Endocrinologist or a primary care doctor?!

Hi! I’m in the middle of changing endocrinologist… I finally picked a new one but doesn’t take my insurance so I have to find a different one! I really LOVE my primary care doctor! She is amazing and helps me so much! She specializes in diabetes so she helps me! I’m not currently on the pump. I was diagnosed on thanksgiving 2013. I’m praying to get a pump ASAP. My primary care doctor is all for me getting the pump… My question is… Do I have to have a endocrinologist? Can my primary care doctor be my “diabetes doctor”? Can she write my diabetic supplies prescriptions? Can she write a prescription for an insulin pump? Also how long did it take to get a pump? How do you get a pump after your docto write the perscription? How long was your training class?!
What pump do you think is best?! In falling towards the medtronic minimed 530 with the enlite sensor!!

Whew, lots of questions! I'll tackle a few. I don't have an endo. I've only seen an endo one time in my life and she confirmed my own realization that I'd been misdiagnosed and was in fact type 1, not type 2. Other than that I just see a primary care doctor. You are ahead of the game of you have one who helps you manage your D! My criteria for a doctor is that they write my prescriptions and otherwise not bother me! That's just me.

Yes, your doctor absolutely can write all your D prescriptions including for your pump. When I got my pump I contacted the pump company I wanted (Animas) and they did all the work for me including contacting my insurance and bringing the form to the doctor's office to sign with their recommended starting basal doses (based on my previous long acting dose minus a percentage - I think 25%. ) They are well motivated to do all this for you because pumps and pump supplies are expensive and they want your business! (Or your insurance company's!) It took a couple weeks and then they had me contact a pump trainer for my area (who works for Animas) and she came out to my house to train me.I met with her twice. They offered me follow up calls to tweak my doses but I turned it down and just asked if I could call if I had a question. I cringe when I hear about people waiting for months until their endos office has a training group or appointment. I really cringe when I hear about endos saying "no, you can't have a pump because your A1C is too high or you can't have one because it's too low!". Going through the pump company definitely facilitates the process.

As for pumps, it's all very individual. I like the Animas Ping most of all because it has a remote, so I can test and then bolus from the meter/remote and leave the pump under my clothes. I don't know anything about sensors. I assume that is related to an integrated CGM? I don't want a CGM, but I know people in the U.S. are waiting for the Vibe which is Animas' integrated system but without the remote.

Finally, I recommend you be fully confident in your I:C ratio, basil dose, ISF, carb counting and tweaking doses before you get your pump. There is something of a learning curve with the pump itself and it's best imho to have all the rest of that under your belt first.

If your PCP is good and supportive, it's fine. You should be set. However, I'd still try and find a Endo that you are comfortable with, so that if anything ever happens with your PCP or they aren't able to prescribe what you need, you'll have another route to go.

There is no "one" correct answer to this. It is what works for you. As a brittle (yes, brittle) type 1, I prefer having an endo who really wants to work with diabetics. Not all endos do. Some prefer or are most expert on thyroid diseases or adrenal gland diseases.

I find that the endos I have had over the years have a more comprehensive and deeper understanding of the complexities of T1 diabetes management. I am guessing it would be the same for T2.
On the other hand, if you are a self motivated person who does self study and can be a partner with your internist, you should be fine. There is nothing that an endo can prescribe that any other kind of MD can't also prescribe. Think about it. There are not enough endos in the country to have all pwd's in their practices. If your doc likes and studies and keeps up to date on diabetes management, then give it a try and see how it goes.

The key ingredient to any relationship is the ability to communicate. Since your primary care doctor has an interest in diabetes management, then that sounds promising. This is not a final or irreversible decision. I would go with your gut instinct.

I've had many endocrinologists and have been disappointed with most of them. They don't have the time or resources to give their patients what they need. I used to fault the doctors for this but now I see that the health care system in the US and how it's financed puts doctors into some difficult circumstances.

I make all of my insulin dosing decisions and changes. I never consult with the doctor about this. In fact I don't think most of them are as competent with day to day management as I am. Like Zoe, if my doc will write me the Rx's for all the supplies I need then I am happy.

I see my endo twice per year. I requested last year that we cut that back from 4x/year and she agreed. If I had some problem that I needed her help, I would request some time.

I was diagnosed correctly as a T1D by an internal medicine doctor 30 years ago. I would select a good primary care doc with good rapport and an interest in diabetes almost every time over the average endo.

I've been using insulin pumps continuously since 1987. I've used MiniMed (now Medtronic) and the Animas Ping for almost all of that time. I had a bad experience with Omnipod but others love them. The Medtronic and Animas pumps are durable and can usually take everyday abuse.

I wouldn't commit to any CGM, especially the Enlite, until you've had a reasonable trial period. There's nothing like actually using a system before you financially commit. I also don't like any CGM system that you will muffle night-time alarms under many layers of blankets. I've used Dexcom CGMs since 2009 in part due to its external receiver that is not integrated with my pump. It can dependably wake me up when things get dicey.

I was diagnosed as Type 2 @ age 43. I was normal wgt, with a history of traumatic pancreatitis at age 23 due to a MVA. I’m an RN & my PCP & I had/have a great relationship so I too figured I certainly didn’t need an endo. But after needing MDI insulin less than 8 yrs after diagnosis & VERY strict low carb dietary, I requested a pump. Dr. M wisely said I HAD to go see an endo as he did not have enough experience w/pumps. (See why I love him?). Well, come to find out, you guessed it, I’m really an atypical Type ONE! After years of beating myself up b/c I “must be doing it wrong” I finally had an endo who was amazed how OVERLY “right” I must have been doing everything as I was keeping myself TOO strict/low!!
Anyways, I’d strongly suggest at least one or two visits w/ a good endo specializing in diabetes to get you on the right track. Saying on top of all the new technology changes for PWD is much work, esp for an internist who has so any other diseases, new meds etc to keep current on.
::steps down from soapbox::

Plenty of good points made here.

As someone else said, there is no single correct answer to the question. Circumstances differ and therefore so do solutions.

Think of it as an equation. On one side are your needs, on the other side the available medical support. The requirements for side B depend on what the needs are on side A.

IF you have a PCP who is knowledgeable, supportive, and able to provide what you need, then that's all you need. If your diabetes is "brittle" or touchy, or an uncommon variety such as MODY, or otherwise requires intense involvement from someone with extraordinary depth of expertise and experience, then perhaps you need a good endo.

Like most things in life (and diabetes), "it depends". The resources on side B need to match up with the needs on side A. You need to balance the equation by making certain that whoever your medical team consists of, it's the right combination to supply the support that YOU need. No one else's answer matters.

In the interest of full disclosure, I only see a PCP. I am extremely proactive about managing my diabetes. He gets that -- our relationship is a collaboration and he is perfectly able to prescribe whatever we decide I need. But that answer might (or might not) fit you. You have to determine that.