Why Do I Need an Endocrinologist?

Consulting an endocrinologist can be helpful to anyone struggling with diabetes. Unfortunately, with the growing obesity epidemic in the U.S., the fact that over 25 million adults now suffer with type 2 diabetes and fewer than 6,000 endocrinologists practice in the U.S., it may not be possible for every patient to see an endocrinologist—and perhaps not necessary.

Endocrinologists and primary care doctors—including internists and family practice doctors and their teams of nurse practitioners, physicians assistants, nurses, dieticians and certified diabetes educators (CDE)--rely on each other to ensure the right patient gets matched with the right professional.

A primary care office can be ideal to address basic concerns around a new diagnosis of type 2 diabetes, including preventative care to slow the onset of complications. Starting oral medicines, basic insulin, lifestyle modifications and nutrition therapy can be handle seamlessly without the time and expense of visiting an additional physician. In fact, dietitians and CDEs can be great (and underutilized!) resources to address the day-to-day challenges of fitting diabetes into your lifestyle.

So who benefits most from seeing an Endocrinologist?

• Generally those patients who find that oral medicines are no longer effective or basic insulin regimens (such as with 70/30 insulin) no longer keep their Hemoglobin A1c controlled to less than 7 percent. Perhaps a fresh set of eyes can help look at the same problem differently and see a new medicine or alternative approach that would work better.
• Patients with complications from diabetes including diabetic retinopathy, peripheral neuropathy (foot pain and numbness) and nephropathy (protein spilling into the urine). Endocrinologists commonly treat other comorbidities including obesity, high cholesterol, high blood pressure, and sexual difficulty/erectile dysfunction that accompany diabetes.
• Patients with unexplained hypoglycemia or in whom the regular treatments are not producing desired results.
• Patients with diabetes due to medical conditions such as cystic fibrosis or organ transplants that require use of medicines, like steroids, that can cause diabetes.
• Patients with type 1 diabetes where the body’s immune system attacks the pancreatic beta cells forcing patients to begin insulin immediately at the time of diagnosis.
• Additionally, some patients may simply prefer to see a specialist for their diabetes particularly if they have specific questions or concerns.

Being diagnosed with diabetes is life-changing event and requires daily attention and new sense of awareness. Coming to a specialist every three months won’t guarantee good blood sugar control without continued effort between visits. An endocrinologist may ask their patients with more complex diabetes to “invest” in checking their sugars more frequently. They may suggest basal-bolus insulin regimens, which afford more flexibility around timing of meals—but also require more frequent injections—so there are trade-offs to consider. 

New non-insulin medicines and devices including continuous insulin pumps and sensors are now available. Pancreatic islet cell transplantation is an option for some patients. An endocrinologist is best positioned to help advise whether these treatments are right for you. Either way, you should expect your first visit with an endocrinologist will focus on your daily habits, diet and activity to identify the best treatment approach to help you meet your goals—one-size diabetes treatment does not fit all.

Erin D. Roe, MD, MBA, FACP