3 ms·

You're intentionally ignoring the part about tests and methodical reasoning vs guesswork so you can be snarky about someone's take.

SoftTalker 1y ago
No but one of the things doctors learn is that when you hear hoofbeats, think horses not zebras. It's not practical to test for everything right away, and if an adult is overweight and presenting with diabetes you initally treat for type 2, and advise losing weight and changing diet. Every medical school class has people who graduate near the bottom. The critera for entry, and the filters that you have to pass before you can practice as a physician means that even those people are generally decent doctors. I'm not saying doctors are never wrong but you're not likely outguess even an average doctor by googling your symptoms. It's very easy to convince yourself you have some rare condition because your symptoms match, but you ignore "rare." The fact that someone has an anecdote to the contrary doesn't change this.
- collingreen 1y ago
  This is a much better comment with some thought behind it and a point at the end and without the snark. Thanks for adding it.
- umvi 1y ago
  In my case I am very skinny (150 lbs, 6'0") which is the main reason that I thought I might have LADA and not T2 - my own research suggested that T2 was rare in skinny patients and that LADA might explain my elevated blood sugars (and also that up to 12% of T2 might actually be misdiagnosed LADA). So IMO the horse should have been LADA. However, LADA doesn't seem super well known or understood among doctors that haven't worked with a lot of pre-diabetic patients. This particular doctor claimed that my A1C would have been much higher than it was if I had LADA/T1 and that I was exhibiting symptoms of insulin resistance. I tried to argue that maybe we were catching it early and that insulin resistance and insulin deficiency present with the same symptoms (high blood sugar), but the doctor suspected I was non-compliant with the requested low-carb/exercise regiment and told me to try harder instead of ordering the tests and that I would see results if I did that. I went to a second random doctor I found on ZocDoc who also thought I was T2, but then LADA was eventually confirmed by a third doctor who I chose specifically because he's worked with a lot of diabetic and pre-diabetic patients. He took one look at me and said "You look too skinny for a typical T2, let's run a GAD-65 autoantibody test", which came back 10x higher than the normal rate. So yes, if you are a doctor and you hear hoofs I do think it's a good idea to think horses not zebras, but also if you've never actually worked with zebras, maybe have the humility to defer to a different doctor or listen to the patient who clearly has done more research than you about the condition they've struggled with for years instead of confidently pushing your wrong theory. P.S. Early on in the process I also tried to see an endocrinologist (who probably also would have recognized LADA). However, they are a gated resource. I was unable to set an appointment with an endocrinologist without a recommendation from my PCP, and my PCP wouldn't give one. Just frustrating all around.

SoftTalker 1y ago

No but one of the things doctors learn is that when you hear hoofbeats, think horses not zebras. It's not practical to test for everything right away, and if an adult is overweight and presenting with diabetes you initally treat for type 2, and advise losing weight and changing diet. Every medical school class has people who graduate near the bottom. The critera for entry, and the filters that you have to pass before you can practice as a physician means that even those people are generally decent doctors. I'm not saying doctors are never wrong but you're not likely outguess even an average doctor by googling your symptoms. It's very easy to convince yourself you have some rare condition because your symptoms match, but you ignore "rare." The fact that someone has an anecdote to the contrary doesn't change this.

collingreen 1y ago
This is a much better comment with some thought behind it and a point at the end and without the snark. Thanks for adding it.
umvi 1y ago
In my case I am very skinny (150 lbs, 6'0") which is the main reason that I thought I might have LADA and not T2 - my own research suggested that T2 was rare in skinny patients and that LADA might explain my elevated blood sugars (and also that up to 12% of T2 might actually be misdiagnosed LADA). So IMO the horse should have been LADA. However, LADA doesn't seem super well known or understood among doctors that haven't worked with a lot of pre-diabetic patients. This particular doctor claimed that my A1C would have been much higher than it was if I had LADA/T1 and that I was exhibiting symptoms of insulin resistance. I tried to argue that maybe we were catching it early and that insulin resistance and insulin deficiency present with the same symptoms (high blood sugar), but the doctor suspected I was non-compliant with the requested low-carb/exercise regiment and told me to try harder instead of ordering the tests and that I would see results if I did that. I went to a second random doctor I found on ZocDoc who also thought I was T2, but then LADA was eventually confirmed by a third doctor who I chose specifically because he's worked with a lot of diabetic and pre-diabetic patients. He took one look at me and said "You look too skinny for a typical T2, let's run a GAD-65 autoantibody test", which came back 10x higher than the normal rate. So yes, if you are a doctor and you hear hoofs I do think it's a good idea to think horses not zebras, but also if you've never actually worked with zebras, maybe have the humility to defer to a different doctor or listen to the patient who clearly has done more research than you about the condition they've struggled with for years instead of confidently pushing your wrong theory. P.S. Early on in the process I also tried to see an endocrinologist (who probably also would have recognized LADA). However, they are a gated resource. I was unable to set an appointment with an endocrinologist without a recommendation from my PCP, and my PCP wouldn't give one. Just frustrating all around.