Hands-off endo; thoughts?

so it seems like a lot of people complain about how endos are too controlling and refuse to let their patients modify their dosing without their approval. this seems totally foreign to me–my endo literally asked me what medications i needed him to prescribe and whether i knew how to titrate my doses on my own, and then told me to email him if i had any questions. has anyone else had similar experiences? is this the sort of endo or PCP you wish you had, or do you think you’d want someone more hands-on?

I can’t imagine seeking medical approval or guidance with dosing. Since the third week on insulin, I’ve adjusted my doses. I do wish I had an endo like yours who asked what meds I wanted. Was a knock-down fight to get changed from Lantus to Levemir & another when I refused statins. I’d prefer a doc who was there to answer questions, but not one who needs to be in an authoritarian role. Hands off is fine with me.

That’s pretty much how all of my doctors have been. They are always sure to ask “do you have any questions” but the whole S.O.A.P. thing is very abbreviated.

It depends on what stage you’re at. 30 years ago when I was a first-diagnosed kid in DKA this obviously wouldn’t work.

20-some years ago I had been asking my docs about switching to MDI from my 2x a day R+N regime, and they didn’t give me much help, said I was doing OK and they didn’t see why I need to switch. But in between appointments I just switched to MDI by myself and I noticed at the next appointment the docs were a little miffed. But they did not get in a huff about it, and I felt so much better about doing things with MDI that I think I might have taught them a little bit at that appointment :-).

And today, if you or I come in healthy, knowing the ropes (or in your case at least some of them), and with decent numbers, I expect a doc to let me manage my bg on my own and to help me make the changes that I want to make, maybe with some subtle persuasion to step things up a notch. I also expect him to help refer me to other specialist/experts in ongoing long-term diabetes care and keep an overall watch (especially via labs and exams) on complications etc. well before they happen.

Now, at the same time, I expect that doc to have a critical eye, to watch not just my bg but other aspects of my health too, probably aspects that I don’t have the same level of expertise watching myself, and to recommend what I do there.

From the school of hard knocks, a couple times I’ve gone to highly recommended endos who told me everything I had ever done before was wrong, I had to stop doing everything I had been doing to control my bg, and put it all in his hands, and you know what? I never ever went back to see those endos. But I can see how a different person, coming from a different place, might actually want to hear that. So I think there’s room for both ends, and for stuff in between.

I think it depends on how long you’ve been a diabetic and the type of control you have. My endo leaves me alone and let’s me do what I need to do. If I have questions, I ask him. But I’ve been diabetic for 25 years, probably longer than he’s been a doctor. I’ve had doctors that griped at me if my levels weren’t good, which I find to be irritating. I’m sitting there thinking, “I hope you enjoyed that cheesecake you had with your lunch, because you have no idea what I have to deal with.” I can understand if you are seriously out of control, like a friend I used to have that was in and out of the hospital all of the time. Or if you are a child and your parent doesn’t really seem to understand how to deal with it. It just depends on the person and a lot of different factors. But for me, what works best is to let me take control of it myself and let me come to you for help.

“probably longer than he’s been a doctor” snicker that’s a good one!

Interesting question, and I’m enjoying reading the replies. For me, there were several junctures at the start of my diabetes journey where I could have used more guidance: When I was misdiagnosed Type 2, when the oral meds stopped working and I didn’t know why, when I started insulin. But for various reasons I didn’t get much guidance at those times, so I figured things out and managed well on my own. Now I just like having a doctor who “doesn’t bother me”. My family is appalled when I say that so it’s nice hearing other people with similar attitudes, although “hands off” is probably a nicer way to put it. If I’d gotten the guidance I needed at those early junctures would I utilize it more now? Knowing myself, I probably wouldn’t be as fiercely self-managing as I am, but I’m a pretty independent person by nature so it probably wouldn’t look much different.

If nothing else there’s the timing thing. When I have a question or a quandry it’s happening today, not concurrent with my 3-month appointment or whatever. So really even the most guided of us is 24/7 in the end.

The doctor knows more medicine than me and I know my body better than she does.

I prefer that she give me her opinion and advice, ask what I want, tell me if I’m medically off base, then write the scrips we agree on.

Terry

Well, there’s hands off, and then there’s REALLY hands off. At the end of last August, I went in with a FBG of 302, A1c of 10.7 and liver enzymes in the 100’s, when they should be under 40. My BGs had been running 400 and up, and I was trying to bring them down with massive doses of insulin, which weren’t working. And my endo did nothing. 6 days later, I was in a coma, and if my friends hadn’t come looking for me when I didn’t show up for a picnic, I would have died.

I want someone who will keep track of me, and KNOW when I’m in trouble (the labs were unquestionable!), and do something about it. I sincerely hope never to get into that kind of trouble again, and I’m now low-carbing, where I wasn’t before, but I trusted this guy with my life, and the trust was misplaced.

Needless to say, I now have a new endo, and he’s a Type 1 on a pump, but I don’t see him that often – I usually see his APN. But he promised me that if my BGs go above 300 and I can’t get them down, to call him, and he will take care of me. I hope I never need to do that, but I NEVER want to go through the coma experience again!

To me, that offer to be available if you need him is the mark of a good doctor, given your history? He sounds like a keeper!!

I really like my endo. I was only diagnosed as T1 Sept 2009 so I’m still pretty new. But she listens to me and doesn’t tell me what to do. I am the type of patient who will stop taking meds if they aren’t working and I’m comfortable playing around with my Insulin. We don’t really agree on the whole ‘statin’ thing but she accepts that I’m NOT going to take it.

I think it depends on your comfort level. Hands off is good because they’ll give you whatever strips, insulins, etc that you need to get the job done without micromanaging. But, on the down side, you sometimes have to push them when you need help/advice. I have a good knowledge of diabetes and metabolism, but I’ve never taken an anatomy/physiology or pharmacology class in my life and sometimes they assume that I know more than I do. That can be frustrating. Of course I like to see the evidence, but a little commentary is useful too. It’s just trying to find a doctor who prefers dialogue over a monologue that can be difficult!

I agree with you Natalie. Sometimes doctors assume that because you’re smart, it means that you don’t need help. I would be surprised if there was any correlation. There are too many docs at the extremes.

Well put, Tom!

So far everything I have read from the start is like reading my history with my endo the last six years. I have no idea what my appointment with her will bring next month. I do know, if I receive no answers from my questions, it is back to my PCP. She listens, encourages and likes to know how I feel about my problem. She is on hands.

Yes the only way to fly. Insulin dosage is the patients responsibility.

We must have the same endo. I didn’t have an endo when I started. I had an internist. When I asked him for a CGM prescription it was as if I had asked for the world. He referred me to the endo!
I had had many experiences with patients being unhappy with their endos, and I didn’t want any supervision. I’m happy with hands-off.

I would put more stock into what the nurses, dieticians, and endos say if they were diabetics themselves. I’m not sure any of the ones I see are. I use them as a baseline but beyond that I do the dosing myself. I told my endo in order to avoid a huge spike I needed to wait 1.5-2 hours after bolusing humalog to eat and she said I was wrong, and that was the end of that conversation.

At this point I expect them to evaluate my current status, and tell me what I need to improve, but let me decide how to get there and give me the tools to do it.

I am LADA but was just recently put on insulin and I told my endo what type of fast and short acting insulin I wanted and he gave them to me and told me to start at 2 units levemir and increase/decrease on my own until I was at a good fasting and the same with my humalog so it has been a lot of trial and error. So as a first time new insulin user I would say this is pretty hands off but I do not mind, I have done my research more than extensively and he was quick to point out how educated I was and that I seemed to know what I was doing and just call if I have any questions. The only thing he has been pushy about at all is for me to eat more carbs/take more insulin and gain weight.

When I was diagnosed at fourteen, for the first six months I was treated by my pediatrition not an endo. and he was very controling. He treated me like a moron, and told me not to change my doses without his approval. I did anyways, because to me it was very clear what my body needed. He got very angry when I did this and acted like because I did not follow his directions exactly that I did not want to help myself, which could not be farther from the truth because my blood sugars improved everytime I adjusted my own doses! He told me not to carb count and, use a type of “sliding scale” as he called it to calculate my doses. Once I got to see an endo.(it took six months to get the appointment) she was much more understanding and could not believe what a jerk he was being. Just like there are different types of people, there are different types of doctors, they are after all only human!