Samantha Walsh has lived with type 1 diabetes for over five years since 2017. After her T1D diagnosis, she was eager to give back to the diabetes community. She is the Community and Partner Manager for T1D Exchange and helps to manage the Online Community and recruit for the T1D Exchange Registry. Prior to T1D Exchange, Samantha fundraised at Joslin Diabetes Center. She graduated from the University of Massachusetts with a Bachelors degree in sociology and early childhood education.
I had to answer in the past tense since my endo of over 25 years has retired and I’m meeting a new one in November. I’m guessing he will ask about my goals but who knows what the future will bring me?
My Endo and I have a collaborative appointment each and every time. This specific question isn’t asked because we are working together through my T1D management.
Seven decades into this diabetes thing and I’ve never let diabetes rule my life, rather I’ve effectively managed my diabetes to allow me to reach – and surpass – LIFE GOALS.
I’ve worked with many doctors, only two being endocrinology “certified” and several being awesome diabetologists, and together driven to keep me sufficiently healthy into my 80s so that I can live a full and very active life. DIABETES DOES NOT RULE!
I have been seeing my endo for almost 30 years and have had type 1 for 67 years. He knows me so well that that we just discuss avoiding hypoglycemia and continue my good control at every visit. He also has Type 1.
You must be your own advocate or have a family member attend appointment with you. Sometimes I feel like I am educating my Endo office. I keep up on latest products that interest me. Some they have not heard of. I have commented before on what works for me but had to educate my Endo. I am on MDI using InPen. The app give me the same info as a pump. For injections have IPort which I rotate site every 3 days as a pump. All injections go through port. This works for me. Unfortunately I have copays for all of these. They are considered part D prescriptions. Unlike a pump which is covered under DME. Doesn’t seem fair to me but is what I have chosen. Love the freedom of no pump attached.
I selected “Yes – I am asked about my diabetes goals and priorities consistently”, but it’s not CONSISTENTLY. It’s more like every few months, but that option was not made available for respondents.
I am only asked my Date of Birth and if I’ve changed my insurance since my last visit. I call this the “lets check your wallet to ensure we’re gonna get paid” phase of my visit. Then it’s a several month wait until my actual visit. I’m not kidding I just made an appointment this week. The earliest open they had was December 23’rd. Such is the state of medical care in the United States. I think Doctors, Politicians, and the Diabetes organization are going to have to do something about it, other than point fingers at each other. Seriously!
Unfortunately, patient goals seem quite secondary. Doctors and diabetes educators seem to have a magic key indicator that they follow… A1C<7.0. If you are higher than this, then they urge you to bring it down. If you are lower "Oh, you are doing great! You could eat more carbs. You know, you don't want that number to be too low." Having said that, some of them do seem to take patient goals into account somewhat once they learn that the patient is educated and takes responsibility for their own care.
No. My endo care PA is very caring and amazingly ignorant and dismissive of things like gluconeogenesis , Very discouraging yet with the current shortage of medical professionals due to the Democrat’s tyranny for dictated experimental drugs on medical professionals
we get what we get.
My goals have devolved to 3:
Don’t arbitrarily change my diagnosis to T2.
Keep my insulin prescriptions renewed and don’t arbitrarily reduce them.
File the needed paperwork so I can keep my CGM.
So basically my goal is to be able to survive the next 6 months.
You have listed what you wish your doctor would achieve. Getting the health provider to follow through can often be on the top of my list of priorities, too.
I wasn’t quite sure how to answer because I never thought of them as goals. For instance, if I am having a difficult time with blood sugars during exercise, I bring that up during my appointment. I never think of it as a goal of keeping blood sugars fairly stable during exercise. I think of it as a problem I am having keeping blood sugars stable during exercise and I am looking for suggestions from the endo to help with my problem. She also will look over blood sugars on my cgm reports and give suggestions on areas that she believes can be tweaked a little bit.
I am very clear about my health related priorities and goals. With each provider I see for whatever reason, I bring it up myself because most of them (except for the endocrine NP and the podiatrist I see), are too busy to really listen or pay attention, and are absolutely clueless when it comes to recognizing or caring for the issues and needs of concern for a baby boomer adult with T1D since early childhood.
I don’t recall any specific questions about my goals/priorities, but I think it must be obvious that I want to manage my diabetes well enough to live a full, active life.
My goals have been established for a long time so it would be repetitive & superfluous to review them at every visit. I see my Endo, C-PA, every 3 months as required by Medicare in order to have the cost of pump supplies & insulin paid by Medicare. We review readouts from my pump each time & make adjustments to pump settings. I also can use secure texting with my care provider between visits.
This kind of question needs context. It would make sense if asked in the setting of a first visit with a new doctor. Otherwise, it seems obvious that my goal is to be healthy and feel good, which requires keeping my management as close too a normal profile as possible.
My blue cross/shield plan keeps offering me various coaches through a variety of different programs. When I have agreed to give these a try, I am always asked about goals. I sa my goal is to be healthy. But they want specifics. They encourage me to discuss a “game plan” with my doctors. (What do these coaches think medical management has been all these years?) I reply that we will keep doing what we are already doing (and maybe a bit better), since it is basically working pretty well.
Sometimes I wish blue cross would not waste money on this touch feely sort of thing with t1 veterans. The people who really need support are the newly diagnosed.
Sorry for the rant.
When I first met my current endo, 8+ years ago, we discussed “goals”. As it was our initial appointment, I specifically stated that I expected her to consider me an equal partner in diabetes management decisions. She readily agreed and has kept her word. Before each appointment I make a list of subjects/concerns and send it to her via MyChart. I also hand the list to the nurse who asks me a variety of questions for the first half of the appointment. On the paper chart notes I’m given after each appointment her management goals are listed, not mine.
Had to switch endos after 19 years due to insurance. Will see how new endo is. Previous endo was with me from the beginning so we were in tune. Not happy that insurance gets to dictate who I HAVE to use for my care.
I have good control on my own. My endo merely reviews my labs and smiles and nods mostly. But, I always want to do better and always ask for a new medication or therapy that I become aware of to achieve that. Sometimes it’s a battle, other tim
es she immediately says yes and gives me what I want.
I can’t remember being asked my goals or priorities in recent years. My endo knows that I am very active with exercise, and that I watch my diet very closely. She routinely asks me if I have any concerns that I want to discuss. We review the blood test results, and whether any adjustments need to be made. The rest is just a social visit.
They always focus on the information from my CGM which is helpful but I bring up questions about goals. My time in range is very good so I think they don’t feel they need to bring up goals.
not specifically that way. But I feel comfortable asking anything I want. and he always asks if I have anything i am concerned about or want to discuss. I think having type 1 diabetes and being a nurse has made me pretty assertive as yo only get what you ask for in any relationship. You need to mention that you have concerns to discuss or something similar when you begin and then you will get attention to your concerns.
Geez. We are so numbers driven and data driven that, like an experienced football club, we huddle, call the play, and see how it works out.
Maybe I should add, we also win some and lose some. Once in a while there’s even a tie.
I had to answer in the past tense since my endo of over 25 years has retired and I’m meeting a new one in November. I’m guessing he will ask about my goals but who knows what the future will bring me?
I hope you catch a good one 😉
I have been T1 for close to 60 years, so this is kind of a pointless question for me.
My Endo and I have a collaborative appointment each and every time. This specific question isn’t asked because we are working together through my T1D management.
T1 58 yrs. 74 YO, lately my Endo has nothing but Praise as my A1c is at 5.4 and almost 0 Hypos. Thank you Tandem and Dexcom!!
Seven decades into this diabetes thing and I’ve never let diabetes rule my life, rather I’ve effectively managed my diabetes to allow me to reach – and surpass – LIFE GOALS.
I’ve worked with many doctors, only two being endocrinology “certified” and several being awesome diabetologists, and together driven to keep me sufficiently healthy into my 80s so that I can live a full and very active life. DIABETES DOES NOT RULE!
I have been seeing my endo for almost 30 years and have had type 1 for 67 years. He knows me so well that that we just discuss avoiding hypoglycemia and continue my good control at every visit. He also has Type 1.
You must be your own advocate or have a family member attend appointment with you. Sometimes I feel like I am educating my Endo office. I keep up on latest products that interest me. Some they have not heard of. I have commented before on what works for me but had to educate my Endo. I am on MDI using InPen. The app give me the same info as a pump. For injections have IPort which I rotate site every 3 days as a pump. All injections go through port. This works for me. Unfortunately I have copays for all of these. They are considered part D prescriptions. Unlike a pump which is covered under DME. Doesn’t seem fair to me but is what I have chosen. Love the freedom of no pump attached.
Ask if I have any concern and then address them accordingly
I selected “Yes – I am asked about my diabetes goals and priorities consistently”, but it’s not CONSISTENTLY. It’s more like every few months, but that option was not made available for respondents.
I am only asked my Date of Birth and if I’ve changed my insurance since my last visit. I call this the “lets check your wallet to ensure we’re gonna get paid” phase of my visit. Then it’s a several month wait until my actual visit. I’m not kidding I just made an appointment this week. The earliest open they had was December 23’rd. Such is the state of medical care in the United States. I think Doctors, Politicians, and the Diabetes organization are going to have to do something about it, other than point fingers at each other. Seriously!
why not make your appt when you leave the one you are at?
I always do that before I leave
Unfortunately, patient goals seem quite secondary. Doctors and diabetes educators seem to have a magic key indicator that they follow… A1C<7.0. If you are higher than this, then they urge you to bring it down. If you are lower "Oh, you are doing great! You could eat more carbs. You know, you don't want that number to be too low." Having said that, some of them do seem to take patient goals into account somewhat once they learn that the patient is educated and takes responsibility for their own care.
No. My endo care PA is very caring and amazingly ignorant and dismissive of things like gluconeogenesis , Very discouraging yet with the current shortage of medical professionals due to the Democrat’s tyranny for dictated experimental drugs on medical professionals
we get what we get.
Please keep political opinions and comments to yourself out of respect for everyone else. Thank you.
Neither endocrinologist nor educator have given enough knowledge for me to know what would be appropriate for my own goals.
Ask them.
My goals have devolved to 3:
Don’t arbitrarily change my diagnosis to T2.
Keep my insulin prescriptions renewed and don’t arbitrarily reduce them.
File the needed paperwork so I can keep my CGM.
So basically my goal is to be able to survive the next 6 months.
You have listed what you wish your doctor would achieve. Getting the health provider to follow through can often be on the top of my list of priorities, too.
I answered I bring it up. But my PA will look at my TIR data and trends. Lte last 2 visits there were no major issues.
I wasn’t quite sure how to answer because I never thought of them as goals. For instance, if I am having a difficult time with blood sugars during exercise, I bring that up during my appointment. I never think of it as a goal of keeping blood sugars fairly stable during exercise. I think of it as a problem I am having keeping blood sugars stable during exercise and I am looking for suggestions from the endo to help with my problem. She also will look over blood sugars on my cgm reports and give suggestions on areas that she believes can be tweaked a little bit.
I am very clear about my health related priorities and goals. With each provider I see for whatever reason, I bring it up myself because most of them (except for the endocrine NP and the podiatrist I see), are too busy to really listen or pay attention, and are absolutely clueless when it comes to recognizing or caring for the issues and needs of concern for a baby boomer adult with T1D since early childhood.
I don’t recall any specific questions about my goals/priorities, but I think it must be obvious that I want to manage my diabetes well enough to live a full, active life.
My goals have been established for a long time so it would be repetitive & superfluous to review them at every visit. I see my Endo, C-PA, every 3 months as required by Medicare in order to have the cost of pump supplies & insulin paid by Medicare. We review readouts from my pump each time & make adjustments to pump settings. I also can use secure texting with my care provider between visits.
This kind of question needs context. It would make sense if asked in the setting of a first visit with a new doctor. Otherwise, it seems obvious that my goal is to be healthy and feel good, which requires keeping my management as close too a normal profile as possible.
My blue cross/shield plan keeps offering me various coaches through a variety of different programs. When I have agreed to give these a try, I am always asked about goals. I sa my goal is to be healthy. But they want specifics. They encourage me to discuss a “game plan” with my doctors. (What do these coaches think medical management has been all these years?) I reply that we will keep doing what we are already doing (and maybe a bit better), since it is basically working pretty well.
Sometimes I wish blue cross would not waste money on this touch feely sort of thing with t1 veterans. The people who really need support are the newly diagnosed.
Sorry for the rant.
I very much appreciate your rant, and agree with all of what you said. Thank you.
I am not asked, but I am told what my goals should be. (No lows, but under a certain number, etc.) That is what I expect.
When I first met my current endo, 8+ years ago, we discussed “goals”. As it was our initial appointment, I specifically stated that I expected her to consider me an equal partner in diabetes management decisions. She readily agreed and has kept her word. Before each appointment I make a list of subjects/concerns and send it to her via MyChart. I also hand the list to the nurse who asks me a variety of questions for the first half of the appointment. On the paper chart notes I’m given after each appointment her management goals are listed, not mine.
I’ve been seeing the same provider for a few years, and this has been discussed before, so we each understand our goals for T1D care. No issues here.
Had to switch endos after 19 years due to insurance. Will see how new endo is. Previous endo was with me from the beginning so we were in tune. Not happy that insurance gets to dictate who I HAVE to use for my care.
I have good control on my own. My endo merely reviews my labs and smiles and nods mostly. But, I always want to do better and always ask for a new medication or therapy that I become aware of to achieve that. Sometimes it’s a battle, other tim
es she immediately says yes and gives me what I want.
I can’t remember being asked my goals or priorities in recent years. My endo knows that I am very active with exercise, and that I watch my diet very closely. She routinely asks me if I have any concerns that I want to discuss. We review the blood test results, and whether any adjustments need to be made. The rest is just a social visit.
Choked laughter. 50+ years nobody has ever asked an “interesting” question.
Give me the scripts I must have to stay alive and go away! I have no use for being micro managed by folks who don’t know squat.
But never had an endo, a CDE, never had anyone ask ever.
My Primary asking yeah good luck with that…..
Luckily I have a great endo that always knows my diabetes goals. She doesn’t have to ask she always knows where I want my numbers and agrees with me.
They always focus on the information from my CGM which is helpful but I bring up questions about goals. My time in range is very good so I think they don’t feel they need to bring up goals.
not specifically that way. But I feel comfortable asking anything I want. and he always asks if I have anything i am concerned about or want to discuss. I think having type 1 diabetes and being a nurse has made me pretty assertive as yo only get what you ask for in any relationship. You need to mention that you have concerns to discuss or something similar when you begin and then you will get attention to your concerns.