I just recently had to go to my PCP for another health issue. He was the person that diagnosed my diabetes. Since the diagnosis I didn’t feel I was getting any better with him and started going to a diabetic clinic and met my current ENDO.
At my visit, my PCP had inquired as to why I wasn't with him for my diabetic care and asked about my meds. I had no problem telling him the truth and told him all the pills and injectables I was taking. In a nut shell, he believes he can control my diabetes better than my ENDO. He thinks all the pills and injectables I am taking is too much and risky.
I don't think my ENDO is doing a bad job but I have to admit I don't like all the pills and injectables that I have to take. I do skip taking pills or an injectable. Plus all this medications is expensive w/insurance.
Has anybody else had conflicting reports from a PCP and ENDO? Whose advice did you take?
My primary care told me that my endo would handle my diabetes and he would take care of everything else. Which is good because my endo knows more than he does.
Sometimes endo’s are no better. i’ve gone through 3 endo’s before I found one that really made a difference. From personal experience, I found that the best way to really handle this, is to evaluate how you feel after your doctors recommendations. Are both doctors listening to what you have to say? Or is your treatment fueled by both of their egos? Does the endo specialize in diabetes and metabolism? Does both your doctors take the time to explain every regimen, and why they feel it’s best for YOU? Most importantly, never stop asking for advice… If you have access to other nurses, CDE, etc., ask away…
I moved away from my favorite Endo a year ago after being with her for over seven years. I didn’t think I’d ever find one as good ever again. I finally got a PCP (Primary Care Physician) after several months of deciding which ‘group’ to be in. Then I started asking about the best Endo around and was given the name of my current Endo. So, to sum things up, my Endo handles the diabetes and related issues (upcoming Cardiolite Treadmill Test). My PCP takes care of everything else. He did say he could handle my diabetes too, and that there was no need for me to have an Endo. So the Endo was my choice, because she is a specialist, after all.
You don’t mention whether you are Type I or Type II, but with unknown pills and injectables, it sounds weird to me. I have had Type I for over 45 years and never took pills. How long have you been diabetic? There are many factors that go into this decision. One thing though, I would do my own research on what I’m taking to see if they are truly ‘dangerous’ together. One site for that is http://www.rxlist.com/script/main/hp.asp
I agree with this… I think sometimes GP’s can get their feelings hurt if they diagnose something and then you go see a specialist… it doesn’t matter what it is, and even if they’re not fully qualified, they seem to think they can do no wrong… at least that’s my experience.
My PCP(s) have been competent to take a glucose test and an HbA1c and tell whether I was doing good (HbA1c > 7%). They could prescribe metformin and dabble in some other pills. But beyond that, they are generally outside their realm. And my current PCP was totally “freaked” at prescribing insulin. It is fine to see an endo for a special condition like diabetes. Why would you Not want to have the best care possible. If you get to the point where everything is fine, then you endo can “release” you back to your PCP for care.
ps. And when my PCP told me she wanted me to keep my HbA1c at or above 7%, that was the last straw.
I had the same thing from my internist. She led me to believe that I could control, even reverse, my T2 diabetes in my 30s with hard work in dieting and exercising. I ate less than 100 gms of carbs a day, worked out for 2 hours a day (1 hour in the am and 1 hour after work) - and I kept off weight. At 36, I developed high trigylcerides. She ignored that. At 38, I developed high blood pressure (when usually I was so low medical staff asked me if I felt faint). She ignored that, even though my D was so bad with my second child that I had kidney damage and I was on Lisinopril anyway. At 40, my liver enzymes dumped, I had a defibrilation issue that contributed to me passing out at a Blockbuster, and I was told I had congestive heart failure. I had just started putting back on my weight. At 42, she finally dxed me with the T2 I had been living with since I was 28 and pregnant, and she gave me 500 mg of Metformin. When my a1c wasn’t any lower, and I struggled to lose weight, following the same diet, I went to an endo. He gave me more Metformin, Byetta, and Vitamin D. I lost 35 lbs in a year - dieting and exercising in a way that didn’t make me crazy, and I feel better, and got my a1c to 5.2 - I will never allow an internist to treat my D again.
I know many people say that T2 contributes themselves to their problems by not eating right and not exercising, but I wasn’t. And all those warning signs should have led my internist to be a little more aggressive. I finally switched internists when she suggested Gastric Bypass for me - and my BMI was 29. I will never be able to get down to my healthy BMI - the lowest I was able to get down to was 26.
I don’t like all the meds, but I do believe that aggressively controlling my diabetes will limit future complications. And I just cannot live so low-carb - I’ve tried, and I cannot stay on it as a lifestyle.
I now shoot for less than 160 grams, and I do exercise, but I have to be careful about cardio now. All that would have been prevented had my internist looked at those signs instead of saying - Gee - why are your liver enzymes so high???
If you have a good idea of what is best for you, trust yourself to make the right decisions and choices. The bottom line is that neither of those doctors will be controlling your diabetes…you will. They won’t be there to help you with everyday tasks made difficult because of complications caused because you might follow poor advice from one of them. The fact that the endo prescribes more meds than the PCP would not be reason enough for me to switch doctors.
This is a short piece of my story…I hope it helps…
I’m relatively healthy and my diabetes is my main health concern… I don’t have an endo, I try to work with my PCP unless he wants me to go to a specialist. The relationship is tricky to manage but it has worked for me. The bottom line for me is that I don’t want more doctors, I want to simplify my life not complicate it…more. As long as my PCP continues to work with me, and my D is under control, I won’t be adding an endo.
What I expect from any doctor is that they work with me in a manner that is similar to a consultant that I might hire for my business or that of a non-managing business partner and I am the managing partner. If I want to take an approach that a doctor disagrees with, I expect them to educate me why I am wrong or to be flexible enough to go with what I want to try.
Since I read a lot about my Type 2 D, I expect my PCP to listen to MY ideas about how to manage MY health. When I want to try a certain approach, I will ask him questions so it looks like I am looking for guidance. More than once he has replied to my questions with “I don’t know the answer, let me do a little research and I will call you”. Since I don’t expect him to immediately have all the answers especially since I am usually asking about something that is slightly different than what is considered traditional treatment, I have a lot of respect for his courage to admit he doesn’t know. Sometimes he’ll come back with answers that taught me where my reasoning was faulty. Sometimes…he comes back and says alright lets try it.
I take metformin and for reasons that are another story, I recently convinced my doctor to decrease the metformin and add a little insulin at bedtime. When I first approached it, he was opposed to adding the insulin and said he wouldn’t write the script. He reversed his opposition after some discussion, well thought out questions from me and I sent him some links to some articles from respected medical journals that questioned the supposed link between a low A1C and heart problems.
Yeah…sometimes it feels as though it might be nice to have an endo that has already read everything that I’ve read. Then again…the endo might not be flexible enough to try something that is slightly out of the norm.
Anyway…trust the doctor you respect…trust your body…trust yourself and good luck.
Not sure this will even be relevant. Often times, specialists, Endo in this case. Go strictly by the book and what they are taught. I don’t think that’s always a good thing. An example being my father. His Cardiologist and Renalogist are often in conflict. The cardio guy wants to treat him as a heart patient and prescribes that way. Not taking his kidneys into consideration. The renal guy does the same. The cardio guy is mine as well. So I stepped in one visit and told him he needed to change medications to one that wasn’t as hard on my dads kidneys. Or possibly stop what I saw as a redundant medication all together. Long story short. It all worked out. Heart doing well and kidneys not being damaged.
IMHO, after a DX for anything. Unless it’s way out of whack or dangerous. The best course of treatment is the least amount of medication in the lowest doses. If that isn’t working. Up the dosage. If it still isn’t working, maybe add something or stop one and start a new one.
As other posters have suggested. Go with how you are feeling. If the treatment makes you feel worse for and extended time. Something needs to be changed. If you feel good. It ain’t broke and don’t need fixing.
At present, my PCP is the only one treating me. My numbers are good and I feel good. If that changes. I’ll bring an Endo into the mix. If that upsets my PCP, since I don’t need referrals. It’s his problem not mine. It’s my health and body and I’m very proactive in it.
