Diabetes,  Doctor Visits,  Medications

The Endo Encounter

So, you know that endocrinologist appointment that I was panicking over last week?  Well, I survived it.  In fact, it went better than I feared it might.  I do have some reservations about it, but I’ll get to those in a bit.  First, the good parts.

Doc D. is a young guy, maybe 34 years old at most.  I’m 31, so we’re close in age.  He was attentive, listened, and took the time to get to know me and my situation.  He asked a lot of questions and documented my responses as we went along.  I appreciated how thorough he was, and the fact that he took the time to process my information and put his recommendations in writing before he tried to explain his thinking behind them.

He revised my meal time insulin regimen, giving me a coverage plan that is more logical and better suited to my needs.  That should help a lot.  He left my Lantus and Victoza doses alone.   He also prescribed the oral type 2 drug Jardiance for me to try, and suggested that I add a coenzyme Q10 supplement to help strengthen my heart and increase my energy levels.

Doc D. also said he wants to check my pancreas output with a c-peptide test.  He was a bit surprised that I’d never had one.  And since he was ordering tests, I requested that he order GAD65, IA-2, and insulin auto-antibody tests while he was at it.  I practically begged my PCP to run those tests, but they were never done.  Now, they will be.  So, I have that bloodwork to look forward in two months.

He took his time and didn’t rush through the appointment.  That was huge in my mind.

And…. AND…. There was no mention of my weight at all.  Let that sink in for a second… The doctor did NOT focus on my weight at all.  I’m really not use to that.  I was honestly kind of shocked.

His focus was more on nutrition.  Eat better, the benefits will follow.  Hey, I agree with that logic.  I know it works.  But the means of getting there are where some of my reservations begin.

Doc D. is something of a paleo diet evangelist and strongly “encouraged” me to adopt that diet and to severely restrict my carb intake.  He wants me to give up a lot of things that I’m just not sure I’m willing to ditch completely.  I have a real problem with having to deprive myself of the things I love, and I have no desire to go back to starving myself like I did for months after I was diagnosed.  While the results at that point may have been beneficial for a while, it ultimately lead to a major crash and burnout.  I don’t need that again.  I’m willing and wanting to make some changes, but I’m not sure the paleo diet bible is one that I’m willing to thump.  And I’m certainly not going to be beaten over the head with it.

The other major reservation that I have concerns the drug Jardiance that I mentioned above.  I had never heard of it, but through some research I’ve learned that it’s basically Lilly’s version of Invokana.  It’s an oral type 2 drug that is supposed to help my body dump excess sugar when I take a leak.   I’ve heard mixed things about that class of drugs and I’m incredibly leery about starting it.

I have two issues with this.  One, yeast infections are listed as common side effect of this medication.  If you’ve read my story, you know that’s what lead to my diagnosis in December 2008.  It’s understandable that I wouldn’t want to venture down that road again.  Secondly, do I really need another medication on top of what I’m already taking to treat my diabetes?  I’m already taking Victoza, Humalog and Lantus.   I think that’s enough. And I’ll spare you a rant about the additional monthly cost of that medication and the CoQ10 supplement.

So overall, the appointment went well.  I have some strong reservations about some things, but there were some really positive things that came out of it.  I’ve got some clearly defined goals to work on as far as my A1C goes, a better insulin regimen, a new supplement that seems to be helping to boost my energy, and hopefully a doctor who will be the same at the next visit as he was at the first.  He listened, he was thorough, and didn’t leave me feeling judged.  I see him again in September.

Time will tell.

Mike

Living with a Confusing Pancreas and a Broken Heart at age 34 #Diabetes #LADA #CongestiveHeartFailure. #MakeDiabetesVisible Creator, Advocate, Blogger, Nature Photographer.

6 Comments

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    Kate Cornell

    This sounds like a GREAT appointment Mike! A doctor who listens and takes time…wow! First: my hubby takes Coq10 also and I’m glad to hear that you are too. It is pricey but worth it. (We buy his at Sam’s) As for the diet, I’m also leery of being pushed to follow a specific diet. I’m “low carb” now but I fine tuned things to fit my life (my diet is called Esther). I mostly cut out processed foods but there’s more to it than that. Pick one thing Mike! Pick one thing to change. You can do it! 🙂 This is a hopeful post and it makes me happy for you. Hugs.

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    Brian (BSC)

    It sounds like you have a real winner of a doctor. I have to say, so many doctors have given me totally useless nutrition advice that hearing a doctor recommend a low carb paleo approach is a breath of fresh air. Let me also comment on Jardiance. I’ve been on Invokana and now Farxiga for more than year (well technically Invokamet and Xigduo). My insulin requirements have dropped like 30%, my fasting blood sugars have improved and I lost a bit of weight. I’ve not experienced any infections and except for more frequent trips to the bathroom it has been uneventful. And while these drugs can cost more, don’t forget, you can probably get Jardiance for free for a year. Just visit https://www.jardiance.com/.

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    Abby

    Glad the appointment went well! I can’t comment much on the medication, except for the clinical pharmacology, but I did want to say something about the paleo diet.

    My therapist, yeah a MENTAL health professional, pushed this on me a few years ago. Even made me buy a book. Not for weight loss but she said it would just make me feel better because I wouldn’t be drinking milk and I wouldn’t be having any bread, etc.

    I trusted her so I tried it. It was awful, IMO. You basically eat meat and nuts. Almonds. SO. MANY. ALMONDS. I lasted about 3 weeks eating like a squirrel and she came off the diet shortly after.

    I am not telling you not to try it, you may love it! I’m just saying, it’s a lot more strict than a “regular” low carb diet!

  • Avatar

    Scott K. Johnson

    Mike,

    I’m so glad to hear that your appointment went well.

    It sounds like he’s very empathetic and someone who’s willing to listen to you and help build a plan that fits you and your needs.

    As you say – time will tell.

  • Avatar

    Douglas Michael Massing

    Hi Mike,

    Congratulations on a good first visit! After talking about it for months, I finally requested an endocrinology referral yesterday.

    I have an off-the-wall insight into the paleo diet from having been in both arms of a crossover study comparing it to a diet designed within ADA guidelines. A glucose clamp at the end of the intervention showed that my insulin resistance worsened on the paleo diet. Apparently I was atypical—I can still recall the puzzlement on the face of the lead researcher as he checked my results. Just another reminder that when it comes to the body, there’s no “one size fits all.”

    Best,
    Michael