My endo Doc Mike is a nice guy. But here's what happened when I saw him today.
Doc: Hi, how are you? You're looking great. How's your baby? [this is my first visit in about 10 weeks, I had a baby 9 weeks ago]
Me: Baby's fine. Growing well. She's gained nearly 3 kg now.
Doc: Don't let her get too fat.
Me: I'm exclusively breastfeeding her. She should be fine!
He looks at my results (thryoid, CBC, HBA1C). Quite a few high and low flags (high monocytes, low MCV, MCHb) the CBC, but he didn't seem to notice them and didn't comment. Maybe not important?
Am a bit hyper at the moment, with readjusting post baby, and quite a lot of weight loss. He feels my thyroid and notes that I've a tremor. Tells me to reduce my thyroid meds a bit. No problem, I will.
Then he asks if I'm still taking insulin. I tell him yes. He doesn't ask any details, but tells me that I should now stop taking insulin and stop monitoring blood sugar. "It won't hurt, because you're not pregnant any more. In 6 - 8 weeks I should do an OGTT and HBA1C to see if you still need meds and if the diabetes is going to be long term".
So I told him that I get 160 - 170+ post meal (if it's got significant carbs and no insulin bolus, and that is with basal on board), and my fasting is low 100s if I don't take insulin at night. And even if I don't eat my blood sugar will rise slowly all day. He kind of shrugged and didn't answer.
Asked me how long I intend to breastfeed and told me to be careful with breastfeeding becuase my prolactin could be high and the prolactinoma may grow. Watch out for double vision, headaches, etc. Well I've been having headaches, but I pressume that is stress and didn't mention it. Vision is fine.
Asked me how old I am now. Said 41. He said we'll have to get me ready for the 3rd baby soon, a boy! Seeing I have 2 girls now, and partner still wants a son.
I told him I'm still having joint pains [I had texted him about this a few weeks ago]. But he didn't hear me and didn't say anything.
No BP measurement, no weight checking, no asking any details about insulin doses and blood sugars, not listening to me .....
Am I wrong to be expecting something else? Why doesn't he believe I am diabetic? I don't think stopping everything for the next 2 months to see if I am diabetic is necessarily wise. When I expressed doubts and asked him further, he told me I have to stop insulin for "at least a week before doing an OGTT, to be safe". I can only assume that means to be sure the insulin won't affect the results....
Am I wrong? Should I follow his advice? This would most likely mean few months of high sugars to prove a point? And eat like a non-diabetic? Can one do much damage in 2 months? I can't beleive this is apparently one of the top guys in Philippines.
Really may be time to find a new Dr. I just need someone impartial to listen to me, to explain, to guide me a little, and encourage efforts if the going seems tough , and do all the general overseeing and monitoring and checking that one should have with long term chronic conditions. Am sure this is not easy to find. :( :( :(
Frightening this man is a top endo. I'd run, not walk, from a doctor who's providing nothing you list that you need. What possible rationale could there be for stopping insulin with 160-170 pp & fasting in the low 100's? You know well that's not healthy & do you want to burn out beta cells by experimenting with your body for a couple of months, especially with a baby? An endo who instructs to stop testing & shrugs his shoulders at your concerns? His recommendation is to put head in sand & come back in a few months.
What's a thyroid tremor? Not heard that one before.
If one is hyperthyroid it can cause a fine tremor. I actually don't feel hyper, but my FT3 is above range, so a slight drop in thyroid dose is warranted. Hyper can also cause rapid heart beat, etc.
Thank you for validating how I feel about this guy. He is a 'nice man' but I don't want him as my doctor any more. I really don't feel he is providing satisfactory care. And he is really not listening to me!!
I am having trouble low carbing at the moment due to massive food cravings. I don't know if that's because I'm a bit anaemic, because I'm breastfeeding, or what. My bolus insulin requirements are quite low, but I do need it.... I need someone to help me work out how to do this so that it works and so I can have tight control / a cheering squad. Someone other than just myself to be accountable to.
I've been given the name of someone who is apparently a very good GP. Will try him out... maybe I don't need an endo as my front line person. Will have to see if we click or not.
He certainly isn't listening to you & know how you feel on that front.
Can't say anything about food cravings & breastfeeding, but that seems plausible. You may very well need more breastfeeding & corresponding basal to handle this. Imagine the hormonal changes having a baby would cause fluctuations in BG also. I believe listening to our bodies & being attuned to our changing needs.
Hope the GP is the one for you. Please keep us posted. You've done an excellent job managing BG while pregnant & sure you can continue to.
I think many of us have dealt with these sorts of endo problems. It really sounds like your endo has rediagnosed you wants to treat you as a T2. I thought you had put this behind you, been specifically diagnosed as T1 and that this was not an issue, but apparently not. I would be hesitant to follow the advice of a doctor that suggested that a T1 should stop insulin in order to do testing and prepare to have another baby. That just seems whacked. Perhaps it is time to get a second opinion. Although your second opinion may not "trump" this "top endo" it will be easier having a second opinion backing up any further discussion you have on this issue.
The problem seems to be that he doesn't want to diagnose me as anything at all. He's the one with head in sand!
All along hes been saying GD. Nice of him not to want me to have D, but I think it's time to get real.
I don't fit GD and haven't for a good while, not least that I was taking insulin even before I got pregnant with baby 2, to keep the target blood sugars. I personally think LADA.
Second opinion coming up, if I can find someone who wants me if I am moving from the "top endo". Everyone knows him! He's also a minor celebrity here because he is the Dr of politicians, which means he gets on television giving statements about their condition from time to time.
Can you provide a cite or link for:
"Historically we've been taught that fasting blood sugars should be around 90 and post-meal numbers should be below 140 for non-diabetics, but more recent studies have shown that this isn't always the case."
I had a look. Latest WHO publications are:
2011 on Use of HBA1C for diagnosis. http://www.who.int/diabetes/publications/report-hba1c_2011.pdf
The executive summary stated:
"The WHO Consultation concluded that HbA1c can be used as a diagnostic
test for diabetes....
An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes.
A value less than 6.5% does not exclude diabetes diagnosed using glucose
tests. The expert group concluded that there is currently insufficient evidence to make any formal recommendation on the interpretation of HbA1c levels below 6.5%."
2006 on diagnosis of Diabetes http://whqlibdoc.who.int/publications/2006/9241594934_eng.pdf
Recommendation 1: The current WHO diagnostic criteria for diabetes should be maintained
– fasting plasma glucose ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose
≥ 11.1mmol/l (200mg/dl).
Despite the limitations with the data from which the diagnostic criteria for
diabetes are derived, the current criteria distinguish a group with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications.
Recommendation 4 - The fasting plasma glucose cut-point for Impaired Fasting Glucose (IFG)should remain at 6.1mmol/l.
But reading through the source document, they state that these are the levels of blood sugar above which significant increases in mortality and morbidity occur. Ie. it states that rates of cancer go up significnatly for fasting blood sugars above 6.1 and 2 hour greater than 7.8.
Thanks Jackie, I've calmed down now. Am also interested in the studies mentioned.
If you're going to go off insulin and not have him check blood sugar for two months, and you're worried that your blood sugar will keep going up and up, I suggest checking the blood sugar once a day or every other day and if two readings in a row are over 200, call it off (and call the endo). I would not be worried about after meal numbers like 160, especially because home meters can easily read high, and also, if they are consistently that high for real, it will show up in the A1c, and it won't cause short term problems. I don't suggest eating in a way that makes you feel bad or that you know causes dramatic highs.
I often have readings like those be off and don't have the endo talk to me about them because they aren't a big deal.
If you have an endo who you feel "doesn't hear you," then even iif his medical advice is sound it might be time to look for somebody else.
Thanks for advice. It is nice to have different input and opinions here.
And many different views, which can help to see things from all angles.
I am a Bernstein follower (at least in priciples, though not always diet) and would like to keep things as close to normal as is practical. Though short term stopping with close monitoring shouldn't be too much of an issue. At least I'll have data to present to go look for my second opinion.
I think the bigger issue now is how he doesn't hear me / monitor things properly. So I am not satisfied with the service. I have a friend who also sees him (for thyroid) and she now feels the same way about him and is looking for another Dr.
Remember, just because somebody is a "top endo" doesn't mean they are a good doctor nor are they a good doctor for you. You may recall my experience with my last endo. I chose that endo because he was a "top endo," he helped write the AACE diabetes guidelines and was prominent, published and well thought of. Unfortunately, non of that contributed to him being a good doctor. That was my mistake.
I just read your post that you linked! Wow!
But I do recall all your issues with being put on (not) on insulin.
Worst case I'll go it on my own, but would prefer not to.