Pat,
One of the things that we all learn here is that every person is different. Obviously, your friend feels that an Endo is best for her treatment. This might be different for you.
I bet that most of the people here have experience with “shopping” for a decent doctor. I know that I spent the first 4 years of my diagnosis bouncing around through a series of sometimes incompetent, sometimes downright hostile doctors before finding someone who both cared and knew what to do. Throughout my history with D, I have seen 2 general practitioner Mds, 3 Endos, an internal medicine internist, a diabetes educator, and a physicians assistant specializing in diabetes. Turns out that my current (and by far the best) health care pro is the last one on the list, the physicians assistant. She works in the same office as an Endo, and she truly cares about her patients and is very knowledgeable about diabetes. Her credentials may not be as impressive as a full Endo, but I literally trust her with my life (don’t we all?).
Having said that, it really boils down to you recognizing that your life is your own, and deciding what is best for you. I would recommend learning as much as you can about diabetes and your body, and then testing what you know against what you are hearing from the Dr. If what you are hearing makes sense, and it’s working for you and your lifestyle, than I would say you have found a good fit. If it doesn’t add up, or you are struggling with the treatment options available to you from your Dr., than it’s probably time to start looking around for someone new.
The greatest moment of enlightenment I’ve ever had about diabetes was when I realized that no one else is ever as accountable as I am for how I manage my own diabetes.
I was diagnosed by my GP, who told me that normally he would treat a type 2, but since type 1 is a bit different he would always refer type 1s to an endo
I’m a type 1, so I do come from that bias, but the benefits of seeing an endo are innumerable, in my opinion. The type 2s I know that see my endo always tell me about how much better they’re doing since they began seeing her and stopped seeing their GPs. Then again, everyone is different. An endocrinologist, however, understands the finer points of how insulin and diabetes meds work to a degree that one just cannot expect of a GP. This is what an endo does all day. They’re current on the most up-to-date treatment standards, whereas ‘most’ GPs would be less so. And they generally have diabetes educators, dietitians, and lab tests easily accessible in their offices. If you have an insurance plan that allows you to see a specialist, I’d recommend it. If you have a plan that makes seeing anyone but your PCP difficult and you feel you’re doing well, then just keep the option in mind for the future.
I would second all of the opnions listed already here. But, I’ll add that an Endo is a specialist in the diabetes field whereas a general practicioner has a much broader knowledge of many different kinds of ailments. Basically, when you’re having car trouble, do you want to bring it to a mechanic, or do you bring it to your friend who has worked on cars in the past?
As for your A1c, that is phenominal and you should celebrate. If your GP is doing a good job, and you don’t sense any issues in your health, don’t worry about it. Don’t fix something that isn’t broken, right? 
I spent about 6 years bouncing from doctor to GP to Endo, trying to find someone who was competent and found very few. I’m with my current doctor and he is very kind and he lets me ask a lot of questions, but I am not completely satisfied. Maybe my dissatisfaction is a reflection of my own results- maybe completely unrelated to his specialty.
So, you can switch if you want to- I don’t think it’s necessary for your overall health, but I do see many many benefits from working with an Endo. I see my GP once per year whereas I see my Endo 4 times per year- talking to him on an almost monthly basis regarding changes in my diabetes care and questions that I have.
If it’s not broken ;don’t fix it. Why change if you are happy and doing well? If it’s working for you stick with it. There are a lot of non diabetic with A1c of 5.6 and I know there are a lot in this group would love to have those numbers. You must take charge of your health .No one can tell you what is right for you.
if everything is going fine ,why add the extra cost.The disease will cost enough on it’s own.
I actually know alot of T2 who are put on Lantus to help regulate their blood glucose as a form of insulin therapy coupled with metformin and/or Byetta. If you are getting god control and A1c numbers, and have a good working relationship with your current health care team, then I really don’t see a reason to change that. That being said, I personally love having my endo take care of my diabetes while letting my GP take care of the other ailments that may come and go - if anything for the pure reason that an endo is specialized in the endocrinology system and may have some guidance on new and advanced treatments that a GP may not, which happens to be the case for me. Everyone is different so I would just advise that you judge the situation with how you feel generally with your health care.
I am type 1 and never seen an Endo, was dx’ed by one. I am a veteran and use that system. My Dr. is pretty good, but since I was 52 when dx’ed. She’s kind of let’s me take care of a large part of my treatment. They are happy with my results and I just keep them informed, to keep records straight. With that A1c what ever you are doing is great and is pretty much normal. Here’s my numbers. when dx’ed bs 672 and a1c of 13.2, now a1c of 6.8 and I am on MDI, lantus 30 in the morning and novolog at 2 for every 15 carbs.
You have to realize that in 2006 there 6,000 hospitals in the US, there only 5100 endos, and probably 1500 of those are not providing clinical care (http://jcem.endojournals.org/cgi/content/full/93/4/1164). So with 24 million diabetics estimated by the CDC in the US in 2007, how many of those are going to get to see an endo. I consider myself lucky as a diagnosed t2 to have gotten to see an endo. If I had gotten competent care from my GP I would not have turned to an endo. In my case, I am not happy with either my diagnosis or treatment, hence I call in the expert. If you are happy with you health team and able to maintain a HbA1c of 5.6, then you have a winning combination. Even with an endo, you are unlikely to get any better.
If you feel comfortable with your GP and your management of your diabetes, your present situation is fine. If you have problems that you feel aren’t being managed adequately or aggressively enough, then perhaps it is time for you to see an an Endocrinologist. Everybody’s circumstances are a little differant. There are no foolish questions. Your goal is obtaining the best possible management of your diabetes.
An A1c of 5.6% is marvelous. The vet may be misinformed many type 2 are on insulin or should be. Lantus and metformin are good. Byetta is not approved in Canada so it makes me wonder why.
Hi Pat, Great job on your A1c. For me it all comes down to competency and how you fit with the Dr. I have also left clinics not because of the Doctor but because of incompetent office and lab staff too. I can tell a good Doc when I first pull out my list of questions and how their facial expressions go. Most dont like to be questioned and others are curious about the questions that helps them in treating me. I always go with the latter. The other big thing is the Dr talking to you or at you!
If you have good control and have stable numbers with your family Dr you may not need to see an Endo.
Whats kinda cool about your post is that you have a great resource about your Diabetes, your Vet. Most Vets spend twice the time explaining the disease process vs MD’s because of patient loads. Many people garner a wealth of tips for their own health via their vet.
Your treatment regimen sounds right so I guess there is no urgency here.
I use an extremely knowledgeable Nurse Practitioner. What I like about going to the NP vs regular doc is how I feel. I feel like the office “gets” it plus they are equipped with the ability to download my bg meter readings and give me A1C results right then via one of those A1C kits. They are completely up to date on diabetes technology and know what they are talking about.
Some of us would have to travel fairly far just to see an endo, so maybe a regular doc is a better choice overall. In my case, the local endo is not covered within my insurance’s network.
Hi Pat…well, I say that 'if the fence holds the cows in , why change it"…whether you’re PWD 1 or 2, you/your doc decide what’s working best for YOU…I’d say, personally, you have a good concoction going on w/the Lantus, Met…I can’t do the Byetta, kept me w/a bellie ache ALL the time.
Susan
I have to say that I completely agree with the Endo doctor…I was misdiagnosed by my family doctor and it caught up with me in the worst way. I began with a simple metformin perscription, and really showed no severe signs of diabetes. My thirst calmed down…at first BGs were in line…so I just took my meds and went on about my day to day. And to my surprise…I lost a great deal amount of weight, and my vision suffered greatly. After getting no real results from the GP…I went to my mothers Endo…and discovered that type 2 was not my true diag.
Long story short…I’m the type of person who can walk around with VERY HIGH BG, and not really be effected daily. When I went to the intial visit to the Endo…the took my BG (finger prick)…the machine just said ‘HI’. Later results were 938BG! My new Endo wanted to place me right into the hospital room.
Just that quick…I learned a very hard, and potentially tragic leason.
I’m now insulin dependent, and my last A1C was 6.4.
Just sayin’
Michael
Endo or GP?? I have an Endo after a very horrible GP experience. I switched to an endo who absolutely saved my life. I thought the GP was fine but I had NO IDEA what he wasn’t doing - I was a newb.It took a near-tragic experience for me to wake up. So I fired him and put together my own team. But the choice is about answering a few questions - Whoever does all this is ok by me!
Can you ask your doctor all the questions you want and feel comfortable, get good answers, feel listened to?
Is there a dietician you can get access to anytime? (office, local hospital)
Does your doctor explain everything he suggests well enough that you could explain it to someone else (like your spouse)?
Is your spouse welcome every appointment?
Is your doctor thorough (my first appointment was 2 hours - I got everything, eyes, ekg, feet, urine and blood work, etc.) - he is concerned with my A1C and my cholesterol, BP, feet - well everything.
If you have a problem is he available, easy to get hold of (ex. I email all my BS every Friday and get a call back that day)
Does he work well with other doctors? (I have a TEAM and they all work together with my GP the glue that holds it all together and they talk on the phone and conference, share blood work, make decisions)
Do they educate? Every time I had a new skill set someone took time to teach me how to do it (several times if I had questions.)
Is your doctor patient? (enough said!)
I also like that all the office calls me by name, do not talk down to me, and when the nurse practitioner, nurse or doctor talk to me they don’t have their hand on the door nob if you know what I mean. Nobody beats me up over mistakes and they actually tell me when I’m doing a good job.
If your GP is good and offers all you need, good for you! the search is over!
Good Luck!
Thanks to all of you for the input! The discussion with my vet caused me to wonder if I was missing an opportunity. All of your responses have shown that it really is about each of us taking control and not accepting anything less than the best for ourselves.
Hi Pat,
I was at a conference for pets and the Dean of the Vet school said that Vets are used for resource for disease processes as many carry over into the human side as well. I would bet a buck your Veterinarian type 1 is reading the latest journals and studies on diabetes just like an endo would be since she is living daily with this disease. Not that it would replace the Endo but you do have a motivated person of medical knowledge involved.
Your little loyal friend helps you in other ways too… best of luck
I have to agree with Paul, I get more information from my vet on certain things, like my arthritis than i do my regular ortho or gp. We don’t have an endo in my town ---- pop. 23,000 and the nearest one is 200 miles away. I have never seen him, probably won’t because my clinic has an excellent diabetic program, grants and much information and education. But then again, is not afraid to refer to the endo either. Just haven’t had a need for it yet. I think the important part is that your gp not be afraid to refer is necessary, and that you are doing so well. You have to do for you what you feel is right.