If you could write your own Rx's, would you visit your doctor?

I have never received any usable information from any medical person in the past 8 years since my diagnosis EXCEPT one orthopedic nurse who whispered "low carb" into my ear and recommended a couple of books to read. Luckily I don't need any prescriptions, but if I did I'd probably order them online just to avoid the useless appointments.

It’s amazing to me that the current medical take on low carb for people with diabetes actually drives low-carb supporters underground. Maybe this “illicit” aspect enhances its appeal. Have you had any follow-up conversations with this nurse?

The main value I get from my current Endo practice is the Rx's. At least they recognize that I do test a lot so I get adequate testing supplies. I am a longtime pumper (I was before I had to switch MD's due to a move). I had an Endo for 20 years with whom I felt like I was a member of the team, not a "child". I am striving to "earn" the trust that I feel I am due. "They" don't believe my good A1C's are due to my work - but insist it must be due to the averaging out of very high and very low bg's. Even showing the CGM data (which I pay for out of pocket) isn't enough. My healthplan dictates who I see, so no opportunity to change. Am I bitter - yes I am. I am required to see them 4x a year in order to keep my pump. I finally have connected with a CDE who I think is beginning to respect me. Will see how it goes.

So No is my answer. But...if I needed help, or had some other medical/health issue of corse I would seek n MD's input.

For Medicare, when on a pump, in addition to the q 3 month dr vists, I am asked every time I call for a pump supplies reorder what date did I last see my 'diabetes doctor.'
I have to look up the date each time. They do check on the visits and my NP told me once that Medicare asks the office to fill out patient visit information records. So, there is no getting around it. My endo gets around it a bit by having me alternate visits with him and the NP. So I see my endo twice a year and the diabetes NP twice a year. I actually like that approach.

Terry - Exercise really helps me a lot. My Endo did change me from Symlin to Victoza. I was having a number of issues with Symlin - as it was slowing things down too much and so much so I would end up with attacks of diverticulitis. Also having to do a shot at every meal...sort of defeats thepurpose of being on a pump. Victoza is one shot and it has helped to even out my blood sugars. (I am a type 1 using it off label.) I kept going from 7.2 to 6.3 to 7.3 to 6.2. Also test 10 times a day - even with the Dexcom. I am learning to really love the G4 as it is within points of my ONe Touch Ping meter.
The upload to Diasend was a breeze. The Animas pump took several tries, but analyzing the data and tweaking the pump settings has been great.

I am not afraid to adjust... I do like the fact that my new Endos office lets people who are managing their diabetes well do their own thing. They do not want to interfere if it is not broken...I insist on more A1Cs as once a year is not enough. At least twice or 4 times a year if the A1C is high...

It would be nice. But I doubt it would ever happen, since we are a big minority. Think of all the diabetics you know who suck at treating themselves. These people need a doctor holding their hand through every little change in dosages.

If doctors are used to "those" kind of people, they would never give us permission to choose our own medication.

That may be - that MD's are "used" to having patients who not as engaged in their care as we are. But...you would think they would enjoy the patients that are engaged and doing a good job. Instead, it has been my experience that they either don;'t believe we are doing as good a job as we are doing, or they resent us for doing just that. My former Endo used to take pleasure in my good work. That made it all the more a joy for me.

artwoman - I also highly object to a doctor that adopts the patriarchal authority figure posture. Respect is key to me, mutual respect that is.

I'm amazed that your medical group won't believe their eyes when they look at your data. They still cling to the idea that a low A1c (I should say "normal" A1c) is only due to averaging many highs and lows. That may be a reasonable conclusion for some patients but they should respect you enough to not throw you into that category without any evidence. That would certainly raise my hackles!

Good luck managing that relationship going forward.

You're right Nell about the pump supply company wanting the actual last doctor visit date. I was caught off guard in the last supply phone call. I was away from home and just took a stab at the date. She accepted it and processed the order. When I got home I checked my calendar and found out that my guess was wrong. I was only off by a few days. Hope this doesn't come back to bite me!

I accept Medicare's policy since I know they are trying to manage a policy that covers a wide range of people and personalities. Perhaps the average pump using diabetic benefits from frequent doctor visits. I'm not one of them, however.

At the risk of offending PWD2's - who do get the bad rep treatment more often, and are the bulk of the caseload - but I am reminded of my veterinarian's practice. They have to doors for entry. One is labeled cats and one is labeled dogs. Maybe our Endo offices should have doors labeled PWD1 and PWD2?

You're right, TM. The people who frequent this site constitute a small subset who generally pay closer attention to their diabetes regimen. Medicare has to deal with the much larger population who don't pay as close attention as the average TuD member does.

That’s what’s called a group bias. People who are active on a diabetes group are either a) people whose diabetes commands a larger role in their life and/or b) inclined to be more active managers… Ever wonder why there is so much more than a representative percentage of T1 diabetics here?

The same kind of generalizations can probably be made, with some accuracy, about almost any other group of people

31 years for me, too! I've NEVER seen my endo appointments as wasted time. No matter how much I think I know about T1, I can always learn new things or see issues in a different way. I also find that seeing my endos "keeps me honest"...someone to be accountable to. It's good to have to face someone every few months to discuss my A1C and admit when I need some fine tuning. In the few periods where I only saw an endo once every several months, my control has gotten sloppy. They don't know everything either, but it helps me to bounce ideas off them and strategize my regimen. Of course, this assumes that they have some kind of bedside manner and are up to date on their diabetes information. I've had a couple of insensitive jerks over the years, but most of them are great. I also love diabetes educators, too. They often have very practical solutions for issues I'm dealing with. One thing I will also say is that like with other things, you get out of it what you put into it. I don't know what your demeanor is like when you visit your endo, but if you go in with the attitude of "I know all I need to know, you can't tell me anything new, I'm just here because I have to be", then why should the endo engage you in much advice? Think about it...they see so many diabetics that take a laissez-faire approach, and most docs want to spend quality time with people they can actually help, that at least try some of their advice. So maybe try a different attitude next time, and maybe you'll have a better experience.

Yeah, Sam, I have wondered why T1Ds are over-represented in diabetes groups. I've often thought that the cultural blame and shame of T2Ds cause people with that disease to choose to remain anonymous and maybe deny that they even have a medical issue.

angivan - I appreciate your take on displaying a good attitude when engaging with your doctor. I fear my words have painted the wrong picture. That's something I take care to do. I choose not to make frank remarks to my doctor because I know it will not be helpful to me. I am duplicitous in this way but I do need to navigate the system and get the things I need, like medical tests and prescriptions. My current doctor respects my positions and she chooses to stay quiet or tread lightly on issues she knows I disagree with her. I treat her in similar fashion.

I'm always open to learning in any situation. I believe once you conclude that you know it all, you are in peril. I don't expect, however, to learn much from medical professionals when it comes to blood sugar control tactics. It's been ages since they've made a suggestion that has value. In the meantime they ask few to no questions about how I do what I do. Sometimes I wish they were more curious. But that's OK. They work within a system construct that forces them to see so many patients per day. They have a tough job!

I saw her 3 or 4 times during that first year and then she moved to a different department. She and one of the nurses who was diabetic were trying really hard to get the hospital to let them teach low carb classes to patients who were interested, but that never happened. I don't like the underground aspects of what I need to do. Earlier this year I felt I really needed to talk to a dietician. I finally got an appointment and was eager to get some questions answered. Whether she honestly didn't know the answers, or was not allowed to discuss things outside the official agenda, I don't know. But it was an incredible waste of time. Like asking a nun about your sex life.

It's unfortunate that you can't feel comfortable disclosing a basic aspect of your way eating to medical professionals that are intended to help you. Especially when diabetes blood glucose control is so driven by what we eat. I'm hoping that we will soon be looking back on experiences like this as the "dark ages" before low carb eating assumes is rightful position as a particularly effective tool to tame blood glucose in diabetes.

I was "promoted" (or is it "demoted?" to seeing the doc twice a year last year because my appointments are pretty dull. Although last time he screwed up the "moment of truth" but looking at the records, my pump/ meter reports, which they download, which I kind of like,he said "everything looks great!" and sort of whizzed through everything else and then he was like "looks good, I'll see you in 6 months" and I was like "uh, dude, what's my A1C?" and he got it wrong which I am really peevish about and, in fact, had told him I fired my last doc for exactly the same thing.

I don't know what he was looking at but I already knew what it was, 5.0 but he blurted out "6.1?" and the nurse yelled from the hallway "it was 5.0..." and I was just annoyed that either he thought it was 6.1 and that was "great" or that he hadn't thought about it at all. "Here's $300!" sheesh. I have another one lined up, one of my local friends rated well but I'm trying to get the Rx refills squared away first.

I would tend to think that it’s more likely that the majority of the T2s out there are just popping a few metformin and going about their business… and a higher percentage of the ones who end up on intensive regimens w/ insulin etc probably end up in “support groups” like this.

I also tend to think that healthcare providers aren't as likely to share with their patients that there are online forums and support groups. I think that comes from the same bias towards PWD2's that we see in the general public. What makes that bias especially bad in my eyes is that from what I understand, type 2 can sneak up on a person, often they don't know they have it until they experience the beginning of complication(s). At least with rapid onset type 1 I knew something was wrong straight away.