 What does your doctor not want to tell you in your diabetes care? Let's make one thing clear. This is not just another eat better or eat no carb, et cetera video. Today we are talking about politics. The politics of medicine, how doctors really treat diabetes and what they know about it and whether or not they tell you about it. As an endocrinologist practicing daily, there are things that I want to tell my patients and sometimes I do, but I cannot keep saying that to every patient, right? Otherwise I will lose my mind. What are they? Do you wanna know? Well, your doctor may not know or tell you about diabetes treatments, for example, other than just insulin or metformin. You know why? Your doctor was not really trained to treat diabetes as an outpatient. Most doctors are trained in hospital settings and see patients in the ER and in the hospital beds in training. The outpatient part of the training is less than 10%. Why? Because residents are cheap doctors, right? The hospital system wants to use them and employ them in the hospital where the money is. On the other hand, where are the most of the patients? Not in the hospital. Over 90% of doctor-patient relationships happen in the outpatient setting. Here's the problem. Doctors are trained to treat diabetes with insulin in the hospital. Why is it? Because it is easy. It is cost effective for the hospital. It is easier to control the whole insulin thing. Since the insulin they use is mostly short acting and stuff like that. And the point is though, that they're not trained to treat diabetes with anything else. When they graduate, they go into the real world and all they know is a few basic diabetes pills like metformin and gulliposide. And if these things don't work, you end up going right on insulin. That is why it is important to know the experience level of your doctor with regards to diabetes. The second thing your doctor won't tell you is, how do you eat right? They have not been really through nutritional training during their residency either. As I said, they're busy intubating ICU patients, typically in their training. But in real life, most of you are not that sick, are you? So how is it that your doctor's ICU or inpatient skills going to help you? Most of you need nutritional education, right? You either don't know much or you're stuck with what you can find online on Google or YouTube. You're lucky actually that you are right now watching this channel. But in reality, there are not many good sources of nutritional resources for you to learn from. Some YouTube channels argue that for example, carnivore diet is the only way to go, only for the good health, while the others argue that the plant-based diet is the only way to go. So you turn to your doctor because you may have some conditions like kidney disease, et cetera. And what do they say? They say just do it in moderation. That's why eating in moderation is bashed by so many YouTubers because in reality, yes, you should eat in moderation, you should eat in moderation, but eat what in moderation? What if you're insulin dependent? What if you have gastrointestinal issues? What if you have gastroparesis? Who is going to give you that personalized dietary guidance? Yeah, your doctor. Your doctor has no idea about the diets. Ironically, most doctors actually eat horribly themselves because during those residency days, they just had to eat whatever they found and that got used to it. How are they going to give you sensible information? That is why I took extra classes to become a diabetes educator after I became a doctor. It's the reverse way. People, doctors say, oh, diabetes educator, why would I do that? I'm a doctor, but that's what you need to do. As an endocrinologist, I'm aware that everyone has unique nutritional needs and in this, I try to provide all that information that I have to give you some guidance. Your doctor won't tell you also about the price of the medications, right? Why is that? Well, most of the time, you go to the doctor. Let's say you go see an endocrinologist just like myself. What happens is that we come up with a great diabetes plan where the medications that you will be using will help you lose weight. They will probably improve your cardiovascular risk profile. We try to choose those medications and they will probably protect your kidneys. That's what I try to do, you know, try to kind of kill multiple birds with one stone and lower inflammation, et cetera, et cetera. You're happy, right? At the end of the visit? Until you see the price tag on the medication copay. Why? Because your insurance willingly and on purpose won't let the doctors know the out-of-pocket expenses that the patient experience. Your doctor is not trying to make you go broke. He or she is trying their best to give you the most state-of-the-art treatment, but they're not informed. Insurance companies know that if doctor did not know and the copay was expensive, patients would not fill the prescription so that they let it ride. Unfortunately, not every insurance is the same, but in my area, the insurances do that frequently and they watch that. They watch the patient going to the doctor, getting a prescription and ending up not filling the prescription because of the expense and they make it look like they're doing their job. Yeah, they watch it just like a movie that they set up. Who wins? Yeah, insurance companies. 50% of the prescriptions go unfilled. Isn't that crazy? Your doctor also will not tell you about natural or alternative treatments. The truth is that there is a division between the mainstream and the holistic doctors, but luckily there's something called integrative medicine. Integrative doctors combine the modern medicine with the natural approaches. The problem is that the modern medical schools do not teach anything about natural or holistic approaches. Holistic providers also like chiropractors and so forth, they're not trained at all in modern scientific medical diagnostics or treatments either. So you should look for medical doctors who are open-minded about using natural approaches or alternative approaches in treating diabetes or anything in that matter, for example. Doing so will save you so much money, headache, and potential side effects from regular medications that you may be forced to take. Like I said, modern medicine cannot be denied. I use them every day. They work great, but not for everyone. They are not always the solution to everyone or for every problem. Plus, they are not inexpensive like the natural approaches. They tend to have side effects and I love combining natural and modern medicine because natural medications sometimes are not adequate either. So you have to sometimes combine them to have a balance and keep the number of medications on the low side. Now, another problem we said that the insurance companies want doctors to prescribe generic and cheap medications regardless of their side effects. So for example, your insurance will say, yeah, we cover medications for diabetes, but they will only cover the medications that will cost them only a few pennies. Your doctor has no choice but to prescribe them because they're forced to. In my practice, I give my patients options. We weigh the benefits to risk the cost and all that and we make a decision together whether if you're gonna be going for generic or the brand medication or a natural approach or whatever it may be. Now, your doctor also want to tell you about what insurance companies are forcing them to do. I'm not talking about the medications here like in terms of medication prices, but for example, insurance companies will send you or your doctors about not being on metformin or a statin or an ACE inhibitor or something like that because they say it's indicated, right? In reality, the same insurance company won't honor the cholesterol medication or prescription that I write for a statin intolerant patient, somebody who cannot take statins for one or the other reason. Why? They will not honor that because they say, oh, that's expensive. Forced your patients take statins because it cost them pennies by sending these letters to you. They're actually sending a message to the stockholders at Wall Street. They say, look, what I'm doing a great job. I'm sending letters. I'm forcing everybody. I'm forcing doctors to write medications to make sure everybody is so healthy to make sure everybody's on statins and so forth. If your doctor does not force that statin on you, what happens? Insurance companies will lower the payment on your doctor or penalize them. Even if you have all sorts of complications or side effects, your doctor will still try to force you to take it. What a double-faced approach by the insurance companies, right? It's disgusting. Well, your doctor does not have time to explain all that drama to you. So your doctor says, either take this medication or I cannot see you anymore. Some of you probably heard that before, but inside he says, or else insurance company will fire me. Sad, but true. Your doctor may not tell you that also you may have a kidney disease or liver disease. That's crazy, right? Why is that? Well, that's because they may not have anything to offer. Until recently, for example, the lower kidney function was not a very treatable condition, except control your diabetes, cholesterol, and so forth, or just end up with dialysis. Now, sometimes doctors won't open the conversation also if they think that it will upset you or it can make you ask a lot of questions they don't have answers for. So you should look at your labs and if you have something that bothers you, ask your doctor. If you're not getting a satisfactory answer, talk to a specialist or ask for a referral. For example, SPLT-2 inhibitors. It's a class such as Jardines or Farsiga. They were recently found to lower the risk of progression to dialysis dramatically. Also, there is a new groundbreaking treatment called Kerendia that also lowers the inflammation in your kidneys, et cetera. Now, there are medications that will prevent going to dialysis, but your doctor may not be aware of it or they may not wanna talk about it because of the insurance limitations. Like we discussed, many factors, your doctor may not even want to talk about those treatments. As a result, they may not wanna even tell you that you have a diabetic kidney disease because they know that they're not gonna be able to go anywhere and they don't wanna waste their time sometimes. Until the day it becomes your job to answer those questions sometimes or ask your doctor's more questions and ask for options. So guys, thank you for watching. I hope that helped you and we will see you in the next video. Write your comments, give a like and share. See you next time. Hey guys, I hope you're enjoying this channel so far and I hope you subscribed already. If you didn't do it and if you did, watch this video right there. I think that will help you too.