Can of Worms
Wednesday, December 15, 2010 at 11:13AM I have been going to my Endo’s office every two weeks for the last several months.
When I think about my Endo I am thankful that I have one, have insurance, and options. I am thankful but there are some things about him that are REALLY bothering me and I am not sure if it’s enough to leave and try to find another.
You see, he does not want me making any changes to my basal rates. In fact, his assistant asked me when I first saw him if I ever made changes myself to which I answered, “Yes” and I swear it looked like she was going to start laughing. When the Endo came in she told him that I had made changes to my basal rates and it sounded a lot like tattling on me. Weird.
Now most of my appointments are with his assistant who is nice enough but she says things that bother me. Take a few weeks ago for instance.
We were looking at my numbers after she circled all the ones that were “BAD” and she noticed a spike between 7AM and 8AM. I explained to her that I don’t eat anything until I get to work so the spike must be from disconnecting when I shower.
“Well how long are disconnected?” She asked as if I take an hour long bath each morning.
“Probably 15 minutes.” I know because I always look at my pump clock when I get in and out.
“Wow, you must really need insulin!” She said it with a straight face. She didn’t even smile. Was she joking? Why would she say that? Isn’t that almost the definition of type 1 diabetes?
I replied, “Yeah, I do like that insulin.” Then I shot her a look that only a hidden camera would have caught but it made me feel a little better.
Now on the flip side my last A1C was the best it has ever been, 7.0! So there is that to hold onto. Also my basal rates and daily numbers are getting better too.
But just yesterday we had another exchange that just seemed weird.
“We have switched all our records to electronic ones so if you don’t mind can I ask you a few questions I need to fill in?” She opened up her laptop.
I agreed as cheerfully as I always do and answered all her questions. She was impressed that I knew how long I had been on the pump, had CGM, when I quit smoking, and even knew my diagnosis date.
“Wow you have a good memory!” I didn’t share with her that blogging about stuff helps you to remember when things happened.
“So what treatment did your doctor start you on when you were diagnosed?” I assumed she meant what type of insulin.
“I started on NPH once a day.”
“Wow. So you started out on insulin huh? Okay.” And that was it. Weird right? Does she think I am a type 2? Do I need to pull out the results from my C-Peptide I had done at my last endo’s because he didn’t think I was a type 1 because if I do, I have it in my bag.
I just realized that I feel the need to carry lab results with me to prove to the medical world that I am a type 1 diabetic. How sad is that? I don’t think I have ever really thought about it but I have it with me at all times!
I carry proof of being a type 1 because I am sick and tired of doctors assuming I am a type 2 because of my weight. That is wrong for those of us with weight issues, it is wrong for all my type 2 brothers and sisters, and it makes me feel terrible.
So do I stay or do I go? Do I open this can of worms?
Reader Comments (13)
Hey there - personally after the old 'don't change basal rates yourself' I would of been gone. They are treating you like a child and not as a fully functioning, capable adult. And they clearly don't know what they are talking about half the time. You must really need insulin? That would have made my head spin around, exorcist eyes and all and maybe even some pea soup come out. Oh yeah, I would have left when I heard that. Just my thoughts, but you can do WAY better than this endo practice.
That, sir, is a wonderfully disgusting picture.
I would ask around and see if you can find someone in your area who is less . . . bizarre. I don't know if I'd feel comfortable jumping ship before I had another option lined up.
Once again, right there with you in understanding. I have been at my endo since I was 17 when I weighed less so I don't have this issue, but I know soon I'll have to change and then we'll see. I do get a lot of ignorant comments from people saying, "if you lose weight won't your diabetes get better?" No. No it won't. Butthole.
I don't see how raising a question for her clarification is opening a can of worms. "You do know I am a Type 1 diabetic, not Type 2 right? Because your questions make it sound like you are confused, is there anything I can help you with?"
George, I think you already opened the can. Sounds like my endo, asked me if I was a Type 1 because I was on insulin. I had to tell her that I did not like the side effects of oral medications and would rather be on insulin. Did not like my refusal to take Byetta. Again the side effects, but she did a jaw drop when I suggested Metformin XR. Had none of the side effects for me that many have and I take at mealtime which also helps. This sounds like the issues are with the assistant who may not have the brightest bulb in the lot. Sounds like the assistant has people stereotyped and can't accept people that do not fit this.
Penny - I questioned my own sanity after hearing that and not leaving. I guess after the last one I just hoped it would be okay. Ugh.
Jacquie - Good idea. I may put out the feelers again.
Sarah Jane - I hope you find a good one the first try!
Renata - I guess the can of works I was referring to was deciding to leave and find a new endo. That seems like an impossible task right now.
Bob - It is amazing to me how undereducated many medical professionals are. The Endo has been alright but the assistant (PA? I am not sure what she is) is where most of my issues lie.
i had a doc once tell me she was going to get me off humalog all together and only take lantus... that was to weird...and she knew i was type 1. If your not feeling it find a new doc, if you can. Or maybe suggest a book to that one incompetent girl. Also why don't docs get that if something doesn't work you have to change your insulin needs, it's either that or be to high or to low! sigh!
George, I'm so sorry you had to deal with those ignorant medical "professionals". UGH...i've been in the same boat lately...I tried changing doctors and guess what the carilion office told me? "You have to have permission from your doctor and the doctor you want to transfer to". So I talked to the two docs and they didn't give me permission...I was like, excuse me am I a freakin 5 year old??? So I left to go find another doc, who was even worse! And the thing is...my husband can't take anymore time off of work to watch the kids while I roam around for the right doc because the weather is making his work hours be very limited and we're about a penny away from not having any money for groceries and I feel like it's so unfair that we all have to work so hard to find a decent doctor and doctor's office.
If you're able, I hope you do find another place to go because you are so worth going somewhere better. But, if not, hang in there...you're last A1c was awesome
I once had an endo (on my first visit to his office!) have a discussion about me in front of me with his assistant (without ever glancing in my direction or talking to me) and then he turned to me and the first words he said to me were "you need to go on a pump." (By the way, at this point he was referring to me as "female, 26").
Sorry, that's a lot of parentheses. It still makes me mad when I think about it, though.
Point is: I couldn't stay there not only because the guy was an ass, but because I didn't like knowing that they were not in the least interested in my input in to my diabetes so they clearly couldn't help me.
I feel like you should find an endo that you trust and that will work with you. Not get mad at you for changing basal rates, not be surprised that you need insulin.... you know... someone smart. :-)
(p.s. Congrats on the 7.0! That's great!!)
I'd look on your insurance website and see who takes your plan, then google their names and see what comes up. You'll see more negative that positive reviews (mad people write more often than happy people) but at least you'll have an idea of the Dr's personality and office staff.
I love my Endo but he's in Phoenix so that doesn't help you out.
Thankfully I ABSOLUTELY LOVE my endo, but she had a NP that I hated. Every time I saw her she questioned if I was really a T1. I finally flat out told her - "LOOK IT, I know I'm FAT, but I've been insulin dependent since I was 16 years old and weighed 140lbs. Would you have asked me then if I was a T2? NO? Then let it go!" Then I bitched her out to my endo and never had to see her again.
I'm done arguing w/ Drs over my diabetes "status". I may come off as abrasive to them, but I just flat out start the conversation w/ any new Dr "I'm T1. Don't question it. I am. Just accept it as fact and let's move on".
It's a tough call man. Switching docs is so much work (the actual switching is not so bad, but FINDING a good new one, and building a relationship from scratch is hard).
It sounds like you like the endo Ok, but that you spend most time with the crazy lady? That makes it hard too. I like the idea of clarifying stuff with her. I mean, this is YOUR health you're dealing with, right? You are totally worth some uncomfortable situations between you and her, and don't settle for less than what you want brother. If that fails, maybe a frank discussion with the actual endo? Maybe you're not the first one he's heard from regarding her.
I don't know man. I say all this proactive stuff, but then I don't follow my own advice.
The basal rate thing would really irritate me, too, but I'll play devil's advocate for the PA when she said, "So you started out on insulin, huh?" Maybe she was referring to the miseducation you suspect her of -- all those Type 1s misdiagnosed as Type 2s who spend a lot of time spinning their wheels because they don't fit a physical stereotype or present as a classic case of 1 or 2. Maybe what she meant was, "Oh, so you didn't have to fool around with some numbskull who prescribed diet and exercise, and a pill?"
It's more likely that she's really confused and needs you to clue her in, though. :/ I'd probably be shopping for a new office if I were you. (That basal rate thing! Man! What the heck.)