My Diabetes Team—The Endocrinologist
Recently, I wrote a piece about two doctors that are on my diabetes team. My family physician and my cardiologist. My family physician (FP), my quarterback, leads my diabetes team. He’s the keeper of all the information coming in from the specialists and is there to support me between those appointments, making judgements with me about what else is needed. The cardiologist looks after my heart and sends my test results back to the FP with recommendations and 'the plan' for me and my heart. Now, it was time to meet the newest member of my team, the doc who will look after my diabetes, the endocrinologist (Endo for short).
How can an endocrinologist help with type 2 diabetes?
Up until this point in my life, I haven’t needed specialists for ongoing care. After a number of attempts to get my blood sugars under control, my FP was clear that he had taken my treatment to the end of his knowledge base. It was time to be referred out. I was pretty nervous but it was obvious it was time to have an Endo involved.
When I first met this doctor, what impressed me from the start was how calm he was. This was a nice balance to my NOT calm. He seemed surprised that I had controlled my diabetes with diet and exercise for 8 years. He even repeated it to verify what I had said.
Review medication plan
We explored what medications had been tried and why I didn’t get the response hoped for. I didn’t tolerate metformin for long, even when the dose was titrated up very slowly. I had been prescribed other diabetic meds in the past that didn’t work either but in this case, it wasn’t about a lack of tolerance. Now was the time to be honest with him. I was basically, in my own words, non-compliant with the other couple of meds that had been prescribed. I wasn’t getting the response hoped for so I just stopped taking them regularly. When I felt the pangs of guilt, I would take them again. He didn’t show surprise or judgement. I liked that.
Review medical history
We talked about my health history beyond diabetes. Not much there for concern. I let him know I had seen the cardiologist the month before, my heart was healthy and strong, and what had been recommended and prescribed. I told him the cardiologist was now part of my team for yearly visits.
The moment had now arrived to share my biggest fear with him. I was terrified he would tell me I needed insulin. I had been ‘informed’ by the diabetic education centre that the ONLY solution for me was insulin. In my mind, if it was time for insulin then I had failed. I recognize now that is not the case but I couldn’t help the way I felt. I couldn’t get my head around why insulin was the only answer for me. It felt like the last resort. I was well aware of the large number of diabetic meds available on the market. Of all of those, I had only been tried on three different ones, let alone combinations of meds. Dr Endo listened and agreed with me. It wasn’t time. There were other meds we could try. He revealed the plan which was to include two daily oral meds, one being metformin again, and one weekly non-insulin injectable med. I had done some homework before the appointment to know that the injectable med was a possibility. I had questions about the risks involved. When he leaned back in his chair and moved away from his computer to address my concerns, I knew then I wanted him on my team. He taught me how to give the injection. Off I went with my new prescriptions and my next appointment to see him in 3 months.
As it turned out, once again, I couldn’t tolerate the metformin. My Endo took me off it two weeks later. I have continued with the other oral med, the injectable, and have returned to paying attention to my diet and getting more walking in. My A1C is now in a good place.
The Endo is a most welcome member of my diabetes team.
Were the financial costs of type 2 diabetes surprising to you?