Sometimes you need a specialist. Someone who knows diabetes inside and out. When my family doctor made the referral, I was pretty sure he would let the endocrinologist know my goal: no insulin before my time. I also am realistic enough to know that the endocrinologist's goal may be, or may need to be, different than mine. I went into the appointment very nervous that our goals may be different. I wasn't sure how I was going to handle it if he said it was time for insulin.
I did my homework prior to this appointment. I read up on the oral meds. I also read up on some of the other medication options like injectable non-insulin drugs. As much as I was hoping this wasn't going to be the path taken, I felt I needed to know more about these drugs. So I read. And I read some more. I got very comfortable with the idea...just in case. I was glad I did. There were some significant warnings on the one injectable. Thyroid cancer. The warnings came from the drug company that makes the drug. I went to the Health Canada website. I came away feeling the risk was not as great as I had thought. I would ask the endocrinologist though.
The specialist was a quiet man. He spent time getting my history. He seemed genuinely surprised that I was able to deal with my diabetes for 8 yrs by diet and exercise. Believe me, I was proud to tell him.
The plan was now to be revealed. It was interesting how he worded this. He called it his plan. I didn't feel left out of the decision though. Not at all. I think it's because of his manner. Quiet. He sat back in his chair relaxed. There was no indication he was in a hurry to get me out of the office.
The plan started with separating the metformin from januvia and discontinuing the januvia. That combo just wasn't bringing my sugars down. So he added jardiance instead and trulicity, the injectable. Time for my questions. I didn't really have any questions about the metformin or jardiance. It was the trulicity and thyroid cancer that I needed his expertise on. The doctor explained that this was a very rare cancer. It was not the 'usual' thyroid cancer that is so common. This cancer has a distinct family history attached to it. I have no such history in my family. He explained the science behind it which went further than what I read on the Health Canada website. I felt pretty good about this drug then. He also explained that although it hadn't be proven yet, it would not be very long before this drug will show that it is cardiac protective like victoza. Trulicity is also a once a week injectable versus victoza that is a daily injection. He taught me how to give the injection into my abdomen. Seems pretty simple. Sold.
The doctor also gave me the time to ask the other questions I had. I had already changed the amount of carb I was eating at meals and snacks. The RD-CDEs all chant 45-60 gms of carb at meals. This is too much for me. My blood sugars do not come down with that much carb! He smiled when I asked him if he could support it, he mentioned that he knows what the RDs would say but yes he supported this if it worked for me. Next I asked him about the ACEi that the cardiologist prescribed that I hadn't started. It's a blood pressure med. I know it protects the kidneys from diabetes. I had my BP checked once a week by a nurse friend since I saw the cardiologist a month ago. I really didn't see the need for a BP med since my BPs were either normal or low. The endocrinologist hesitated, thinking it through, then said he'd like me to hold off taking that med because the new diabetic meds can lower my BP even further. He told me to check my BP once a week and we can talk about it again in 3 months when I come back. I can really appreciate that he did not want to contradict other professionals, that's what the hesitation was. His respect for me and other members of my health team was such a relief. He obviously believes in individualized care. In my opinion, he's the quarterback. He's the one running the show. And I am very glad he is.
You have no idea how relieved I felt leaving that appointment.
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