When should I see an endocrinologist for diabetes?


Here are the five most common scenarios that I would recommend seeing an endocrinologist for:

1) Your diabetes is not well controlled despite the best effort from you and your primary care doctor.

2) You have recently been hospitalized for very high or very low blood sugar.

3) You have type 1 diabetes.

4) You would like to use an insulin pump.

5) You want to participate in diabetes research.

“The ideal person to take care of your diabetes is someone who knows diabetes AND who knows YOU well.”

However, visiting an endocrinologist can be expensive and inconvenient. You may need to take time off from work, pay a copay or travel a long distance. It can also be confusing and frustrating. After sitting in the waiting room for an hour, you may end up getting dozens of cookie-cutter instructions without being heard first. Those instructions may involve more medication or injections which are hard to do and hard to memorize. Therefore, you need to make the most out of the visit.

How can you maximize your visit with your endocrinologist?

The ideal person to take care of your diabetes is someone who knows diabetes AND who knows YOU well. Most important, you know yourself much better than anyone else, including your doctor. Speaking from the perspective of an endocrinologist, I have worked hard to understand people’s values, lifestyle, diet, family support and so on. So far, I have to acknowledge that I struggled hitting my goal of “getting to know my patients well”. With all the time constraints in modern medical practice, it becomes an impossible mission to understand thousands of people and their ever-changing life circumstances.

Many of my patients make daily decisions that impact their blood sugar that can, unknowingly, affect my diagnosis and recommendations. Unfortunately, they get into trouble when full details are not shared with me. For example, I once asked a gentleman to increase his Lantus insulin from 40 units to 50 units a day because his blood sugar had been high. A few weeks later, he had to go to the emergency room for low blood sugar treatment. It turned out that he had a low appetite from a viral infection those past few days and was still taking the 50 units. Had I known he was eating less, I would have recommended he cut down his insulin dose. Another example is a woman who loved bananas. I shared with her that bananas raise blood sugar a lot and she should eat less of them. A few weeks later, she called me saying that her blood sugar was higher after she stopped eating bananas. It turns out that she started eating plantains instead. Had I known she switched from bananas to plantains, I would have explained to her how to look up the carb content so she would be able to find a better substitute and not raise her blood sugar.

Diabetes is a chronic condition that people have to make decisions for on a daily, and sometimes, hourly basis. Therefore, is it possible to teach my patients more about diabetes so they will make the best decisions for themselves on every occasion? I believe yes, so this is the next step I took with my patients. Now I tell them what to do for their diabetes, but I also tell them the rationale behind my advice. For example, instead of just telling the patient how many units of insulin to take, I now show them how an endocrinologist thinks through the insulin dose adjustment (what are the rules behind it). I am now training people how to fish instead of giving them the fish directly, especially since each person likes/needs different fish. In this way, my patients become the best person to take care of their diabetes, because they know themselves better than anyone else and now they are also equipped with medical knowledge.

“Take your questions one step further and ask them, “Where?” Where did you get your information?”

When you go to an endocrinologist please ask the question, “Why?” Find out what you should do, but then ask why should I do it or why shouldn’t I do it? Take your questions one step further and ask them, “Where?” Where did you get your information? Where can I find more information about my situation? Asking why gives you flexibility when your situation changes, and asking where helps your endocrinologist reflect on whether they are giving you individualized advice. You can get the most out of an endocrinologist appointment by asking why and where to help manage your diabetes.

Chi Tang, M.D. , M.S.

Endocrinologist and initiator of the “Help My Diabetes” app. An application to help you safely manage diabetes at home. Contact: app.helpmydiabetes@gmail.com

Dr. Tang is an endocrinologist at Griffin Health in Connecticut. He is one of the initiators of “Help My Diabetes” project to help people safely manage diabetes at home. The focus of his work is to give people more control of their health and life.

Follow me on twitter at: https://twitter.com/ChiTang85224567.

On Facebook at: https://www.facebook.com/helpmydiabetes/

Youtube: https://www.youtube.com/channel/UCDmoH1puIsHJibw6YX2JiWA/videos

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