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April 5, 2005

Aches and Pains, Other

Question from Kenosha, Wisconsin, USA:

Recently, I have developed a pain in my right heel. When I walk, it feels like walking on a bruise. Right now, it is a discomfort. Should I go to the doctor and inform him of this problem? Should I seek the aid of an endocrinologist without my doctor's knowledge?


This is a common complaint. If you have foot problems as part of your diabetes care, you may want to see a foot care specialist. They may be able to pad the heel. You may have bone spurs or other foot abnormalities they may need long-term management.

I am commonly asked about which patients with diabetes should see an endocrinologist. I will share with you what I believe to be a reasonable response to that question. The problem is highlighted by the fact that endocrinologist sees less than 10% of all the patients with diabetes. This means that there are not enough endocrinologist to see all the patients with diabetes. That is why I take my role as an educator very seriously. We can impact the lives of many patients with diabetes if you can also train physicians to adequately care for patients with diabetes while in their training. Endocrinologists see relatively more patients with type 1 diabetes than primary care physicians and this is reasonable. Many patients with type 2 diabetes are easily controlled with lifestyle or minimal medications and do not need specialty care. I would say those patients with type 2 diabetes can see an endocrinologist if they are not meeting their treatment goals. These goals include hemoglobin A1c less than 7% without hypoglycemia. If you are having side effects with your therapy, that might be another reason (i.e. frequent severe hypoglycemia). Finally, there may be advantages to specialty care because of additional educational opportunities. Seeking out and requesting a referral requires patients to be advocates for their own care.