I went to establish myself with a new primary care doctor today. We obviously spoke about my diabetes. For background, I’ve had my first and only pump, a Medtronic 670, since last March. It has changed my diabetes management entirely. After DKA ( before the pump) … I was diagnosed as a 1.5. Anyway, I’m trying to decide if I like the guy because I haven’t had much trust in doctors recently…so I’m curious what the wider opinion is in some of his comments…because he had a lot to say.
He indicated that if my prediabetes stages had been treated aggressively earlier with diet, I may never have developed type 1. That doesn’t make sense to me. What am I missing? I have the antibodies my body produces little insulin. That doesn’t seem like something I could have avoided, but maybe I’m wrong.
I am extremely insulin resistant. He gave me a five minute lecture about the ketongenic diet. He made it sound like it would have fixed all my problems and kept me from being resistant. He then said it wouldn’t be safe for me anyway because it would put me in DKA. He didn’t talk about a different diet except for having the nurse staple something to the back of my visit summary My husband and I are only barely existing about survival mode after the last year and a half. I don’t eat perfectly but I do know what I should be and not be eating. Why is he telling me this??? It’s not particularly helpful.
He seemed to think he would be treating my diabetes. Sorry, buddy, but that’s my endo’s job.
Not diabetes related, but he prescribed me a med for high blood pressure without realizing I already was on one (I was still trying to find my way out of the things he threw at me). That seems like a major slip.
He kept saying things like, “that’s my problem with the medical community…”. It was just annoying as I have very helpful doctors otherwise.
My husband and I are still figuring me and the disease out. We are doing our level best. We are trying to get to a place where we can get pregnant which is another post entirely. I’m tired and stressed and don’t want to go through this with another doctor. Am I overreacting to his comments? Being too sensitive? Fresh eyes on these statements needed
Sounds like a pretty weird visit to me especially since you already have an endo who is handling your diabetes care. There is nothing that could have stopped type 1 or LADA/1.5. If you’ve got antibodies then it was just a matter of time not diet. Unfortunately their are a lot of Dr.s who prescribe drugs without checking to see what drugs you’re already on. This Dr. doing that to you shows inattention and negligence. IMO you should drop him like a rock.
Sounds like you already know the answer, but yeah, those are all really bad indicators. Sounds like he’s mixing up T1 and T2, and is arrogant in his ignorance to boot. Everything else aside, you don’t want a PCP telling you one thing and your Endo another. That’s just going to keep being a problem. My PCPs have always stayed strictly out of the way of my endo other than general questions about my a1c and overall BG management. There’s a reason you see a specialist: PCPs can’t know everything, and shouldn’t act like they do.
@Tim35 Haha, yes! That is a good way to describe it.
@DrBB Yes, I think I do already know my answer. Last night, I felt like my perspective was maybe off, being tired, stressed, and not having great experiences with doctors lately. It doesn’t really matter why, if I don’t feel good about it, he’s gone! Thanks for the reply.
This doctor’s comments about avoiding a diabetes diagnosis with eating a ketogenic diet applies to type 2 diabetes, not type 1. He’s confused. This doctor, like many primary care physicians, has had a lot more experience with T2D than T1D. When someone says, “diabetes” to him, he hears T2D. I agree with the general conclusion here that he’s is not a good fit for you. Good luck with finding another.
@SarahMichelle - I fully agree with what everyone above suggests. I’ve been dealing with T1D for 55+yrs and like Terry, live the low carb/keto life. My own GP (what we call PC’s in Canada) doesn’t have a clue about low carb and ketosis. Elevated levels of ketones are exactly what we want - it’s how we manage healthy BG’s and score A1C’s in the non-diabetic range. By elevated ketones, I’m referring to numbers in the 0.5-5.0 mmol/l. DKA doesn’t become a concern until ketones are well above 10, more likely > 20.
Run fast, run far. Find someone younger who’s more recently educated for your PC.
I had a PC tell me I was no longer diabetic (T2) because I controlled it with diet and exercise and did not need medication.
I was so surprised I just looked at him and told him he was fired. And walked out.
It was a good choice.
QUESTION: By type 1.5 do you mean that you are a LADA or a type II that uses insulin?
I would say that if your a LADA, then there’s absolutely nothing that could have been done to prevent it. If you are a type II on insulin, then perhaps aggressive intervention may have helped, but perhaps not.
Any diet that you are on has benefits and liabilities. I dont think that eating a high fat/low carb diet has anything much to do with DKA. DKA is the result of not having insulin. You need the find the food thats right for you.
Agree, but its helpful to have a primary thats comfortable/competent with your type of diabetes.
Oooops! Where you visiting a new clinic for the first time without complete medical records on file?
I think its relatively common to have “problems” with the medical community, but this post doesn’t give enough information for me to infer what his perspective was exactly.
Summary: If you didn’t jive with this man, its reasonable to shop around. Its reasonable to try on a few Docs for size and see who fits. You might get a good match on the first try, or you might need to see a bunch before settling on one for the long term. I think you’ll know when you have found your Doc.
wow, how’d you make that smiley face upside down? Is that a computer bug? Never seen that before.
Sounds like he didn’t know what a LADA is. I bet that happens to you all the time. Do you often need to explain what type of diabetic you are? You might need to start explaining. Maybe that’s your new bit of community service work.
That is what happened to me in mid 2018 as well, the AutoMode feature of the 670G is a very different way of using an Insulin Pump & CGM. And even though I have been using an Insulin Pump for around 20 years, the AutoMode feature of the 670G made a huge improvement in my numbers.
I obviously don’t have any experience with pregnancy & how it is affected by diabetes (being that I am a single guy that doesn’t even have a girlfriend), but based on the fact that this guy seems very arrogant and isn’t even paying attention to what medications you take, I would suggest not paying much attention to him when it comes to getting pregnant. Getting a new doctor might be a good idea, but don’t make yourself too stressed about it, just ignore the guy until you find someone better. It’s sad, but there are a few people that made it through med school, but that doesn’t always make them a good doctor.
Diabetes and pregnancy can be managed. You will need a high risk pregnancy MD. They are called Perinatologists. You should have your reg Gyn recommend one who practices at a Level 3 or 4 perinatal center. Be prepared for lots of visits and lots of testing but a safe and healthy pregnancy and delivery is a reality. I worked as HRP pregnancy nurse coordinator We got many Moms with diabetes, post transplants and quite q few dialysis. Get your diabetes in the optimum condition as possible, for you and see a perinatalogist as soon as possible after you are pregnant.
The last time I had to find a PCP, I asked my endo for recommendations because my doctors need to work together in a team. I treat the first appointment with a new doctor as a job interview for them even though they don’t know it.
This is partly true. If you are on insulin, then resistance is a sign of lots of carbs and lots of insulin. My experience was about 100u a day with an a1c of 5.9 to 6.3. Now it’s 45u a day and a1c of 6.7. Unfortunately insulin is inflammatory so the less the better. May not notice if your young but in our 50’s tp 80’s inflammation is everywhere. . Btw: type 1 52 years and pump 33 years.
I have type 1 diabetes and I am a doctor myself. You need to find another primary care doctor. It doesn’t sound like this person is good fit for you and probably not for anyone else either. Good luck.
Jane Gwinn
I was diagnosed with T1 at 50 (!) and was fortunate enough to go to a large NYC diabetes center where they ran the auto-antibody tests immediately in addition to looking at the metabolic data and physical exam.
You explained in your post about the auto-antibody tests. If this doctor doesn’t know that T1 is an autoimmune disease, he will not be helpful.
A low carb diet can be a useful adjunct in managing T1, but it is certainly not preventative.
