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Question:

From Ft. Sill, Oklahoma, USA:

My father was recently transferred to Ft. Sill, Oklahoma from Houston, Texas where my parents and I completely trusted my diabetes team with all our hearts. The doctor the military gave us is a endocrinologist but he prefers to only treat patients with type 2 diabetes.

I was diagnosed with type 1 diabetes April 1998 after a three month fight with severe pancreatitis. I have had five other episodes since then, which resulted in me on TPN (total parenteral nutrition) for two and a half months. My current C-Peptide is 1.3 and my A1c is 5.7% (with at least two severe lows every six months). I have been on insulin the whole time and I am now on a pump. The new doctor told me that I do not have type 1 and he wants to take me off my insulin. According to him, at the most, all I have just a severe case of hypoglycemia and I must be "making my blood sugar severely fluctuate." I called our insurance company (Tricare) and he is the only endocrinologist within 100 miles. I can get a second opinion, but it would not be from an endocrinologist. Can they do this? If this doctor takes my off insulin, I WILL DIE! Is there away around this?

Answer:

This does not sound right. If there is no diabetes specialist with experience with type 1 diabetes and insulin pumps, then I would strongly suggest you find one elsewhere. If your military insurance does not cover this, then you will have to get assistance - congressman/woman, senator offices can help. Veterans affairs can help. Also, your previous diabetologist could also be contacted and perhaps call and see about helping by talking with this new endocrinologist at the base. I would expect that you can demand proper care if it is not available locally and that this would have to be provided at one of the bigger service centers if not one of the university diabetes services. Keep monitoring and stay with your current plan if it is working.

SB

Additional comments from David S. Holtzman, Esq.:

Your fallback is to seek care from a "civilian" physician who participates in Tricare, the health coverage program for military personnel and their dependents. Tricare is a PPO that will pay for the care at any participating provider. The issue here is the perceived competency of the civilian physicians located in the area of the new family home. You could seek care at a participating provider away from the family home, but you would be responsible for the travel costs.

DSH

Additional comments from Dr. David Schwartz:

I really understand your concern. Do you have OTHER evidence of pancreatic insufficiency? For example, do you also require enzyme supplements to help digest food? The pancreas makes digestive enzymes, as well as insulin, and, thus, the need for digestive enzyme supplements is additional evidence that you have more global pancreatic dysfunction.

I think that you MAY have residual beta-cell function and it MAY be worthwhile to find out. You could ask the new doctor if they would be willing to have you undergo a carefully supervised oral glucose tolerance test (OGTT) after coming off your pump for a couple of days. During that time you would be assessing your glucose carefully at home to watch what your glucose values do before the OGTT. This even could be done in a hospital setting, although I doubt you would have such rapid decompensation in just two or three days, but if you did, you could simply intervene before things got too out of hand. I suppose that if you have glucose readings at home that show a pattern of hyperglycemia, then you can just have your doctor review these when he downloads the glucose meter. If you are in fact shown to have diabetes, then I think you should insist to your doctor that you stay on your pump, with which you have shown success. Insulin pumps are used in folks with type 2 diabetes, but if the new doctor just is not comfortable with pumping, then you should write a formal letter to your health care administrators insisting that you be allowed to see an endocrinologist with more experience.

DS

Additional comments from Debbie Butler, MSW, LICSW, Licensed Clinical Social Worker:

This sounds like a very dangerous situation. Can you ask your doctor from Houston to contact your new doctor in Ft. Sill to coordinate care and send your medical records? Your old doctor should be able to tell your new doctor whether you have type 1 diabetes and require daily insulin.

DB

DTQ-20080319070043
Original posting 13 Apr 2008
Posted to Daily Care and Insurance/Costs

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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