Well, tomorrow is the big day! I see the Endo for the first time. I was diagnosed with diabeties and Hashimoto's disease March 21, 2012 and now i will finally get to see my Endo. I want to make sure that I get the most outof my appointment and do not want to seem too pushy when I go in for the appointment. My BG numbers have been ok for the last fews weeks, not as tight as my GP sugessted (85-90), but closer with still some crazy spikes and several lows, and I have lost a nother 6 pounds, mostly because I am peeing like 15 times a day. ( I really do.) So my big question is what do I need to ask and what should I expect? I want to get the most out of my appointment. Any suggestions will be warmly welcomes!
"Holy hole in the donut, Batman!"
I thought I set aggressive targets for blood sugar. If my endo suggested 85-90 mg/dl, I would still be on the floor laughing. And I'm diagnosed as a T2, it should be easier for me.
But seriously, this is a first appointment. This is about getting to know each other. Tell the doctor what you want out of him, not that day, over the long-term. Tell him your concerns. Call ahead of time to make sure your records are there, I always get copies of my test reports and bring them with me. But have reasonable expectations. You may only see the endo for 15 minutes and you won't "fix" everything. It is really about starting a relationship, if it works, you will see the endo on a regular basis.
Thank you! Slowing down is something that I am trying to do. I have been on tradjenta and it seems like I am taking nothing. I told a nurse friend of mine what numbers that my GP suggested and her reply was much they same as yours. I know that it can't be fixed in one visit and I am always a go getter and want it all right now. I have never had to deal with a health issue like this and i just want to have some form of control. I am a vegan as well so foods are limited. I really feel all i am doing right now is eating for numbers which is making meals boring and awful! I feel like junk and I have a snappy attitude with my students and family and that is just not me.
I would suggest to have all your stuff organized. Log books, a priotitized list of question you want answered, etc. This helps to maximize the time you have available. Those appts go fast!
First, have you been "confirmed" as a T1? If not, that should be the first order of business. A concurrent diagnosis of both diabetes and Hashimotos smells like T1 to me. You would want to make sure you're checked for GAD antibodies and have your c-peptide checked. If the endo even hints that this is "not necessary" or tries to automatically label you a T2 and stick you on meds, my advice would be to find a new endo immediately. At the very least, the endo should be amenable to ordering these tests regardless of his/her personal opinion or hunch.
Second, get a clear idea for what treatment options this endo sees as being necessary given your situation. For a T1, oral medications are NOT a good idea from what I understand. Not only can they speed up the burn-out of the beta cells, but they can be downright dangerous for T1s.
Third, get a clear understanding of whether this endo has the same approach as you do in terms of managing your health. There is no one right answer here, but rather a personal fit. Does his/her philosophy match yours? Is he/she able to provide you what you need? For example, I really prefer a "hands off" endo at this stage in my life. I want someone who writes my scripts and is there is an emergency, but otherwise doesn't bother me with tons of tests and appointments. I want someone who supports my use of technology (a pump and occasionally a CGM) but respects me if I decide I want to go back to MDI or stop using the CGM. This is a very personal thing and it took me awhile to find someone who would be all these things. For the most part, my endo now is. But it took time.
Finally, hold your ground. If you feel strongly about something, do your homework before the visit and go prepared. Gone are the days when "doctor knows best," mainly because we all have access to so much information via the internet. A doctor should never negate what you are feeling/experiencing - this is really a sign of a doctor who is not listening to his/her patient. If you are experiencing it, it is reality.
And a range of 85-90??? Even for a person with a normally-functioning pancreas that would be absurd. If you are in fact a T1, that is just down-right delusional!
Hi Ahaney: I totally agree with MBP's advice! The only thing I would suggest is getting full suite of antibody testing (Glutamic Acid Decarboxylase Autoantibodies (GADA), Islet Cell Cytoplasmic Autoantibodies (ICA), Insulinoma-Associated-2 Autoantibodies (IA-2A), and Insulin Autoantibodies (IAA). Just getting GADA is not enough; many people with adult-onset T1 are only ICA positive. A positive autoantibody test means you have Type 1 autoimmune diabetes. Good luck with your visit and let us know how it goes!
Going for my first time in May. Typed a list of questions & information. One for me and the
Dr.
Hey, good luck. Only thing I might ask about is celiac disease — Hashimoto's and T1 co-occur in about 20% of T1s, but celiac also co-occurs in about 10% so it's probably worth asking to have a test for it. Beyond that, MBP covered it pretty well.
Update!!! The visit went well. The Endo is nice and very knowledgeable. He spent a little over an hour with me. He was very receptive to my concerns and questions. When asked about diabeties type he stated " it is very hard to escape our genetics, and since my father is a type 2, you are presenting that way right now. Although you do not look like one, it is what it is.". I then asked anyway I would be a type 1.5? He said " I don’t really think so, but since I am running antibodies test for your thyroid I will do these as well.". Switched me to metformin from tradjenta, and said that I need to watch my diet but I did not have to limit myself to the basic six to ten foods I was eating to keep the numbers down. Should here some thing back from blood work next week. He also put me on some bp medicine to protect my heart and kidneys. Low dose but he stated that my bp was a bit high and that the gp noted this when she sent my info to him. He is also checking my adrenal glands, and for signs do cushing’s syndrome, which involve a 24 hour urine catch! Still leaning towards hashimoto’s though. Fun fun! Final thoughts were, " I have some ideas in the back of my mind, I want tests to confirm those, but it is something that we can get a game plan for and work at." when I asked what his ideas were he said " once the blood work comes back I will let you know. You are educated and do not need to be self diagnosing. Let me handle this and trust me, then you can work on management.". Ha, Ha, Ha! I guesss because all of his questions were responded with educated answers he was amused!
I feel like he is positive and willing to work with me. I also stated I did not want to be a pill head. If it is necessary then I will do it but if it is just a suggestion then I might not be willing! I do not like having to take meds just to try and see and then there be o reall response and ultimately no reason to take it.