Learning and teaching the endo

[dqmomof3]

This has been a most interesting week. Can I just say that I don't think very many patients at my endo's office do much self-management of diabetes care? :-) This is an interesting balancing act for us. I am a self-care advocate to the utmost degree. I am a childbirth educator and birth doula (temporarily on hiatus!), and one thing I am always teaching my students is to take responsibility for their own healthcare - even when they are pregnant. I can't count the number of times I have watched the lightbulbs go off when people finally realize that they have a say in their own healthcare decisions.

So I guess I came to this disease with a different mindset. I used to tell my childrens' doctors that I valued their opinions, but that I would not necessarily be taking all of their recommendations! It was usually pretty funny to watch the responses. Most actually commended that decision - I had one pediatrician tell me he wished all his patients would do that much thinking!

Anyway, this week I asked the PA about the blood glucose meter. We had a great discussion about it, but would you believe that she had never researched it? No one had ever asked her about it before. No one! Their office has 5,000 patients - mostly type 2's, I'm sure, but still. I sent her some abstracts, she researched and sent me one to read, and we both came to the conclusion that it was a good thing to have. I think she will be recommending them to her patients now. It's been a good collaboration, I think - but something I wouldn't have expected. In some ways, though, I like it. I like that she is willing to learn, and that I am learning along with her. She has made lots of suggestions, some of which we've gone with and some of which we haven't, but I like the meeting of the minds via e-mail for decision-making.

Just pondering, I suppose. Do any of you have a relationship like this with your endo's office? I'd like to hear about the different ways diabetes care works in different places.

[twodoor2]

I guess I get surprised sometimes about what I hear from other people at their endo's offices. The big thing to me that is really shocking is that so few endos have ever heard of the Omnipod. I just find that strange since it is new technology in the world of insulin delivery systems (sorry, I hate calling them pumps - seems demeaning to these marvels of technology:)). I'm also shocked that many of them don't know what the "untethered method" is, or they just keep prescribing NPH so often. I've spoken to two CDE's on two separate occassions, and they both told me that what I was talking about went way over their head:confused:

Well, that's my shpeel! Thanks for posting this, it was very enlightening.

[dqmomof3]

I know what you mean on the untethered method. I had to explain that one to my endo PA as well. I sent her an article about it and how it worked, and she did e-mail me back and said it looked like a useful method for very active children or adults who spend long periods of time off the pump. I told her we might do that with Jayden this summer, and she's ok with that. Before us, she didn't even know what it was! We don't have a CDE, so it's just the endo, the PA, and me :-).

[Heather(CA)]

Yes, we have a great relationship too. I LOVE Seth's endo. I do things a little differantly than everyone else. I add or subtract 1/2 units to the amount of carbs Seth is eating. I can translate it into the way everyone else does it, but for us it works. She smiles and says...Well, whatever your doing, it's working, so keep doing it.

For example, if Seth is running high a few hours after dinner, I add 1/2 a unit to his fastacting dose. This works out to upping it about the same as going from 1:12 to 1:10. It's just a different way of doing the same thing....

Lantus adjustments are the same as everyone else, and are done 1 unit at a time...

[Abby-Dabby-Doo]

That's one of things I like about our Endo. He asks us questions about products.
Most recently he asked us how we get the sites to stay on so well- he had an active patient involved in sports, and the site kept coming off.
We gave him the extra Skin Tac we had in her kit.
He questioned our Salter scale at another visit, and most recently I showed him the Glucophone. We had it compared to a lab draw- Lab Draw 81 Glucophone 89. Since the phone had a blood meter in it, he was hesitant until the lab draw.

I like the fact that he doesn't act like a "know it all" and isn't afraid to ask us something.

[mjtjmcouch]

Lanae,
Where do you get the Glucophone?

Jennifer

[jendean]

Nolan goes to the same Endo as Abby. I remember the first thing he said to me, that first, he is a child, and second, he has diabetes... That he does not like to hear "Diabetic Child" Dr. Gupta is really very cool, listens, and gives good sound advice.
He is a pediatric endo... and that makes a big difference.
Not all endos are up to date, just like not all computer techs know how to run Vista.
The world of medicine is one that you can be very quickly outdated in.

But our doctors are under OUR employ. You can fire any doctor you dont like.

We love Gupta, in fact, most of us would not save the hours drive to go to someone in town if we had someone.

and his nurse, Cheryl--- the best nurse on earth.
No doubt about it.

[Twinklet]

Honestly--I haven't had a situation where I've asked a question of our Endo or CDE and not received a very thorough response. They are VERY up-to-date on technology and current trends in D care, but they spend a lot of time doing in-house research, publishing and attending conferences.

They definitely have a philosophy of teaching their patients how to manage their own disease and view themselves more as instructors initially, then collaborators later. They put all new patients through 6-8 weeks of classes (with homework) and expect us to learn to fly semi-solo at some point.

This fits my personality very well, so I really like this practice and consider myself to be very lucky! However, I've met several people IRL who are not one bit interested in learning how to make adjustments; they don't want to experiment and want to do as little thinking as possible. It always surprises me to meet people like this, but I think they're more common than those who post on here and want to learn self-management.

[Abby-Dabby-Doo]

Lanae,
Where do you get the Glucophone?

Jennifer

The site is down right now, but here is a link where I posted about it...
I'm sorry they aren't giving them out free right now, but here is a phone number, web site, and some info for you!
http://forums.childrenwithdiabetes.com/showthread.php?t=8874&highlight=free+glucaphone

[valerie k]

I would be very shocked if I could surprize matts endo with something she doesnt already know. She is an excellent endo, in fact, there is a whole team (tho we see one) and the support they give is the best.