Braving the GP - Critique my notes?

[BB8.HG]

So I'm reluctantly off to my GP.
I'm going to register with a new one, but it'll take 3 weeks to get an appointment (boo...) so I've decided to bite the bullet as I really can't have it going up and up like this for no identifiable reason)

Background is in my last post, but essentially my problem is rising blood sugar to crazy levels despite diligent keto, IF, exercise and weight loss for 5 weeks now.
This morning it was 21. I'm not having it.

I'm trying to be open-minded, but I also want to avoid my GP turning around and saying 'You're fat, be a better diabetic'.
I need her to treat this seriously as I feel there's clearly something at play that needs to be addressed

I've made notes explaining the following areas so she's fully appraised of my habits - Is there anything you think I should add to try to prevent her just telling me to try harder (as if I could...)?

• Blood sugar stats
• Testing Schedule
• Food and Exercise schedule (not a food diary as such, but i eat the same every day with very little variation - variations are captured)
• Medication
• Other conditions
• Symptoms

 

[Rachox]

Well done for deciding to ask for more help. I always go with a list of what I want to discuss too when I go to the GP. I saw someone else describe doing this as going with an agenda like a formal meeting, and why not, it’s all to easy to forget something. I would be explicit about what tests you are asking for, GAD and c peptide I assume?
Here’s a link to your previous post you refer to, just to make it easier for other members to access the back ground info:
https://www.diabetes.co.uk/forum/threads/bg-astronomical-despite-keto-confused-and-upset.166956/

 

[JoKalsbeek]

So I'm reluctantly off to my GP.
I'm going to register with a new one, but it'll take 3 weeks to get an appointment (boo...) so I've decided to bite the bullet as I really can't have it going up and up like this for no identifiable reason)

Background is in my last post, but essentially my problem is rising blood sugar to crazy levels despite diligent keto, IF, exercise and weight loss for 5 weeks now.
This morning it was 21. I'm not having it.

I'm trying to be open-minded, but I also want to avoid my GP turning around and saying 'You're fat, be a better diabetic'.
I need her to treat this seriously as I feel there's clearly something at play that needs to be addressed

I've made notes explaining the following areas so she's fully appraised of my habits - Is there anything you think I should add to try to prevent her just telling me to try harder (as if I could...)?

• Blood sugar stats
• Testing Schedule
• Food and Exercise schedule (not a food diary as such, but i eat the same every day with very little variation - variations are captured)
• Medication
• Other conditions
• Symptoms

...Be a good diabetic...?! Counter that with "Be a good GP". Listening to patients and taking them seriously would help. You're coming to the appointment with a lot of information and background, don't let all that data be ignored. Let them know you actually know a thing or two about a thing or two, and you won't be sent off without proper help this time.

You're doing everything perfectly. Something else is at play here.

Good luck!
Jo

 

[BB8.HG]

Well done for deciding to ask for more help. I always go with a list of what I want to discuss too when I go to the GP. I saw someone else describe doing this as going with an agenda like a formal meeting, and why not, it’s all to easy to forget something. I would be explicit about what tests you are asking for, GAD and c peptide I assume?
Here’s a link to your previous post you refer to, just to make it easier for other members to access the back ground info:
https://www.diabetes.co.uk/forum/threads/bg-astronomical-despite-keto-confused-and-upset.166956/

Thank you! Exactly those tests- yes Thank you for linking to my post.

 

[Suz2]

So I'm reluctantly off to my GP.
I'm going to register with a new one, but it'll take 3 weeks to get an appointment (boo...) so I've decided to bite the bullet as I really can't have it going up and up like this for no identifiable reason)

Background is in my last post, but essentially my problem is rising blood sugar to crazy levels despite diligent keto, IF, exercise and weight loss for 5 weeks now.
This morning it was 21. I'm not having it.

I'm trying to be open-minded, but I also want to avoid my GP turning around and saying 'You're fat, be a better diabetic'.
I need her to treat this seriously as I feel there's clearly something at play that needs to be addressed

I've made notes explaining the following areas so she's fully appraised of my habits - Is there anything you think I should add to try to prevent her just telling me to try harder (as if I could...)?

• Blood sugar stats
• Testing Schedule
• Food and Exercise schedule (not a food diary as such, but i eat the same every day with very little variation - variations are captured)
• Medication
• Other conditions
• Symptoms

...Be a good diabetic...?! Counter that with "Be a good GP". Listening to patients and taking them seriously would help. You're coming to the appointment with a lot of information and background, don't let all that data be ignored. Let them know you actually know a thing or two about a thing or two, and you won't be sent off without proper help this time.

You're doing everything perfectly. Something else is at play here.

Good luck!
Jo

Since your GP does not appear to be respectful of you or your honest communication, be very bold and cut her short when she begins this nonsense. Interrupt and ask her what SHE is going to do for you since what you have done, clearly communicated, ISN'T WORKING!
I know it isn't "proper" to be so forward, but this isn't a hangnail. It's your life. Be bold.

 

[Fndwheelie]

I know in your other post you said you don’t want to end up on insulin, but if your misdiagnosed LADA or type 1, insulin is the only way forward. You already seem to have a good handle on T2 eating but it’s no longer working, which makes me wonder if it’s something other than T2 at play here. If it were me I think I’d print off your previous posts (linked by @Rachox) and take that for her to read, along with taking your pointers to talk about.

 

[Listlad]

Well done for deciding to ask for more help. I always go with a list of what I want to discuss too when I go to the GP. I saw someone else describe doing this as going with an agenda like a formal meeting, and why not, it’s all to easy to forget something. I would be explicit about what tests you are asking for, GAD and c peptide I assume?
Here’s a link to your previous post you refer to, just to make it easier for other members to access the back ground info:
https://www.diabetes.co.uk/forum/threads/bg-astronomical-despite-keto-confused-and-upset.166956/

Yes. I stick a set of bullet points in my mobile phone notes. And of course refer to it as I go.

 

[copilost]

there's clearly something at play that needs to be addressed

Hi, sorry it's being so tough for you right now.

I'd say that you might find it helpful to have a very clear outcome or goal formulated. So what would a good outcome look like? Would it be that certain tests are done? In which case maybe just start right there, don't even go the "I'm doing this/you're not doing this route" but be direct and say I'd like these tests for these reasons. State that you are worried and why you are worried. Or maybe you'd prefer that the doctor listened to what you are saying and helped you formulate a plan together, there again I'd say state your purpose clearly at the outset. A good outcome would be having the tests or having a plan you've agreed with your doctor or possibly both!

It's always possible that despite your communication being superb the doctor just isn't In which case try to see where it's going wrong and if the appointment is going "off track" into "you should be doing this, more of this, tough luck" territory see if you can steer it back by saying something like "I understand what you are saying (note not that you agree, just you understand) but I'd like to talk about XXXX today." If your doctor fails you at this point (and make no mistake it is a failure) then i'd say just quit that doctor, this is not something you can fix. (Others may have advice on useless doctors - I'd be interested to hear possible techniques/actions).

Wishing you a good outcome whatever it is.
CoP

 

[Listlad]

Hi, sorry it's being so tough for you right now.

I'd say that you might find it helpful to have a very clear outcome or goal formulated. So what would a good outcome look like? Would it be that certain tests are done? In which case maybe just start right there, don't even go the "I'm doing this/you're not doing this route" but be direct and say I'd like these tests for these reasons. State that you are worried and why you are worried. Or maybe you'd prefer that the doctor listened to what you are saying and helped you formulate a plan together, there again I'd say state your purpose clearly at the outset. A good outcome would be having the tests or having a plan you've agreed with your doctor or possibly both!

It's always possible that despite your communication being superb the doctor just isn't In which case try to see where it's going wrong and if the appointment is going "off track" into "you should be doing this, more of this, tough luck" territory see if you can steer it back by saying something like "I understand what you are saying (note not that you agree, just you understand) but I'd like to talk about XXXX today." If your doctor fails you at this point (and make no mistake it is a failure) then i'd say just quit that doctor, this is not something you can fix. (Others may have advice on useless doctors - I'd be interested to hear possible techniques/actions).

Wishing you a good outcome whatever it is.
CoP

@BB8.HG
At my surgery I have a choice of about 6 GPs to choose from so I select the best for me.

 

[pixie1]

Have you thought of going back to basics and keep a strict diary monitoring Bm results from foods. See if there are trends. Just a thought.

 

[BB8.HG]

Have you thought of going back to basics and keep a strict diary monitoring Bm results from foods. See if there are trends. Just a thought.

Well I essentially eat the same every day, and every time I have something different or there's something particularly unusual about the day (did more exercise, had a weirdly late dinner, tried a new meal, a new restaurant etc) I do make a note of it on my app. My portion sizes aren't creeping up either, everything is measured and standardised.

 

[BB8.HG]

I live in a very small town, so choice of GPs is limited.

I actually had quite a positive experience. I decided to lay out my whole management strategy to her, I was hesitant because I thought I might get a raised eyebrow with LCHF, home-tesing etc. But on balance decided that it's just so weird that I should just give her all the information available in the hope of resolving it.

She did sharply ask why I was testing when I brought out my stats, I told her it was useful to see what food is doing to my BG and that I found it to be a good accountability tool - She nodded and accepted that quite readily.

She seemed on board with low carb, but seemed slightly less on board with high fat, but not horrified (maybe just ingrained anti-fat culture at play here)

We discussed the diet generally and she said 'Well we'll all have to get used to low carb soon, I think' which I found quite encouraging.

She ordered a big panel of tests over the next few weeks.

She said I'm doing everything right and that it isn't fair that the figures aren't better. She's reluctant to take any immediate action in terms of treatment before the results are back and we figure out what's causing it, which is fair enough.

Ultimately an unexpectedly positive experience. Maybe i'd caught her on a series of bad days previously....

It's a weight off that I can be open with her about my lifestyle and have it 'endorsed' - this reassures me that every appointment won't be a disheartening battle.

Thanks everyone for your input, on this and my other thread. It's been useful and gave me things to think about and helped me to prepare.

 

[JMK1954]

Really glad that you got the sort of response that you needed. Although I'm a type 1, I know what it's like when you can't get a GP to listen to what you say - and more to the point, take it seriously. In my experience, it always pays to be pro-active. Ring the surgery if you are expecting action that doesn't happen. I would have had no flu jab last winter if I hadn't asked about when they were bring done. Human error is always a factor in what goes on.

Good luck and best wishes.

 

[jjraak]

Hi, sorry it's being so tough for you right now.

I'd say that you might find it helpful to have a very clear outcome or goal formulated. So what would a good outcome look like?
Would it be that certain tests are done? In which case maybe just start right there, don't even go the "I'm doing this/you're not doing this route" but be direct and say I'd like these tests for these reasons.
State that you are worried and why you are worried.

Or maybe you'd prefer that the doctor listened to what you are saying and helped you formulate a plan together,
there again I'd say state your purpose clearly at the outset.
A good outcome would be having the tests or having a plan you've agreed with your doctor or possibly both!

It's always possible that despite your communication being superb the doctor just isn't In which case try to see where it's going wrong and if the appointment is going "off track" into "you should be doing this, more of this, tough luck" territory see if you can steer it back by saying something like "I understand what you are saying (note not that you agree, just you understand) but I'd like to talk about XXXX today." If your doctor fails you at this point (and make no mistake it is a failure) then i'd say just quit that doctor,

I think that's a great post @copilost
full of good advise.

i think i may be taking a good dollop of that next time i visit my doctors.
thanks

And @BB8.HG

what a lovely outcome.
How nice for you that the visits in future won't be a minefield of misunderstanding and suspicions.

some times, just vocalising a problem leads us to some affirmative action.
good on you

bets of luck getting a resolution in the upcoming tests.

 

[Swillbos]

Some of what you describe chimes with my own recent experience as a T2, currently awaiting test results to see if I am LADA (late-developing type 1 aka type 1.5). If you have any other auto-immune diseases (in my case thyroid disease) these would also be worth mentioning to your GP as risk factors for LADA/T1. Even if you don't have family history, it might be worth asking for a thyroid test as there is an association.

FBS in the 20s are unsustainably high and, although you say you don't have other symptoms, you are confident in your meter readings. This being the case, you should also ask for or provide blood or urine ketone readings. I had no idea what these where until very recently - in April, mine read at >4 which I have since understood as dangerously high. At the time I was beating myself up for not managing to reverse T2 and doing a lot of intermittent fasting; my GP thought fasting might have contributed to my high ketones (not unreasonably) and I could not be sure just how much my own stress levels and poor sleep were also contributing. I did, however, have a very dry mouth, thirst and needed to go to the loo a lot. The thing that did freak was that started to loose increasing amounts of weight after a point when I really no longer wanted to (eating loads, albeit low carb high fat and still harbouring a belief that I might do my own wholesome real food Newcastle diet). Insulin is a fat building hormone, and my latest working hypothesis is that I was losing weight not in a positive planned way, because of my low carb/intermittent fasting (strategies which had worked well earlier), but because I simply was no longer able to produce enough of my own insulin, so ended up burning fat and weeing out sugar (not a fab combo!)

We are all different and cannot give medical advice to each other, but I have found anecdotal information on this site a great help. Reading your posts, I think you have been more diligent on the diet front (although low carb, I have never wished to do keto), and I have been more active on the exercise front (walk/jog 6-8 miles most days, plus a lot of gardening).

I have cut and pasted a bit of my personal background, which may (or may not!) be of interest:

//////////////////////////

Between the ages of 30-50, I was overweight, gradually moving up the ranks to full-blown obesity. When I turned 50 I set myself a goal of losing 4 stone over two years. I never really understood how carbs and calories were different but through trial and error I came up with my own DIY weight loss protocol: lots of walking and c1800 cals a day of which no more than a third from carbs, which I estimated at 150g a day. This worked very well for me and I found I was comfortably losing 2-3 pounds every month. When I was diagnosed with type 2 nine months into my regime, I had already lost 1.5 stone (c.10kg) and a tenth of my body weight. The Dr explained the parameters for diagnosis had recently changed, but that at HbA1c of 49, I was officially diabetic. Must admit my initial reaction was disbelief and extreme annoyance that things had changed, but it did spur me on to carry on with my diet and exercise routines.....now I know a lot more I suspect I had probably been diabetic for some time. Three months later my HbA1c had come down to 46 and I was congratulated on "reversing" my diabetes(!)

I lost three stone in a little over a year, and basked in the praise of the local practice nurse......I kept the weight off for a year, and then stressful work and family illness threw me off course, and weight started creeping back on. Nonetheless it was still an unpleasant shock to me when my GP suggested the time had come to start Metformin. It was then that I found this forum and started reading up, and realised that of course I hadn't reversed anything. I responded very well to Metformin (2 x standard 500mg - never had any problems with digestion after the first week or so) and discovered the joys of intermittent fasting, low carb baking and so much else! Over the course of seven years I have lost over five stone (34kg) and a third of my body weight but very, very slowly.

Things started to unravel a bit last summer and Metformin was increased to 1500mg. Then I had a step change in April, no matter what I tried I suddenly couldn't get my blood glucose lower than 15. Started on full whack Metformin (2000mg slow release) and 2mg Glimepiride, fully expecting great results....absolutely zero response, moved up to 4mg Glimeperide and still no improvement. Started panicking, GP told me to hang on in there and give it a chance, but ended up getting referred to the local hospital service and started insulin three weeks ago ago.

I can't tell you how much better I feel now, I don't think I realised how poorly I was until I started insulin. I had high ketones and probably did very well to avoid diabetic ketoacidosis (DKA). The new approach does take some getting your head round, though.

///////////////////////////////////////

I wish you the very best of luck in your diabetes journey. My own diabetes team is not exactly a dream team, but like my mid-table Championship side (OK Sheffield Wednesday!!!) they are still my team......I swerve on most of the dietary advice given, but have come to accept that when some blood sugar readings are alarmingly high or low (latter yet to be experienced in my case), despite best endeavours, then a medical approach is needed

Big hugs xx