I was just diagnosed with T2 diabetes (Feb. '09) and I don’t understand my internist’s behavior. Her nurse called me at work to tell me that I “without a doubt had diabetes” and that she had called a prescription for metformin in to my pharmacy. I was in shock so I got off the phone pretty fast, but called her right back to ask for a glucose meter. I quickly discovered the wonderful Blood Sugar 101 website and read Dr. Bernstein’s book. I called again and asked my doctor to change my prescription to metformin er and to increase the dosage to 1500 mg. She agreed but told me I was testing too much. So I had another appointment last week for my yearly exam and tried to discuss my diabetes treatment with her. I guess I thought I was going to have a physical exam because I had diabetes, but no, it was just the usual pelvic and breast exam and little extra listening to my circulation with her stethoscope. I could not get a conversation going about diabetes treatment or get her opinion on any kind of target for my blood sugar levels. I came away with this: I’ll get scar tissue on my fingers from testing so much (I test 6 - 8 times a day) and she doesn’t want my blood glucose level to go too low because I’ll become hypoglycemic - oh, and not many of her patients are compliant in their diabetes management. That’s all. No discussion about diet, exercise, treatment options, or anything.
I think I’m doing pretty good, I was diagnosed with an A1C of 11 and my fasting blood sugar was 315 mg/dL. It’s too early for a new A1C but my average meter readings are 118 mg/dL and I am usually between 95 and 120 mg/dL but had a high of 171 and 2 of 150 when I discovered a couple foods I can not eat. I eat a carb restricted diet and I’m trying to add daily exercise. And even I know that I can’t go hypoglycemic on metformin er as it doesn’t control blood sugar levels.
What do you guys think about my doctor? Is this pretty normal in your experience? I guess I expected to get a ton of help from my doctor and was surprised by her lack of concern.
Yvonne,
Sounds like you need a new doctor! You should be getting help from her regarding diet, exercise, etc. As far as testing too much, that is pretty ridiculous. Testing is the only way to know how you are doing and how foods and exercise affect you, so by all means, test!! It sounds like you are doing a pretty good job on your own.
I am a type 1 so I don’t really know for sure on the issues. But what they may be saying about testing to much is that you have hit your daily insurance limit on test strips. Now as far as testing to much, I overrun those limits all the time. I am a habitual tester and if i run out of strips, and have run over my insurance limit, I go buy some out of my own pocket. Ok, thta is a bad alternative, but it works for me.
Keep up the good work, get a new doc, if you are not happy.
A1c should be 7.0 or lower for a diabetic- 5.0 is normal for a non-diabetic anything over 7 can lead to complications in the years to come. test as much as you like- more info is better I always say
Awesome that you found Jenny’s site & Dr. Bernstein right away. Both of them changed my life, my attitude & treatment. Great numbers! Good for you!
My experience has been that PCPs see so many Type 2s (& many patients who aren’t following guidelines) that they’ve become blase & disinterested. Not good at all. Doctors in general do not wanted informed, questioning patients who want to take control of their treatment. They complain about non-compliant patients & they also don’t want patients who challenge their authority. We’re supposed to be sheep following their god-like dictates.
Diabetes is a condition that requires self-management for control. Find a new doctor who’s supportive of your goals & approach. Yes, definitely–you have a right to help & concern! Dump her. Get a referral to an endo & a CDE (certified diabetic educator), in addition to a new doc. I went through two endos until I found one I could work with. The first two spewed ADA high carb crap & told me I couldn’t do low carb ala Dr. Bernstein. They told me “not to worry.” I told them that my goal was to be as close to normal as possible, that I didn’t want the “good enough” attitude & asked if they were going to help me attain my goal. Neither were. That was apparent right away.
Testing too much–ridiculous! Good grief.
Hypoglycemia is a not good thing & doctors dwell on this because it does present an immediate danger & one that involves their liability. My first doctor had me so scared about hypoglycemia that he had be convinced I was going to go into a coma overnight & die. I was setting the alarm to test in the middle of the night, But, I’m Type 1 on insulin–different than being on metaformin.
Make sure you get a C peptide test (to see how much insulin you’re producing) & a GAD antibody test (to determine how much your pancreas may be under attack), if these haven’t been done. Misdiagnosis is common.
First a Dr. should not tell you that you test to much. She should be proud that you do. Second anytime you feel that your health isn’t being addressed the way you think it should you might want to look into maybe finding another Dr. that fits the bill. Maybe an endo. This Dr. does nothing but deal with diabetes maybe leave the other Dr. dealing with the other stuff. Anytime I don’t feel comfortable with my care I research and usually that means Dr. change. And I am glad I did, I have a great Dr. who has done everything imaginable for me. But it is to the point to where he said it was endo and pump time. He is a very concerned Dr. Good luck and trust you above all else.
I personally think you need to find a new doctor. I know that Type 2’s like myself are common and the vast majority of Type 2’s do not manage their disease but when you try to manage your disease you do need the support of your doctor. This doctor sounds like one that is just waiting for you to burn out your cells and go onto insulin.
For you own health, research and learn as much as you can, manage your disease, and find the support you need from the medical community.
Get a new or another doctor. I don’t know how the hell she knows her other patients are ‘non-compliant’ since she apparently doesn’t give them any directions to comply WITH. Jeez!
Ask her to refer you to an endocrinologist NOW. If she is your ‘gatekeeper’ doctor in your health plan you’ll need that referral. If she asks why you want one, tell her.
Testing too much. Unbelievable. As if calloused fingers are your biggest worry.
Un-friggin’-believable. I think she needs a visit from Dino, Oneless and Al. I’ll come along and watch the door.
Thanks for the replies, you guys have reinforced what I was thinking. This doc is pretty laid back and maybe I need one with more - oh I don’t know, more something. The information at this website from you guys is amazing!
Did anybody have trouble finding a doctor that would support their treatment choice? I’m getting very used to eating low carb - even though I did dream about tasting a piece of fudge last night. I think it’s funny to dream about high carb foods and worry in my dream that it will give me a nasty BG peak.
I have an appointment for a diabetes education class in April. I’m already on my guard because the phone coordinator told me I shouldn’t eat a restricted carb diet and that “I wouldn’t be able to keep it up forever.” She said to eat a snack before bed and didn’t even ask if I’m hi or low when I wake up. I already know that a bedtime snack sets me up for a stronger dawn phenomenon and higher blood sugar after breakfast. That’s one of the benefits of testing alotl
Assuming your insurance requires referrals and a PCP, like mine does. I did an online search on my insurance website for a PCP that was also an endo. I found a few and tried them out. Unfrotuneatly they did not work for me but that’s not saying it wont for you.
Keep looking for the right doctor for you!
A1C, unless your insurance says it’s too early you can still have another one now. I had an A1C a couple weeks ago and will have another one in 3 weeks, that 5 weeks instead of 12. This just measures a 3 month average and you can change that average very quickly. My doctor and I are expecting my average to go up quickly because I was experiencing a lot of extreme lows with my previous medication and she wants to adjust my Actos or put me on insulin before it gets too high again.
Testing too much? that is insane. I did have to convince my doctor I was not testing 8 times a day because I was looking for something to be wrong and explain to her that it is the only thing that tells me when to avoid certain foods. When she understood that she was more than willing to write me a new script for the amount of test strips I needed. You do have to be careful with how many your insurance will provide though. Some insurances will only allow 4 a day. My insurance is pretty crappy compared to policies I’ve had in the past but they do cover up to 10 strips a day thankfully!
I went through this as well. I discounted ADA for a long time because all the recipes I read that they published had very large amounts of carbs. I know that after the first year I started adding bread, potatoes, rice back into my diet, bur really a diabetic recipe that has 65 grams of carb in a single serving!
ADA’s standard advice never fit me and a low-carb lifestyle really lowered my diabetes the first time around. I kept a low carb lifestyle up for about 1 year before I started traveling almost every week. Over the last 18 months, my low-carb has turned into med to high carb and my numbers went up accordingly. I am now more convinced than ever that it is the carbs that are doing me in. ADA has just now started figuring out that low-carb is the way to go but it will take time to get everyone retrained. You have to be your #1 coach and if carbs make you go high, take them out no matter what your official health personal or educators say.
I went through two endos before I found one who’d be supportive of my low carb diet. One I have now is great & I convinced my internist (PCP) as well.
The diabetes ed class I attended after diagnosis was useless & dumbed down. I went to two sessions & quit. It was geared to Type 2 (I’m Type 1) & was ADA party line. You’ve already experienced this on the phone with them:) I was told my brain would suffer if I went low carb. Their meal plan for me would have sent me back into the hospital.
You’re already so far ahead of most people in researching & having a good understanding!
Greetings. get a knew doctor please.Your doctor is an idiot. She probably thinks its your fault that you have this bearable condition. Ones lifestyle is by trial and error or you are dealt with it when you are born.I remember the days when I would eat until I couldnt breath anymore.I didnt know.Now I have sowed my life and must control it.You have to take charge my dear.And I am so sorry.
I would tell your Dr. She is FIRED!!!
You need to find an intelligent,kind,compassionate Dr. who will listen and guide you through this journey.
God Bless!
I think you need a new doctor. Your experience is typical, but the typical person with diabetes in the US develops neuropathy, retinal damage, and heart disease.
It sounds like you are making a huge improvement in your blood sugars. You have no reason to fear hypos unless you are taking insulin or a sulfonyurea drug in which case the treatment isn’t to eat more carbs, it’s to lower the dose. Doctors who don’t understand that are dangerous.
I had a doctor just like your when I was first diagnosed except she wouldn’t even prescribe me strips as I wasn’t using insulin. I had to pay for my own strips for a year. Then I found a new doctor who was thrilled that I was willing to take charge. The new doctor was in the same practice as the other, too, which shows how individual this can be.
Cut back to testing 3 times a day now that you have a better idea of what food does to you. Ask yourself “Why am I testing” before you test, and if the answer, is “curiousity” rather than because you are trying to figure out what you can eat, give it a pass.
I would find a new doctor. I have a cat with diabetes and I had the same issue with the vet. And I immediately started calling referral services asking for vets (in your case they have them for doctors) that deal with diabetes patients.
It took several calls and I even visited the office before making the appt. The front office staff are a good indication of the quality of an office. If they are concerned, helpful and show caring, and the doctor has the background you need, then try it. Good Luck. Don’t wait for them to change, they won’t.
I have dismissed two internists who have treated me this way. In addition, my father-in-law is in a hospital near death because his internist did not manage his diabetes well.
Internists are great generalists, but my endocrinologist is the one I let give me the final word on treating my diabetes.
I think you should definitely tell your internist that you would like to get the best care entitled to you by seeking the advice of someone who only treats diabetics.
Plus, all internists will do is nag you about your diet and exercise, not actually send you to someone who will give you specific ideas about treating that.
I am sooo adamant about not getting treatment for my diabetes from my internist because I’ve seen first hand where some internists ignore what you say.
Any doctor who doesn’t listen to you, and doesn’t want to follow your wishes to aggressively manage a chronic condition, needs to understand that you have a choice in who you go to.
Don’t worry about getting a calloused finger from testing too much. I test an average of twice a day, I got one, and you will too. As for your doctor’s attitude or reluctance to address your diabetes, that appears to be pretty common, especially toward type 2s. The type 2 diagnosis is seen as the result of one being over weight, etc. This same attitude can be seen with a diagnosis for high blood pressure, etc. They normally just give you some pills and send you on your way.
Your doctor has probably resigned to the fact that most patients just remain over weight, obediently take their pills, and don’t change their ways. I think this same attitude has gained traction withy medical workers. I have noticed an increasing number of nurses and techinicians in hospitals and doctors offices with bulging waist lines and rear ends.
Keep up the AWESOME job of taking care of yourself. Like the others here, I think you should get a new doctor. If you want to try a low carb diet and it ends up working for you, then you should do that. Some people do have a hard time sticking to it though (like me, I no longer eat high carb but I definitely do not eat low carb, I am in the middle).
As far as getting callouses and scar tissue on your fingers, that is the dumbest thing I have ever heard as a reason not to test. I have been testing 12+ times a day for almost 2 years now and my fingers are fine. Prior to testing that much I had phases in my life where I tested 2-4 times a day and some times where I didn’t test at all. I have been diabetic since 1986 and my fingers are fine. Just look for a lancet device that works best for you. I love the Accucheck Multiclix, smaller needles and no need to touch the lancets.
My doctor doesn’t deal too much with my diabetes either. I suspect that it is a very time consuming process and he doesn’t want to be bothered with it. But his office does have a special diabetes nurse that is available for all sorts of help. You need to try to find someone out there with expertise who will help you. Diabetes is a very bewildering disease and although you seem to be doing well on your own, you will need help, guidance, and emotional support with it. Best of luck.
