Back to Ask the Diabetes Team Ask the Diabetes Team

From Anchorage, Alaska, USA:

My son moved to California and is seeing a family doctor for his diabetes. Because of his insurance HMO, he is required to get a referral from his family doctor to see an endocrinologist. His doctor refuses to refer him to an endocrinologist saying he is perfectly qualified to treat his diabetes. My son always saw an endocrinologist when he lived with us in Alaska. His doctor put him on a drug called Lotensin, saying it would be good for his kidneys. I have never heard of giving a type 1 diabetic this drug and it worries me. What do you think about this?


In healthcare markets where HMO models predominate at the delivery system, it is important to have access to specialty care. It is true that many primary care physicians have the skills and expertise to provide good care for patients with diabetes. However, in most markets, patients with type 1 diabetes still see an endocrinologist. There are several key issues related to your son's right to specialty care. First, is he having good results? If his blood sugars are not in good control, it makes it difficult to ethically withhold specialty care. If he is doing well, and he still wants to see an endocrinologist, he may have to chose another primary care physician who has a different philosophy regarding endocrine referral.

With regard to Lotensin, this medication is from a group of medications known as ACE inhibitors. ACE inhibitors are appropriate therapy for patients with type I diabetes who also have elevated albumin excretion in their urine or if their blood pressure exceeds 130/80. In the absence of these indications, it is controversial as to whether ACE inhibitors should be used. It is important to note that if patients do have diabetes involvement of their kidneys, ACE inhibitors have been shown to protect their kidneys from further disease progression.


Original posting 13 Oct 2005
Posted to Other Medications


  Back to Ask the Diabetes Team Return to the Top of This Page

Last Updated: Tuesday April 06, 2010 15:10:04
This Internet site provides information of a general nature and is designed for educational purposes only. If you have any concerns about your own health or the health of your child, you should always consult with a physician or other health care professional.

This site is published by T-1 Today, Inc. (d/b/a Children with Diabetes), a 501c3 not-for-profit organization, which is responsible for its contents. Our mission is to provide education and support to families living with type 1 diabetes.
By using this site, you agree to our Terms of Use, Legal Notice, and Privacy Policy.
© Children with Diabetes, Inc. 1995-2018. Comments and Feedback.