I'm wondering if anyone gets precriptions through his/her PCP. I'm trying to save time and money. I also don't really see the point of seeing an endocrinologist. I pretty much just go for insulin and supplies.
I don't use an endocrinologist. I did when I was first diagnosed, but now, it's not worth the extra cost in copay for me. My diabetes is extremely stable (A1C well under 7, no issues whatsoever), as are my insulin doses. My PCP is knowledgeable about diabetes, and feels comfortable writing my prescriptions for insulin/pump supplies/strips/etc. I do see a CDE from time to time if issues arise, however. For me, it was more of that I couldn't find a competent endo in the area, but I did find wonderful providers that weren't endos, but were able to help me more.
An endocrinologist ? Who can afford one? and I have never met one that knew any more about diabetes than I did. I tell my doc what I need for my diabetes and he fills out the paper for the pharmacy. He does add things to my needs as he sees fit. I am in charge of dealing with my diabetes on a daily or minute-by-minute basis and he cannot do that. Doctors are only the sounding board for how you take care of your needs, they are not in charge of doing the work, or making sure you do the work, they only give you the tools as you request them. Remember - Cancer can be cured, Diabetes cannot.
Just do what works for you. A good doctor is all you need, whether he/she is a PCP, internist, endo or whatever.
I didn't see an endo (or even have a regular doctor) for years. More recently I got great insurance and have started seeing an endo. She is more knowledgable and has a depth of experience because she has so many patients with diabetes. I also appreciate the more thorough check up she does, simple stuff like checking the pulse in my feet to make sure my circulation is good.
I have only just found a wonderful endo after living in NYC for 7 years. Here's my blog about it:
rundiabetes.com/my-dream-team-naomi-berrie-diabetes-center
I am so grateful to have her as part of my support team. It was very depressing and stressful having no one except my gf and a family doc/nurse look after my basic diabetes needs. Jeff - I feel your frustration but I disagree. Docs do know more than we know in terms of overall diabetes. Yes, we know most about ourselves but they can and will help you improve good control. Ask EVERYONE you know for help in finding an endo that works for you. The struggle is worth it, don't give up. Good luck.
I do not have an Endo...but that is just because I live in rural Montana and am 4 hours from the nearest one. Each time I have gone (it's been over a year now) I felt like the Endo told me things I have known since I was diagnosed at age 7. I use my PCP (Nurse Practicioner) because she specializes in internal medicine. For the most part she can tell me everything I need to know, but adjusting doses is sure tricky without a Diabetes specialist. I actually had my A1C and appointment with her this morning and I save a ton of money and time by just asking her. If you find a really great PCP that you trust, like I did, you should be fine.
Thanks, guys! Your advice/insight has been really helpful. I think for right now, given my financial limitations, I'm going to try to channel everything through my PCP. Maybe one day in the future when I have more money I'll go back to getting an endo.
UPDATE: I saw my PCP yesterday. She told me I would need an endocrinologist because I have a pump... Drat.
First off Congratulations! What an exciting time in your life to get married and now have a little blessing on the way. I'm currently half way through my pregnancy and also a T1. From all the research I have found and gathered from talking with my doctors the first trimester is really the most critical for keeping your blood sugars down. The first trimester is when everything is developing and then after that everything is growing.
I don't know if everyone else will agree but from what my medical team has told me it's the highs that really hurt the baby. The baby will get any extra glucose in your system. Are you on a CGM (continuous glucose monitor)? I wasn't before getting preggers and am really glad that I'm on one now.
Also, just a warning doctors will try and scare you. They tell you how high risk you are just because your a diabetic. They tell you everything that can go wrong with your baby. Just keep asking the right questions and make sure you have a team that your comfortable with. From what I can gather if a T1 mom has her blood sugars under strict control than there shouldn't be any complications. Just relax and enjoy being pregnant!
Congratulations!
Brigid
I had an unexpected blessing too, after 28 years with type 1. My pregnancy was healthy and normal.
If you take an ACE inhibitor like Lisinopril, stop taking it immediately and contact your doctor. it's linked to birth defects.
Insulin pumps are great for managing the ever changing insulin needs of pregnancy. At the advice of a nurtritionist I ate the same breakfast every day of my pregnancy so it was easy to see if basal rates needed adjustment.
My goal during pregnancy was to have a non-diabetic A1c, so I aimed for blood sugars of 80 and tested A LOT to make sure I could catch lows early. Low blood sugars can impact your baby's brain development.
I'm also a fan of Cheryl Alkon's book "Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom Healthy Baby."
Congratulations!
Hi I am a pregnant type 1 and I have found it to be a bit tricky dealing with diabetes and pregnancy. During the first trimester I had a lot of surprise lows because of the baby. The lows really would hit hard during the middle of the night. Now in my third trimester it is the highs that are hard and the very large doses of insulin that I am having to take. Talk to you endo. He/she will try to work with you and make adjustments frequently to keep both you and your baby healthy. Good luck!
Hi Tara!
First off congratulations. You may be in a state of surprise/shock now but down the road you'll see that having a child is the most amazing thing in the world. I have a son who is almost 2 and am currently pregnant (unexpectedly) with my 2nd and can vouch for this as a fact! I have been T1 since 1997 and have gone back and forth over the years from shots to pump. For both of my pregnancies I've used a Minimed pump and CGM which have helped me to do my best to control my BSs and keep the baby and myself healthy (and really helped during nursing). (First preg A1c 5.9 avg and now 6.4). It's definitely a challenge to maintain healthy sugars given the hormones, lack of sleep, weight gain and food requirements, but if you are willing to put in the energy you will feel great and have a healthy strong baby to show for it!
Drs definitely try to put all the risks on the table and that can be scary, but know that those are mainly applicable to diabetics who have not had good control over long stretches of time. The most damage is done, according to my Drs, from extreme lows or prolonged highs; and these are the easier things to avoid.
Fortunately for you you have a healthy platform having only been recently diagnosed so YAY! If you have any questions please feel free to reach out. I also wrote about a lot of my experiences on my site: www.mommabetic.com if you are curious.
Be well and don't worry too much!
Danielle
I went to the endo last Wednesday and my A1C was 6.3, not too bad!! I've been feeling pretty good!! My OB appt is the 30th, so fingers crossed and lots of prayers!! And, I HIGHLY recommend Cheryl Alkon's book "Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom Healthy Baby." I'm already half way thru it and it is very helpful and inspiring!! Thank you all!!
Congrats on the baby! I am T1 and on the pump. My husband and I have been seriously talking about having a baby, but I am very nervous about getting pregnant. In all of my research and talking to my gyno and my previous endo I have always heard that I need my A1C to be as close to 6 as possible. Today I went to a new endo for the 2nd time (moved to a new state and had to switch) and she said that my thyroid now has to be managed while pregnant, but there are no issues now. I have never heard this before. My mom told me to talk to a gyno and do a little more research. Has anyone else been told this? I feel like being put on thyroid medication while pregnant wouldn't be a good idea. It is all too much and overwhelming. I told my husband maybe we should just adopt.
T1 since 1999
Alison,
Hi there I am a T1 and also have hypothyroidism. My last A1C was 6.2 and my endo is actually more concerned about my my thyroid than my blood sugars. I don't know all the details but basically when you have a baby inside of you it really messes with your Thyroid. If you thyroid levels are off during pregnancy it can really harm your developing baby. My doctor checks my TSH, Free T 3 and Free T4 every 6 weeks to make sure we are being proactive and keeping my levels at the right spot. I would say that it's good to be proactive and perhaps start some synthroid (if necessary) rather than waiting till your doing damage control.
Hope that was helpful!
Brigid
Thank you very much. That was very helpful. I am the only one in my family with diabetes and don't have any female friends with it either. My mom is able to give me advice most of the time, but she doesn't know what a pregnancy would be like for me. I do value what my doctor has to say but she is not diabetic so sometimes I get frustrated having no one around that understands what I am going through. Thank you very much.
Alison,
You shouldn't borrow worry. Whether you're a diabetic or not, every mom stresses about health concerns for her baby and herself. One of the most humbling parts of being a parent is that you quickly realize you are not in control. You just do your best to prevent problems and learn to live with whatever challenges you have.
As a diabetic there's no reason you can't have a healthy pregnancy. I never planned to have children because of my D, but after getting pregnant unexpectedly I was surprised to learn how very possible it is to be a healthy diabetic mom who delivers a healty baby. Wish I had known this when I was younger... I would have had 6 kids.
Before pregnancy my A1c was about 7, but once I was eating, carb counting, and bolusing for two it was easier to have really tight D management and my A1c quickly dropped to 5.1 and stayed there for the pregnancy.
Do you have thyroid issues now that your doctor is concerned about? If so, get more information from your doctor and assess your risk. I would definitely get a second opionion from someone. Many women have thyroid changes caused by pregnancy or just by getting older. It's not the end of the world and can be managed. I'd been hyperthyroid most of my life (used to be able to eat anything without gaining weight) but my pregnancy made me hypothryroid.
My endo said she's not worried about my thyroid now, but it will be a concern when I do get pregnant. I am definitely thinking of getting a second opinion. I want to make sure I have all my facts straight before getting pregnant. Thank you so much for all your input. It really has put my mind at ease to hear it from people who have experienced this.