cholesterol in diabetes

[CollieBoy]

I just read this on Pulse - seems like we will be in trouble if GP's stick to these guidelines without thinking I have a thinking GP - maybe he won't be allowed to think :shock:


GPs set for strict new QOF indicators to control cholesterol in diabetes
By Craig Kenny | 09 Jan 2012
A trio of new QOF indicators have been proposed to promote tight cholesterol control in diabetes, in the first of a new style of packaged indicators designed to tightly define the treatment GPs deliver.To achieve a target for successful lipid management for patients over 40 with type 2 diabetes, GPs are expected to commence a moderate dose generic statin within 90 days if the patient's cholesterol is recorded at more than 4.0 mmol/l in the past year.NICE is piloting the indicators in practices across the country and is now proposing them for the 2013/14 QOF. They reflect a new approach to clinical incentives reported by Pulse last year, packaging indicators as a pragmatic alternative to basing them on hard outcomes.For those already being prescribed statins, the expectation is their dose will be increased within 90 days of a cholesterol reading of more than 4.0 mmol/l. If readings remain high, the indicator rewards switching statins.The target will also be achieved if the patient's cholesterol reading is 4.0 mmol/l or less in the past year.Dr Terry McCormack, a GP in Whitby and council member of the Primary Care Cardiovascular Society, said: ‘For diabetes, prescribing statins is more important than hypoglycaemic drugs.''Simvastatin is best tolerated at 40mg, so to get a cholesterol target of 4.0 you need more intensive treatments. Atorvastatin comes off patent in May, so this target is now economically viable.'The other two proposed diabetes indicators set targets for the percentage of male diabetic patients with a record of being asked about erectile dysfunction in the past 15 months.

If my GP weren't such a nice chap, my reply might involve fornication and travel :twisted:

 

[sooliz]

I was diagnosed as Type 2 beginning of November last year. My GP is trying to shove statins down my throat - have seen her twice since diagnosis, she tried to press them on me both times but I've resisted so far. Having read about side effects and heard from a friend who was unwell on them for several years, until she came off them when miraculously all her symptoms vanished, I am not at all keen to take them. Reading the above, I can see now why my GP is so anxious to prescribe them! What annoys me even more, is that she doesn't actually know what my cholesterol level is....out of the battery of blood tests I've had so far, none of them were for cholesterol! (clearly an oversight on her part.....I've just had a test for this, though).

My view is that, as I'm reducing the amount of fat in my diet, less red meat, cheese, butter etc, and increasing the quantity of chicken, fish and veggies, my cholesterol level (whatever it is) will naturally come down and therefore I won't need statins.

 

[noblehead]

I know when I was in hospital last year with suspected angina statins were mentioned to me despite my cholesterol being 3.9 and lipids within range, after getting a clear bill of health after the angiogram I said I would consider them but have yet to take them.

It seems that they are handed out to people with diabetes not just for the cholesterol lowering benefits but for the protection they give against future heart disease, my brother and mother take Simvastatin in a 40g dose and handle them without any side-effects, it is something I am considering given I am fast approaching 50!

At the end of the day prescription drugs can't be forced upon anyone....it is up to the individual if they want to take a statin or not and the gp's/consultants can only advise in a professional capacity.

 

[clearviews]

Today I went looking for a GP who could see me before my practice could (tomorrow afternoon). I guessed I had a UTI, the first ever in my 60 years. I did indeed and was prescribed anti-biotics where for 5 days I had tried to flush it out with lots of water.

As I was paying my bill I saw the receptionist pass two huge cartons of Lipitor across the desk. My husband had been in the waiting room and had seen the sales rep give them to the staff! He really, really wanted to call out how nasty this drug was due to my experiences but held back. I should point out that in this country prescriptions are filled at the chemist of your choosing not the surgery so these statins were to become freebies to patients. No wonder Lipitor is one of the world's most prescribed drugs!!!

I took courage all those years ago (3 I think) and booted all my meds. I cut my carb intake down to about 30 grams a day and increased the fats. More cheese, cream, pork rind, coconut oil, olive oil and eggs. So many eggs that now have backyard chooks!!!! I also lost weight while doing this. Due to my consistantly normal BP and A1c, my enlightened GP is comfortable that my total cholesterol in not 4 and under as the HDL, LDL and trigs are all excellent.

I will never take statins again nor do I believe that the consumption of fat lands up in my arteries. If I increase my carbs I know that would send my cholesterol all wrong.

 

[Grazer]

I cut my carb intake down to about 30 grams a day and increased the fats. More cheese, cream, pork rind, coconut oil, olive oil and eggs. So many eggs that now have backyard chooks!!!! I also lost weight while doing this. Due to my consistantl

Interesting. I have been on 20mg simvastatin for years, ages before I was diagnosed with type 2. On that level, my cholesterol was always about 5.5
After diagnosis, i cut down on starchy carbs, and although I didn't aim for more fats specifically, I had to replace the carbs with something which was cheese, eggs cream etc. In other words, more fat. A year on, and on same statin levels, my cholesterol is now 3.8

 

[whatdoesthisbuttondo]

I have just got the results back from a 3 monthly bloods run to find that having done the medications since the last test my cholesterol is now at 3.7....a vast improvement!
My HbA1c has dropped to 53 which is also going in the right direction....

I eat a better diet, 'everything in moderation' rather than a regime and was sorely tempted to have a go at the Newcastle type diets that a lot of folk are doing but with these results I think I'll wait until the next set of results to see if the trends are still lowering.

 

[noblehead]

After diagnosis, i cut down on starchy carbs, and although I didn't aim for more fats specifically, I had to replace the carbs with something which was cheese, eggs cream etc. In other words, more fat. A year on, and on same statin levels, my cholesterol is now 3.8

Proves the statin is doing a good job Malc!

Many argue it's the combination of carbs and fat that leads to high cholesterol, as you are on a moderate carb diet of 150-180g of carbs (similar to myself although mines closer to 150g) it does disprove this theory somewhat. I still eat eggs every day and cheese every other day and have never had a total cholesterol result above 4.3 for a very long time, and yes I don't take any statins........yet!

 

[Grazer]

Yeah, thanks Richard. Point is though, they're doing a BETTER job (5.5 to 3.8) since eating less carbs and more fat. It's the same statins as I was on years BEFORE diagnosis when I was always at 5.5 on a lower fat higher carb regime

 

[bmorgen]

... as I'm reducing the amount of fat in my diet, less red meat, cheese, butter etc,...my cholesterol level (whatever it is) will naturally come down and therefore I won't need statins.

Good luck but using diet to control high cholesterol is no longer considered adequate. Statins, on the other hand, work remarkably well and have been safely in use for decades. Because you know someone with side effects doesn't mean you will have them. You have to try them and see. And if you get a side effect, there are alternative statins to try. I've been on Atorvastatin for years with no side effects. My cholesterol is under 3. Prior to statins it was over 6!

 

[noblehead]

I've been on Atorvastatin for years with no side effects. My cholesterol is under 3. Prior to statins it was over 6!

Isn't Artovastatin out of licence soon, should make it more widely available as I believe it has less side-effects than Simvastatin.

 

[smitha48]

hi all,

Just thought i'd put my tuppence worth in.

I have T2 and CAD. i've had 10 stents and 4 angoioplasty's, and had a Cholesterol level up in the 7s with LDL (the bad stuff!) above 5.

I was put on 80mg Atorvastatin, and my total Cholesterol dropped to 2.9. :clap:

Also diagnosed T2 and altered diet, reducing carbs, and have managed to keep my HbA1C at 6.4, which is down from the 7 at diagnosis.

As i have a friend who has had serious side effects with statins i asked the Cardiologist if i could come off them as a trial, because the levels were now low and i had altered my diet. He agreed but insisted i had further bloods at the 6 week point.

Had the bloods and unfortunately the experiment was a TOTAL failure. Total Cholesterol at 6.9 with LDL at 4.8 :cry:

Needless to say I'm back on the Statins. Personally I've not had an issue with Atorvastatin and my experience would seem to suggest that Diet alone doesn't work, especially if you happen to have FH.

I obviously can't recommend one method or another, but would suggest that if you have Cholesterol outside the accepted limits, give the statins a go........You may not get any side effects, and they may keep your arteries and heart healthy. After all we've all got enough to cope with having Diabetes.

Hope you all keep well.

Tony

 

[clearviews]

Just commenting on Smith48's observation that at 6 weeks after stopping statins the cholesterol results had worsened. Mine were tested 6 months after stopping and my combined results had risen also. I had researched this and was prepared for this as it seemed it was a likely result if losing weight at the same time ( I was). I stuck it out with my heart in my mouth and after another 6 months every figure was moving in the right direction. LDL going down, HDL rising and combined coming down while the ratio was improving too. I don't have CVHD or have had a heart event. If I had not expected an initial rise I would have panicked. Mine results came after 6 months and now 3 1/2 years on GP holds up my results as a remarkable achievement.
Interesting that today the Australian medical advisors are now promoting coconut oil, a saturated fat, as healthy. Many older people like my mother won't touch the stuff because they were advised 30 years ago by their doctor not to touch sat fats. Mum has just been diagnosed with T2 at 84 years of age and had been strictly following doctor's order about reducing fat in her diet. Today in our Sunday Telegraph we are being told that up to 50% of T2s can reversed their diabetes by taking up a plant based, wholefood diet.

 

[smitha48]

Hi clearviews.

Very interesting that it took longer thab the 6 weeks i gave to get the results going in the right direction. Promlem for me is that with CVHD as bad as mine is, i don't know if i couild risk giving it that long especially as the LDL quadrupled.

Anyway it worked for you and hopefully will stay that way.

Good luck

Tony

 

[Daibell]

I wonder what the evidence is that prescribing statins is more important than hypoglycaemic drugs? I suspect it's just part of the current obsession in the profession for keeping cholesterol levels way below 5. Yes, keep them low'ish partly through good diet but also take account of family circulation history (genetics etc) and not just throw drugs at everyone. I'm one of those who can tolerate 40mg of Simvastatin with no muscle aches etc but my wife had a disastrous liver reaction as th GP ignored the fact that she had had Hep A. My GP prescribed 80 mg for starters (wrong) but after a year I asked for it to be reduced to 40mg and my cholesterol level is still only 3.5. Metformin is a lot safer than a statin.

 

[diment]

so why is your liver producing so much cholesterol ?
thats what you should ask your doctor....not take drugs to upset a normal body function..
I was worried about my high cholesterol....271mg/dl up from 230mg/dl a month before should be under 200mg/dl.so i started reading about cholesterol.its seems that the numbers dont mean that much and i should not be too worried.i read about statins being the answer,but no not for me after reading about all the side affects.
Then i read a story about a doctor telling some one that cholesterol is made by your own liver....how can your own liver make something that will be harmful to you ? it goes on to say only a small percentage of cholesterol comes from food we eat and most is made by our own liver and for good reason.it appears we need cholesterol to repair our bodies cells etc especially when we have .. inflammation ....im thinking what is wrong with my body !!! what inflammation could i have . easy ive been a diabetic for more than 20 years with bad blood sugar numbers.Then i found the Atkins lifestyle and now my numbers are down to HbA1c 5.4..... .but after 20 years of high sugar in my blood...all that sugar scratching and scraping the insides of my veins and arteries ...equals...inflammation,so my body is making lots of cholesterol to repair my damaged veins and arteries..inflammation !
im sure if i take care of my sugar numbers that my liver (cholesterol) will fix my inflammation in time and then i will see my cholesterol numbers come down.
i live in thailand and its only $20 to have blood tests done here so i will do one every month and log my progress.
if i had never started Atkins my sugar would have been out of control and my body making more and more cholesterol until it did clogg my arteries and stroke...heart disease.
so i have a good reason to stay on Atkins lifestyle.i wish some health care worker had told me this a long time ago....but the drug companies love to get us all on there statins....