Frustrating trip to docs - A little good, a little bad

[RFSMarch]

Ok let's start with the good.
I got him to happily sign a form that explains about the Freestyle Libre sensor I need to take with me to the US, and the scanner and I successfully got him to switch me to Metformin Slow Release because my first two weeks building up with the normal were ok, but shifting to three a day saw the usual symptoms associated with it - so I dropped back down to two, but he decided to move me to slow release, which the pharmacist reliably informs me clears up the stomach issues for the majority of people.

He also gave me my NHS exmeption form, so that was good.

What disappointed me though is...
He insists he never recommends to diabetic patients to even finger-prick to monitor their blood levels before telling me that basically the Freestyle Libre has been a fun toy (at the price I paid for it, this is no **** toy!) but I don't need it anymore - and quite literally take the tablets and come back when I get back from the US. he all but told me to stop using it. I could have understood if his concern was it is not as accurate as finger-prick tests, but he wasn't even advocating those!!! Literally... just take the tablets and come back later!

The pharmacist was slightly more engaged, saying this is all about understanding and managing within your set of circumstances, Mine are quite challenging. The way I left it was that I would track my meals as best as I could in My Fitness Pal and keep taking my BP when I am home (I draw the line at packing that for a three week trip!) and I would sit down with him and see how things are.


My first set of bloods were horrendously high with high BP and high cholesterol and I need to have a second set done when I get back from the US. If I can't manage my blood sugars by myself and the medication, then he will refer me to a diabetic clinic (which leads me to another gripe - I reached out to a local group - have I heard anything back? Nope!)

I don't often go to the docs as it is, so... surely trying to proactively NOT rely on tablets for the rest of my life or if indeed I will be on metformin for ever now, surely trying to LIMIT what I am on is a better approach that... 'oooh what can we add to your tabletload'?

I dunno... I think that at least trying to be proactive, move from high GI to Medium and low GI foods and manage my portions etc is a better approach.

Curious as to what other GPs have been like with folks after your initial diagnosis.

 

[Prem51]

Your GP's advice is the standard NHS guidelines advice that Type 2s don't need to self test, unless they are on insulin.
My GP didn't give me any advice except to avoid grapes (which I didn't eat) and cut down on sugar.
I was referred for a diabetes management course (DESMOND) but the advice there was to continue eating carbohydrates, which I have since learnt aren't good for T2s.
You say you are changing from high GI to medium and low GI foods. But what sort of carb content do they have. You really need to lower carb intake if you want to lower your blood sugar levels.

 

[Bluetit1802]

Your best bet is to completely ignore what the GP said about testing and the Libre. He is wrong, you are right. Good self management requires knowledge of which foods cause you problems, and that knowledge can only come from testing and also keeping a food diary so you can see patterns and be able to adjust your food choices accordingly.

The medical profession tell us all that diabetes is progressive. This is because they tell us to eat carbs and tell us not to test. They give us a pill and leave us to it. Next lot of tests and, yes, we have got worse, so another pill is prescribed. This is repeated year on year until there are no more pills to try, so insulin is prescribed. Hence, the disease has progressed. This is completely unnecessary. With rigid self management, testing, and applying what we see on our meters to our food choices, plus an odd pill if necessary, we can avoid all this.

 

[Phoenix55]

Your doctor will not recommend finger prick testing, if he did he would find it difficult to refuse a prescription for strips. I hope that your bg has come down from the initial tests. It would seem that most GPs believe that people come to them for a tablet to fix anything and everything that is wrong with them. It is logical then to suppose that T2 diabetics are the same and content to continue to take a tablet for life. Some of us are rebels to this perception and want to try to manage our health with minimal medication but hope that by making lifestyle changes we can take control back.

My own Gp suggested that I could reduce finger prick testing to just once a week instead of regularly after meals. I ignored the advice and continue to test to make sure that I am still eating appropriately sized portions. You have found a way that works for you, using your fitbit. Take notice of what you have eaten that raises your bg. Don't be afraid of the healthy fats found in some fish, olives etc. They will help you to feel full, one thing I remember from school, many years ago, was that we found that eating fat does not make you fat.

 

[RFSMarch]

Your GP's advice is the standard NHS guidelines advice that Type 2s don't need to self test, unless they are on insulin.
My GP didn't give me any advice except to avoid grapes (which I didn't eat) and cut down on sugar.
I was referred for a diabetes management course (DESMOND) but the advice there was to continue eating carbohydrates, which I have since learnt aren't good for T2s.
You say you are changing from high GI to medium and low GI foods. But what sort of carb content do they have. You really need to lower carb intake if you want to lower your blood sugar levels.

Agree but I also have found myself in the first two weeks since going back to work outs at home to be in a MASSIVE calorie deficit. So there has to be balance. I am sorry I do not espouse the 'run away from all things' school of thought. My biggest 'sin' was I stopped exercising as much (no cartilage in my knees doesn't help) and was setting up a new website and dealing with a family issue and since then a bereavement,.

My GPs advice was 'don't eat sweets or have fizzy drinks' which I was only doing at tournaments anyway. So that's easy enough to stop. I can exercise when I am at home - but I am rarely at home and it is not always financially possible to stay in a hotel with a gym. More often than not it is an AirBnB! Not many of those come with treadmills!

Trying to get him to understand the challenges of a job as a sports writer has been hard enough! Being able to understand what causes me to spike and what is manageable with the monitoring has helped. So we'll see.

 

[RFSMarch]

Your best bet is to completely ignore what the GP said about testing and the Libre. He is wrong, you are right. Good self management requires knowledge of which foods cause you problems, and that knowledge can only come from testing and also keeping a food diary so you can see patterns and be able to adjust your food choices accordingly.

The medical profession tell us all that diabetes is progressive. This is because they tell us to eat carbs and tell us not to test. They give us a pill and leave us to it. Next lot of tests and, yes, we have got worse, so another pill is prescribed. This is repeated year on year until there are no more pills to try, so insulin is prescribed. Hence, the disease has progressed. This is completely unnecessary. With rigid self management, testing, and applying what we see on our meters to our food choices, plus an odd pill if necessary, we can avoid all this.

100% agree. Still at least he signed a medical certificate and gave me my exmeption form! So, you know... bonus!

 

[ringi]

There is no need to test BG with Type2 unless

• You are not able to motivate yourself base on a number you will get in 3 months time
• You can’t work out how each meal will affect your BG by reading the food packets
• You don’t remember and do everything the low carb books tell you.
• You make errors on planning your meals, so need quick feedback
• You eat out, so have to know where you can trust to eat

Think of BG testing as a tool for learning, it is well known we remember most of what we discovered ourselves but little of what someone else tells us. Hence the more tools you have for self-discovery the better.

 

[Bluetit1802]

Agree but I also have found myself in the first two weeks since going back to work outs at home to be in a MASSIVE calorie deficit. So there has to be balance. I am sorry I do not espouse the 'run away from all things' school of thought. My biggest 'sin' was I stopped exercising as much (no cartilage in my knees doesn't help) and was setting up a new website and dealing with a family issue and since then a bereavement,.

My GPs advice was 'don't eat sweets or have fizzy drinks' which I was only doing at tournaments anyway. So that's easy enough to stop. I can exercise when I am at home - but I am rarely at home and it is not always financially possible to stay in a hotel with a gym. More often than not it is an AirBnB! Not many of those come with treadmills!

Trying to get him to understand the challenges of a job as a sports writer has been hard enough! Being able to understand what causes me to spike and what is manageable with the monitoring has helped. So we'll see.

Exercise isn't always about treadmills and gyms. Wherever you are in the world you can walk, climb up stairs or swim. Even swimming isn't obligatory. I haven't been to a gym in years, nor used a treadmill, and nor do I swim these days. I walk, I climb up and down stairs whenever I can and I don't use lifts. I do housework. Pushing a vacuum and cleaning windows is enough. It can be done without any special equipment, and IMHO diet is the key to success.

 

[RFSMarch]

Exercise isn't always about treadmills and gyms. Wherever you are in the world you can walk, climb up stairs or swim. Even swimming isn't obligatory. I haven't been to a gym in years, nor used a treadmill, and nor do I swim these days. I walk, I climb up and down stairs whenever I can and I don't use lifts. I do housework. Pushing a vacuum and cleaning windows is enough. It can be done without any special equipment, and IMHO diet is the key to success.

yep - I mean hate walking without a purpose and in truth the job really does not lend itself to it, until maybe after the first few rounds (is it morally acceptable to wish for half the field of players to lose and go home and make my day easier? It is? Oh!)

Diet only is an issue when I am away - when I am home I actually CRAVE being able to cook and have nice stuff! That being said - this next tournament actually has a good range of healthier options. I am actually dreading Indian Wells again next year as they give you next to nothing on your card and the nice stuff blows your daily allowance in one hit! Oh... but if you have the deepfried all American stuff - why that makes your card last all day!!!

Trouble is from the start of the season I am away on average one a month for at least a week and a half each time. In my chat with the pharmacist we decided that I would use MFP, scan my blood sugar like I do now with the Libre and then look and see what the numbers tell us. Then we can decide if it is likely I will be sent to diabetes school (!)

I dunno @Bluetit1802 I just thought I was being proactive and was quite surprised the doctor was almost desensitised to it. The Pharmacist reckoned especially in the area where I am, they see a lot of people who just take the tablets, come back for more and still have their full fry ups and roasties each week. I guess someone wanting to ration a hashbrown is a little strange!

 

[RFSMarch]

There is no need to test BG with Type2 unless

• You are not able to motivate yourself base on a number you will get in 3 months time
• You can’t work out how each meal will affect your BG by reading the food packets
• You don’t remember and do everything the low carb books tell you.
• You make errors on planning your meals, so need quick feedback
• You eat out, so have to know where you can trust to eat

Think of BG testing as a tool for learning, it is well known we remember most of what we discovered ourselves but little of what someone else tells us. Hence the m, re tools you have for self-discovery the better.

Well, not quite. I am at the mercy of media centres, whether they feed us, if they do WHAT they feed us, and if they don't feed us, how much they give us to feed ourselves. So by your criteria, I do feel the need to test my blood glucose because I can tell you right now, the only meal next week I can rely on having is breakfast in the hotel.

After that I am at the beck and call of players requested for press. We have absolutely NO idea what time they will finish matches, be in for press, and we can't just hoof off for a bite if we have actually asked to speak to them. Actually that's not true. Of course we can - just don't expect them to EVER grant you an interview or want to answer any question from you if you muck them about!

Funnily enough I am looking at some part time work when I get back where you have one hour break in the day or a half-hour break in the evening if you are doing a night shift - who knew that a 'regular' sportsdesk shift might actually be even more challenging that being at a tournament!!!

 

[NoCrbs4Me]

There is no need to test BG with Type2 unless

• You are not able to motivate yourself base on a number you will get in 3 months time
• You can’t work out how each meal will affect your BG by reading the food packets
• You don’t remember and do everything the low carb books tell you.
• You make errors on planning your meals, so need quick feedback
• You eat out, so have to know where you can trust to eat

Think of BG testing as a tool for learning, it is well known we remember most of what we discovered ourselves but little of what someone else tells us. Hence the more tools you have for self-discovery the better.

Self testing is also a great way to discover that the standard dietary advice to eat potatoes, whole meal pasta, porridge, whole meal bread/toast, etc. is not good advice.

 

[ringi]

The "full fry up" is not an issue for BG control provided you don't have any bread with it. The roast dinner is OK apart from the potatoes.

One option is to use "intermittent fasting" just eat a carb free breakfast (lots of eggs, meat, cheese etc) and drink water for the rest of the day, this should soon bring down your BG levels. Tinned fish is a good low carb option that keeps without a fridge and does not need heating so letting you avoid the high carb food.

But even a BigMac is not too bad for diabetes provided you don't eat the chips or the bread roll along with having water or tea/coffee as the drink. Or the fish from a fish+chip shop removing the butter before you eat it.

 

[DCUKMod]

Ok let's start with the good.
I got him to happily sign a form that explains about the Freestyle Libre sensor I need to take with me to the US, and the scanner and I successfully got him to switch me to Metformin Slow Release because my first two weeks building up with the normal were ok, but shifting to three a day saw the usual symptoms associated with it - so I dropped back down to two, but he decided to move me to slow release, which the pharmacist reliably informs me clears up the stomach issues for the majority of people.

He also gave me my NHS exmeption form, so that was good.

What disappointed me though is...
He insists he never recommends to diabetic patients to even finger-prick to monitor their blood levels before telling me that basically the Freestyle Libre has been a fun toy (at the price I paid for it, this is no **** toy!) but I don't need it anymore - and quite literally take the tablets and come back when I get back from the US. he all but told me to stop using it. I could have understood if his concern was it is not as accurate as finger-prick tests, but he wasn't even advocating those!!! Literally... just take the tablets and come back later!

The pharmacist was slightly more engaged, saying this is all about understanding and managing within your set of circumstances, Mine are quite challenging. The way I left it was that I would track my meals as best as I could in My Fitness Pal and keep taking my BP when I am home (I draw the line at packing that for a three week trip!) and I would sit down with him and see how things are.


My first set of bloods were horrendously high with high BP and high cholesterol and I need to have a second set done when I get back from the US. If I can't manage my blood sugars by myself and the medication, then he will refer me to a diabetic clinic (which leads me to another gripe - I reached out to a local group - have I heard anything back? Nope!)

I don't often go to the docs as it is, so... surely trying to proactively NOT rely on tablets for the rest of my life or if indeed I will be on metformin for ever now, surely trying to LIMIT what I am on is a better approach that... 'oooh what can we add to your tabletload'?

I dunno... I think that at least trying to be proactive, move from high GI to Medium and low GI foods and manage my portions etc is a better approach.

Curious as to what other GPs have been like with folks after your initial diagnosis.

Is the local group a Diabetes UK group or another one? If your local group is one run by volunteers, it's quite conceivable they could be on holidays right now.

 

[Snapsy]

@RFSMarch it's always good to keep appraised of all the information out there, which is what it sounds like you're doing. My advice would be to see what works for you, and to plough your own furrow.

You might find your GP is sometimes on a different page of the manual than you are.
No matter. YOU are the patient.

Mr S is a photographer and also like you often at the mercy of media centres! He doesn't have diabetes but he and I make sure he has access to what he needs to eat and drink rather than what happens to be available by default. Takes some planning sometimes!

A belated welcome to the forum from Snapsy (a type 1 usurper on this thread - sorry!).

 

[RFSMarch]

Is the local group a Diabetes UK group or another one? If your local group is one run by volunteers, it's quite conceivable they could be on holidays right now.

Yep it was a Diabetes UK one - ok hopefully I ought to hear back while I am gallivanting in the land of terrifying nuclear arsenals, fire and fury and the like!

 

[RFSMarch]

So have gone back to the start with the slow release metformin, and build up again although GB has been pleasingly a lot lower than normal (and it is still quite high, and if the Libre is a couple mmol out from finger-pricking, then there is still a ways to go!

I only ever had the really severe symptoms with the instant release metformin when I went up to three tablets a day, so hope that by the time I get back from the US when I connect up the libre to the PC we have some sensible figures! Just laminated a medical certificate to be able to cart the sensor and scanner in hand luggage - although people seem conflicted on the GB group as to whether you can or can't scan on a flight. I am opting for NOT scanning, and doing my usual trick of setting my watch to Cincy time when I leave and having dinner when I get there to try and get my body into time sync a little quicker. I have actually found just nibbling when they bring food round has helped because I am so ravenous when I get there at around tea time!

Weight, having dropped by a stone and a half in the four months after getting back from Australia has now stabilised so hopefully it should come down more gradually with exercise.

 

[DCUKMod]

Yep it was a Diabetes UK one - ok hopefully I ought to hear back while I am gallivanting in the land of terrifying nuclear arsenals, fire and fury and the like!

Yes, the Diabetes UK groups are volunteer/ fellow traveller led, so they may be away. I know my local group doesn't meet in August, due to all the logistical shenanigans of the committee and members.

Roughly where are you in the UK (not town or anything, maybe county/region)?

 

[RFSMarch]

Yes, the Diabetes UK groups are volunteer/ fellow traveller led, so they may be away. I know my local group doesn't meet in August, due to all the logistical shenanigans of the committee and members.

Roughly where are you in the UK (not town or anything, maybe county/region)?

Hi - My closest group is in Kingston upon Thames