Interview with Dr. Anita Ramsetty, Endocrinologist - Part3
Posted on: Wednesday, April 9th, 2008 at 1:39 pmGestational Diabetes, Pre-Diabetes and Endocrinologists versus General Practitioners for addressing diabetes.
Interview with Dr. Anita Ramsetty, Endocrinologist Part 1
Interview with Dr. Anita Ramsetty, Endocrinologist Part 2
SugarStats’ host interviewer, Nedrra Lanakila, continues her talk with Endocrinologist Dr. Anita Ramsetty of EndocrineHelp.com. In this third and final post from their first interview, Dr. Ramsetty talks about Gestational Diabetes, signs of pre-diabetes and some of the factors to consider when determining your physician of choice to provide medical diabetes care.
N (Nedrra Lanakila): You mentioned about gestational diabetes. How do you treat your patients diagnosed as gestational diabetics?
A (Anita Ramsetty): We always end up in a somewhat odd situation because these women are split between the endocrinologist and their obstetrics teams. It can be a little bit dicey at times, trying to get all the communication loops closed but it gets done and quickly.
As an example, my case of gestational diabetes was fairly mild. I was pregnant with twins at the time so I sort of saw it coming. Between having the twins, gaining lots of weight and then having a strong family history I had seen it coming from afar and wasn’t too surprised.
In my case, I ended up checking my blood sugars very frequently, probably about 8 times a day for the last 4 months of my pregnancy and doing some dietary changes that kept my blood sugars within range.
I cut back on my carbohydrates and spread them out into very small meals all day. Then I was able to keep my blood sugars within my goal range.
Many oral medications are not approved for use in pregnancy. As a result, even though one or two have been used in small studies and obstetricians can recommend some of them, I think that endocrinologists as a whole would still either recommend a strict dietary regiment for… not too long – usually under 3 or 4 weeks just to get blood sugars under control.
If they can’t be pulled under control with dietary means then they’ll immediately get put onto an insulin regiment with very, very aggressive checking and reporting into your physician.
The patients that I’ve had in my own clinic were either on insulin pumps during the pregnancies or they were on regiments including a long lasting insulin and flexible mealtime dosed insulin. They check their blood sugars usually about 6-8 times a day and fax blood sugars to me every 2-3 days, calling me every few days with either weekly or every two week visits to the clinic just to make sure that everything was in check.
This is just one of those critical times in someone’s life where you just can’t afford to make a lot of mistakes. So, if anything, over checking is probably better than under checking just to make sure that everything’s going well. Our gestational diabetics are very, very closely followed.
They also tend to be another group of very dedicated patients because it’s not just them, but their children are involved already.
N: We oftentimes hear from pre-diabetics or individuals who wonder whether they may be pre-diabetic. How might a family of a diabetic be able to recognize signs that they may be pre-diabetic?
A: Prediabetes is a sort of in-between normal and having diabetes. Even within that range it can be very, very mild to almost right on the edge of having diabetes.
One of the problems with pre-diabetes, just like pre-hypertension, is that many times people feel just fine. There often have no symptoms whatsoever. Occasionally, we have individuals who say, ‘I’m really tired.’ That’s probably the number one symptom that I’ve come upon, where a patient says “I’m just so wiped out and I don’t know why.” Upon checking their blood sugars it turns out that they’re just a little bit higher than normal.
I think fatigue is often one of the first indicators but other times it’s something like frequent urinary infections, or not being able to clear an infection as well as normal.
Still really and truly, most of the time it’s not symptoms that form the trigger, it’s the family history like you mentioned. Oftentimes an individual might say, ‘My mom or dad has diabetes and I’m a little bit concerned. I would like to get checked out for it, do you mind if we do a blood test?’
Then we’ll do either fasting blood sugar in the morning or we’ll do an oral glucose tolerance test to determine if they have pre-diabetes or not.
It’s a tough thing to come up on because unless it just crosses your mind – either the physician’s mind or the patient’s – it isn’t looked for that often unless there’s rampant family history.
N: For the newly involved parent, family or friend, or the newly diagnosed diabetic, please describe the difference between an endocrinologist and their primary care / general practitioner.
A: Most endocrinologists receive a specific, dedicated portion of their training towards diabetes care, the diagnosis, management and treatment of complications including Type 1,Type 2 and all the variations in between: for example insulin resistant and other abnormalities that are associated with glucose handling.
For the most part a large proportion of our [endocrinologists] training is devoted to diabetes care. Even individuals that go into research-dominated programs often have a portion of their training that’s dedicated to diabetes.
There are also many general practitioners including family practice practitioners and internists who are very good at diabetes management. When I’ve had this question from many patients, my general response is that it depends on 3 factors:
- The general practitioner’s level of comfort with diabetes as a whole
- The general practitioner’s level of comfort with complicated cases of diabetes – and that for me means a situation where the current regiment is not working and a patient desires to be on a pump or, they are interested in a more complicated regiment that include injected insulin and oral medications, or they have co-morbid conditions that make glucose management more challenging. That comes down to the comfort level of the general practitioner and experience with those types of regiments, whereas most endocrinologists have a great deal of experience dealing with more complicated situations in diabetes care.
- The patient’s level of comfort. If you feel that you would benefit from a specialist’s opinion, then you should seek it. If you are happy with your primary practitioner’s level of care and you think that your diabetes is well managed, then there is probably no reason for you to seek an expert opinion in terms of a specialist.
N: For the diabetic who, let’s say might be in Hawaii, and has their own primary care physician but would like to receive a second opinion from another medical expert outside of their residing state: is there a way for you to provide service to them?
A: There are only two states within the United States right now that would allow what is called the Primary Care Exception, where the primary care provider can initiate the consult for you, and all of the contacts would be through the primary care provider.
Those states are Mississippi and Missouri.
Every other state, including Hawaii to my knowledge, will require a full medical licensure from a specialist even if it’s a second opinion coming through a primary care provider.
N: Since we service a global market and currently have users in 24 countries, is that also the case for people who are in foreign countries?
A: Those rules I’m not sure about. Different rules may exist for individuals in other countries in terms of seeking a second medical opinion, legally.
We’ve had questions come from individuals in the United Kingdom and inquiries from Canada as well. Those situations were slightly different because it turned out that they were seeking second opinions on other endocrine conditions where they actually would have required a physical exam. So I had to decline the option to include them in my medical practice because it would not have been responsible of me to take them on as patients, not being able to examine them in person.
There are legalities of them being in countries where I do not hold a medical license: I would ask them to look into it and in general, we would ask them to have their primary doctors involved anyway.
For more information on Dr. Anita Ramsetty please go to: www.endocrinehelp.com
In the upcoming months, look to our blog for more information on diabetes-related topics as shared by dedicated experts in the field.
If you know of a topic you would like more information on, or you know of a qualified expert in a field that would be of benefit to our community of diabetics, their friends and family members, and the medical establishment in service to them, please email Nedrra Lanakila at: nlanakila@sugarstats.com with your thoughts.
Related Posts:
- Welcoming our Newest Endocrinologist Blogger: Dr. Anita Ramsetty
- Interview with Dr. Anita Ramsetty, Endocrinologist - Part2
- Interview with Dr. Anita Ramsetty, Endocrinologist - Part1
- TechAddress Interviews SugarStats
- “Sweet” conversations
- SugarStats.com Interview on Episode 34 of the DiabetesPowerShow.com Podcast
