Another One Of Those Conversations With GP

Bluetit1802

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I only test once a day because I'm on a consistent diet avoiding all carbs where poss. I find testing fasting glucose every morning very useful. We don't all use the same methodology.

My original comment was aimed at the study that concluded testing is a waste of time - because the 2 groups in the study that did test only tested once a day - and didn't do any better than the group that didn't test at all. That's why I said the once a day was nonsense - they didn't improve because they learnt nothing about their food choices. Had they been taught to eat to their meter by testing out meals it would have been different. The study was nonsense.
 
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Jenny15

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********. It turned my life around.

This is terrible advice with no place on this forum.

Edited by moderator for language
I've noticed that absolute statements and blanket generalisations about individual health choices lead to never ending squabbles in online forums.

I would have said something like "One sizes does not fit all. I found once daily testing was great for me."

I agree with you that once daily testing at certain times is useful if there are no better alternatives. But there are better alternatives available to most people.

If for some reason I could only afford or access 7 test strips a week, I'd probably use them once a day, too. IMO the immediate priority is to get your fasting BG down. It is possible to do this without testing before and after every meal.

Once my fasting BG was below 7.0 I might then save up my test strips to study the effect of individual foods at mealtimes. It's totally up to you, as long you are working towards your BG goals.

So, IMHO you're both right. But word choices matter.

Just my two cents worth.
 

Jenny15

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She's 92 has meals on wheels most of the week and mainly eats the desserts.. she refuses to eat anything green. Last time she had a funny turn the paramedics took her blood glucose and it was 7.9 . She lives on her own in a wardened block and when she comes to us she hardly eats anything so to be honest there's not a lot I can do and I'm sorry but she is not coming to live with me ever.. We got her off statins and methotrexate but then she started to have atrial fib so is now on meds for that and high blood pressure (which I'm pretty sure may be white coat syndrome). There comes a point where you just have to say what will be will be...
Just my two cents worth here, but I think if a 92 year old wants to eat desserts and not greens, she should do it to her heart's content.

I hope I make it to 92 and that I am allowed to eat whatever I want without others trying to persuade me differently. My parents are getting up there in age and there's no chance of persuading them to do anything different with their eating, lifestyle or health choices.

My Dad has health issues that I know would be much easier for him to bear if he took medication for them but he will not budge. So I respect his autonomy and focus on enjoying the time he has left with me. I like your approach: What will be will be.
 

ickihun

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Never surrender!

My experience is mixed. One nurse takes notes about how I lost 25% body weight and halved my HbA1c in 6 months (LCHF, more exercise, great ideas and support from this forum and the lowcarb forum). She passes this on to other patients so they can help themselves.

The other gets sour when I say:
* The NHS diet advice is literally poisonous (regular brown bread, brown rice etc). Do the tests and you wise up very quickly. Would you rather wake up at 5.5 or at 15+?
* That (self funded) home testing is the only way I could sift the good advice from the quackery about what enjoyable food wouldn't harm me.
* Given the amount I anticipate saving the NHS in avoided complication treatment costs by self management calibrated by self testing it is a bloody disgrace that I have to pay to do their job for them. She actually has the temerity in the face of evidence to debate with me the point of a type 2 self testing. Disgrace.

End of rant.

The NHS in general is wonderful. I really mean that. My late wife got 14 extra years through their work in another specialism.

But they wilfully p*ss away 20% of their budget treating type 2 complications when the correct advice and test strips on prescription might cost 5%.

I am incandescent that this is not obvious to those in charge.

How do we change this?
I'm wondering if that is why msk department is getting busier at our hospital.
No strips policy is false ecomony.
Just my opinion.
I'll quiz msk more in 2mths time. Its going to take a lifetime to get my physio help at this rate.
 

ickihun

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I am going to say, at the beginning of this journey, that i found testing once a day to be more useful than nothing at all. Maybe @JonM1 is not yet a regular tester?
Although I've agreed.
I've never only tested once a day since diagnosis in 2002.
Only burn out 4yrs ago had an occasional day where I was testing less. Even then.

It becomes part of your life like brushing hair.
 
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bulkbiker

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Just my two cents worth here, but I think if a 92 year old wants to eat desserts and not greens, she should do it to her heart's content.

I hope I make it to 92 and that I am allowed to eat whatever I want without others trying to persuade me differently. My parents are getting up there in age and there's no chance of persuading them to do anything different with their eating, lifestyle or health choices.

My Dad has health issues that I know would be much easier for him to bear if he took medication for them but he will not budge. So I respect his autonomy and focus on enjoying the time he has left with me. I like your approach: What will be will be.
Completely agree that's why I mention to her that she eats too much sugar but let her get whatever she wants whenever we take her out shopping. If only she didn't moan all the time about the aches and pains that I reckon she gets because of various inflammation problems... hey ho
 
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Jenny15

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Completely agree that's why I mention to her that she eats too much sugar but let her get whatever she wants whenever we take her out shopping. If only she didn't moan all the time about the aches and pains that I reckon she gets because of various inflammation problems... hey ho
Yes, I have to put up with my Dad's complaining about the health problems he won't get modern treatments for, too. To be fair, there might not be a clearcut link between what she eats and her pain. The geriatric body is winding down and maintenance issues are to be expected.

IMO anyone in pain should get it treated, to restore quality of life but I know a lot of people won't go down that path. I have a chronic pain condition so I take whatever I need, within what is prescribed for me. If I don't, I am too miserable.
 

ickihun

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Completely agree that's why I mention to her that she eats too much sugar but let her get whatever she wants whenever we take her out shopping. If only she didn't moan all the time about the aches and pains that I reckon she gets because of various inflammation problems... hey ho
It is difficult when a parent just doesn't get it or even care. My mum yesterday took apples from 5yrs old mini trolley for her fruit feast which compliments her fruity yoguarts. I think she's addicted. She'd been told about her fatty liver. I'd hate for her to become type2. It will devastate her. She just doesn't see how fruit addiction can cause T2. She is determined not to listen. She talks over my advice and dumbs it down. What should I do? Shout it at her. No. :(
She has huge osteoarthritis pain. Whole family do but I don't. Never have. I'm only one with T2 even though all morbidly obese too.
 
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ickihun

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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?
Most GPS are content in treating ailments rather than preventing them all to our mental health detriment.
I now have full faith in my gp who is excellent in treating my ailments. Prevention is my job if I which to take all my preventative mismatching needs and my own decision which to prioritise. Your gp feels heartattacks and strokes are worth preventing.
I feel you have an attentive one. Not all are.
 

AdamJames

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I feel you have an attentive one. Not all are.

To be honest I'm not so sure about that. More often than not I have to correct him about things like how long it's been since he last saw me, and whether or not I'm on medication.

On the visit that I mentioned in the OP, he weighed me at one point, then two minutes later said he should probably weigh me. I kid you not! Luckily the penny dropped when I said "errr....." before he weighed me a second time.
 

Jenny15

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To be honest I'm not so sure about that. More often than not I have to correct him about things like how long it's been since he last saw me, and whether or not I'm on medication.

On the visit that I mentioned in the OP, he weighed me at one point, then two minutes later said he should probably weigh me. I kid you not! Luckily the penny dropped when I said "errr....." before he weighed me a second time.
I was reading your post and thinking "my doctor forgets things like how long since he last saw me, but they're busy," then I read that he forgot he had weighed you after two minutes and I'm like "Yep. Adam may indeed have a slightly inattentive doctor there." A bit of a worry really. But I am sure you will help him stay on task better. Good luck!
 
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AdamJames

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I was reading your post and thinking "my doctor forgets things like how long since he last saw me, but they're busy," then I read that he forgot he had weighed you after two minutes and I'm like "Yep. Adam may indeed have a slightly inattentive doctor there." A bit of a worry really. But I am sure you will help him stay on task better. Good luck!

Yes, thanks! I really see him as someone to prescribe medication as and when needed rather than for advice.

My main concern was that he seemed very pleased that I'd gone from 42 to 47, and was happy to just see me again in 6 months. It seemed to be simple maths to him. I was at less than 48, so computer says I'm doing fine. Never mind the trend over the last 3 months, or science.
 
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dbr10

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Yes, thanks! I really see him as someone to prescribe medication as and when needed rather than for advice.

My main concern was that he seemed very pleased that I'd gone from 42 to 47, and was happy to just see me again in 6 months. It seemed to be simple maths to him. I was at less than 48, so computer says I'm doing fine. Never mind the trend over the last 3 months, or science.
It's bizarre.
 
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Fenn

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Doctors, plumbers, taxi drivers... good and bad, be happy we have the internet.

I will be honest, I don’t see any point in testing once a day, I don’t actually see any point in fasting tests in the morning, unless we re eating late at night and that is affecting our morning reading? I’m not sure how it could but what do I know. The more I learn about diabetes, the less I understand

When my numbers were great, my early morning numbers were always much worse, as I figured I couldn’t change them, I never bothered with the testing, I just tested before and after eating because that was the thing I could fix.

On saying that, I do get pleasure from the numbers people post each day on those threads and I am finding it inspirational, i am doing the test in the morning just to play the game (even though my numbers are not good enough to post) in fact I am finding this whole forum inspirational, it’s making me take much greater care of myself. I have almost pulled my head clear of the sand
 
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Jenny15

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Yes, thanks! I really see him as someone to prescribe medication as and when needed rather than for advice.

My main concern was that he seemed very pleased that I'd gone from 42 to 47, and was happy to just see me again in 6 months. It seemed to be simple maths to him. I was at less than 48, so computer says I'm doing fine. Never mind the trend over the last 3 months, or science.
He is a robot, an automaton. They could replace him with an actual robot and get the same results, with less money.:D
 
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Jenny15

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Doctors, plumbers, taxi drivers... good and bad, be happy we have the internet.

I will be honest, I don’t see any point in testing once a day, I don’t actually see any point in fasting tests in the morning, unless we re eating late at night and that is affecting our morning reading? I’m not sure how it could but what do I know. The more I learn about diabetes, the less I understand

When my numbers were great, my early morning numbers were always much worse, as I figured I couldn’t change them, I never bothered with the testing, I just tested before and after eating because that was the thing I could fix.

On saying that, I do get pleasure from the numbers people post each day on those threads and I am finding it inspirational, i am doing the test in the morning just to play the game (even though my numbers are not good enough to post) in fact I am finding this whole forum inspirational, it’s making me take much greater care of myself. I have almost pulled my head clear of the sand
Good to hear!

I think the reason for the focus on fasting BG is that it's the one time of day when we can usually be expected to be on a level playing field, from person to person ie, we've all gone at least 8 hours without food (give or take). By that amount of time we know one thing: we won't have been affected by the fluctuations that occur within 2 hours of eating.

This is helpful for conducting research. A lot of the parameters used in clinical medicine seem to arise from what is needed in research.
 
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Fenn

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Good to hear!

I think the reason for the focus on fasting BG is that it's the one time of day when we can usually be expected to be on a level playing field, from person to person ie, we've all gone at least 8 hours without food (give or take). By that amount of time we know one thing: we won't have been affected by the fluctuations that occur within 2 hours of eating.

This is helpful for conducting research. A lot of the parameters used in clinical medicine seem to arise from what is needed in research.


The only thing is that our livers presumably dump at different rates, I am convinced my liver leaves my body once I’m sleeping and goes down the local tandoori, returning 2 hours before I wake
 

Jenny15

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The only thing is that our livers presumably dump at different rates, I am convinced my liver leaves my body once I’m sleeping and goes down the local tandoori, returning 2 hours before I wake
I think you're right, there is a lot of variation. I haven't had to manage the liver dump problem myself but I have read that if you eat something just before bed, that can counteract it to some extent. Others here know more about this than me.
 

ickihun

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To be honest I'm not so sure about that. More often than not I have to correct him about things like how long it's been since he last saw me, and whether or not I'm on medication.

On the visit that I mentioned in the OP, he weighed me at one point, then two minutes later said he should probably weigh me. I kid you not! Luckily the penny dropped when I said "errr....." before he weighed me a second time.
Oh dear! He doesn't sound well himself.
There is such a shortage of GPs now. Female ones are paid less so once wage is equal the nhs will overwork them even more.
I know I'm so different to you but I'm a more complicated patient to manage and my GP does me proud. I'd hate a patient like me. I'm hard work, my health is brittle at times. I've just received help on not being able to walk properly for nearly or more than 3yrs. I was coping but at times don't. I must drive my gp nuts?!
My GP would love it if I only had type2 and was an overweight male. A much gentler patient.