Time to consult an endocrinologist? How do you handle that conversation with your primary care doctor?

Dr Gary
By Dr GaryCA Latest Reply 2013-12-05 12:59:32 -0600
Started 2013-06-03 21:48:57 -0500

Awhile back, I posted an article on how to tell your doctor that you want to consult with a specialist. Here is the link:


In my article, I talked about how patients sometimes come to the point where they want to have a specialist on their treatment team. Reasons might include a concern that their doctor doesn’t have enough training or experience, or that his/her approach may be outdated. Or wanting a second opinion.

As your healthcare needs evolve, so should your healthcare team.

While consulting with another doctor may or may not mean breaking up with your current doctor, this can be an uncomfortable conversation for patients, their doctors, or both. Patients may have to get over their own fear that they will hurt their doctor’s feelings, or cause him/her to become angry. On the other hand, patients can feel pretty comfortable in having this discussion, but learn that their doctor isn’t so happy about the idea.

So, if you have made the decision to consult with an endocrinologist or other specialist, how did you get the conversation going with your doctor? And, how did it go?

Any advice to share? Stories?

8 replies

buffy360 2013-12-01 14:53:21 -0600 Report

For some reason the link you provided is not a hyperlink, nor can I copy it on smartphone. Wondering if in future there is a way to create hyperlink in DC.app? Thank you. I would like to read the referred article.

Dr Gary
Dr GaryCA 2013-12-05 12:59:32 -0600 Report

Hi buffy,

So sorry you can't get to this. I will see what I can find out. Thanks for your interest!


Type1Lou 2013-06-05 11:12:33 -0500 Report

Back in 2010, I had become uncomfortable with my PCP's handling of my diabetes. I had been experiencing increasingly frequent low BG episodes and he advised me to increase my Lantus while decreasing/eliminating my mealtime Novolog. (???!!!) After landing in the ER and being admitted to the hospital while on vacation 2000 miles from home, when he told me to continue on the same insulin regimen, I decided I needed the expertise of an endocrinologist and made my appointment. Because of insurance, I did ask my PCP for a referral which he promptly provided. I still see him for my non-diabetes health care needs. As a PWD, I feel it is important to learn as much as I can about my condition since there is a large component of self-management to good control. I'm convinced that seeing that endo saved my life and spared my husband from dealing with the crises engendered by the hypoglycemic episodes. I started pumping in 2011 and have virtually elimanted the scary low BG's. Life is good!

Dr Gary
Dr GaryCA 2013-06-05 22:04:32 -0500 Report

Hey Type1Lou,

Thanks a lot for jumping in to the discussion.

Your story is an excellent example of the value of reaching out to a specialist when you suspect your doctor may not quite be up to the challenge of treating your diabetes. However, given that you ended up in the ER, not up to the challenge may be an understatement.

I totally agree with you. It's important to be an educated patient, and this is especially important for diabetics given how involved you have to be in your own care. Being an educated patient also means knowing when it's time to consult with a specialist. Glad to hear you made this move, and that you are doing so well.

Great to hear from you!


buffy360 2013-06-03 23:09:13 -0500 Report

The conversations took a year of "discussing" and my talking several times to insurance about five different TSH levels.

Dr Gary
Dr GaryCA 2013-06-04 21:48:59 -0500 Report

Hi buffy, the insurance companies play a pretty key role here, don't they? That can be a big barrier to get over.

buffy360 2013-06-05 17:04:05 -0500 Report

I didn't mean to confuse any reader by talking about my TSH (thyroid term) on Diabetic board. I forgot to mention that last spring 2012 I began treatment for Hypothyroidism (Levothyroxine), ADHD (Concerta). I was only able to reduce 10% body weight, not enough yet, I know. Evidently my PCP (P.A.) is now using the term prediabetes. Waited almost two years to try to find an Internist to replace my PCP, P.A., for Internist, but there was only one available and 50 mile drive, ugh. I'm on SSI, and everything feels limited from transportation to access to proactive care. The insurance is Medicaid, unfortunately, keeps changing. I've been Asthmatic since 1964 with food allergies, three immunization programs and still can't get help paying for decent allergy medicine requiring PA (prior auth) which would save money on nebulizer and supplies and Albuterol, Advair meds. After diagnosis of UC (Ulcerative Colitis) in 2009 after losing 65 pounds from diarrhea put me in hospital for Hyperkalemia (low potassium) and the saga continued through gall bladder surgery (admitted for 6 days), PICA, Pneumonia followed by Iron-Deficient Anemia, then asked my GYNO to test TSH (5.58). Through Gastrointerologist got to Allergist last summer finding new food allergies and finally saw an Edocronologist last week! He has 30 years in the field and couldn't believe how many issues I've had to experience before looking into Metabolic Syndrome or even increasing Levothyroxine. I'm sorry if this is hard to follow, it's confusing. Just took 24 urine collection for creatine? Am awaiting results of many blood tests and hope to hear something this week that can explain why my immune system is on the blitz.

Frankly, having food allergies in 1964 and allergists for 20 years was a big clue of possible issues to watch for. I'm learning about GMO issues and trying to afford organic food to reduce pesticides, hormones, dyes, preservatives in my food. I've given up red meat, bread/wheat, condiments, sauces, fried food, HFCS, corn syrup, sugars especially sorbitol, aspartame, etc. New food allergies from milk, chocolate, tree nuts, shellfish, tomato childhood allergies to lactose intolerant, gluten intolerant, eggs, corn, soy… Industry has put corn, soy, egg, milk in just about anything.

Been through a lot of learning choices, reading labels, and pray there will be something that can change these progressive conditions to full blown diabetes. My Mother suffers as her Mother before her did.

Dr. Gary, yes the insurance companies short-change PROACTIVE consumers and encourage Doctors to gage compliance of their patients and in some cases have made me feel crazy. Maybe some tests could've helped to sort out what has been going on. Since 1990 I have been dealing with PTSD which contributed to break down of my strengths.

Thank you for starting this conversation. It's finally started but I had to really be a "pill" to get the referral. I've lost 2-3 years now on top of the twenty of dealing with PTSD. I am looking forward to learning that I am not crazy.

Dr Gary
Dr GaryCA 2013-06-05 21:54:23 -0500 Report

HI Buffy,

Thanks a lot for the additional clarification. Your post was really fascinating to read, and I appreciate that you shared all of this with us. Your story is a great example of the journey many patients have to on to get to the right diagnosis and then the right treatment for that diagnosis. And a great example of what it means to be empowered.

It seems to me that so often medicine is about treatment but not prevention, reactive but not proactive.

Your comments about food choices were also interesting. I am hearing more and more about GMO, as well as corn syrup and some of the chemicals you mentioned.

We are all having to be much more involved in our healthcare.

Thanks a lot! I appreciate your wisdom and experience.


Next Discussion: Brittle Diabetic »