Should i go to the doc?

Marie suggested that I find an endo, so I scheduled with some random endo…also as a last resort that I could use to fill my pump RX if the PC couldn’t do it. Some people think that if I make special accommodation for the medical system and go pay for a specialist, then prescription filling process might be easier/smoother. I dunno. The PC didn’t have any trouble until this pump script.

I feel kinda irritated with the medical system of late, like maybe its not the right time to start a new relationship with a new endo. I’ll get over it eventually. I don’t need another appointment for 6 months.

My relationship with medicine feels a little antagonistic right now, like I want to give them the cold shoulder for a while and not go out of my way to accommodate them. They have just been such a pain in the ■■■ lately. We might not jive or understand one another well at this particular point in time. Maybe I should cancel the appointment. But, holding grudges with a complex, abstract system might be a little impractical. But, I feel angry.

1 Like

The whole idea of having to start a new relationship with a new endo who doesn’t know me is full of distasteful “needing to prove myself,” and verifying that they aren’t someone who’s gonna strong arm me and be a good patient advocate. I just don’t want to do all that work again.

3 Likes

Sorry @mohe0001 If this has been the only problem with getting scripts and it’s been solved, then I don’t see any reason for an endo. If it hasn’t been solved then I suppose it depends on how bad you want the pump and supplies.

It is very irritating that we have to see a doctor so regularly for things that make our life easier. A lot of that is because insurance wants to only pay for what it needs to for the person actually insured. And the doctor doesn’t want to get sued for not keeping track of a patient they are prescribing for.

Be careful of picking just any endo. Some seem to only want you on specific pumps.

1 Like

I don’t have a recommendation for any specific Doc so its gonna be a shot in the dark. I still have a month to decide to keep the appointment.

It would be good to get an A1c and a kidney test because I haven’t had one in ages.

The risk regarding specialists that I recently encountered is that they kinda take over care from the PC because they have a higher level of skill & credential. Most PCs defer to me because they know that they don’t know anything. Endos can get a little bossy in a way that leads to other difficulties.

I have 6 months before I HAVE to see someone for script renewals, so there’s time to think it over.

I would get this test and Lipoprotein Fractionation, Cardio IQ, Ion Mobility, ApoB, and a bunch of other tests from UltaLabs (Quest Diagnostics) and bring them along to any visit. As soon as a doctor or Endo sees you come in with your own test results, they have a very different attitude, especially when you approach them with keeping diabetes under control will be of little value if the heart is not addressed at the same time.
A very comprehensive set of tests is only about $250 which in the grand diabetic scheme of diabetic costs is very reasonable.

2 Likes

That’s not a bad idea. I was considering just paying outta pocket to see one of the Docs in town that I know and trust. $250 is affordable and it buy me a way out of collecting a super extensive BG record like I used to do.

I got a face like a happy gnome and I just look like a kid still at 42 years old, so I just lack any kinda credibility when I first meet a Doc…or anyone. Its bad. Some of those crappier Docs come at me swinging in a really authoritarian way and I will just rage out if they do that in the near future. I’ll take their clipboard outta their hand and start hitting them with it like I did to that moronic intern at work some years ago.

1 Like

I see a lot of posts where people feel they need to prove something to their doctors. I ask my doctors what I want and I usually get it. I deal with diabetic educator RNP for all my scripts. My doctor looks at my most recent blood work and my dexcom data and says hey take a bit more at this time etc.

I generally do not have arguments or long discussions. I doubt I would stay with a doctor like that.

I was living in Seattle for 2 years and I went in to a new doctor and told him I needed scripts and that was that.

Really as a type 1, I need insulin, I need cgm and I prefer a pump. What is the doctor going to do? Withhold my prescriptions? For any reason?

I have had doctors who don’t understand it very well, but they usually defer to me.

Even back before cgm and I wasn’t in great control, my docs would just say “ do better “ “test more”

I really want to know what happens in the exam rooms for anyone here who feels they need to prove something or have a less than cordial relationship with their doctors, cause there are millions of doctors.

4 Likes

I’m interested in getting these tests as well. I checked the UltaLabs site. Is the Comprehensive test the one to get?

1 Like

I have been getting my tests there for years so the packages have changed occasionally. I just ordered my full set this past week. They constantly run various sales, so you should always get at least a 20% discount. If you don’t get that discount online, call them. They are great to deal with on the phone. My package always runs about $250. Last week’s order was:

91727 - Apolipoprotein Evaluation, Cardio IQ™
10231 - Comprehensive Metabolic Panel (CMP)
91723 - Direct LDL, Cardio IQ™
31789 - Homocysteine
91737 - hs-CRP, Cardio IQ™
91716 - Lipid Panel, Cardio IQ™
91729 - Lipoprotein (a), Cardio IQ™
91604 - Lipoprotein Fractionation, Ion Mobility, Cardio IQ™
17306 - Vitamin D, 25-Hydroxy, Total, Immunoassay

They still include BG, but the past 1 1/2 years no longer include A1C. I don’t care because I have CGM GMI and Endo will do A1C but you can add as an additional test for about $20 if you want.

3 Likes

I need all of those. That’s great, CJ.

You can get an over the counter A1c package at Walgreens.

They do this all the time. It’s their main source of leverage now that the DMV paperwork was removed from their authority. That used to be their main source of leverage. They would say, “If you don’t do ____, I wont sign the form for your drivers license.”

Thanks, CJ, this is very helpful! I will add the a1C as my Dr will want to see it.

Remember to call in your order if you are not getting at least a 20% discount on each test; the discount sometimes vanishes when orders are placed online. Also, review each test before you place your order and after testing, as they give a great explanation both before and after testing. They store your last six tests, so if you like this, you can do more in the future and compare your progress. I do these twice a year.

There was a reply by @Timothy, who questioned why there were contentious episodes between the doctor and patient. I have a fantastic endo, but she can’t spend as much time reviewing my results as I can, so it is not contentious. However, I get much more out of each visit, analyzing my data in advance. Furthermore, diabetics are dying from heart failure at an alarming rate. I believe this will only worsen because Endo does not have the time to do a deep dive into Cholesterol and Atherosclerosis. Due to time constraints, endos are also geared toward a one-size-fits-all approach, but we all know YMMV. Patients will find that longevity is based on controlling Blood Sugar, Cholesterol, and atherosclerosis. Controlling one of these three legs of a stool without caring for the other two is a near-futility exercise. Watch the ApoB; measure the arterial plaque if it is over 50. There is amazing AI CT non-invasive technology now to determine exactly where and how much and what type of arterial plaque exists. We now have great technology to see all the data; if ignored, what we don’t know will kill us.

2 Likes

Thanks for the reminder! I do see discounts online but I am more comfortable calling the order in anyway!

I have a video call appt / my Dr in a few months so I have time to get the results. I have not had blood work done since pre covid so she will be glad to see them, as will I! I think video allotted time is 30 minutes so that should be plenty of time to review results, and I will definitely send the test results and CGM results before the appt. She is always very good at preparing for my appt. I don’t believe I have ever had a ApoB test so this will be interesting! Thanks, again, CJ for your response and experience on this!

2 Likes

It makes me feel better that your as behind on bloodwork as I am. :sweat_smile:

1 Like

I agree with Timothy. I’ve been super fortunate to have awesome endocrinologists at two of the country’s top medical hospitals. (Had to change several years ago due to insurance network issue. But both providers are top notch. One in Durham NC and the other Chapel Hill. Not sure if we are allowed to name prividers.) They are very involved and focused on my care, though I am a staunch advocate for myself.

I discuss my diabetes with my primary and even take him Carelink charts for his review of my progress. But, with my Endo, I can ask more detailed questions about dosing, cgm issues, etc., consult with their nutritionist or meet with the CDE to help set up my new pump. I guess I’ve always had an Endo and am used to it. I can’t imagine a primary dealing with my insurance co. My insurance co wants my A1c every 3 months. I do that at my primary at no charge to me and forward it to my endo.

Is there any reason you can’t get that Lab panel listed above at your primary or Endo, so it’s covered by insurance?

He just hasn’t ever ordered a lab panel. I think he probably just isn’t aware that such a thing is standard practice. Even if I go to a new endo, they won’t place an order for one until I show up to an appointment. Then we will have an opportunity to discus the lab at an appointment the following year. Lab just has a tendency to get lost in the mix if everything isn’t synchronized. I can read my own labs. But, if I have an opportunity to bring the labs to the appointment, that’s more valuable.

3 Likes

You always can CALL the new Endo’s office ahead of time as ask what blood work he or she would like you to have BEFORE your appointment. Then ask that those orders for what he or she wants be sent to a lab near you or mailed to you so you can take them in and get the lab work ahead of time. That way, you have the results ready to discuss when the appointment time comes. I have TWO ends – one in Florida and one in Minnesota. I always set up blood work ahead of time and get the draws a week before the appointments. There is no reason to see a new Endo if you have no results to discuss. Just call ahead of time and get the blood work orders.

2 Likes

Every practice I’ve been to in the past two decades, they do it one of two ways and you don’t wait a year . One way, they give you the lab order a week before the appointment and you can discuss at the office visit. The other way is, they draw at the office visit and call you or message you via patient portal the results with their analysis a few days later. Admittedly it’s often a kinda one way analysis not so much a discussion.

I had a great NP for my T1D needs. All I need to see them for is the Rx’s (I wish that one Dx of T1D is enough - no need for Rx’s for insulin and prior authorizations for that same damn insulin!) Anyway she retired and the chair of the Endo Dept I have to use (HMO plan) came in and first things out of his mouth: “It’s impossible for someone like you to have such good labs”. I kid you not.
He went so far as to suggest that I had a family member submit their arm for the lab work. I told him the only family member I hae is male (I’m female) and 6’6" - I doubt they would confuse us - and they do check ID’s at the lab.
I had been CGM’ing with Dexcom for years, and thankfully brought hard copies of my reports. If I had gone to another appt with him, I would have asked where he learned that any person Dx’d with any type of D MYST be Dx’d with 3 co-morbidities: Stupidity, Laziness and a Propensity to lie.
I did get “assigned” (at my request) to another Endo, and am still training him to respect me. My 40+ years with T1D should account for something.
I also think that a few of the ED docs I worked with back in the day (first responder) must have said something to him - I did share my rage with those guys.

1 Like