GP - Low Carb Supporter

[xyzzy]

Well today was the big day. My DSN had booked me a 20 min end of day appointment with the practice diabetes expert gp. I went along with all the same printouts (see thread) http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=25&t=28972I had taken to see the DSN and printouts of my spreadsheet that shows my BG progression , what I'm eating, BP that kind of thing. The intention was to evangelise the low carb mantra. Arrived in his surgery complete with the onset of the mother of all sore throats and have nearly lost my voice so I was hoping I wouldn't have to argue too much.

First a personal bit. Got me a repeat prescription for test strips! Like the DSN he recognised the good they are doing so we got that out of the way really quickly. Next on the problems with cramp I've been getting. Suggested not prescribing anything as the slimeline tonic is working. Made sense as if the small amount of quinine in the tonic is enough why prescribe a pill. Just come back if it gets worse.

So onto the main event low carbing. Absolutely no evangelising necessary! Got told the Swedish stuff is fine, he'd seen that along with a large long term Danish study that shows intensive treatment of Type 2's is very beneficial. He was up to date with the latest ADA 2012 130g RDA as "my friend does a very similar approach to you". He recognised the UK is only "gradually catching up". To my direct question if what I eat is ok he recommended eating at a level of carbs required to "keep your diabetes in remission" as he described it! Looked at my spreadsheet so he could see the g's of carbohydrate I'm not eating!

His only warnings on low carb were quite sensible. Pick a regime that you can stick with or else he implied some people end up yo-yo-ing between low carb high fat and high carb high fat! Unlike the DSN he was not surprised to see fasting level BG's in the 4's and +2 hour BG's in the 5's. Just commented on how well controlled I am.

He reckons the number of diabetics he meets like me who like his friend take it as seriously as it should be amounts to around just 3% of the total.

His bluntest statement was that at some point be it one year, ten years or whenever years to expect my BG's to begin to rise. At which point I would need more meds. I said my plan was to lose weight to around a BMI of 22 then monitor both my BG's and my ability to stick to a LCHF regime. If either went astray I would want to go straight on insulin as I saw no point in killing off what pancreatic function I had left. His response "I wish more patients saw it like that" however he did suggest an intermediate step of one of the non insulin stimulating drugs like Januvia which acts like a more powerful version of Metformin which seems fine by me. Didn't take my Metformin away!

Another interesting viewpoint he had was that he saw the combination of reducing Cholesterol, Blood Pressure and Weight as just as important, if not more than getting a really low HbA1c. He said obviously an HbA1c is a reasonable predictor of complications but the other are really serious indicators of just snuffing it young.

I went hoping he would reduce my Ramapril instead he wants to look at raising it from 7.5g to 10g a day because of the long term benefits it will give to BP.

So all in all a good result and we chatted for around half an hour. He said he didn't expect to see me that often about db but to keep up the regular quarterly visits with the DSN so she could continue to see what I was up to.

So now the challenge for ALL of us is how to raise that 3% awareness.

 

[catza]

That was a really positive consultation. :clap: for you and the GP.

Now fess up, you were a tad disappointed as you were relishing being able to flash all your paperwork and convert a non-believer. :lol:

 

[tree-peony]

lol!

 

[xyzzy]

Yes what's the point of having an establishment to fight if it already agrees with you!

I must say it was the 3% figure that shocked me. Didn't ask him as such but I can see no reason why any newly diagnosed patient who goes to see him wouldn't be told or encouraged to do the method that works for the 3%. Why don't those 97% take the message seriously? I can understand why a good proportion of people will never listen to any message but surely not all of them?

 

[Magill]

And I thought I had a rare and unique discussion yesterday! I was at the dietitian. I went armed with my eating records and was duly praised for my control and my low carb regime which "was obviously working for me". She believed my average intake at about 50/60g per day was fine and the only negative point she had on my diet was that it was a bit calcium deficient (and to be fair she was correct).

She even raised the question of the Newcastle diet as she believed I had the willpower to go through with something like that but, for now she would rather I keep it in reserve as I am progressing fine at the moment. She confirmed I had lost almost 10% of my body weight and she set a realistic target of another 5% over the next 3 months as she knows I am upping my exercise levels again.

She spent over 1 hour with me looking at possible solutions to deal with my post exercise sugar spikes and other alternatives to try with meals generally for any foods I particularly missed.

Must admit I was in a state of shock as I have never encountered a dietitian like her and I said as much. She did say that a large number of dietitians do disagree with low carbing but she always says you cannot argue with results and she believes the tide is starting to turn (music to my ears) and it is just a case of pushing on :clap: and maybe one day everyone else would catch up!

She also confirmed what you were told xyzzy that we are in the minority. She too reckoned it was only about 3 or 4% that really took control of their diet. She said it can get quite frustrating to get people to change their eating habits so when someone like me comes along who has made the changes, has tight control and has researched everything to find out what works it makes her job worthwhile.

I was sent off to report back in 3 months to check progress or to call her if I had any problems meantime. Must admit I left feeling happy with the world!

 

[Daibell]

Hi. I wish my young diabetes GP was so enlightened. She said I should be having a 'normal healthy diet' whatever that is and not trying to starve myself to keep my BS low. When I suggested moving to insulin she said that was a 'last resort' and offered sitagliptin (Januvia) when I refused a glitazone based on health risks. It has helped so the inevitable insulin has at least been delayed.

 

[xyzzy]

Well Magill that is the first low carb dietician advocate I think I have heard of since I joined. At least some people will be getting a chance!

Januvia is the drug that my GP suggested I should go on prior to going on insulin if I ever wanted or needed to. It is coincidentally the same drug I asked the specialist drugs nurse "Nurse Nightshade" about a couple of months ago. She told me it wasn't going to be suitable for me and I would have to go on Gliclazide which I refused to consider at the time for the same reasons as yourself. The honest answer is the combination of weight loss, Metformin and the herbs I take (in that order of importance) are fine for the moment.

 

[Unbeliever]

The key , as always, seems to be encountering the "right " HCP from the beginning. If everyone saw Xyzzy's GP and Magil's dietiian the percentage would almost certanly rise There would be long queues though :lol:

I do think hat things are changing - albeit slowly.

A GP remarked o me 3 years ago that things had to change as the old way of doing things was not working. It has been a long time oming but there are glimmers of hope to be seen just by reading recent experiences of members of this forum..

 

[Defren]

Another low carb GP!! I am thrilled not only for you Steve, but also for the other patients in the practice. These positive posts are almost becoming a habit on here, how wonderful is that?

Well done on all you have achieved this far!

 

[Unbeliever]

Well Magill that is the first low carb dietician advocate I think I have heard of since I joined. At least some people will be getting a chance!

Januvia is the drug that my GP suggested I should go on prior to going on insulin if I ever wanted or needed to. It is coincidentally the same drug I asked the specialist drugs nurse "Nurse Nightshade" about a couple of months ago. She told me it wasn't going to be suitable for me and I would have to go on Gliclazide which I refused to consider at the time for the same reasons as yourself. The honest answer is the combination of weight loss, Metformin and the herbs I take (in that order of importance) are fine for the moment.

I have only ever spoken o one dieitian and she strongly "hinted" that I should research the carb situation. She said that was he only dietary advice she could offfer as I was fine otherwise. and had a good understanding of nutrition.
This was not a regular apponintment but I happened to be around and she had just been "stood up " by a patient and I was asked if I would like to speak to her.

It was a very useful talk as i had just been prescribed Januvia and she explained how his worked and tld me about liver dumping which I hadn't heard of until then.

I have to say that NONE of this would have happened had I not been able to show the Diabetologist t my bg meter readings with notes from the previous fornight. These demonstrated that although my readings wwere almost always in the 4s and 5s they would spike after my eveing meal - and I o mean spike- if this meakl happened to be less substantial than usual.
I don't have a large appetite and would sometimes merely snack in the evening or occasoionally have my main meal at lunchtime.

The dietitian also pointed out that the decline of he pancreas is not a gradual even process. It is unpredictable. Sometimes if behaves as if it were fully functional and at other times will produce practically no insulin.
That is why Januvia apppears to be such an effective drug. It nly works when it is needed. We don't know when this will be
for the reasons staed above. many diabetics know - through testing that they eperience the dawn phenomenon but spikes can occcur at other times on an irregular basis.

When i was first advised to go onto insulin I immmeditely thought that this could be a good idea for he same reason as xyzzy does.. I was immediately disillusioned because I was old I would also be aking the full raft of oral meds i was then taking
as well , maybe being allowed o drop one or two pillls after a time..

This horrified me. I had already been harmed by oral meds and I very much doun=bted the abillity of the Pracice DSN o manage both ogether, I therefore refused insulin.

That was prior to Januvia. I started l reducing starchy carbs shortly after beginning the Januvia and showed remarkable results immediatelty. I also had some remarkable hypos - making nme very thankful that I had not taken insulin and oral nmeds ogether as the consequences could have been drastic. I dropped most of the oral meds wihou further consultation
and noone disagreed when they found out.

I can now understand why insulin for T2s is considered a final resort. It may indeed slow he decrease of the pancreas but
his may make control very diffficult . It used o be the case that t 1.5 would be reated with insulin from the start but this I believe, is no longer necessaril he case.

This is obviously the reason why your Dr is recommending Januvia befor insulin xyzzy. I don;t tink they wish to precscribe i oo soon after diagnosis because iher may be other fatcors which need sorting out first . We all need ime to ge o know how
we are affeced by diet etc.

My almost chance meeing wih his dietitian was extremely useful to me. The only sad hing was that she had to HINT at low carbing almost looking over her shoulder as she did. I now strongly suspect hat the Consultant I saw . only working there on a short term basis steered me in her direction deliberately perhaps sharng her views. I was not overweight and there was no obvious reason for me to see her - but he ook my file in and was in here for several minutes. I

I look forward o he day when all this subterfuge is no longer necessary.

 

[MaryJ]

Great result xyzzy

 

[xyzzy]

This is obviously the reason why your Dr is recommending Januvia befor insulin xyzzy. I don;t tink they wish to precscribe i oo soon after diagnosis because iher may be other fatcors which need sorting out first . We all need ime to ge o know how
we are affeced by diet etc.

The case for prescribing Januvia (Sitagliptin) ahead of any of the insulin stimulating drugs seems very strong to me. I don't have enough knowledge to know when it isn't suitable however. When I first researched it I found that even though it is NICE approved it only gets prescribed in 50% of PCT's because of cost. From the posts on the forum from people who use it I've not seen one who hasn't been pleased with it. Like any other diabetic drug its only ever going to do so much so I would never see it as a replacement for low carbing but it does seem to be very effective. Now I know my gp will be willing to prescribe it if I ever start to see my Metformin and Herbs combo begin to fail I would have no problem asking to be put on it.

 

[hanadr]

That's a brilliant doctor you have there xyzzy!
You are so lucky to find him.
I think though that if you keep your numbers where you are AND lose the weight, not only will you look wonderful, but also you will not need more medication.
I have been diagnosed almost 10 years. I started on 3 x 500mg Metformin with 20mg Gliclazide. i achieved an HbA1c about 7.5% and my weight went up to 107Kg!!!
Since I discovered low carbibg a few years ago, I've dropped Gliclazide completely and gone down to 2 x 500 Metformin and kept my HbA1c in the mid 5% rqange. I've qalso lost about 20Kg in weight.
Now if I could lose about 10 - 12 more, I'd be happier
I don't expect my medicaion demand to od up. I DON'T mean to let it!
Hana
Ps have you read David Mendosa's story? He grasdually got off ALL mediation.Google him. His website is a mine of information. It's HUGE.

 

[xyzzy]

That's a brilliant doctor you have there xyzzy!
You are so lucky to find him.
I think though that if you keep your numbers where you are AND lose the weight, not only will you look wonderful, but also you will not need more medication.
I have been diagnosed almost 10 years. I started on 3 x 500mg Metformin with 20mg Gliclazide. i achieved an HbA1c about 7.5% and my weight went up to 107Kg!!!
Since I discovered low carbibg a few years ago, I've dropped Gliclazide completely and gone down to 2 x 500 Metformin and kept my HbA1c in the mid 5% rqange. I've qalso lost about 20Kg in weight.
Now if I could lose about 10 - 12 more, I'd be happier
I don't expect my medicaion demand to od up. I DON'T mean to let it!
Hana
Ps have you read David Mendosa's story? He grasdually got off ALL mediation.Google him. His website is a mine of information. It's HUGE.

Thank you Hana. I'll read up on David Mendosa. If you think he's a good guy then good enough for me!

Yes like yourself I don't anticipate having to up the meds as I think keeping in a non diabetic BG range should be excellent protection against that possibility. However I do like to think through all the possible scenarios that could play out and have a strategy in place well in advance. Who knows what any of us will be like in say 10 years?

Losing weight is the problem at the moment. Got myself back to just inside the "normal" range but haven't lost a pound in nearly 3 weeks! It is beginning to get very very irritating as part of the xyzzy master plan is to lose another two stone. Not quite sure how to kick start the weight loss again. I seem to have hit Grazers carbs v weight stability point at a BMI of 24.5 rather than the 22 I was after.

 

[Unbeliever]

I definitely agree that you are bettter off without any meds if you can do it as i think I posted when xyzzy originally mentioned it.. Especially with something like Januvia in fact where the longterm effects are not yet known.
The good thing about it is that it does not cause weight gain as so many other meds do. Given a choice I would prefer not to have to take it either.

My Gp does not consider Januvia to be unduly expensive. Maybe they all have different criteria. At the moment here is a standard dose of 100mg per day . I can imagine that after a certain period consideration may be given to allowing certain patients to increase this dose.

I very much envy anyone who has been able o come off their meds Hana. I have been able to ditch much of mine but I am afraid to take it much furter as any change seems to trigger further bleeds in my eyes. By the time better control kicks in
if it does it will probably too late to save my sight.

Have you considered a different sort of exercise to usual to kickstart your weight loss xyzzy? You probably know all about that already I expect .

Like you I like to plan ahead . There is no harm in being prepared . I have a feeling though , that in ten years ime we will have
more options should we need them. There seems to have been more progress on the drugs for T2 front in the past couple of years than in the previous wenty or more. We are the T2 babyboomers.

 

[xyzzy]

Have you considered a different sort of exercise to usual to kickstart your weight loss xyzzy? You probably know all about that already I expect .

Yes the "E" word beckons ever nearer. I have been working hard in the garden over the weekend which has been rather pleasant.
That's the kind of exercise I like as it has some interest to it. Trouble is its pretty weather dependent.

 

[Unbeliever]

I know what you mean. I have always hated exercise for exercise sake. Seems like a waste of energy. I find myself wondering if somethig USEFUL couldn't have been done with all the energy used in marathons For example}

While I am out pounding the sreets on my daily walk or, when it isn't raining the woods and fields I keep thinking of all the jobs awaiting me at home which , unfortunately, don't have the same effect on my bg levels !

Maybe an exercise bike atached to a generator?

 

[robert72]

I have an exercise bike and it annoys me that the little onboard computer thing seems to eat batteries. Why couldn't it have rechargeable batteries than charged from the pedals

 

[Unbeliever]

I have an exercise bike and it annoys me that the little onboard computer thing seems to eat batteries. Why couldn't it have rechargeable batteries than charged from the pedals

Good idea that Robert. Maybe suggest it to the manufacturer.

 

[catza]

It would be great if you could have a dynamo which powered a radio or video player. Having the music or film go slow would be a great incentive to peddle harder.