Just had to find an outlet to rant and rave.

My endo wins the golden award for Worst Bedside Manner in the Universe. I've seen him only twice since being diagnosed in June 2009 for a grand total of about 10 minutes. The first time he was curt, the second time rude and impatient as well.

Here's the story: the first time was December, when he met with me for about 5 minutes, gave me the brush off, wouldn't answer any of my questions, told me to get my A1C under 5.7 (A1C was 6.0...diabetes discovered very early due to follow-up testing after GDM) and prescribed me Januvia, told me not to come back but to follow up with my GP. Long story short: adding Januvia, daily workouts and a low-carb low glycemic diet did NOT budge my A1C. After six months I emailed him ("are you SURE I'm type 2?"); he said to meet with him and he would add on another med.

So I went to my appt but was informed he was away on a family emergency (thanks for the call! I had to take time off work for that, too), and the next available appointment would be in five months. FIVE MONTHS. Even in Canada with our loooong waits for treatment I thought that was extreme so I begged (well, begged, complained, begged, wheedled, cajoled...) and managed to get in to see his associate, a Diabetes Case Manager (DCM).

So, DCM meets with me and suggests that perhaps I should try Janumet for a month before going onto Lantus. Ok. But, DCM starts me on Janumet 50g/1000mg 2x/daily. Yes, folks, that's 2000 mg of metformin daily, as my introductory dose. Boy, did my body have something to say about that! After three days of pure hell, I couldn't take it anymore and emailed again. At least Endo emailed to say to stop the Janumet. And was generous enough to fit me in for an emergency meeting three days later. Maybe generous is the wrong word, though; in retrospect I think he was just trying to get rid of pesky me as soon as possible. (God forbid that a new diabetic should want answers or guidance!)

[*All Endo's answers need to be read with a condescending, brusque, rushed, "you're-wasting-my-time" tone of voice. Feel free to interject a very impatient "I have a deadline to meet in FIVE MINUTES" every few lines or so.]

So the meeting lasted about 10 minutes at most. Shot down my questions. Am I type 1 or type 2? Time will tell. Do you think I could get the antibody tests? No. May I ask why not? Wouldn't make a difference in your treatment. (hello, isn't it the patient's right - and the doc's responsibility - to know?!)

Accuses me multiple times of "starving myself". I say, no, I'm taking 30g a meal and 15g at snacks (this is very high for me, but his nutritionist told me to). He says that's nothing, you're starving yourself (said very rudely). I argue, no, this is exactly what your nutritionist told me to eat, and it's more than I ate even before I was diabetic. He sniffs.

He gives me Lantus and Humalog and tells me I can use one or the other, but not both. I can choose. (Choose?! Shouldn't there be more of a treatment plan than that?) Endo: Maybe the Humalog because you're starving yourself. I'm not! Yes, you are. Do I need to clean the injection site? No, don't bother. Do I need to change the needle? No...well, you're supposed to, but everyone uses them multiple times. You'll be fine.
(Ok, maybe true, but coming from a doctor? Encouraging multiple use of needles?)

He tells me to keep my 2hr pp under 7 (126). I say, it's already under that, my highs are 1 hr pp, when I hit 10 or higher (180+). He says, well keep the 2hr pp under 7. I ask "do you mean the 1 hr pp?" Well, WHATEVER (impatiently). You're being difficult. Look, I have a deadline to make in THREE MINUTES and then I'm late. Do you want me to show you how to use this or not? (meaning, shut up and STOP asking questions!)

Shows me out the door with 2 pens and prescriptions. No packaging, inserts or instructions for the pens. (online, I see that before opening they are supposed to be refrigerated, which they were not. Are they still ok to use?) No follow up appointment. No instructions on how to adjust the Humalog based on carb intake. Now I have absolutely no clue how to begin. I am scared to death to take either in case I go low. How do I figure out my doses? Who do I
see for help in managing this?

I'm not going back to him again, but a referral to another endo could
take months. So, I pick my poison...dive into the world of insulin with
no guidance, or keep my elevated BG levels until a referral comes
through.

I am not a writer and I'm too exhausted to try, so I don't think I came anywhere close to capturing how horrible this session was for me. I was on edge the entire appointment; I felt inconsequential and helpless, and I was so upset by the whole thing I had to pull over on the way home to calm myself down. I see on Rate My MD that he was rated terribly by other folks, so I am not the only one to experience this.

Why do people become doctors if they have no interest in helping patients?






Views: 12

Comment by Gerri on July 1, 2010 at 12:18am
Yes, he wins the award & you'll see many stories here of close runner-ups. You were treated horribly, disrespectfully, rudely & received no help. Gee, what else is left to further mistreat a patient!

Get the following books. Using Insulin by John Walsh & Diabetes Solution by Dr. Richard Bernstein. Also, check out www.bloodsugar101.com.

Doctors typically start patients on a ratio of 1:15 for Humalog. One unit of Humalog for every 15 carbs. Begin with something that you're certain of the carbs. Better to start with something that's 15 carbs. Test before you eat. Test again 1 & 2 hours after the meal. If you're within a reasonable range (not terribly high or low), then you've got the correct ratio. Eat the same amount of carbs at the same insulin dose for three days to get the full picture. After three days, adjust the dose up or down by only 1 unit of insulin. Don't make wild changes. Log all your readings & doses.

Most rapid acting insulin peaks in two hours & lasts 3-4 hours. Good to space your meals 4 hours apart to avoid stacking insulin that will cause lows.

Lantus dose, taken once or twice a day,is based on weight for starters.

The general guideline is take Humalog 15 minutes before eating. This is something that may need adjusting to see what works best for you.

People often have different insulin:carb ratios for different meals. Morning tends to a time when the ratio is smaller. Lunch can be a higher ratio & dinner lower.

Using Humalog to correct highs is also important. This is loosely based on weight, but everyone is different. For example, I weigh 105 lbs & use Apidra for rapid acting. One unit of Apidra lowers my BG by 60 points.

To correct lows, you'll need to experiment to learn how much 1 gram of glucose raises you. Use fast acting glucose, not food. Also by way of example, 1 gram glucose raises me 10 pts. It can take up to an hour to see the effects of glucose.

Test a lot, write everything down & go slowly & conservatively. You should test first thing in the morning, before every meal, 2 hours after meals & before bed. Test before you drive & if you feel low or high. You don't need to snack.

You don't need to use alcohol or anything to clean your injection site. Wash your hands & dry them well before testing. You don't need to use alcohol swabs on your fingers either.

You shouldn't use needles more than once, but people do. Keep needles for Lantus & Humolog separate, if you're going to use them again.
Comment by Tim on July 1, 2010 at 5:48am
Your "world's worst endo" is clearly at least in 2nd place.

In the 90's I went to an endo that had been highly highly recommended. He refused to treat me until I took a glucose tolerance test. I thought that was really weird because I came to him with a log sheet of all my bg tests and insulin doses in the past couple months, but he refused to look at those. I knew that the glucose tolerance test was several hundred grams of carbs; I asked if I was supposed to take my insulin before or after the test. He told me I was supposed to stop taking insulin until the test was done.

He told me that because I was an adult that I couldn't have "Juvenile diabetes" anymore and needed the glucose tolerance test.

I never went back to that guy!

The thing was, he was regarded as a "god" by many of the other docs in the area - they swore up and down he was the best at treating diabetes and had been doing it for many decades.

That really fundamentally altered my perception of the medical system.

Tim.
Comment by Trudy on July 1, 2010 at 5:52am
Gerri, what good and complete advice. I would add just one thing: lows are much less likely to occur with Lantus (or Levemir) if the dose is divided into two shots. I would be forever traumatized by such an unthinking endo!
Comment by Xanthasun on July 1, 2010 at 6:48am
I'm sorry your first endo had to be so bad...but the way it was written was well done (I enjoyed your thought comments! when you were writing the dialogue)
It's rough when your endo seems to have no interest in helping out and even is discouraging because you already have enough to deal with especially when you're new!
I recommend reading what you can (Gerri's book recommendations are good) but also come back and ask questions. There's a number of newly and newer diagnosed people on the site as well as 1.5 types and those trying to figure out what they really are.
Comment by Joe_h on July 1, 2010 at 7:01am
wow sorry for your troubles that guy is a tool. your A1c is 6.0 and they want to put you on insulin to get it even lower?
Comment by Bubbaluv on July 1, 2010 at 9:15am
I would put him in the larger pool of worst professional, let alone worst Doctor or Endo. I don't get his statement regarding "it wouldn't change your treatment". Excuse me? I'm pretty new to all of this, but i have spent a ton of time reading and researching and since you were not originally on insulin at dx, i would think if you were in fact T1, your treatment plan would be significantly different.

Gerri's suggestions are great, whether you end up being T ot T2 or something else (LADA, MODY, etc). I'm not on insulin so haven't the read the John Walsh book yet, but bloodsugar101 was my first read and Bernstein the second and both provide great resource for overall healthy living with D.

Its hard enough as a D managing things we know about, particularity early in the process (diet exercise and things like that). Its that much more difficult when we have to learn skills like treatment plans, MDI, pumps, Medications, how each works and how they interact. That's what docs are for and its unfortunately that there times we have to manage it ourselves. But your not alone and at you have the ability to identify there is issue and start working the process.
Comment by Sidney Partridge smile on July 1, 2010 at 11:01am
I don't know what you can get away with in Canada but here in central Illinois. I definitely stand up to my rights. I'm 60 years old and a 20 year type 1. I knew what I was talking about. My wife and I are team players together and well informed. Lost my doctor to sudden death on tennis court. This new doctor was young and full of it. He discounted my questions on lower leg issues and says it was not diabetic related. He did not like the challenging questions we had. He said that I was copping out. That was it. We ended it right there and walked out. Told the nurse that we will not pay the bill and certainly not $60 for a toothpick for poking my feet. We told her that he was an arrogant ass h--- and fired. We asked her to inform him of this discussion and will tell others to avoid him as a doctor. She was not too surprise. Now have a doctor who is perfect. He ask lots of questions and we banter.
Comment by Tim on July 1, 2010 at 11:24am
I'm not claiming he's the most perfect doc in the world. But I look at what you write (just like he listened to what you said) and come to the same conclusion: you're T1/LADA and the insulin will do you good. C-Peptide tests are popular but some things are obvious enough without the C-Peptide test. I take insulin for the past 30 years and I myself would scoff at anyone suggesting that it would do any good to have a C-peptide test run on me - I see my scoffing reflected perfectly in your endos remarks! It's too bad your endo couldn't fill you in like you deserved to be, though.

You have some of the tools (pens, prescriptions, bg tests) and a little reading will get you far more up to speed than another 15 minutes with the doc would've.

Today most hands-on training by CDE's would be regarded as primitive by those who know how to crack open a good book or just use google.
Comment by nel on July 1, 2010 at 1:22pm
You may want to complain , followed up by a letter as you described the conversation here ...I am uncertain if the BC Medical Association can direct you .Did you not have any contact with CDE's??
What training does a DCM have ?
Comment by Ligetia on July 1, 2010 at 2:50pm
I really appreciate all the responses, advice, empathy and shared stories. It makes a huge difference to have this network esp. when new and trying to figure out what to do and how to manage all the various aspects of life with D. It can be overwhelming, and it's just such a shock to have a nasty endo who just makes everything 100 times worse. Gerri, thanks for all the practical advice on using the insulin. I'm going to start tonight...

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