Are Endocrinologists Even Necessary Anymore?

The topic says it all.

I've been pondering this because I have been seeing a specialist for
over 30 years. I'm a T1. It has become difficult to continue seeing
one due to my present location.

I'm considering just seeing my family doctor, since the only
dependency I really have is receiving prescriptions.

<jamil@onepost.net> wrote in message
news:5nkje397mcdvod4hq1eca1d4akr70uu1dh@4ax.com...
> The topic says it all.
>
> I've been pondering this because I have been seeing a specialist for
> over 30 years. I'm a T1. It has become difficult to continue seeing
> one due to my present location.
>
> I'm considering just seeing my family doctor, since the only
> dependency I really have is receiving prescriptions.

For some of us, yes. I have had a thyroid problem. Don't at the moment,
but it needs to be checked. I've yet to have a GP who would address both
thyroid and diabetes.

"Julie Bove" <juliebove@verizon.net> wrote in message
news:vCmGi.9131$qV3.953@trndny02...
>
> <jamil@onepost.net> wrote in message
> news:5nkje397mcdvod4hq1eca1d4akr70uu1dh@4ax.com...
>> The topic says it all.
>>
>> I've been pondering this because I have been seeing a specialist for
>> over 30 years. I'm a T1. It has become difficult to continue seeing
>> one due to my present location.
>>
>> I'm considering just seeing my family doctor, since the only
>> dependency I really have is receiving prescriptions.
>
> For some of us, yes. I have had a thyroid problem. Don't at the moment,
> but it needs to be checked. I've yet to have a GP who would address both
> thyroid and diabetes.
>

I've had 2 GPs, a nurse practitioner and an internist address both my low
thyroid and my diabetes, so I guess it is not universal that they will not
address these problems together.

For me I always know what I want from the doctors, and if I don't get it I
go elsewhere. I did find it easier to get what I wanted from an endo, but
don't currently see one because the nearest endo to me that takes medicaid
is a 6 hour drive.

KC

On Sep 13, 8:22 pm, ja...@onepost.net wrote:
> The topic says it all.
>
> I've been pondering this because I have been seeing a specialist for
> over 30 years. I'm a T1. It has become difficult to continue seeing
> one due to my present location.
>
> I'm considering just seeing my family doctor, since the only
> dependency I really have is receiving prescriptions.

For me, a factor is how long it would take to get an appointment with
a new endo.

In my neighborhood, you have to wait months to get an appointment if
you aren't an existing patient. Makes doctor-shopping hard! But if
you've got a good one, stick with him!

When I was a kid, I had to travel 50 miles to see my endos, but they
were really really good. Is your distance similar/greater? Some places
might be hundreds of miles...!

Tim.

On Thu, 13 Sep 2007 20:22:42 -0400, jamil@onepost.net wrote:

>The topic says it all.
>
>I've been pondering this because I have been seeing a specialist for
>over 30 years. I'm a T1. It has become difficult to continue seeing
>one due to my present location.
>
>I'm considering just seeing my family doctor, since the only
>dependency I really have is receiving prescriptions.

My wife who is a type 2 has had two endocrinologists that made
decisions on her medicine that ended her up in the hospital, once for
10 days. So she won't be seeing any more of them if I can help it.
Her PCP she has now is pretty good in diabetes control.

"Darrel" <dfland@att.net> wrote in message
news:7ekle3phtcpmv603ut1m87bn7crj42mn0a@4ax.com...
> On Thu, 13 Sep 2007 20:22:42 -0400, jamil@onepost.net wrote:
>
>>The topic says it all.
>>
>>I've been pondering this because I have been seeing a specialist for
>>over 30 years. I'm a T1. It has become difficult to continue seeing
>>one due to my present location.
>>
>>I'm considering just seeing my family doctor, since the only
>>dependency I really have is receiving prescriptions.
>
> My wife who is a type 2 has had two endocrinologists that made
> decisions on her medicine that ended her up in the hospital, once for
> 10 days. So she won't be seeing any more of them if I can help it.
> Her PCP she has now is pretty good in diabetes control.

What is her story?

On Fri, 14 Sep 2007 06:12:53 -0700, Tim Shoppa
<shoppa@trailing-edge.com> wrote:

>For me, a factor is how long it would take to get an appointment with
>a new endo.

This is one of the reasons for me wanting to change. I am not a new
patient, but I have to wait months for an appointment.

>In my neighborhood, you have to wait months to get an appointment if
>you aren't an existing patient. Makes doctor-shopping hard! But if
>you've got a good one, stick with him!
>
>When I was a kid, I had to travel 50 miles to see my endos, but they
>were really really good. Is your distance similar/greater? Some places
>might be hundreds of miles...!

The distance to the office is actually not very far, but I am limited
in my choices for an endo. I can't shop easily, and the current group
I see appear to be over-booked. Is there a shortage of endos or
something?

<jamil@onepost.net> wrote in message
news:joule3hf34uqi0k0ri9p96v2q6hij238sl@4ax.com...

<snip>

> The distance to the office is actually not very far, but I am limited
> in my choices for an endo. I can't shop easily, and the current group
> I see appear to be over-booked. Is there a shortage of endos or
> something?

Yes.

In article <5nkje397mcdvod4hq1eca1d4akr70uu1dh@4ax.com>,
jamil@onepost.net wrote:

> The topic says it all.
>
> I've been pondering this because I have been seeing a specialist for
> over 30 years. I'm a T1. It has become difficult to continue seeing
> one due to my present location.
>
> I'm considering just seeing my family doctor, since the only
> dependency I really have is receiving prescriptions.

This is purely a personal decision. There's no one size fits all answer.
If you feel a regular physician can help you maintain good blood sugar
control, then that's the route you should take.

When I was diagnosed with T2 diabetes, I asked my primary care physician
if he felt I should see an endocrinologist. He said it would be a waste
of time. He told me, his criteria for referring a patient to an
endocrinologist is if the patient cannot maintain good blood glucose
control by following his directions. He said that if a patient is
getting inexplicable test readings over a short period of time, that's
an indicator that a visit to an endocrinologist is warranted.

Is your blood sugar well controlled? Do you think your primary care
doctor can help you maintain good control of your T1 diabetes? If so,
then you have the answer to your question.

jamil@onepost.net wrote:
> The topic says it all.
>
> I've been pondering this because I have been seeing a specialist for
> over 30 years. I'm a T1. It has become difficult to continue seeing
> one due to my present location.
>
> I'm considering just seeing my family doctor, since the only
> dependency I really have is receiving prescriptions.

Really depends if they help.

First one wasn't for me, a T2. All the "care" really turned out to be
ways to increase the bill.

Second one seems better in that he changed tabs and insulin and I feel
better for it, but I know he isn't that good, especialy for diabetics.

Try shopping around.

It really is a matter if your other gp/specialists can cover that area
and you wont really know unless you get 2nd, 3rd, etc opinion.

On Sat, 15 Sep 2007 06:57:56 -0400, Shawn Hirn <srhi@comcast.net>
wrote:

>Is your blood sugar well controlled? Do you think your primary care
>doctor can help you maintain good control of your T1 diabetes? If so,
>then you have the answer to your question.

I didn't think it was quite that simple. Otherwise, I would not have
posted in the first place. My thought was that an endocrinologist
lives, sleeps, dreams about diabetes where a primary care physician is
a jack of all trades. Regardless of how well controlled I am, there's
always new advances and improvements. Between the two doctors, who is
more likely to know about these improvements first?

However, I haven't seen a good endo since I was a child. Other than
that one doctor, I think any doctor, regardless of practice, would
have sufficed instead of the endocrinologists I have seen. They
aren't managing my dosage amounts, nor making decisions based on my
test results. I am. I didn't even agree with the last endo I was
seeing as far as the importance of an A1C test. I think the test is
almost useless and a waste of my money. I always give my doctor a
printout of three months worth of test results, and I test no less
than five times a day.

Here's a few of my A1C results the latest being in June:

06/07/2007 - 5.7
03/16/2007 - 6.3
11/24/2006 - 5.5
08/15/2006 - 6.2

So if a patient is testing his or her blood sugar routinely and
providing the doctor with printed reports of all results over a three
month period, what is the point of another A1C when the past tests and
reports presented all look good? I've never gotten a good answer to
this question from the last endo I was seeing.

On Sat, 15 Sep 2007 20:59:54 +1000, Terryc
<newsthreespam-spam@woa.com.au> wrote:

>Really depends if they help.
>
>First one wasn't for me, a T2. All the "care" really turned out to be
>ways to increase the bill.
>
>Second one seems better in that he changed tabs and insulin and I feel
>better for it, but I know he isn't that good, especialy for diabetics.
>
>Try shopping around.
>
>It really is a matter if your other gp/specialists can cover that area
>and you wont really know unless you get 2nd, 3rd, etc opinion.

The ones I have seen recently in the past were not really helping.
Although the one I have seen prior to the last one gave my three vials
of Lantus for free. Too bad this doctor left that practice.

Too bad I cannot purchase everything I need without a prescription. I
can understand the requirement of a prescription for syringes. I
wonder why a prescription is required for Lantus though? You can buy
Humulin insulin over the counter, but Humulog and Lantus require a
prescription. This makes no sense to me.

jamil@onepost.net wrote:

> So if a patient is testing his or her blood sugar routinely and
> providing the doctor with printed reports of all results over a three
> month period, what is the point of another A1C when the past tests and
> reports presented all look good? I've never gotten a good answer to
> this question from the last endo I was seeing.

I think the "real" answer is cause they're doing a reality check. A
doctor knows you're doing well if the blood drawn by a neutral third
party shows a good A1c.

Whereas they don't *know* for sure that you didn't just make up all your
own numbers, or get them from bg readings from your dog, or whatever.
Doctors have to deal with a lot of various types of patients, some of
whom are not as rational or educated as most of us are. If they have a
nutcase patient, they sitll have to help treat their diabetes as much as
possible.

I consider it a good thing that my internist does an A1c on me
regularly. I mean... it's part of his job. He *does* let me primarily
take the lead on deciding how to manage my diabetes, but I *expect* him
to "interfere" with me if he sees me losing control via the A1c. How
else does he know I'm not just full of it?

--
http://www.ornery-geeks.org/consulting/

jamil@onepost.net wrote:

> Too bad I cannot purchase everything I need without a prescription. I
> can understand the requirement of a prescription for syringes. I
> wonder why a prescription is required for Lantus though? You can buy
> Humulin insulin over the counter, but Humulog and Lantus require a
> prescription. This makes no sense to me.

I am WAY more knowledgable about diabetes than my doctor. WAY more.

But I find this attitude a bit scary. The thing is... a doctor provides
a reality check, and that's not a bad thing.

If I were going to be without insurance for a period, I'd probably ask
my doctor to write unlimited scripts... I need my insulins whether I can
afford to see him regularly or not.

But even if I needed to see him much less often... the guy is useful.
Among other things, there's diseases and problems that I *don't* know about.

--
http://www.ornery-geeks.org/consulting/

On Sat, 15 Sep 2007 08:50:04 -0500, Jackie Patti <jpatti@ccil.org>
wrote:

>I am WAY more knowledgable about diabetes than my doctor. WAY more.
>
>But I find this attitude a bit scary. The thing is... a doctor provides
>a reality check, and that's not a bad thing.

Hehe. Don't get me wrong -- I would definitely continue to see my
doctor, but just not as often. I have poor experience with some of
these doctors. I generally do not get sick. I rarely catch colds or
get the flu. My blood sugar is very rarely high. It does go low, but
I manage that via testing. So, I do not have diabetic related
problems as a result of high blood sugars.

With this being the case, what is the point of an endo only writing a
prescription with enough refills to last three months? (just enough
time for the next visit). Also, if the patient has been with the
doctor for two years with the same results, I think there should be a
level of trust at that point. That is not to say that the doctor
should cease all tests, but perhaps relax them a little. Perhaps have
the full gambit of blood tests done every other visit instead of every
visit?

I just feel like a source of income for the doctor, and I do not feel
as though the doctor is helping me. That is all.

>If I were going to be without insurance for a period, I'd probably ask
>my doctor to write unlimited scripts... I need my insulins whether I can
>afford to see him regularly or not.
>
>But even if I needed to see him much less often... the guy is useful.
>Among other things, there's diseases and problems that I *don't* know about.

For the problems I don't know about, I depend on my family doctor
(which I do see at least once a year).

jamil@onepost.net wrote:

> For the problems I don't know about, I depend on my family doctor
> (which I do see at least once a year).

Yeah, I'm not disagreeing that mebbe you don't need an endo; I don't see
an endo myself, but an internist.


--
http://www.ornery-geeks.org/consulting/

jamil@onepost.net wrote:
> On Sat, 15 Sep 2007 06:57:56 -0400, Shawn Hirn <srhi@comcast.net>
> wrote:
>
>> Is your blood sugar well controlled? Do you think your primary care
>> doctor can help you maintain good control of your T1 diabetes? If so,
>> then you have the answer to your question.
>
> I didn't think it was quite that simple. Otherwise, I would not have
> posted in the first place. My thought was that an endocrinologist
> lives, sleeps, dreams about diabetes where a primary care physician is
> a jack of all trades. Regardless of how well controlled I am, there's
> always new advances and improvements. Between the two doctors, who is
> more likely to know about these improvements first?

Endocrinology involves a heck of a lot more than just diabetes. I like a
direct translation from Chinese: "doctor of internal secretions". That's
a *big* ball park!

I'm usually a bit ahead of my endo only because she doesn't have the
time to research like I do. Reading here is the difference. She's even
slooooowly coming around to things taken for granted here, like reducing
carbs to keep spikes minimal (even for a T1!).

If you're comfortable with your GP then keep him/her. If you feel in
future you need a referral to an endo, then ask for one.

>
> However, I haven't seen a good endo since I was a child. Other than
> that one doctor, I think any doctor, regardless of practice, would
> have sufficed instead of the endocrinologists I have seen. They
> aren't managing my dosage amounts, nor making decisions based on my
> test results. I am. I didn't even agree with the last endo I was
> seeing as far as the importance of an A1C test. I think the test is
> almost useless and a waste of my money. I always give my doctor a
> printout of three months worth of test results, and I test no less
> than five times a day.
>
> Here's a few of my A1C results the latest being in June:
>
> 06/07/2007 - 5.7
> 03/16/2007 - 6.3
> 11/24/2006 - 5.5
> 08/15/2006 - 6.2
>
> So if a patient is testing his or her blood sugar routinely and
> providing the doctor with printed reports of all results over a three
> month period, what is the point of another A1C when the past tests and
> reports presented all look good? I've never gotten a good answer to
> this question from the last endo I was seeing.

Statistics.
Don't laugh...it's the only tool they've got for otherwise healthy
diabetics.

Vicki

<jamil@onepost.net> wrote in message
news:rogne3tgf5d9hm5d5qcqldkluemd6inffg@4ax.com...
> On Sat, 15 Sep 2007 20:59:54 +1000, Terryc
> <newsthreespam-spam@woa.com.au> wrote:
>
>>Really depends if they help.
>>
>>First one wasn't for me, a T2. All the "care" really turned out to be
>>ways to increase the bill.
>>
>>Second one seems better in that he changed tabs and insulin and I feel
>>better for it, but I know he isn't that good, especialy for diabetics.
>>
>>Try shopping around.
>>
>>It really is a matter if your other gp/specialists can cover that area
>>and you wont really know unless you get 2nd, 3rd, etc opinion.
>
> The ones I have seen recently in the past were not really helping.
> Although the one I have seen prior to the last one gave my three vials
> of Lantus for free. Too bad this doctor left that practice.
>
> Too bad I cannot purchase everything I need without a prescription. I
> can understand the requirement of a prescription for syringes. I
> wonder why a prescription is required for Lantus though? You can buy
> Humulin insulin over the counter, but Humulog and Lantus require a
> prescription. This makes no sense to me.
>

You can get Lantus, Humalog and syringes from online Canadian pharmacies
without an Rx if you want. I have bought Humalog from 2 pharmacies online.
1 was great and shipped it quick with cold packs. The other stupidly
shipped it by a method that took 2 weeks in the summer, so be careful to
make sure you are getting quick shipping with insulin.

KC

KC

<jamil@onepost.net> wrote in message
news:n2fne3h92re10vpbrelkps3m3t96nhk39i@4ax.com...
> On Sat, 15 Sep 2007 06:57:56 -0400, Shawn Hirn <srhi@comcast.net>
> wrote:
>
>>Is your blood sugar well controlled? Do you think your primary care
>>doctor can help you maintain good control of your T1 diabetes? If so,
>>then you have the answer to your question.
>
> I didn't think it was quite that simple. Otherwise, I would not have
> posted in the first place. My thought was that an endocrinologist
> lives, sleeps, dreams about diabetes where a primary care physician is
> a jack of all trades. Regardless of how well controlled I am, there's
> always new advances and improvements. Between the two doctors, who is
> more likely to know about these improvements first?
>
> However, I haven't seen a good endo since I was a child. Other than
> that one doctor, I think any doctor, regardless of practice, would
> have sufficed instead of the endocrinologists I have seen. They
> aren't managing my dosage amounts, nor making decisions based on my
> test results. I am. I didn't even agree with the last endo I was
> seeing as far as the importance of an A1C test. I think the test is
> almost useless and a waste of my money. I always give my doctor a
> printout of three months worth of test results, and I test no less
> than five times a day.
>
> Here's a few of my A1C results the latest being in June:
>
> 06/07/2007 - 5.7
> 03/16/2007 - 6.3
> 11/24/2006 - 5.5
> 08/15/2006 - 6.2
>
> So if a patient is testing his or her blood sugar routinely and
> providing the doctor with printed reports of all results over a three
> month period, what is the point of another A1C when the past tests and
> reports presented all look good? I've never gotten a good answer to
> this question from the last endo I was seeing.

I did one time just cross it off the list of tests on the lab slip. It had
just been tested 2 weeks before when I was in the hospital, so I thought it
was useless and didn't want to pay for it.

KC

On Sun, 16 Sep 2007 05:11:42 GMT, "KC" <nomail@forme.com> wrote:

>You can get Lantus, Humalog and syringes from online Canadian pharmacies
>without an Rx if you want. I have bought Humalog from 2 pharmacies online.
>1 was great and shipped it quick with cold packs. The other stupidly
>shipped it by a method that took 2 weeks in the summer, so be careful to
>make sure you are getting quick shipping with insulin.

I keep forgetting about Canada, but I am not certain I can trust all
of the sites out there. The counterfeit OneTouch strips were ordered
from Canada, weren't they?

I will need to do research on the pharmacies in Canada to find a good
one.