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. :( :( :(
Good news! Happy your comfortable with your decisions & feeling better.
Other than anti-inflammatories, what have he & the rheumatologist suggested for reactive arthritis? Has the joint pain been worse with higher BG? An infection is the usual suspect.
Second followup with him yesterday.
He was nice. Examined all my monitoring in details. Said I looked like everything was well under control. Was concerned about a few lows (but I explained them) and a few high (also explainable).
He's obviously not familiar with people who try to have excellent control becuase he thought testing 5 times a day is already too much (he almost said OC)!
He was very concerned that I should not have lows and said lows can also cause problems. I agree!! But said that my goal is to keep things steady, ideally 80 - 100 range all the time.
He was concerned about kidneys and a high protein diet. I tried to explain to him about the studies. He listened. I explained that the diet anyway is moderate protein and high fat. I think he was envious reading what I eat... hahaha.. :)
He says my low carb high fat is anti establishment. Yes... but does it work? I will prove it for him. Will test lipids for when I see him next. He was asking more about Bernstein!
He said it seems he is not needed. I reiterated that 'Yes, I can manage for now, but I need someone to oversee and know what's going on, and monitor, etc.' Hopefully he doesn't need to do anything more than that...
He said, ah, yes, a PCP! Exactly! I don't need him to do anything but be there and know for now.... but if something else happens (I get sick, injured, or something) I need someone who knows the full picture and my history.
I really like this guy. I feel I can talk easily with him. Another very long, mostly chatting, appointment! Will see him again in a month or so.
Sounds great. Of course, to be expected that he'd relay the mainstream approach--watch the lows (do they ever warn as strongly about highs?), caution about protein & be concerned about saturated fat. Wonderful that he has an open mind & listened. I'm envious. Doctors in the US never spend the time yours do.