Should I be consulting with an endo?

SherryRH

Hey everyone, I wanted to get some advice because I am a little unsure of how I should handle this.

I am currently only seeing my primary phyiscian for my diabetes care. He has never recommended I see an endocrinologist. When I attended my diabetes classes, the nutritionist asked me what type of medication I was taking and I told her nothing. Her response - "with an A1C of 9, I am surprised he didn't put you on any medication." Is it a normal response to put someone on medication right away?

I had a 6 week check up after being diagnosed but he told me that he only wanted to see me in 6 months. My A1C at the six week mark had dropped to 7.5. Is that normal or does he have a lot of faith in me to control this on my own?

I am currently not taking any medication, I work out 4-6 times per week, and I just raised my calories a couple of weeks ago because I needed more. Before I raised my calories I was eating 1200 and managed to keep my fasting bs under 100 for most of the days. Over the past week or so my fasting bs has been just under 120. Should I be concerned or should I go with the flow. I am thinking going with the flow is not very helpful.

Thoughts and/or suggestions?

melissam226

I feel like he trusted you because he probably didn't see any red flags with you. I know my previous primary care doctor didn't put me on meds because he saw that my A1c dropped over 6 months, I was seeing a nutritionist, and I had already lost weight. I was put on oral meds after I lost weight when my A1c was creeping up again even though I was eating well and working out. Then a few years later, I was put on insulin and another medicine when my A1c was still climbing without an explanation.

I say trust him and just keep track of your numbers. Doctors sometimes only know as much as you tell them before the tests show something's wrong so if your blood sugar starts going crazy without an explanation and you're doing everything right, let him know.

Hope that helps!

Scubanana7

A1c from 9 to 7.5 is a good drop. I'm surprised he didn't put you on meds. But that is not what alarms me. It is the 6 month wait to be retested. That makes me uncomfortable. If he is not going to try meds, then I would think he would want to keep a closer eye on your progress ??? I'd want another test after 3 months just to be sure your are still dropping. Under 6 is the magic number my doctor wants to see from me. a1c's are a 3 month average. I'd request another test 3 months after your last. I wouldn't change doctors unless he refused my request.

You are doing great....keep up the hard work.

travisseger

I'm interested to see the responses to this question because I am in the same boat. Seeing my primary care physician only. When I was diagnosed in September '11 with an A1c of 14.2, he gave me Metformin and told me to come back in three weeks, so we could see how I was responding to the Met. At that appointment, I asked about an endo but he wanted to stick with what I was doing for three months and see what my A1c was then. When I went back in January, my A1c was 5.1 and he said he didn't want to see me again for 6 months. I asked again if I should be seeing an endo and he told me that with my current numbers there was really no point.

My numbers are still good, but my wife is convinced I should be seeing an endo, because a couple of her co-workers who are diabetic keep insisting that I should be under the care of a diabetic specialist rather than just a general physician. I think I'm OK with the primary care doctor as long as my numbers remain as good as they are, but don't want to just assume that an endo could do nothing more to help me at this point. My wife and I had this conversation just yesterday, so I too am curious what you guys think.

robert65ferguson

I would also be uneasy about a test at 6 months particularly from an A1c of 9 at the start. I'm in the UK and the standard schedule is to test every 3 months, an annual review of all aspects of your progress, and regular foot checks at 6 months with annual checks for retinopathy. My A1c results have been 7.5; 6.3 and 6 on my latest test controlled through diet and exercise. I suggest you query the gap of 6 months to your next test.

JaceyMarieS

Hmmm, I'm also kind of surprised with an initial A1C that high, that you aren't on meds. My initial A1c on 1/5/12 was 7.3 and i was immediately put on metformin 500 mg 2x per day, given a BG monitor and told to lose weight. I had a follow-up after 1 month.

At the 1 month check-up, I'd lost weight and my fasting levels were down from 180 to 120. My next check-up, with A1C testing, OGTT and lipid panels is scheduled for August ...6 months.

My numbers are now down in the normal range, I've lost 60 pounds and I also wonder if i need an endo. I'm working on a big list of questions/concerns for that August follow-up.

robert65ferguson

Hi Travis, I'm in the UK and the standard practice is for treatment to be supervised by the GP (General Practicioner, your equivalent of Primary Care) One GP in the Group Practice has responsibility as Diabetic lead and would oversee the treatment. My primary interface would be the Diabetic Nurse in the practice who would flag up any results she was concerned about. The standard in the UK is A1c tests every 3 months, an annual review which is undertaken by the Diabetic nurse, the lead GP and a peripetetic dietician at which progress is reviwed and any issues dealt with. We have foot checks at at least 6 month intervals and an annual retinopathy check. Only where concerns are raised by the review team would we be referred to an endocronoligist. Any cases deemed to require specialist intervention would of course be supervised directly by the endocronoligist team directly who would keep the GP informed of decisions taken and meds prescribed. There is a great emphasis here on the need to have regular A1c checks since this would be the trigger for any further intervention. It may do no harm to query the 6 month gap to your next check. The protocol in the UK is to try diet and exercise for at least 6 months before considering medication. Obviously if the A1c was very high this would call for a more rigorous approach. Hope this helps.

NotThePest

I started out with an A1c of just under 12, 11.9, back in 2001. I am now @ 6.3-6.5 and my endo told me I really don't have to come back. Upon first being diagnosed by my Primary Care, I didn't know what to do and considered my fate as being inevitable. However, once I began my own research I realized my health was in my hands and I began emphasizes movement, exercising.

Between the time of my feelings of inevitability and the realization I could take charge of my own health, I was basically non-compliant because I didn't no better. I "fired" my first endo, whose clientele was basically where I was, fatalistic, so he treated everyone like that. He didn't engage this patience in their own treatment but had the attitude of O, Poor You!. My numbers were coming down but my weight wasn't; however, my clothes were falling off my body because my measurements has shrunk.

My new endo is also a researcher (the one who told me I don't have to come back), a diabetes, obesity and nutrition specialist and works with her patients as partners in their treatment. She immediately explained to me how exercise works by telling me which type of exercise, strength, resistance, aerobic, cardio (all aerobics are cardio but not all cardio are aerobics) and stretching caused certain reactions in the body and how that helped or hindered glucose processing. Like sore muscles become insulin resistant until they heal (those sore muscle feelings with we begin exercising or start a new routine.). I took her counsel, also began reading books and research material on the benefits of exercise on diabetes (Handbook of Exercise in Diabetes was and is my foundational book). I began studying my body's reactions to food and certain kinds of workouts.

Endo's, like everything else and everyone else can help you or hurt you. When you find one that is willing to work with you as a team member, you have found gold! Although I have been officially released from my endo’s care, I still want to show up at least twice a year so I can keep up on the latest research and share in her knowledge.

SherryRH

She immediately explained to me how exercise works by telling me which type of exercise, strength, resistance, aerobic, cardio (all aerobics are cardio but not all cardio are aerobics) and stretching caused certain reactions in the body and how that helped or hindered glucose processing. Like sore muscles become insulin resistant until they heal (those sore muscle feelings with we begin exercising or start a new routine.).

Thank you for this bit of informaiton. I have begun a different work out and I have been really sore for the past few days and the past few days are where my fasting bs# are higher. I will have to keep an eye on this and see if this is a pattern.

SherryRH

Thank you everyone with your responses so far.

I will keep an eye on my numbers and see where I am. If things get to be too bad or really out of wack, I will call my doctor and schedule something before my 6 month check up. I did sign up for the advanced nutrition class with people that did the initial diabetes class with me. That doesn't start until June though.