Health Care Providers and Type 2 Diabetes
It may seem surprising to some that I went from an endocrinologist to a primary care physician when I made the thousand mile move from Colorado to Minnesota. It may seem surprising to others that someone with type 2 diabetes would ever be treated by an endocrinologist, or that insurance would even allow such a thing. Another determination, often dictated by insurance, is whether a diabetes patient should see an ophthalmologist or can get adequate care from an optometrist for the critical annual exam to check for diabetes related eye complications.
Seeing an endocrinologist for my care
A primary care physician diagnosed me with type 2 diabetes in 2005 and sent me along with a prescription for metformin, yet without one for a blood glucose monitor and test strips. How would I know that diet changes and exercise were even working? How could I keep motivated with only having A1C bloodwork twice a year?
I happened to be diagnosed with hypothyroidism around the same time, and that was good enough for my insurance to be able to be seen by an endocrinologist, who did prescribe blood glucose testing supplies. And I never needed to stop seeing him until the big move. I trusted him to tell me when changes in care were needed, and he believed I knew my diabetes best as the person living with the condition. Case in point - it was a difficult day for both of us when the highest A1C result popped up, and a GLP-1 was necessary to temporarily add to the daily routine.
Seeing a primary care physician for my care
When I knew for sure I would be moving, we discussed the possibility of using a primary care physician for diabetes care if results from treatment with metformin, diet, and exercise remained stable. I felt comfortable with this option.
It has been a year since I underwent care with an internal medicine generalist. I researched doctors in the area and found one who seemed to be a good fit on paper with management of chronic illness being an interest of hers. After a rough start due to my reluctance to start statins along with some white coat hypertension issues, we found some common ground once I explained that I try to be as informed a patient as possible.
Seeing an optometrist for my care
Another element in diabetes care that changed when I moved was who performed my annual eye exam. Due to significant nearsightedness and astigmatism, a medical doctor (ophthalmologist) performed eye exams since I was barely walking. After I was diagnosed with type 2 diabetes, I thought for sure I was I must be receiving excellent care if it was from a medical doctor.
As it turns out, insurance would only cover an optometrist when I moved. My first visit ended up being a much more comprehensive eye exam not just for diabetes, but also for glaucoma testing and to gain a prescription update for glasses. This provider will refer to a medical specialist should any further testing ever be needed, and she seems genuinely interested in ensuring her patients with diabetes are in good hands.
Choices of health care providers for type 2 diabetes can be tough, especially if insurance intervenes. Ultimately, my decisions to stay with a doctor have been made upon comfort level, regardless of the type of degree or specialty, and that is what is most important for me (and for every patient out there).
Do you live with any sleep disorders (eg. insomnia, sleep apnea, RLS) in addition to your diabetes?