Should every diabetic see an endo at some point?

Hi all,

Been a while since I have been here.

I was dx'd a little over 2 years ago. When I was dx'd, I had no job or insurance so I went to a low cost clinic for the first two years. I never went to see an endo.

I am a thin, type 2 - probably highly genetic. But now I have a job and insurance - I need to find a new doctor (not going to the low cost place) and was wondering since I have never seen an endo whether i should or should I just pick a general dr?

I need to go for some gastrointestinal stuff and I am in the begininng phases of perimenopause (so my hormones are a mess) - I know endo's deal with hormonal issues also. I do have an appt to see an OB soon though so I may talk to her about that.

Anyhow, it is a good idea for all diabetics to see an endo if they can? Or it is not really necessary?

KimKat, we are all different. I have no interest in seeing an endo as my PCP just writes me prescriptions and I manage my own Diabetes. But many people find them very useful to help with management. Whenever I see "thin type 2" I always suggest you get antibody testing to make sure you are not, in fact, Type 1. 2 1/2 years is still reasonably in the frame of time in which you could be LADA/Type 1, a slow onset form. Other reasons to suspect this would be weight loss, other autoimmune condition like thyroid (or such in your family) and, of course, rising blood sugars despite no change in management.

Hi Zoe,

Yes people are always saying this to me. I have had my thyroid tested and it was fine. I lost weight when I changed my diet when I diagnosed but I haven't been losing weight now - I think I actually gained some. My BG has been different but I think it is stress and hormonal changes from peri.

I am always tired though and I never really feel good no matter what.

What is the antibody testing? I forget.

Type 1 is an autoimmune condition, one in which antibodies attack and destroy the cells that produce insulin, Type 2 is not autoimmune. So the presence or absence of antibodies indicates Type 1 or Type 2. There is a full panel of antibodies to test, but the more common one for those of us with LADA/Type 1 is GAD.

Not sure what you mean by your BG has been "different" but if you are, in fact, LADA, you would start to see a slow but steady rise in blood sugars when previously your BG was well managed on your meds.

I went to a GP like Zoe, used him for RXs and I think that he was a very good doctor as, if he didn't know a lot about diabetes already, he seemed to have read up on it and told me to do all the things I didn't think I needed to do because I knew what he was doing but I thought "I don't need to learn about carb counting, I can just wing it..." Then I sort of wised up, a new friend had his wife tell me about her pump and I decided it fit with other stuff I was going so I did it and he said "you need to see an endo."

I agree with Zoe that some of what you are describing, particularly the rise in blood sugars would be a concern, even if it's "moderate" rather than "severe." I think that would warrant an endo or at least require a very good GP who, if they didn't consider the possibility, may not be this doc.

I'm with Zoe. I would see an endo to at least be sure that I was T2. There are thin type T2's but they are the exception rather than the rule and a lot of them are misdiagnosed LADA type ones.

Most GP docs and even some endos will automatically type any newly diagnosed adult at T2 especially if they are nearing middle age.

It's important to get a correct diagnosis because it will affect what treatment is best, Zoe can attest to that.

Not everyone needs an endo but everyone needs a correct diagnosis. I say go see one and ask for the antibody tests Zoe mentioned.


I think everyone who is diabetic has a right to seek a specialist, an endo. There may be things like insurance or money that limits things, but I believe we all have the right to pursue the best health care possible.

But I have to tell you, as a T2, I have not had the best of luck getting the time of day with endos. There are far too few endos than are needed. And just because you see a specialist doesn't mean they will give you the best care, only that they should presumably have the best capability to make a proper diagnosis and select treatment. I say presumably, because my experience doesn't necessarily suggest that endos do a real good job of diagnosing T1/LADA. They are just too hurried, don't think early diagnosis matters and just have decided that if it is really T1/LADA then it will show up vividly in an ER visit.

I currently see an endo. She listens to me and works with me. At this point, it really doesn't matter what type I am. I already moved on to insulin. I may get more testing, we shall have to see.

I also rely on my PCP for all meds. However, he does not feel he is knowledgable enough for my pump. As a result, I see an Endo once a year to keep my scrip for my pump up to date. I manage my diabetes and endos have never been helpful at all with the day to day stuff.

Endos have a lot more information about the technology, what is new, etc. than a PCP in most cases, I think.

Interesting, Spock. You're the second person to mention "a scrip for my pump." when I first got my pump in January, 2011 the Pump person went to my PCP to get an order for the pump (they handed him the order with initial doses already written in because he wouldn't know what to put). Nobody has asked me for an updated one since then.

That in my opinion is tricky. I mean diabetes certainly requires a higher level of understanding. BUT with that being said, I've heard of some REALLY whacky endo's and I've heard of some general practioners who were really very knowledgeable. I think it all really depends on where you live. Here, we have a wide number of endos available. Most of our internal medicine doctors, family practice, etc won't even tackle diabetes. They are like we don't manage it, and refer you to endo

I think too, Type 2 overall just isn't as aggressively treated. Dr's seem very reluctant to start type 2's on insulin, and that includes some end's as well. I personally recommend for any Type 2, or anyone who may potentially be misdiagnosed, EDUCATE yourself, and if what your DR or Endo suggests doesn't sound right or like good advice seek a second opinion

Thanks guys! Sorry I didn't respond earlier - I have the notificiations turned off and I forgot. I have an appt to see a new OB this Saturday and I know there is an Endo that works at this office. I am starting perimenopause and it making my life hell. I plan to talk to her about that but I know that endos deal with hormone disorders (not so sure about this). I was wonder if she might have an opinion on whether I should see one. The endo is a male though and I would rather see a female but if he is any good than I don't care.

What I mean by my bg being higher is that I used to be able to wake at under a 100? now it is normally between 100 and 130 - the only time I get under 100 hundred anymore is if I almost starve myself. Now that I am working though I need to eat more - I get hungry more often. I have to eat. And I still eat like a bird compared to most people.

So I think my higher numbers in the morning (I don't really test during the day - why depress myself? Either way if I am hungry I HAVE to eat or I feel like crap) might be due to stress, my new hormone flucuations (estrogen dominance) or my diabetes getting worse. I have been on the lowest dosage of Met 500mg 2x day for about 2 and 1/2 years - never switched. All of the doctors I have seen say I am highly genetic diabetic.

I am in Chicago. If anyone knows a good endo that WILL listen, I am all for it. I have to find a new GP or anything because soon I will need a new prescription.

Just wondering if taking insulin makes one feel better. Exhaustion is my middle name.

I think it really depends on the person and the doctor involved. If you can go into your PCP and ask him to run antibody and c-peptide tests and are comfortable managing your own diabetes, I don’t think you need an endo. I have seen people that were told they were T2 by endos and those endos refused to run tests – they went to a different endo to get the tests run. You can see an endo and still be at a roadblock with them.

When I wanted a pump, my PCP signed off on the script like Zoe’s did. He was worried what he would have to do and I assured him that Animas provided the training and I would not be asking him any pump related questions.

As far as your thyroid goes, did you get copies of the labs that you say your thyroid is fine? From reading thyroid boards, most endos suck at thyroid and I won’t go to one for that reason. Most doctors, including endos, will test TSH and say your thyroid is fine. TSH is like BS and fluctuates throughout the day. It is not a good indicator of what your thyroid is doing. If you are going thru menopause, then you are at the right age that a lot of non-diabetic women start having thyroid issues. Your fatigue, higher BS and weigt gain can all be caused by thyroid. You want to test your Free T4 and that should be about mid-way of the lab range. You also want Free T3 and that should be in the upper 2/3rds of the lab range. Don’t bother looking at TSH!

I had my c-peptide tested and they said my body made plenty of insulin. That was 2 1/2 years ago - should they test that every year. I was going to a low cost clinic before so they didn't test that the second year.

Well, I have found a doctor I think might be good but I will still talk to my OB tomorrow.

Yes, they SAID my thyroid is fine but I do have many syptoms that thyroid related and no they never showed me the test. I ASKED for the test and I think I asked for the result but never got them. What do you expect for a low cost clinic.

Not menopause - PERI-menopause - I am estrogen dominant right now. Cry jags, moodiness, lots of nausea - some weeks I am fine - but if I forget the cream -UGH!!! This is something else I plan to talk to the OB about tomorrow too. I hope she listens to me. Another user on here said that I have many symptoms of this and I have consulted with other and that women with diabetes and out of control hormones with have higher BG. I am 43.

I don't think I should have to starve myself to keep my BG in control.

So when I go see an endo (or GP) I should ask specifically for them to test the "Free T4 and Free T3" - What is it that they usually test??

What are the chances they will say "no"? I don't care if I have to pay for the test either. But wouldn't an endo be able to help with hormonal issues too?

It depends on the level of involvement you have in your own diabetes care. I think that if you prefer to just manage most things yourself and do pretty well with it then it matters less if you see a specialist. But if you are struggling a little, an endo can often times have a lot of great resources for you outside of prescriptions or diagnosing things.
As a lot of people have said, be picky about your doctor. Your doctor should make you feel supported and that they are on your team. They should also know what they are talking about and up to date with current medical technology etc. so ask a lot of questions, what are thier philosophies of inspiring better control in thier patients, etc?
You might have to try on a few doctors before one fits. I’ve also had really great endo nurse practitioners. Those that is a possibility as well. Good luck. Be patient. Finding a good doctor can be a process sometimes.

So I went to the OB today and describe all my symptoms and she knows I am diabetic (this is a new OB) - I think she wanted to dismiss my nausea to the Metformin! Haha, no way honey - I started taking that 2 1/2 years ago - it is definately NOT that. (that kind of irked me). I am smart enough to know that if I start taking something and I get nauseated that it is the meds - I would never even bring it up otherwise.

Anyhow, as usual, the dr. doesn't take me seriously, But I pushed the whole menopause button enough for her to have me tested ( I had to ask) - she also suggested the thyroid test! Haha - I was thinking - I didn't even ask her about that because I figure OBs don't do that but since she brought it up - I told her I was tested but they said it was fine but I did bring up the fact that I wanted the antibodies tested and she said that they don't test those unless the TSH is abnormal! GRRR!!! I didn't think I was going to win this and I figured this is an OB not an endo or PCP so I didn't even push it further. But like you are saying Kelly - just like hormone levels and BG - the TSH changes throughout the day!!! Why then do the drs do this?? There is no way they can get an accurate results if they go by this TSH - Do they not believe that the TSH changes or they just not care?

I weighted 108 today - haha - so I did gain some but really that isn't much because I was weighing 105 before I think. I am still too thin. I had my winter boots on so I probably weight 106.

Kelly, what do the drs say when you finally convince them to test the antibodies even thought the TSH is fine? Are they embarassed that you were right and they are wrong? Will they even pay attention to the antibody results and figure out a treatment?