Chalk up yet another one of those visits to the GP in which we start to wonder why we bother to go, and end up taking refuge in a forum like this instead. My GP is the diabetic specialist by the way.
First of all the good, or at least "not as bad as I thought it would be" news: My HbA1c has gone up to 47. I'd got it down to 42 from 90 but now it's gone up again. I expected it to be higher since my fasting readings have often been 9.5 for months. Was also expecting to be told to start Metformin again, but the doc said I narrowly avoided that recommendation.
But a summary of the conversation was:
Me: "I'm expecting it to be a bad result, based on the readings I've been getting".
Doc: "It's 47. That's just within what we like to see for diabetics, so not so bad."
Me: "Wow. I know I've been in the toxic range fairly constantly. Most mornings I've been getting a 9.5."
Doc: "That's be nice thing about the HbA1c. It's more accurate and gives us a better picture. We don't encourage testing at home."
Me: "But how would I know which foods raise my blood sugars and which don't."
Doc: "We don't encourage testing because it can just worry people. And it's the expense of providing the strips as well."
Me: "But I get my own strips"
Doc: "Yes, but we still don't encourage it. It only seems to worry people. Look at you, you were worried about your results but it turns out they aren't so bad. Blood pressure is more important, anyway. Heart problems are the main thing and it's important to keep blood pressure low."
(My blood pressure had also gone up so this was a moot point).
This is the first time I've offered any resistance to what the GP said, and he clearly wasn't happy, and he had a response which he felt was sound - he certainly places a lot of faith in the HbA1c.
What should I do? Print out references to studies which suggest that two groups can both have the same HbA1c but the group who constantly keep spikes below a certain threshold are much less likely to have complications?
How does a patient educate a doctor without causing offence?
Do doctors actually know better - is there good evidence that an HbA1c below 48 leads to a longer and healthier life for a T2 diabetic? Have I just been focusing on fringe studies, but the overall body of evidence actually supports what the GP is saying?
I think an interesting thought experiment would be: can we make a case to support the GP's view? It's very common that we tear views like his down here, but what if we tried to find the evidence to support it? Would we get anywhere?
First of all the good, or at least "not as bad as I thought it would be" news: My HbA1c has gone up to 47. I'd got it down to 42 from 90 but now it's gone up again. I expected it to be higher since my fasting readings have often been 9.5 for months. Was also expecting to be told to start Metformin again, but the doc said I narrowly avoided that recommendation.
But a summary of the conversation was:
Me: "I'm expecting it to be a bad result, based on the readings I've been getting".
Doc: "It's 47. That's just within what we like to see for diabetics, so not so bad."
Me: "Wow. I know I've been in the toxic range fairly constantly. Most mornings I've been getting a 9.5."
Doc: "That's be nice thing about the HbA1c. It's more accurate and gives us a better picture. We don't encourage testing at home."
Me: "But how would I know which foods raise my blood sugars and which don't."
Doc: "We don't encourage testing because it can just worry people. And it's the expense of providing the strips as well."
Me: "But I get my own strips"
Doc: "Yes, but we still don't encourage it. It only seems to worry people. Look at you, you were worried about your results but it turns out they aren't so bad. Blood pressure is more important, anyway. Heart problems are the main thing and it's important to keep blood pressure low."
(My blood pressure had also gone up so this was a moot point).
This is the first time I've offered any resistance to what the GP said, and he clearly wasn't happy, and he had a response which he felt was sound - he certainly places a lot of faith in the HbA1c.
What should I do? Print out references to studies which suggest that two groups can both have the same HbA1c but the group who constantly keep spikes below a certain threshold are much less likely to have complications?
How does a patient educate a doctor without causing offence?
Do doctors actually know better - is there good evidence that an HbA1c below 48 leads to a longer and healthier life for a T2 diabetic? Have I just been focusing on fringe studies, but the overall body of evidence actually supports what the GP is saying?
I think an interesting thought experiment would be: can we make a case to support the GP's view? It's very common that we tear views like his down here, but what if we tried to find the evidence to support it? Would we get anywhere?