Very newly diagnosed Diabetes II.

[Divernan]

I am on glyburide-metformin 2.5/500, exercising daily, have met with dietician and am waiting for appt. with a general diabetes counselor. What really scares me is that I was about to have cataract surgery(pre-op testing revealed the diabetes). Based on my web research/medical journal articles, my eye doc should have spotted that there was a medically significant anomaly between my cataract size and the amount of vision loss indicating peripheral neuropathy. This is particularly true given my age, medical history of pre-diabetes and weight. She didn't and scheduled my surgery for 4 months later. Now here I am, 4 months later, with newly developed peripheral neuropathy (1 month ago). Med. articles state cataract surgery should be delayed until my eyes are further tested/measured to determine the exact extent of retinal neuropathy. If certain conditions are found, they must be treated/stabilized before cataract surgery, or I could risk serious vision loss.

I've lost confidence in my eye doc. Will be calling her office today to delay/postpone cataract surgery.

My internist offered, in a frankly discouraging way, to refer me to an endocrinologist, or to treat me herself. "I treat a lot of people with diabetes." But she didn't give me any info about retinal neuropathy, and when I asked her if I should go ahead with cataract surgery, she said that would be up to my eye doc.

You all remember how overwhelming all of this is - I know I'm facing a steep learning curve. I need to have confidence in my doctors. At this point my plan is: continue my daily exercise, work on understanding and implementing diet restrictions, take my meds, and
1. Cancel for now any cataract surgery,
2. Meet this week with the diabetes counselor (who's been unavailable over the holidays),
3. Find a good endocrinologist (whom I hope would refer me to an eye surgeon with lots of experience in diabetic retinopathy).

What are your thoughts on having my disease managed by an endo. doc versus an internist?
Finding a really good endo. doc.? Do endo docs sub-specialize in diabetes versus other areas?
Anyone know a good endo. doc. in the Pittsburgh area?

I'm just so upset and angry (well aware that my anger arises out of fear) that my eye doc didn't pick up on this four months ago, long before the peripheral neuropathy started. And here I am with a very good insurance policy - no limitations on seeing specialists or getting a second opinion.

At this point, it is just all so frightening.

[Altoid_Cyclist]

1. I don't know if this will help, but the UPMC Eye Center helped me a few years ago.

I was having all kinds of vision problems and was completely mis-diagnosed by an Ophthalmologist and two Optometrists.

I went to Pittsburgh and saw their Neuro-Ophthalmologist and finally received the proper diagnosis. Not good, but at least now I know what was causing so many problems. The entire staff there treated me like I was their most important patient. One of their specialties treated is Diabetic retinopathy.

I can provide you with the name of the Doctor I saw if you want. I would highly recommend her to anyone with vision and nerve problems.

Link to their site: http://www.upmc.com/Services/ophthalmology/Pages/ophthalmology-experts.aspx

[Divernan]

2. Thank you very much for your reply.

If you would pm me the doctor's name, I will call to make an appointment. I talked to the UPMC Diabetes/Endocrinology Dept. today, and the earliest appt. I can get is in April! I have requested my internist call them and ask to get me in earlier.

I definitely want to get an opinion from another opthalmologist, and the doctor/group you describe sounds excellent.

Again, many thanks.
Nancy

[Warpy]

3. When was diabetic retinal neuropathy actually diagnosed?

If you have a question about whether or not you in fact have this condition, you need to make a pre op appointment with the ophthalmologist to have your retinas evaluated.

Either the surgeon will find nothing and go ahead with the operation or will discover the condition and delay the surgery again while you are stabilized.

Dr. Google does not know you personally. Please consult a real doctor about this.

[Divernan]

4. I am insisting on having my retinas evaluated for diabetic retinopathy.

Of course you're right, and I understand my situation must be individually evaluated. When I canceled my surgery, I also made an appointment for further examination. To clarify, I had the pre-op examination in September, but the eye-doc didn't schedule me for surgery until early January. The pre-op lab tests required by the medical facility within 2 weeks of surgery revealed the diabetes. What alarms me is that my opthalmologist was forwarded information about my diabetes and nevertheless was going to proceed with the surgery without any fresh exam/evaluation of my eyes for diabetic retinopathy. If such retinopathy exists, it must be stabilized before cataract surgery. (My internist advised me to delay surgery.) What's the point of pre-op testing if the eye-doc ignores the results?

And I found in making an appointment to see an endocrinologist, that there is typically a 4 month wait to get an appt. with an experienced, board certified specialist. There was one guy with a degree from some medical school in Uganda and no board certification available earlier, but no thanks.

I think this is an excellent example of the need for patients to inform themselves and exercise control over their medical care. As to your less than kind remark about "Dr. Google", I was a NIMH research fellow for three years, and know my way around the New England Journal of Medicine, JAMA, Lancet, etc., and simply because peer reviewed medical research articles are found through googling, in no manner invalidates or diminishes their findings.


When there is discussion about switching to a Canadian style health care system, the typical objection is that, oh, we'll have to wait to get to see a specialist. Well, that's currently the case in Pittsburgh, home of the ever-expanding UPMC health "care" system. When delays cause irreversible damage to one's health, this is pretty damned alarming.

[Altoid_Cyclist]

5. WPA and UPMC certainly have a stranglehold on medical coverage in western PA.

Did you have any luck with the UPMC Eye Center? As I said, I just sort of lucked out when I was able to be seen so quickly. I've had some great experiences with UPMC and I've had some terrible experiences.

I wouldn't trade the Cardiologist that I see at the UPMC CVI for anyone this side of Cleveland. Some of the other Doctors in their system that I've seen didn't really impress me though. Sometimes they just make you want to grab them and shout "listen to what I'm saying!"

Good luck with your health issues.

[Divernan]

6. The nurse practitioner/diabetes educator with whom I met this week

Got on the phone and called the doctors' offices for 2 specialists, an endocrinologist and an opthalmalogist whom she highly recommended as having a lot of experience with diabetics' issues, AND she sweet talked the doctors' respective gatekeepers/office managers to get me appointments next week. My internist of about 15 years, on the other hand, refused to make calls to specialists on my behalf - and told me I should just "keep bugging them."

The nurse/practitioner also gave me my first blood sugar test (cause my internist had not bothered to prescribe a monitor for me). In the 2 weeks I've been on meds, exercising and following the diet, I reduced my blood sugar by 50%, into the targeted "good" range. I was bouncing off the ceiling with that good news. In fact she told me I was exercising too much, and to cut it back to 90 minutes daily. It really is a lifestyle changing disease, but now I feel I can control it, and hopefully, losing a bit more weight, get off the meds & control it w/diet & exercise.

Thanks for your kind wishes.

I hope we both enjoy better health in 2011.

[Altoid_Cyclist]

7. Lots of good news in there!

That's fantastic that you were able to make so much progress so quickly.

I've seen too many people who refuse to alter their diet or lifestyle even when their health is at risk. Congratulations and good luck with the two appointments!

My wife and I are going to see my Cardiologist at the UPMC CVI this Tuesday. I didn't like the way that her local one was treating (not treating actually). Hopefully it will go well, but at least we'll have a very qualified second opinion.

Good luck to you this year and for many years to come.