After my last–incredibly frustrating–appointment with my endocrinologist last week, I’ve started to wonder what exactly having a good endo would do for me…other than prescribe me my medication, of course.
At my appointment last week, I find out my A1c was 5.5. Which followed my last several of 5.7, 5.4, 5.3, etc, ever since I started my pump and CGM a bit over a year ago. Prior, my A1cs were in the 7s. The worst ever being 7.8.
Now I kid you not, I got lectured far, FAR less about my BG when my A1cs were in the 7 than now when they are in the 5s. Reason? He thinks I must be low all the time. Which is not true. Of course, it was hard to argue my case when I was 61 when the nurse checked it when I came in. This was the week my CGM sensors didn’t work and I was mega stressed out about it (I have new sensors now, and they work great!)
But he wouldn’t listen to me. He didn’t even remember I had a CGM, and by the end of it, I’m not convinced he even understands what a CGM is, despite me showing him the graphs in multiple appointments in the past.
Now I’m a far cry from perfect. I go low (who doesn’t!?); but I do not feel like my lows are out of control anymore. I also probably could eliminate some of my frustration with him by using Minimed’s carelink software regularly and printing out a whole ton of graphs and bringing them to my appointments. But I’ve come to realize all this would solve is my desire to be right. And maybe it wouldn’t even solve that.
Anyway, the second he walks in he starts babbling about some (idiotic!) study about where more diabetics died / increased risk of heart attack when their A1cs are at the levels mine have been. Never mind any possible flaw in this absurdly flawed study! He’s only brought this up every single one of my appointments for the past year. He also says the following when bringing it up: “Now this is mostly much older people, or type 2s…” Really? So it’s dogma to my situation how? Plus, how about instead of focusing on JUST the stupid A1c, we discuss actual daily fluctuations in my BG levels.
But this is never discussed in my appointments. He judges by A1c only. I tell my non-diabetic fiance this and he immediately responds with “isn’t A1c just an average? So you could either have a lot of swings up and down to make the number, or be steady to reach the same?”
YES. Ugh! He gets this! Why does my doctor not even think to ask about my numbers? Again, yes, I should and can bring graphs to my appointment. I suppose my frustration is in the immediate response to lower my insulin doses and get my A1c up to 6.5 without so much as asking me what my actual numbers are like. He says I should really be 120 to 140 2 hours after meals instead of 100.
But what if I don’t eat many carbs that meal? What if I manage to not rise NOR fall after my meal enough to need to go to 140? Because this happens more often than not with my CGM, particularly on days I exercise, which is 5 out of 7. I will start my meal anywhere from 80s to 110s, and finish on the same level 3 or more hours later without going up to 140 more times than not.
Is this every day? Of freaking course not. Some days I do go high. Some I do go low. (I bitch about most of those days on tudiabetes! XD) I’m not bloody perfect at counting both carbs and warding off diabetes fairy events that make my BG crazy for a variety of reasons (equipment malfunction, hormones, WE all know how it is).
But my average day does not swing very much, and this is why I have a good A1c. Not because I’m hanging out low 24/7. I try to tell him instead of having an A1c at 6.5, wouldn’t it be better to have a 5.5 with fewer high/low fluctuations. I get no response to this, as if he didn’t even hear me.
I truly do not think he gets it. I think he has too many type 2 patients who know nothing of their disease, or type 1s who don’t manage theirs as tightly. Which was me, when I started seeing him–and why I liked him to begin with because unlike my last doctor he didn’t take my meter from me and hook it up to a computer. So when I was being ■■■■■■, checking my BG perhaps once a day, sometimes not, I could go into my doctor appointment and not get the slightest bit of lecture.
Funny now that I feel like I’m doing things right, do I get chewed out.
Anyway, immediately after my appointment I thought “well, I should just change doctors”. But then I got to thinking about it, and I realized, what exactly do I expect to get out of a new doctor? Some sort of confirmation that I’m right? A nice pat on the back? Seems rather stupid.
And arrogant on my part. But I’m just not sure how I would benefit. I feel like I have supreme control over my numbers. That my mess-ups cannot really be helped by a doctor who only sees me every few months and does not live in constant monitoring like I do. I control my insulin intake completely. I read a lot about diabetes and am not clueless to the best treatments available.
So what exactly would a new endo do for me? What do you all see your endos for? Because I know there are way more knowledgeable people on here than I… I suppose I just feel that I’m in a place in my life right now where I’m doing everything I can to take care of myself and visiting my endo seems like a stupid game. And when I say that I feel like I’m being ignorant and arrogant, never the less I can’t help it. Perhaps I just need a good kick in the ■■■.
But…at least he gives me two free vials of Apidra when I go in. Hard to be too obnoxious when it ends on that note.
In all seriousness, I do tend to like this doctor most of the time. He is always promoting the best insulin and devices for my diabetes. I would never have gotten the pump or CGM without him. He seems very well learned. Perhaps that is it? He knows things on a technical level, but I don’t feel like he connects on a patient level. Doesn’t connect the technology to actual use–hence his inability to understand that with these tools he promotes I CAN safely have a 5.5 A1c.
I will concede him a few points: yes I need to be weary of all lows, especially any low patterns. Yes, I’d love to take less insulin to help me lose weight (I did lose 5lbs since October, so it was not as craptacular as I was expecting). But I’m not willing to have crappy BG just to weigh less.
Also, obviously it’s good to have him around for lab tests (though he never explains my results in detail; I look and learn myself), and for thyroid–because I understand this far less than diabetes. Oh, and in follow-up to my last blog, my thyroid is functioning on the higher end. TSH was actually 0.2 (and he didn’t lower my synthroid dose). T3 and T4 were in the middle ranges, though the exact numbers have escaped me now, I remember them not being near one end or the other of the normal range. So, hmm.