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Diabetes Basics

Prepare to See Your Diabetes Doctor

When we learn how to manage diabetes without drugs, we rarely need to see an endocrinologist, a doctor who specializes in diabetes and the rest of the endocrine system.

I haven’t had an appointment with an endocrinologist in more than 10 years. I do have regular checkups that we all need with an opthamologist, a dermatologist, a podiatrist, and a dentist. I also go to my primary care physician at least once a year to get an annual physical examination and to help me manage my other chronic medical condition, hypothyroidism.

Not all of us who have diabetes need to see an endocrinologist, but certainly some of us do. All children with diabetes need a pediatric endocrinologist, and other people will benefit from a referral to an endocrinologist in eight different situations. My friend and colleague at HealthCentral, Dr. William Quick, suggests “When to Go to an Endocrinologist.” He is both an endocrinologist and someone who himself has diabetes.

When you make an appointment to see an endocrinologist, be prepared to wait. “It is standard to encounter waits of 3–9 months, and many endocrinology practices are closed to new patients,” writes Dr. Andrew F. Stewart in “The United States Endocrinology Workforce: A Supply-Demand Mismatch” in a 2008 issue of The Journal of Clinical Endocrinology & Metabolism.

The reasons why you will have to wait is that more and more people are getting diabetes and the United States has fewer and fewer endocrinologists to treat them.

In 2011, the most recent year for which we have data, 18.8 million Americans had diagnosed diabetes, according to the Centers for Disease Control and Prevention. Another 7.0 million people had diabetes but didn’t know it yet, so they weren’t yet seeking an appointment with an endocrinologist. Millions more had other endocrine disorders, and all of these numbers are certainly higher now.

Only 4,000 endocrinologist are “available in the United States whose primary focus is to provide clinical care,” Dr. Stewart writes. The shortage of endocrinologists is not only enormous, he writes, but it will continue to get even worse.

The clear implication is that most of us won’t be getting an appointment to see an endocrinologist. Unless we can manage our diabetes without drugs, we will have to rely on a primary care physician to prescribe the medicine we need and to guide us to better management of our diabetes.

When we make an appointment to see our doctor, whether he or she is an endocrinologist or a primary care physician, it’s because we recognize that we need help with our health. But when we enter her or his office we need to be sure not to abdicate our responsibility.

We have the primary responsibility for our health. Diabetes is a disease that, perhaps more than any other, depends much more on those of us who have it than on the doctor.

Actually, how could it be otherwise? Few of us will get more than 15 minutes of the doctor’s time every three months.

We decide what we eat, how much physical activity we get, and whether we will take our prescribed medicine. While that’s obvious, too often we trade this active role in managing our health for a passive role at the doctor’s office.

Our first responsibility when we see the doctor is to go prepared with a written agenda. It works best when we write it out in our priority order. We need to cover a limited number of points that we can work on together in a quarter of an hour. The agenda should be bullet points, not paragraphs. Give a copy to the doctor.

Second, you might want to bring all the medications and supplements that you take for any condition. At least bring an up-to-date list of them.

Third, unless your doctor gets a record of your blood sugar levels electronically, bring your meter and any printouts from it showing your levels since your previous visit. Graphs help, particularly if you consistently test two hours after the first bite of a meal and the graphs separate out your pre- and post-meal levels.

Fourth, if you see other specialists in a different medical system and get lab reports from them, make copies for the doctor who helps you manage your diabetes. Keep her or him in the loop. This will insure that you won’t be duplicating your treatment.

But maybe a fifth point is even more basic and important. We need to find a doctor whom we respect. Remember that we hire our doctors and have the primary responsibility for our health. Our doctors are there to help.

This article is based on an earlier version of my article published by HealthCentral.

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