To Punch Him, Or Not to Punch Him?

About two weeks ago, I called Dexcom to get some information about a CGM Then, I went to their site and printed off the forms that they had for a questionnaire. They had a section where my doctor needed to sign. So, I sent him a letter, along with instructions to fill out that page and send it back to me.

My issue:
He changed the section where I marked off 8-10 injections per day and he wrote "was on insulin pump but came off of it 2 years ago"
He marked the box that says: Hypoglycemic Unawareness (which is totally un-true)

So, I’m have been majorly pissed off since I got the letter back from him and am teetering on the edge of having a “talking to” with him. Please let me know if I am out of bounds with my anger.

Thing is, I’m trying to get my private pilot’s license. If it’s ANYWHERE in my records that I’m hypoglycemic unaware, then I CANNOT get my license… EVER.
I have never had signs of hypoglycemia unawareness. I can feel myself going low when I’m in the 60s. I may have hyp-er glycemia unawareness, when I don’t feel sick until I’m over 200. But, that doesn’t pose an immediate risk to my health, so the Pilot’s Association doesn’t care about that as much.

So, I want to scream and punch my Endo right now because he’s messing with my life.
But, I’m trying to just calm down first.

What would you do?
Please help, because I’ve been through about 5 Endos in the past 10 years and there really aren’t any good ones around here. There is only ONE other Endo in my entire state whom I haven’t seen so far.
:frowning: And I’m really not that picky about my doctors. I just want someone who LISTENS to me.

Ask him why he signed that box [x] Hypoglycemic Unawareness. Maybe he has learned by experience that this box will assure the approval of the CGMS. If so you should thank for his help but insist that this hurts other future plans you have. You could start the argument by pointing at the risk of loosing your driver’s license by this inappropriate information.

I prefer to hand carry paper work that needs a doctor’s signature directly to the doctor. That is, I complete the form for the doctor’s signature–and in the past the doctor seemed to appreciate that I had taken the time to fill in the blanks and check the proper boxes. I usually have to wait but can catch a doctor between appointments. Or else, if the matter can wait or catching a doc between appointments isn’t allowed, I hand carry the paper work to my next appointment. Because in the past I’ve experienced doctors confusing me with other patients. Apparently, the doctors didn’t bother to pull my chart. So I think you should simply resubmit the form–correctly completed by you–to the doctor for his signature. Hope this helps.

Lucile K

Yeah, that’s so frustrating. I send him a letter once a month, just with updates and stuff on my health and my responses to the dosages that I’m taking. I tend to forget things when it comes to my diabetes, so I send him a letter when something crosses my mind and then he brings the letter up during my next appointment with him.

When it comes to something important like this, though, I guess I’m going to have to hand deliver like you said.

Holger

That’s a very gentle way of doing it. Maybe you can come with me to my next appointment and mediate? :slight_smile:

I’m so peeved that my heart is pumping as I’m writing this. It’s a huge statement to make. And I’m angry that he had the gall to erase my writing, only to interject something that isn’t really pertinent. For him to erase my 8-10 injections and to write that I “used to be on the pump”… how is that stating what my CURRENT conditions are?

He probably is trying to tell them that I know how to function something like that… but, I would rather be truthful and NOT get it, than be untruthful and get it.

Is my Endo in politics?

Unforunately, he is trying to help you get past the insurance company. The most allowed statement is Hypoglycmia Unaware. But it won’t help you to have it in your records.
You need to calmly call, or better, go to his office and request a copy of your medical file. In most states it is your information and they have to give you a copy. You will have to read every entry made on you. The Pilot’s Assoc. will do this as well but you don’t want any surprises. It may be deep in your file where someone wrote that tid bit. If it does not appear then you have evidence that it doesn’t. If it does appear you can ask for a explanation and clarification to be entered. They can add to a record for any day but they aren’t supposed to change what was written at the time.
Does your current Endo have your entire file? If not you will have to track down the rest of it. I got mine a number of years ago and there were some very unflattering things written in it.

I agree with Holger - you’re doctor probably thought he was helping. He just went overboard. Insurer’s approve CGMs to prevent hypoglycemia. Print out new forms and ask him to re-sign them with some other designation, such as ‘hypoglycemic episodes.’ In any case, your records are likely to show frequent low blood sugars.

It may be that you have to choose between a CGM and a pilot’s license. Which do you want more?

Terry
P.S. don’t punch him.

eeew. I’m afraid to look.
I guess I really need to know what’s in there, though, huh?
I’m sure he was trying to help, and I should probably be grateful…
Thank you for the info. I have my 3 month check up with him in two weeks. I will ask for copies of my records then.
Do you know if they copy them right in front of you? Or do they copy and then send the files to you?

I agree Holger and say that perhaps he didn’t think that he was doing anything wrong and even think that he was trying to help you out by maybe writing what they wanted to hear in some twisted way. I would calmy tell him your concerns and get some answers.

Yeah, it can be scary.

You have been diabetic for a while and have had a lot go wrong with it. Your file will take time to copy, but some places have a form you can send in ahead so it is ready for you. If you ask your Doc, be aware that this tells him you are questioning the care you have received. Not always cool. Be clear that you are trying for your pilot’s lic and just want to be aware of anything that may cause issues. Your Doc should understand but some just get pissed. I usually try to get it from the clinic staff, they usually don’t care why you want your file.

Thanks. I agree that I should be calm. I guess it just makes me worried about what else he’s been “tweaking” in order to “get” stuff “by the insurance companies”.

FWIW write a ‘red’ letter where you b!tch him out. you don’t have to give it to him but always makes me feel bettter to vent it out somewhere. good luck

That’s right. Don’t punch him. He might be a member of “Fight Club!”

Shhhh… Rule #1

Otherwise, I agree with Terry who agreed with Holger. Your doc probably checked it as a way to bolster your claim with the insurance company. If you talk with your doc about your concerns with reference to your pilot’s license, hopefully things will get worked out.

Cheers, Mike

Yep, my doctors claimed that I had hypo unawareness based on the fact that I ever went below 50 mg/dl (2.7 mmol/L). They can claim that we SHOULD have noticed it sooner.

I do feel my lows, but I sometimes don’t wake up until I am in the 30s or 40s (1.6-2.7 mmol/L). So this was sufficient for my doctor to write that I was unaware of lows and therefore needed a pump.

I’m sure that he was trying to help you. You should tell him that it is important that you are NOT recorded anywhere as having hypo unawareness (does your endo know that you are trying to get the private pilot’s license?)

Confront him, there is no reason to allow him to record things which are not true and could be on your “permanent record”. Maybe he has you confused with someone else.

I will never back down from a doc who I believe is incorrect or downright wrong. He’s screwing with things in your life which he shouldn’t be, so speak up! HE works for you!

No, he doesnt know yet. I’ve only been in Ground School for the past few months and I havent told him yet. My next check up is in 2 weeks and I will be informing him then.

I’m under the same issue that you are. I tend to wake up pretty low. During the day, though, I can tell when I’m going low by the time it hits the 60s.

Thank you. Great confidence booster. :slight_smile:

Marps,

I believe that hypoglycemic unawareness is key to getting the dex approved. I made sure that hypoglycemic unawareness was checked off on my form. I don’t have any problems with hypoglycemic unawareness during the day. However, I don’t always wake up when I am low. Now my dex wakes me up. I had no idea how often I went low during the night. Maybe hypoglycemic unawareness while being asleep is no handicap for a pilot.

I understand, believe me:) I would talk w/ him and clarify that you have never had hypoglycemic unawareness and what your real goals in getting CGMS are, so that he can better support those goals. They are told by the companies, etc. that the best way to get insurance coverage for CGMS is to claim hypoglycemic unawareness…and standard thought is that folks w/ longstanding T1D probably have it. If he has to give justification, I would advise him to clearly state it would support your goals of decreasing your HgA1c safely (this is code for it prevents needless hypos) and would provide better BG stability and minimize long term complications. I would take the paperwork to his/her office and ask to talk in their office about it. Take a deep breath, give him/her the benefit of the doubt…and explain that it could impose needless restrictions on driving, etc…if he/she gets snappy and insists…I would calmly explain that I needed to find another physician that could better support my treatment goals and “hear” what I am saying:) Unfortunately, I have had to do this a few times myself. I have found that It is hard to find someone who sees us really as partners in our care. I am lucky, I now have someone who is quit a bit better than the patriarchal, males I have seen in the past:) I have had to deal though w/ the system and staff in her office…not so good.

Best of luck, Marps:) I feel for you. Maybe we will both be in the Phase II or III of Faustman’s trials and not have to keep trying to find new endos:)) If so, we should celebrate in Bean Town and you can give me a ride in your plane:)

I agree with previous posters… Prior to me getting Dex, some of the requirements or list of wants my insurance company wanted was…

a) Hypoglycemia Unawareness
b) A1c above 8% (can’t quite remember exact number)
c) Willingness to have worked with doctor to try to be perfect through insulin control; food control; etc.
d) Type 1
e) Type 1 for X amount of years
f) Hospitalized due to diabetes complication (either hypoglycemia or hyperglycemia type episode, etc.)
g) On insulin (insurance companies do not like Type 2’s who are on pills trying to get a CGMS)

It sounds like the Endo was trying to help by saying that you are on insulin shots as many of us do very poorly on shots compared to insulin pump and Endo is showing that he has been seeing you regularly (which insurance companies want to know that patient has worked at trying to make sure they have good control). Endo could also be trying to say that the pump did not work well for you and that is the reason for not being on pump. (It seems like insurance companies first okay insulin pump as the first step to helping a diabetic then okay a CGMS later… for example, when I upgraded my insulin pump I was told to wait until the next year to try for a CGMS device due to money left toward how much could be spent on me for the year).

I agree with others and ask to talk to the Endo about your concerns. (I do have to say I LOVE LOVE LOVE my Dex! Good Luck getting a Dexcom 7+)