My First (Minnesota) Endocrinologist Appointment

occupations_doctorThis morning I had my first endocrinologist appointment in Minnesota. The appointment went okay. It wasn’t terrible, but it wasn’t exactly great either. It’s hard to put into words, which is kind of a problem when you’re a blogger!

When I first moved to Minnesota, I crowdsourced suggestions about endocrinologists from various people I know in the area. There was one endo mentioned more than the others, but the clinic is pretty far from where I live right now and it will be even farther when Erik and I move into the house we just bought in July. I decided to try another endo that was recommend that I thought would be convenient to where I live.

The office environment was very different from what I’m used to. The waiting room was a general waiting room for about five different departments. I wasn’t even sure I was in the right place when I first walked in.

A young woman eventually called for me, and brought me to an exam room where she asked a few questions. I knew right away that she wasn’t a regular at the office because she asked me if I was on any medication for my diabetes. Turns out she was a student medical assistant. She took down a few more notes, and then took my CGM and Omnipod PDM. It wasn’t until she got back that I asked her if I would an A1C done. She apologized, telling me that she forgot.

Seriously? The A1C test is pretty much the only reason why I even show up to endo appointments.

When the endo finally arrived, we talked a bit about my history, like how long I’ve had diabetes and some about my family’s medical history. I told him about the Vitamin D and hypothyroidism issues. We went over my blood sugars, which were pretty terrible and made even worse by the fact I was traveling this past weekend for a family wedding. The endo wasn’t even sure what my A1C was, but had thought it was somewhat close to what my last A1C was, which was 7.7%. He said he’d have to doublecheck, but meanwhile we talked about some issues that I had been having.

Overall he seemed pretty reasonable, but one thing that I couldn’t get past was his attitude about how I manage my diabetes during exercise. Now, I’m not saying I have it figured out (I do not), but I was pretty emphatic that I did not like to use a temp basal for exercise. I have had really bad experiences with it over the years and I told him flat out it didn’t work. He countered by asking if I changed my basal rate, and I said, well yes, and he said it was the same thing, just that a temp basal was temporary.

First of all, it doesn’t matter if someone doesn’t like or understand that a temp basal doesn’t work for me. I’m the patient and I said it doesn’t work. If you argue with me, it makes me think you’re not listening to me and you’re not respecting me. Second, a temp basal rate for exercise is not the same thing as simply changing your basal rate to match your liver’s production of glucose. Not the same at all. The fact he tried to argue that was very confusing. I would never correlated those as being the same.

He made the observation that it appeared from my high blood sugars and the amount of insulin that I take that I have insulin resistance. This I agree with. I’ve known for a long time that I have insulin resistance, and even used metformin a few years ago but I had a hard time staying on it because I don’t swallow pills very well. He suggested that I use one of the other type 2 drugs, and I said that I would be interested in trying Victoza because I’ve heard more about type 1 PWDs being on that medication versus the others. Of course, it’s been awhile since I’ve written about type 2 meds so I feel sort of clueless about what I just signed up for! Anyone have any experience with it?

Another thing that I found kind of strange was a comment that the endo made at the end. He described my diabetes as being atypical because of my insulin resistance, that my diabetes was an outlier. I know he wasn’t talking about me personally, just that my diabetes is pretty sensitive to changes. I can be high on several different settings and then suddenly the next change makes me low. This is all true, but at the same time I don’t really think my diabetes is strange. I think this is pretty typical to diabetes, and I wasn’t really sure what point he was trying to make.

At the end of the appointment, the conversation somehow drifted back to the issue of using a temp basal while exercising, and he made the point that by using food during exercise that it can hurt my ability to lose weight. I explained that I use my meals, not extra snacks, when exercising so that I’m not consuming extra carbohydrates. But the whole thing just rubbed me the wrong way. I just felt like we were fundamentally not on the same page and I don’t want to have to constantly argue with a doctor about why I don’t want to pursue something.

On top of that, I had to remind him to get my A1C so I knew what it actually was. Turns out, it was higher than he thought. It was 8%, up from 7.7%. It was not a shock, and I’m not surprised that being on Dexcom hasn’t made a difference because I’ve only been back on the system for about four weeks.

I’m not sure I’ll be going back to that endocrinologist. I might check out one of the other endocrinologists in town. I feel like an endocrinologist can be an intimate relationship because diabetes affects so many different facets of our lives. Especially since I’m hoping to get pregnant some time next year, I want to work with someone I’m comfortable with. I’ve never really endo-hopped before, and I’m not looking forward to it, but I also know what it’s like to work with an endocrinologist who I feel really gets me and wants to work with me. I don’t care if it sounds like I have too high of standards. It’s important to me and I think it’s important to my future, so that’s what I’m going to do.

8 thoughts on “My First (Minnesota) Endocrinologist Appointment

  1. I don’t use temporary basals either, and I don’t lower it hours before exercise, IT DOES NOT WORK. I eat carbs and exercise and yes I need to lose weight but this won’t fix that. Also I cannot exercise on a bolus so I can’t exercise after a meal. I would drop him in a heartbeat. I am not even seeing an endo anymore, talked my primary MD to taking me back. She said fine as she was not concerned with me being on my own with my pump.

  2. Maybe you are an outlier because you bothered to tell these la-las about your D in so much detail? It sounds like you were incredibly patient with the whole scene!

  3. What Katy said. And… I know you’ll find the right endocrinologist, and I know she/he will be happy to have you as a patient.

  4. Before hiring him, tell him that you aren’t sure you are hiring him because of the A1C mixups and your feeling:

    “If you argue with me, it makes me think you’re not listening to me and you’re not respecting me.”

    Also look at Innokanna. Quite a few Type 1s are taking it. My endo. prescribes it for Type 1. I just started it in January and he is happy with it. I still think the reason my A1C is down, is that I’m not hanging with crazy people any more.

  5. The “endo-hopping” (or “endo-shopping”) – so hard. I interviewed 4 endos in 2010 before I found the one I have now. And now the bar for me has been set pretty high. He’s the only one who has ever said he’s “learned” from me. Sounds like you had one of the best here in NY and you need one just as great in your new state.

    I’ve found the local pump reps to be a resource of excellent information about the endos in this area.

  6. Not sure if you prefer to do this (once you’re established somewhere), but I always go in the week before to have all labs drawn, pee in cup, etc. etc. That way, when I go in for the actual appointment the doctor already has the results and it results in a more helpful conversation. (I don’t trust the quick A1c tests, hence going in a week prior to bake in time for the blood draw to be processed.) Anyway, once you have a place you like going to, you may want to consider doing the labs pre-appointment.

    • I only need yearly labs, so I don’t know if I would go in a week early to get my A1C lab. I think the in-office A1C is close enough to what I am. I might be more particular if I was on the cusp and trying to get pregnant!

  7. I was in the same boat as you about 6 months ago…although I liked my endo as a person, she wasn’t good for my diabetes care and I endo hopped/switched and I’m so much happier now. I had never done it before and I had major anxiety about it but it was so worth it!

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