Apologies for taking some time to respond, but I have been somewhat busy today. Again, I’ll deal with each point in order.
“….I've been diagnosed for 3 years, but I'm not sure why you think that's relevant….”
Thank you for the information. I wondered how long you had taken to develop your options, and also to gauge how close you might be to 40, and therefore your predicted need for insulin. hank you for the information. Whilst of course, the discussion isn’t about you, but it is about your beliefs and statements you make, so context can be helpful.
“….The worst aspects of the NHS approach, eg over-reliance on drugs and telling people to eat carbs at every meal, are terrible…”
No challenge on this one. But these are their official guidelines, and you talk about the implications of deviation further into your post. I sympathise with their plight on this. I believe GPs have a hard time keeping up with all the chronic epidemics they face every day; hypertension ,back ache, stress, non-diabetic obesity, arthritis to name just a few, and have frequently acknowledged it on these boards..
Not every patient these doctors see is willing to do what it takes to lose a large amount of weight and restrict their food choices long term…. But if you are a doctor faced with someone you have known for years, and you have reason to believe they are not likely to see it through with long term changes, then that doctor will probably try to protect them from harm using things they as the doctor can control…”.
That a doctor predicts or assumes an outcome from a range of options, based on his experience of the most of his patients does not mean he can ignore his responsibilities. In UK, we have a concept of informed consent, which means, his patient must understand what I am being recommended, or prescribed, and that I must also understand the alternatives and implications. Where a patient’s cognitive abilities are impaired, the person giving consent should have all of that information and be making those choices.
In their circles, saying "but the patient wanted to manage their condition with diet only, so I didn't mention medication" wouldn't cut it.
Absolutely not, but it would be utterly acceptable if the patient was informed of the option to medicate, but declined it. Adults need to be accountable for their actions. To treat adults as if they are incapable of making decisions is, to my way of thinking, offensive.
Whilst I no longer practise, I am a former clinician, dealing with and accountable for my patients wellbeing on a daily basis. I would never, ever have written a prescription or performed a procedure without explaining without my patient understanding what and why I was prescribing.
“….Also, a lot of people with T2 diabetes who are overweight and over, say, 45, are likely to already be on some form of medication. Some will be on a lot. For those people, the prospect of taking one more is not daunting, like it is for someone on no medication….”
Of course they might be, but equally plausibly, they could hate being a slave to the pharmacy, or even feel that your “just one more” is the straw breaking the camel’s back.
I’m sure your view is informed partly from your own experience of taking medication, and from your description of other medical conditions, perhaps you already fit the description you paint above, but I value my freedom from regular medication.
“….Maybe it's a personal thing but I am much more comfortable and contented accepting what I think is likely to happen, than I would be wishing and hoping for something, only to be disappointed or worse when it changes…”
I am genuinely happy for you, that you have found a good place in dealing with your condition. I am also in a good place with my own. Where we differ is our current picture of the future. I remain committed to remaining med-free where I possibly can, but I am open minded enough to accept that were I no longer able to deal with a condition without pharmaceutical support, and the implications of not medicating were serious, I would submit.
“….I have been through a lot already and if I have to use insulin in my old age it wouldn't seem so bad compared to stuff I've already been through.”
Please don’t assume that because I am currently extremely fit and well, that this has always been the case. I was a sickly child, and lost a certain amount of school time, early in my education. And in my 20s I was also very ill. And I mean very ill. It’s quite a sobering experience when your parents fly, from another country, to say goodbye to you; such are the expectations of ones’ survival. Nothing will ever erase the look on my either of my parents’ face. There is so much about that period of my life that I do not remember for one reason or another, but I will never forget those expressions.