The overall level of general knowledge is not the main thing in my experience.
I have found diabetes knowledge to be totally and dangerously random. Chances are we all come across total novices diabetes wise, poor medics, excellent medics. The trick is to be in control of your own knowledge and be willing to stand your ground when needs be. Also be willing to take evasive action when need be.
I was in an ER at New Year that resembled the Crimea (every bed and corridor was overflowing - 'flu season and alcohol had filld it) and with sugars 27-33+ (UK)/ 500-600+ (USA) but no ketones so they were going to make me wait 3-5 hours to be seen without treatment, and being a pump user, I judged it safer to take rehydration salts at home with insulin. As it was my, own doc admitted me straight to ward the next morning with a 33+/600+ (meter said hi), but no ketones - at least I'd kept ketone free and dehydration to a minimum.
In this case even senior diabetologists mucked up when faced with additional medical problems - they focussed on the pump when a prescribed drug sensitivity was the cause of the high sugars.
I feel like I'm wasting money that my insurance company and I are paying them. I have had pretty decent luck with the doctors I've seen since the early 2000s. I had a pretty lengthy period where I didn't see a doc, but the pharmacy kept getting refills from nurses or whatever, because their process was so automated. Eventually, I got cut off and found a GP who turned out to be pretty sharp, either knew or read up on what to do. I sort of did my own thing anyway, which in retrospect was sort of dumb. When I asked for a pump, he said "you need to see the endo for that." I could pick two and chose the young, Indian doc, rather than the head of the department white guy, reasoning that in the rural community I resided in, the Indian would be underselected and easier to get appointments with. This proved correct. She was excellent at math and took my insane log and turned it into an almost perfect estimate for pump settings for which I am always thankful.
The biggest danger faced by people with diabetes is getting stuck with a doctor who refuses to prescribe enough supplies to meet our needs. We still hear about these docs online and, since the online community is the tip of the diabetes iceberg, I'm sure there are more of them out there.
I'd add that some of the "inexperience" that we can run into is because the medical industry sets lower standards for people with diabetes. The goals of A1C of 6.5 and 7.0 advocated by various medical organizationss in the US sort of set us up to "fail" in even attempting to have normal BG. These imply an "average" of 140-150ish BG that is well-above "normal." I'm not a doctor and have no years of clinical practice with anyone but myself but I think that aiming at 140 will lead you to more ups and downs than aiming at somewhere between 80 and 100. I have achieved my best control when I work at a target and balancing there, rather than aiming at the broad side of a barn and fly back and forth around it. I think a bad goal may lead many of us to "give up" and feel badly but I don't think that this is the fault of people with diabetes, when the medical industry is giving us bad information.
I agree with AR, Ayomideji. Unfortunately, doctors who don't know much about D are more common than ones who know a lot. And the ones who know a lot it's almost always about Type 1. One doctor I had admitted he hadn't had any Type 1 patients. I appreciated his honesty. If you are lucky enough to find a knowledgeable doctor you can work with (most likely an endo not a regular doctor) you are lucky. If not, you do what most of us do which is read, come on here and learn to manage our own D. My doctor just writes my prescriptions for me.
I notice that your page says "Type 1" but also says "orals, diet and exercise". Are you LADA? (a slow adult onset form of Type 1). I'm LADA as well and was on oral meds for 15 months until my numbers started to go up and up. Current thinking says that all Type 1's should start on insulin as soon as possible to preserve beta cells.
I think in the US, general medical education spends a day or two on diabetes. Jeez. No wonder we walk into the office a GP and find they don't know much about diabetes. I finally sought the advice of an endo when it became clear that my GP was not competent to treat me further. She absolutely refused to prescribe insulin and finally when I requested the antibody tests and a c-peptide to determine whether I was T1, she said she didn't know how to interpret them and that I couldn't be T1 since T1 was only diagnosed when you ended up in the ER with DKA. Jeez.
I have diabetes, I have T2, but like all of us I live with it everyday. Over time, I will have a pretty darn foundation of knowledge about diabetes. And I now clearly know when a doctor is competent. But there is another side to what I want out of a doctor. I want not only a doctor that is knowledgable, I want one who listens and lets me make decisions about my care. At one point I had to leave an endo who was quite knowledgeable, but he didn't listen or involve me in my own care. And I have had doctors who, even if they were not diabetes experts, they listened, gave me my prescriptions and really helped.
You can read more about my experience looking for a new endo here.
My reaction to inexperienced doctors depends on my expectations. I was diagnosed by a GP who had little knowledge about T1D and was upfront about it. I appreciated her honesty and began to see a CDE. The CDE was sympathetic, but often couldn’t answer my questions, giving the excuse that she primarily worked with people with T2. I found that response unacceptable and switched to another CDE. This one was a bit more knowledgeable, but wasn’t interested in helping me fine-tune my BG control because she thought it was good enough. I didn’t care for that at all!
After that, I gave up on CDEs and now do my own research and only see an endo. My endo isn’t totally up-to-date in her approach to treating T1, but she’s willing to troubleshoot with me and slowly work toward helping me solve problems in D management. It’s not perfect, but it’s working for now. In a way, I think that unless a doctor also has firsthand experience D, we are always going to have better working knowledge of BG control, insulin & medication dosing, and all the other aspects of day-to-day D management. What matters most to me is their willingness to keep learning and collaborate with us respectfully.
I don't mind having my Dr not so up on diabetes, becuase I self manage to the standard I want to. I have an expereinced GP. His job is just to generally oversee everything and so i have someone who knows what's going on with me. I can also go to him for non-D concerns (and there are a few from time to time).
He believes that a good target A1c is 5.5 and is very concerned with lows. I disagree because I don't personally have a problem with lows. For me I want to be between 4.5 and 5.0, and this is achievable if I stick with my diet and exercise (though I must say I've fallen off the wagon badly over christmas and new year and am struggling to get back on - I seem to have some eating and food issues at the moment). So we agree to disagree and I am very happy with him.
Compared to my endo whose only concern seemed to be if I wanted to get pregnant again (this was just weeks after my second child was born), and who told me to stop insulin after the birth of my second baby, without asking how much insulin I was taking or what my blood sugar readings were (and also no bp check or weight or anything else, even when I brought it up)......
I went through hell looking for doctors after being diagnosed. Each doctor I went to wanted to diagnose me as a Type 2 just because I was still producing insulin. Totally disregard the fact that I went into the hospital DKA (upon diagnosis).
Anyway, one of them, and I still can't believe it, wanted to keep treating me with metformin AFTER my GAD antibodies test came back positive. I begged her to put me on insulin therapy because it was becoming harder and harder for me to control my BG's.
I left her and actually asked around about doctors in my area who treated Type 1 Diabetes. MANY of these docs are ONLY versed in Type 2 Diabetes (since it is so prevalent and publicized). If you are type 1 you have to go the extra mile in some cases...
I finally found my new doctor (who practices in the same facility, the irony)and have had better treatment since then.
I've learned that some of these doctors care more about being right than the welfare of the patient. You really have to be your own advocate and learn as much as possible on your own. Diabetes is the only disease out there where it is totally up to the patient to handle the bulk of their treatment.
I agree with everything you said, Toddy! How absurd that they would want to call you Type 2 because you were producing insulin, despite being in DKA. Then to want to continue giving you inappropriate treatment just so they didn't have to admit they were wrong! I was living in a Third World country at the time my blood sugar started going up and up (after 15 months on orals). My doctor agreed with my assessment that I needed to be on insulin even though neither of us understood why. I'm ok with a doctor not knowing something but can't abide one who wants to insist he is right when he is obviously wrong!