My 1st Endocrinologist visit what should i ask and/or tell ? And any other pointers you might have.Keep in mind i have painful diabetic neuropathy
Its hard to say what to ask without knowing your situation. I’m going to make an assumption that your diabetes is like that of all Type 2’s, it is progressing. Most T2 get sent off to an endo when their diabetes advances past the comfort level of your average general practitioner.
Many times a endo visit for a T2 means it is time for insulin. If that’s the case the question should not be how can I avoid it but rather how can we make things better and indicate you are willing to do whatever is necessary that is within your power.
Ask what your goals and targets should be, ask detailed questions about any treatment that is prescribed, especially if insulin is involved. How much and how often, when to make changes, if at all, Ask what should trigger you to make unscheduled contact with his or her office. Also ask about how often to test. And by all means ask about your neuropathy and any other complications you may have.
Doctor are busy folks, many will try to rush through the visit if you let them, remember you are paying the bill here. Write down any questions because the doctor will attempt to control the direction of the visit. By writing questions down you won’t forget to ask.
I look on a first visit as a test. A new endo should give you somewhat of a total once over and catalog all that is going on. A good endo will ask you to take your shoes off, look at your feet and give you basic tests for neuropathy. I think it is important for you to disclose to the endo that you have neuropathy. And you should be honest about things, the doctor will have a hard time helping.
And I often prepare a written set of issues/questions when visiting a doctor and bring it with me to either give them or to remind me during the visit. I don’t know your situation, so it is hard to suggest things. General first visit questions might be: What would they recommend for control targets What is their treatment philosophy for T2. When would they recommend starting insulin? Do they recommend a low carb diet?
Hi Gary thank you for your response i have a lot going on right now. I’m 20 days away from my appointment hopefully things slow down a bit and i can reply in a thoughtful detailed manner. I should’a never posted this without more revealing more facts.
Thanks in advance for your patience
Hi Brian thank you for your response i have a lot going on right now. I’m 20 days away from my appointment hopefully things slow down a bit and i can reply in a thoughtful detailed manner. I should’a never posted this without more revealing more facts.
Thanks in advance for your patience
Are you currently receiving any treatment for your neuropathy? Many diabetics myself included have had success with a medication called gabopentim - something you could suggest to your doctor or the endo when you see them.
Yes sir i have tried Gabapentin i got to 2100 mg a day it changed my personality some how it made me feel trapped in my body and it did help a little at first . Right now i’m on Lyrica 300 mg a day which is max for diabetic neuropathy and no relief at all if fact its getting worse I’ve only been managing my diabetes for 6 months and the one thing i know is i have know as much as i can about my condition… It’s a steep learning curve so thank God for the internet
And thank you for taking a interest in me.
. . . the online world of the diabetes community where the truth lives
The only other thing I can say is that there is a very direct connection between diabetic neuropathy and current blood sugar levels. In most cases the symptoms will subside once blood sugars are normalized (for example with an hba1c below 6.0) . The route to that is threefold - diet (low carb or low GI), activity (at least 2 hours walking a day) and medications, as prescribed by your doctor.
Low carb diet i’m doing my best, Meds that’s easy… But walking is out of the question at this point maybe swimming… I think that my neuropathy is so bad because i lived with it for over 10 years before being diagnosed Plus i was working on my (sore) feet over 10 hours a day.
Data is king. Given your situation, it seems to me a CGM is justified, and keeping tight control of BG.
As far as I know, this is the only thing that has a chance of improving and even reversing diabetic neuropathy.
The tough thing about it is you need to keep tight control for 3, 6, sometimes 12 months before improvement really shows. And there’s no guarantee – given how long you have had the condition, there’s likely damage that can’t be reversed.
Still, your best bet is tight control, and a CGM is a near requirement to get there. Also, I’d start insulin therapy to achieve that tight control.
As a first step I would wait with any changes until you’ve met with your endocrinologist. Expect more than one visit as he will want to do some blood tests following your first appointment. Have you had a recent hba1c measurement? Also be aware that starting insulin therapy often results in considerable weight gain which again increases insulin resistance. That is because what insulin does in order to lower your BG count is to convert excess blood sugars to stored body fat,
It is easier to gain weight when on insulin (some of us would argue the flip side – its easier to lose weight with high and out of control BG), however this is something that can be managed. Physics is law: Calories in vs. calories out and all that.
I’m not saying it’s easy. Just that it’s not inevitable.
Also, keep in mind that insulin does much more than simply stimulate adipose tissue to convert glucose to fatty acids. In fact, the most sensitive tissue to insulin is hepatic (the liver), and most glucose from digestion is taken up by the liver, in response to insulin stimulus, then converted into glycogen complexes for later release.
Adipose response is somewhat slow compared to the liver, and in fact large muscle (which also absorbs glucose and makes glycogen in the presence of insulin).
This is why exercise “sensitizes” one to insulin for hours after the activity. Muscle is more sensitive to insulin taking up glucose to replenish consumed glycogen stores.
As a few others have suggested, make a list so that you don’t forget your issues. In addition I would put the three most important issues at the top of the list. Before the doctor gets rolling with his or her agenda, at the very beginning of the exam room visit, state very clearly that you have a list of issues that you want to get to before the appointment ends.
Most endos will make your questions wait till the end of the appointment and that puts the patient at a disadvantage with the clinician pressed by the clock near the end of your allotted time. Having said that, I’m hoping your doctors will give you more than the usual time since it is your first visit. Good luck!
I started being diagnosed in May with a 13+ then a 7.1 now three days ago i was 5.7 so i do have something to be happy about
.Again thanks for your input i need all the help i can get…
Someday i hope to know as much as you do …
Thanks for being here for us Newbies
Thank you for taking the time to reply and i will use your advice wisely
Again Thanks …
Maybe the reason the neuropathy is getting worse is because it is actually starting to recover. Regrowing nerves can be incredibly painful. Ie it gets worse before it gets better. Time frame for improvement can be 3 - 12 months. Sounds like you are doing incredibly well with getting blood sugars under control.