depending on what your management regimen looks like and your caloric intake, 130 grams of carbs a day is not at all unreasonable. you can obviously do far fewer, but that’s 25% of a 2000 calorie diet and works for a lot of people. one of the endo’s i work with wrote the book on T1 diabetes, has lived with it for 40 years, and eats pasta and bread for dinner regularly. this site has a definite low-carb bias but 30 grams of carbs a day is not right for everyone and the evidence goes both ways on how effective carb restriction is.
anyways, the larger point is that reasonable people disagree on management strategy. i have 5 people on my “team” (an endo at UCSD when i’m home, endo at Joslin when i’m at school, my parents (who are both doctors with 30+ years experience) and the above-mentioned guy, who works with my dad) and the disagreements in management strategy are often striking. i think it’s important to do your own research and to find a doctor you can trust and who will answer your questions. a lot of management strategy is a guessing game, and in the end it comes down to finding someone who can help you formulate a short-term and long-term gameplan.
I didn’t fire my first diabetes doctor because I just didn’t kniow better. There is definitely a learning curve for newly diagnosed diabetics and until you’ve progressed a bit along that curve, it’s very difficult to make informed decisions about your care on your own.
That being said, my first doctor was not very helpful and just wanetd to keep upping my dosage of Diabinese. Luckily, I was contacted by a CDE who was working in a research project for newly diagnosed diabetics. The PI for the project was extremely knowledgeable, but it still took some convincing by the CDE that I really needed to make the switch to a new endo, preferrably the PI of the project, but really to anybody who was capable of providing better care.
well for me, i talk to my doctor about my health, and if he doesn’t consider what i say, i find another doctor. I hate doctors that just wanna give advice but don’t receive your opinion. i just moved to a new diabetic doctor this month.
my last doctor i wud go to see him and wait for 3 hrs to see him, then he sees me 15 mins and seems to be rushing. I didn’t like that. I want personal and quality time to talk about issues and problems with my diabetes.
Haha! I DO! I don’t like the doctor for whatever reason or esp. if they don’t listen to me. then I am Audi 5000 and their ■■■ is fired! There are LOTS of doctors. I live in a big city so there are plenty to choose from. I could see if you lived in a small town where there weren’t alot and you didnt have a choice. But if you don’t, there are plenty to shop around for.
That said - I don’t think that doctor are perfect at all. People seem to forget that they were once unknowledge babies like us. Too many people give them the “God” complex and some doctors often have this themselves. Like they are all powerful and all knowing - sorry but they are not. Medical School is just that - school of “medicine” - they learn how to dispense drugs. Very few doctors will know how to get to the very root of a problem - esp. one like diabetes which no one knows what causes it or how to cure it. Until doctors figure that out, they are pretty much just just guessimating and using whatever they have. I never take a doctors nutrtion advice - why? I honestly know more than they do! If I wanted too, I could go to medical school myself and be a doctor - it doesn’t take a ‘special’ human with some ‘special’ powers to be a doctor - they are just a person like me and I will question everything they tell me. I do my research and make my decisions based on that - not just on what ONE doctor tells me. I am sure there are lots who won’t agree with me - but sorry that is the way I think.
That said, I have had some great doctor and some lousy ones. Not saying, NONE of them are good. But just because someone went to medical school doesn’t mean they did great (lets not all forget what our Missy went through with that one doctor she had after her surgery).
I do think doctors are good for ER and getting lab results etc. but in many other areas - it is all about just giving you a pill. How many times has anyone waited two hours to get in to see the doctor for something (un- D related here) simplier like a infection and you are in there 5 minutes tell they what you have and they hand you a prescription for anitbiotics? Very few doctors will ask enough questions to figure out HOW you might have gotten your illness - why? Because even though YOU had to wait 2 hours and was ON TIME for your appointment - they still don’t have time for you. Because it is all about money - money and drugs - So, they get you out of there are quickly as you can.
Of course, me, I try to be a pain in the ■■■ by asking a bunch of questions and they don’t want to be rude so they have to spend extra time asking them - I am sure it pisses them but sorry I don’t care - I had to wait that long - I am getting my money’s worth. 
Hello Frances:
Firing someone is simple and easy. The “hard” part is finding the NEXT “white coat”, who’s perspective we can either respect sufficently or simply tolerate!
We are not friends. Medical doctors provide a business service which unfortunately we “require” their assistance or in theory their “supervision” -rofl- Informed, if we reach different opinions, very different conclusions must we succumb? Or worse if they make money directly from their insistance that we use a specific approach; a pump or a CGM for example…are we then still compelled to obey?
IMHO we tolerate them under the very best circumstances, nothing more…
Stuart
It is like Field Marshall Alan Brooke said in the last war: " if I was to fire them I could not find any better." 1 gp and 3 Endo’s refuse to do the necessary 10 years ago in my case. One Endo even said : " You do not want to touch that sh it (i.e. insulin) with a 10 foot pole."
I have to agree that the reason most people don’t fire them is because there aren’t that many. I had a doc I didn’t see for like 6 or 7 years, despite her persistent threats to cancel all of my Rx’es because I guess her staff didn’t read her notes or Walgreens kept up the full-court press to get them refilled? Then I found a new GP who regularly suggested I switch from R/N to Lantus/ 'Log or a pump and, as soon as I did that, he said “I’ll refer you to an endo” with whom I got an appointment really quickly,perhaps so I didn’t defect? She was ok too, good w/ Rx’s during my really crazy testing period and they just keep coming. I don’t have that much trouble keeping steady and don’t really ask them for a lot of advice though. I always wonder what will happen when I have some sort of problem?
I would suggest to anyone switching doctors, make sure you have a backup plan for your prescriptions. The summer of 2009, I changed PCPs. I saw the new one before I called the old one & cancelled my appointment. When they asked about rescheduling, I told them I was changing doctors. Friday afternoon, they called my pharmacy and cancelled the refills on all my prescriptions. I had Levemir & Apidra insulin, BP meds, thyroid meds & a diuretic. Nothing I really needed! That is legal to do in the State of PA. It was the only time I ever filed a complaint with the state licensing board & they said the doctor did nothing wrong. Fortunately I had already seen the new doctor so was able to call them to get what I needed.
The gross salaries are much higher in the USA but when you factor the several hundred thousands in liability insurance need the net is no better than in Canad where they only need minimal insurance what is much better is the climate in most places. My friend Gerry’s brother was practising in the USA but had to leave because the insurance made his efforts uneconomical. For the lawyers and by the lawyers.
Great advice, Kelly. I experienced the same when I fired an endo. Would have been nice if I had been told this by his office. Fortunately, I have a great PCP who quickly faxed an Rx to the pharmacy.
I wasn’t told by the doctor’s office either - my pharmacy called & told me. I guess there is more than one slime ball out there!
It’s interesting reading all the responses to this thread, and everyone’s reactions. While I don’t know if the thread was started in reaction to any specific blog or posting from someone, I think this is what I got from it:
- Obviously, we DON’T know any better when we are first diagnosed, so I seriously doubt this post refers to people who are just starting out and know nothing about Diabetes, or any other illness. It would be ridiculous of anyone to expect someone starting out to completely be knowledgeable about how smart or well kept up their doctor is, even with the plethora of doctor reviews that may be out there, on the internet.
- Obviously, this post is not referring to people who have been diagnosed with their disease for years, and years… and could care less about learning more about Diabetes. They are happy to just take a pill, every day, or an outdated sliding scale insulin regimen every day. Believe me, there are boatloads of these people out there in the world…
- Obviously, this post does not refer to completely jumping ship from ALL doctors, like some people have hilariously assumed. There are, indeed, great doctors out there, and patients with a wonderful team working for them. It just seems that some people always take discussions as “black or white,” and never shades of gray. No one is talking in here about how all doctors are bad and how we should ditch them all… NOR, God forbid, how ALL doctors are ALL KNOWING, and we should ALWAYS listen to them without question or concern, with our brains turned off… as mindless passengers through the Diabetes ride of life.
I feel a lot of people failed reading comprehension in school, sometimes, from reading these forums…
This post is, obviously, about US. People in the DOC, who are knowledgeable… Who HAVE experience. Who read up LOTS on their condition… Who are very, very meticulous about taking care of themselves, and actually DOING what they have to do… and may even come in here and advice others on issues… Can write up papers if we wanted to on any type of Diabetes… And we have a sucky doctor, who we know is a sucky doctor… Who we know is AWFUL, and there are NO OTHER obstacles keeping us from finding a new doctor but our own… what? I dunno. Some people may have location struggles, living in small towns with few medical personnel… Some people live in areas with lots of medical personnel, but few specialists? Some people… Where held on tight by the hope their doctor was awesome, because of all of his reviews and other people comments, and don’t want to admit their doctor blows…? Some people, for the life of me, I don’t know why they stay… It’s like a vicious cycle. Some of us get tired of saying to those people "find another doctor…"
Truly, this is what this post is about… If you were one of those people who lazily plodded along with the same doctor… forever and ever… despite knowing fully well your doctor was a.) lacking in knowledge, b.) a bully c.) an extortionist, d.) disinterested, etc, etc, etc… Why did you do it??? It would be nice knowing the thought process…
Saw a Ducati get unloaded from a plane last night.
Db Welfare Queen-- I suspect that the people you are wanting to hear from are not aware that you are talking to them. I think that everyone has “a story” that is unique to them and they do not view themselves as the person you describe–due to their circumstances. I think it is also related to folks believing that they are doing the best they can given their life circumstances. That and/or they simply have no other endo or other Doc options. The crazy thing is that when you live in a small city or rural area, specialists tend to group together. Once you get in with one doc, they do not allow you to switch to a different Dr in the same office. There may only be one group of cardiology docs, for example, and ditto endo docs, etc. This is true, even if it sounds stupid. I could go on but… let us hope you get some responses from your target group!
Definitely… lots of valid reasons why people sometimes don’t move on. It’s a hassle to move on, and “break up” with someone, too… Just like in any relationship. Some people dread the confrontation.
What I really need is a court reporter to follow me around and write down all the stuff I eat/do/ bolus/ stress, other useful information. Then I could provide a meaningful summary for the doctor. I don’t see that happening any time soon so the status quo will prevail. I wonder if there’s a way I could finagle that out of BCBS? I think they usually run a hundred bucks an hour or so?
Well…
1- Why do you think they are called "Practicing"Physicans?
2- This Damn Disease Changes Constantly… There is No set ;program that last Forever…
3- Unless your a Dr. Bernstein advocate? You’re going to be lucky to ave btwn 6-7% A1c’s and more like btwn 7-8% over your lifetime…
4- Even with a Top Pro on T1? They would probably have to spend at least 15 -20 min per day, 7 days a week for many Months to get you All Dialed In and then? Be On Call the ave olf at least once a Month for changes… Now, Imagine the Costs for doing that?
5-Most Mix the 2 types…1’s and 2’s and that is where one of the Big problems lie…
6- Add the fact if your over wieght to obiese and that stigma causes more problems… blaming you all the time…for not Complying…You’re not exercising 1-2 hrs Everyday and Eating rabbit Food and Not Loosing enough weight,etc…
Best bet with New dr.'s? Just print out what Joslin and the ADA and others say to have done and bring it up to your Dr. and ASK for their Opinion about doing it… and then see what happens…
Imagine Not having the Internet and PC’s and Had to maybe find this stuff in some Limited # of books? and even then? They really knew so Little even 15-20 yrs ago…
I am not a Dr. Bernstein advocate (although the gimlet in the pic is a double, b/c then you get less carby limejuice…) and have < 6 for several years now, and was several years on R/N, albeit at the cost of gaining weight (much of which I lost…oh well, it’s in my bio, wait, I think I know you?).
It’s not impossible, it’s lots of work. But even if you don’t it’s lots of work. Don’t get me wrong, I like and respect Dr. Bernstein a lot. Unfortunately, I like OCCASIONAL french fries more.
I partied a lot in the 80s so perhaps that colors my notions of dangerous medication? And 90s now that I think about it?
I think that just about any doc could calculate a ‘tactical’ solution to any problem of IOB/ carbs/ whatever but integrating it into someone’s life is the challenge and, like you said, the doc would have to be pretty much on call or just hanging out with you to figure it out. And insurance won’t cover 24x 99213s every day…
Hi Frances: I think some people don’t fire their doctors because they live in a small town or remote area and there is a limited supply of doctors. I think some people (those with adult-onset Type 1 diabetes who aren’t correctly diagnosed or treated) don’t fire their doctors because they just don’t realize that they could be misdiagnosed, and they don’t realize the sheer numbers of people misdiagnosed. Some people won’t stand up to doctors. It is a complex problem. Thankfully now, people can come to a forum like TuD and get assistance and hopefully be able to insist on better care from their doctors.