Confusion within NHS Over The Treatment of Tyoe 2

[Aphorism]

Hi
I am finding now that things are getting very foggy in the NHS regarding the treatment, diet etc of people with type 2, which I myself suffer.
I have been type 2 for a decade, although a previous doctor failed to make a simple diagnoses after de facto evidence of classic type 2 symptoms; which led to urinary tract complications and having to undergo a full circumsition in my 50s. Nightmare!
Anyway, my cholesterol levels have always been historically low, consequently I refused to take statins on the basis that they made me ill and they were not needed to lower what is a low personal cholesterol count anyway. Now the doctor has just tried to get me to take Pioglitazone, but failed to mention the risks, even the fact Germany and France have banned this controversial drug.
Interesting, this was my doctor's response to my pancreas showing signs of packing up, and the possibility of myself having to take insulin! Confusing.
My doctor has told me that apparently the usual way of measuring blood sugar is out! Now he uses a different method which I knew nothing about - let alone actually understanding what it all means (no leaflet or web link to help was given).
When I had my last blood sugar test it proved to be high; although I was being treated for an infection and was post prandial, having eaten my breakfast three hours before the blood was taken; facts he refused to consider. Confusing!
I will not take Pioglitazone on the informed basis that the risk outways the confidence of success; apparently all patients must have a liver function test, especially if in the past you have suffered liver damage (with me it was a gallstone problem). I did not.
Some friends and relatives have told me to change doctors!
Plus, NHS staff all seem to have their own views! Confusing!
Finally, on my low carb diet I have lost 2 stone in weight and I exercise rigorously every morning.
But I remain confused.
Thanks for reading this!

 

[NoCrbs4Me]

The standard western medical treatment for type 2 diabetes is:
1. Follow the government recommended low fat high carb diet.
2. Metformin.
3. A statin.
4. A blood pressure reducing med.

As the patient’s blood glucose levels rise, prescribe stronger diabetes meds until finally they need to be on insulin.

 

[Diakat]

Was the blood test for a HbA1c? This measures average blood sugar over 3 months. Eating will not affect the result.

 

[catapillar]

apparently all patients must have a liver function test, especially if in the past you have suffered liver damage (with me it was a gallstone problem). I did not.

Where did you get this from? All patients must have an LFT? Do you mean all patients on Piogltazone or all diabetic patients? There are plenty of drugs that come with a risk of impacting on liver function and are often accompanied with recommendation for LFTs while taking them. There is no NICE guideline for regular LFT testing for diabetic patients. Liver damage is not a complication of diabetes, so there is no reason to screen for liver damage in diabetic patients.

 

[Tophat1900]

I would find another doctor if it were me.

 

[Mike d]

Some friends and relatives have told me to change doctors!

They're right

 

[Aphorism]

Was the blood test for a HbA1c? This measures average blood sugar over 3 months. Eating will not affect the result.

Where did you get this from? All patients must have an LFT? Do you mean all patients on Piogltazone or all diabetic patients? There are plenty of drugs that come with a risk of impacting on liver function and are often accompanied with recommendation for LFTs while taking them. There is no NICE guideline for regular LFT testing for diabetic patients. Liver damage is not a complication of diabetes, so there is no reason to screen for liver damage in diabetic patients.

Hi
NICE states that a liver function test should be made prior to being prescribed Pioglitazone.
If my pancreas is kaput then the next stage is normally insulin injections to lower my blood sugar. I will not take the drug prescribed; France and Germany have highly efficient health systems, I am assured, and their judgement is final for me. Plus, in the USA their are pending high profile court cases brought by people affected, apparently, by this drug causing bladder cancer and fluid around the heart (leading to heart failure).

 

[Aphorism]

They're right

I know docs are under pressure and empathise, truly. However, when a doc is a diabetes specialist he or she needs to be absolutely clear with their patients. Footnote; my doc said that if he were a lawyer the bill would be mounting up! And it was not a joke.

 

[Aphorism]

I would find another doctor if it were me.

Thanks; yes this us the question right now. Years ago, I had a diabetic nurse who kept asking me if I wanted a heart attack and kept telling me to be quiet while she was typing. I changed her after she suddenly prodded my stomach feintly aggressively because my blood sugar not come down like before!

 

[Aphorism]

Was the blood test for a HbA1c? This measures average blood sugar over 3 months. Eating will not affect the result.

Yes, but with my pancreas dying off a bit, this might explain the levels. However, I have no ideas what 'new way of measuring blood sugar' is! Which mysteriously alluded to. Anyone have any ideas?

 

[catapillar]

NICE states that a liver function test should be made prior to being prescribed Pioglitazone.

Really? I can't find a NICE guideline that provides for this. BNF simply states that Piogltazone shouldn't be prescribed to people with hepatic dysfunction and patients should be warned of signs and symptoms of acute liver dysfunction as this is a rare side effect of the drug (the warning will be in the patient information leaflet in the pill box).

Yes, but with my pancreas dying off a bit, this might explain the levels. However, I have no ideas what 'new way of measuring blood sugar' is! Which mysteriously alluded to. Anyone have any ideas?

How do you know your pancreas is dying off a bit? Have you had a cpeptide test to see what your insulin production is looking like?

Who has "mysteriously" alluded to new ways of monitoring blood sugar? Do you actually monitor your blood sugar at the moment, are you testing before and two hours after eating to see what impact food is having? The allusion may have been to the freestyle libre, a flash glucose monitor, which is available for anyone to purchase.

 

[Aphorism]

Really? I can't find a NICE guideline that provides for this. BNF simply states that Piogltazone shouldn't be prescribed to people with hepatic dysfunction and patients should be warned of signs and symptoms of acute liver dysfunction as this is a rare side effect of the drug (the warning will be in the patient information leaflet in the pill box).



How do you know your pancreas is dying off a bit? Have you had a cpeptide test to see what your insulin production is looking like?

Who has "mysteriously" alluded to new ways of monitoring blood sugar? Do you actually monitor your blood sugar at the moment, are you testing before and two hours after eating to see what impact food is having? The allusion may have been to the freestyle libre, a flash glucose monitor, which is available for anyone to purchase.

OK now you sound really patronising!

 

[Aphorism]

Really? I can't find a NICE guideline that provides for this. BNF simply states that Piogltazone shouldn't be prescribed to people with hepatic dysfunction and patients should be warned of signs and symptoms of acute liver dysfunction as this is a rare side effect of the drug (the warning will be in the patient information leaflet in the pill box).

You have read through properly. So your opinion is surplus. But thanks anyway.

How do you know your pancreas is dying off a bit? Have you had a cpeptide test to see what your insulin production is looking like?

Who has "mysteriously" alluded to new ways of monitoring blood sugar? Do you actually monitor your blood sugar at the moment, are you testing before and two hours after eating to see what impact food is having? The allusion may have been to the freestyle libre, a flash glucose monitor, which is available for anyone to purchase.

 

[Aphorism]

OK now you sound really patronising!

You have not read it through; I used to work for a drug company so I know my way around. I exercise my free will, don't you? Or do work for a drug company?

 

[Aphorism]

Really? I can't find a NICE guideline that provides for this. BNF simply states that Piogltazone shouldn't be prescribed to people with hepatic dysfunction and patients should be warned of signs and symptoms of acute liver dysfunction as this is a rare side effect of the drug (the warning will be in the patient information leaflet in the pill box).



How do you know your pancreas is dying off a bit? Have you had a cpeptide test to see what your insulin production is looking like?

Who has "mysteriously" alluded to new ways of monitoring blood sugar? Do you actually monitor your blood sugar at the moment, are you testing before and two hours after eating to see what impact food is having? The allusion may have been to the freestyle libre, a flash glucose monitor, which is available for anyone to purchase.

I don't wish to discuss this with you anymore. Bye!

 

[Aphorism]

The standard western medical treatment for type 2 diabetes is:
1. Follow the government recommended low fat high carb diet.
2. Metformin.
3. A statin.
4. A blood pressure reducing med.

As the patient’s blood glucose levels rise, prescribe stronger diabetes meds until finally they need to be on insulin.

Thanks

 

[Mr_Pot]

OK now you sound really patronising!

No she doesn't. @catapillar is always very helpful with her advice.

 

[catapillar]

OK now you sound really patronising!

Well I'm not sure how you took my question seeking the NICE guidelines - which I quite openly said I had been unable to find myself, so really I was asking for your help in finding the guidelines you had referenced - as patronising?

Or is it the reference to the freestyle libre that you think was patronising? Sorry if I was mentioning something you already knew. But until people are told about new things, they won't know about them. The popularity of the libre spread in a great part by word of mouth amoung diabetics. If everyone kept silent on things because they thought it would be safer to assume everyone else knew rather than risk being called patronising it would probably hinder the spread of useful information.

 

[Tophat1900]

OK now you sound really patronising!

They're pretty good questions. And they're coming from someone who really knows her stuff.

 

[Mike d]

@catapillar is brilliant. One of the best ... don't judge too early @Aphorism

Few here are at her level. VERY few so don't get off on the wrong foot