Endocrinologist and/or PCP?

Hi i’m a new egg i’m wondering if i should be seeing a Endocrinologist or trust my PCP with my diabetic care? My a1c was 13 when i was diagnosed in may and my PCP has me on METFORMIN HCL 500 mg tablet … if so why should i be the one insisting on a Endocrinologist and should i be looking for a new PCP?

I think a lot depends on HOW new? When I was first diagnosed in June, 2012, my excellent PCP put me on Metformin. The advice I was given was that, because many people have problems tolerating Metformin, I should start with 500mg for a bit, then increase the dose slowly. He also had me return in 2-3 weeks to see how I was doing. In my case, I never got past 1000mg when my PCP decided that the results were not satisfactory-enough, so he added an additional medication.

My A1c was 11.8 at diagnosis. On oral medications and some diet changes and regular exercise, my A1c after three months was 6.5. I did, however, have intolerable side-effects from the medications, so I changed to taking only insulin after four months - at which point, I was also referred to an endocrinologist… For me, that was the best option, but everyone is different. There are many that believe that insulin should be used at the start, including the Joslin Institute, at least to get things into range. Others believe that the standard practice of medications is better – and, perhaps, it is easier for many people.

To answer your original question: It is not unusual for people with Type 2 diabetes to have their care managed entirely by their PCP. I certainly don’t have enough information on your doctor, situation, or case (though an A1c of 13 is quite high!), to tell you whether your PCP is knowledgeable-enough for you. Aside from your A1c, what was your fasting blood glucose? Your random tests? Have you been instructed to test your blood glucose? How often?

Sorry for more questions than answers. With diabetes, it seems there always are.

Oh - welcome to the club no one asks to join. Aside from my ramblings, you’ll find a lot of resources and much smarter people than me here that can help you on your journey.

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Either is ok, providing that the Dr you do have is appropriately helping you manage your diabetes, and by appropriate, I should hope that means aggressive management. With hba1c of 13 your blood sugar is averaging at least 350, nearly 5x what your fasting blood sugars should be.

In my option, that is almost worthy of a trip to the ER. Certainly you are at risk of quite rapid onset of complications… none pleasant…

Thas’ questions are all relevant.

If he just put you on 500 mg of metformin and left it at that… not acceptable… has he given you information about diet and exercise to help with management?

Do you have a blood sugar meter and know how to use it? Are you monitoring fasting blood sugars and also what is happening at meal times? Are you eating lower carb?

If you are not satisfied with your care or the rate at which things are being managed, I think you should be pushing for a new Dr. or at least seriously discussing with your current Dr on what the treatment plans are and what and when the progression will be with treatment.

Thank you for responding, 1st she never looks at my feet only on my first visit …2nd she thought my 3 month a1c of 7.1 was acceptable,…3rd. my bg test everyday is between 90 and 130 but mostly it;s always around 110 every once in awhile 145 i try and watch everything i eat …4th.i have polyneuropathy so she has me ramped up to 2100 mg of Gabapentin which i’m really hating

Hi,
Sounds like your blood sugar is a good deal better than it was, but still not normal.

Polyneuropathy, if caused by diabetes / high sugars, is best addressed by getting sugars down to close to normal and stable.

Are you on any other diabetes meds than metformin?

What does watching your diet mean? low fat, or low carb approach? Low carb will likely be more effective than low fat.

If you are not satisfied with your Dr then you should be looking for one you are comfortable with. This is a long term condition to be managed.

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I’m thinking i’ve had diabetes for at least the last ten years looking back now at the signs and symptoms.And my feet are killing me 75% to 80% of the day i started a log time stamping my distress also she has me only on the metformin and i do try to keep to a low carb diet And thank you for your advice.

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500 mg metformin twice a day plus a cholesterol pill and a blood pressure pill

I have read that the “standard of care” is to have your feet checked by a doctor at least once a year. My PCP checks my feet annually, though, as I see an endocrinologist, they are checked more frequently as well. You, of course should try and check your feet daily to catch any problems that occur as quickly as possible.

Not everyone can gets their A1c into a preferred range in three months - 7.1 down from 13 is quite good, but, as @JustLookin said, you want to continue to work for better. It does show that you are responding to the medication and diet changes you’ve made, though. Remember - diabetes is a marathon, not a sprint. You didn’t get this way in a day, and you cannot expect to set things straight that quickly, either. You are making terrific progress, and should be proud of that.

As to the testing… in my experience (I’m not a doctor), testing at the same time each day, while useful, is missing the bulk of information you need for optimal results. You should - at least sometimes - test 2-3 hours after meals and before you go to bed. Knowing how food, exercise, etc. affects you will help you make more informed changes to your habits and choices.

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So that’s 1000mg of metformin daily, not 500mg. Metformin does not exit the system in 12 hours - the effects build up and last for days. Taking it twice a day, instead of 1000 at once, makes it easier to tolerate. That said, some people do take larger doses – but, again, everyone’s needs differ.

As my polyneuropathy is horrible i take great care of my feet every waking moment and i did test bg 3 to 4 times a day in the beginning i’m going to go to the Walmart and get the cheaper bg monator & strips.

Thank you for caring and putting up with us newbies

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I’m still a newbie myself – I was diagnose just over four years ago, and I’m still constantly learning! We all help each other. Stay strong!

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At first i thought it wouldn’t be that hard just eat right, exercise and follow dr orders…Hahaha… Then i found the online world of the diabetes community where the truth lives

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This is exactly what i told her when i ran outta strips…Again TY

That’s brilliant. I’m going to steal it. :laughing:

Seriously:

Lots of good advice here. 13 down to 7 is terrific progress, as noted. Also as noted, you want to keep pressing for continued improvement.

I would particularly emphasize two things.

  • Lowering your blood sugar to a relatively normal range is the key to almost everything: reducing and minimizing complications and symptoms, feeling better generally, peace of mind, etc.

  • The reason the online community matters is that with diabetes, if you’re going to control it effectively, you must become as knowledgeable as possible. The best doctor on the planet can’t manage it for you. In the first place, no one knows your body like you do. In the second place, no one else is there 24x7 to do it—only you. And it really is a 24x7 job, if you want to do it as well as possible. Self education is key. In addition to the wealth of experience here, there are some really excellent books out there that can fill in a lot of blanks for you. Welcome to the journey :wink:

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For what it’s worth my DH had/has very painful neuropathy but we’re pretty sure that as he’s gotten his blood sugar down (low carb diet, metformin, weight loss, exercise) the neuropathy has gotten more tolerable, which makes exercise easier and probably leads to better BS control and continued weight loss and around and around in a virtuous circle. I’m hoping he’ll continue to improve or at least not get worse for a long time…

Hi Thas i don’t have many people to share good news with that appreciates it as much as you will so i’m screaming it from the roof top… my 3rd A1c was 5.7 down from 7.1 that was down from 13 …I really can’t belive it maybe pcp is using a faulty tester … lol

Thanks in advance for listening

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Hi david i copied and pasted this from a reply to Thas hopefully you won’t mind …
i don’t have many people to share good news with that appreciates it as much as you will so i’m screaming it from the roof top… my 3rd A1c was 5.7 down from 7.1 that was down from 13 …I really can’t belive it maybe pcp is using a faulty tester … lol

Thanks in advance for listening

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Congratulations, good job! You’re doing all the right things to get this under control. Keep up the good work!

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That is absolutely terrific. Great job!

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I recommend you take full credit and celebrate all good lab numbers. When numbers turn up bad … well, it’s just a number. :wink:

Whatever you’re doing is the magic solution. Keep on keeping on!

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