First diabetic nurse appointment. Hmmm.

[geoffh]

Had my first diabetic nurse appointment today and I reckon it went about as badly as I feared.

The first thing she did was start to write out a prescription for metformin. No explanation of the test results, no explanation of what diabetes was or an official diagnosis. I explained that I'd assumed I was diabetic from the fasting glucose results (12) but hadn't managed to speak to anyone else. We are short-staffed at the surgery at the moment, so maybe I'd have normally seen a GP first. If it weren't for this website I would have known nothing!

I asked if I could start out by changing my diet and lifestyle, she said no. In fact she said the NHS don't do that any more - everyone gets metformin! I also asked how long I'd be on it for - and she gave me a funny look and said "for life!" I asked - even if I lost a lot of weight (I've got a lot to lose!) and transformed my life - would I be able to come off it - she said no. I'm pretty sure that's not true.

I asked her to weigh me - we confirmed I've lost about 6kg in the last 2 weeks. I explained I'd (in the last week) cut pretty much most carbs out of my diet. She said that was a bad idea and I should be eating carbs each meal. I'm confused now. I'm actually doing ok at the moment, the weight is falling off and I'm feeling great. But I don't want to completely ignore her.

To be fair she did encourage me that diabetes was not necessarily progressive - if I managed it I could stay on metformin for the rest of my life and not necessarily progress to insulin.

I just wanted some hope and I didn't hear much. I explained (in a really nice way) that I thought it would be much better to give people hope rather than "the best you can hope for is that you won't get much worse".

Not really sure where to go from here. Any suggestions hugely appreciated

 

[CollieBoy]

At risk of being accused of giving medical advice , I would just remind you (and your practice nurse) that no-one is forced to take a tablet!
Congratulations on the weight loss. BTW, what were the actual test results? I would ensure you get a written record of these values, if only to give you a baseline fo future improvements1
As to her assertion that you MUST eat carbs with every meal, I would admit that a totally carb free diet is quite hard, you CAN get away with the carbs in your green/low carb vegetables and manufacture the rest by gluconeogenesis.

 

[Daibell]

Hi. The nurse represents the bad, arrogant side of the NHS. Fortunately they aren't all that bad. She is supposed to agree your treatment with you and not tell you. The carb advice was totally wrong as you know. Being arrogant and ignorant at the same time is best avoided! You may be able to come off the Metformin if the weight loss works; many have. Keep doing what you're doing.

 

[ButtterflyLady]

Had my first diabetic nurse appointment today and I reckon it went about as badly as I feared.

The first thing she did was start to write out a prescription for metformin. No explanation of the test results, no explanation of what diabetes was or an official diagnosis. I explained that I'd assumed I was diabetic from the fasting glucose results (12) but hadn't managed to speak to anyone else. We are short-staffed at the surgery at the moment, so maybe I'd have normally seen a GP first. If it weren't for this website I would have known nothing!

I asked if I could start out by changing my diet and lifestyle, she said no. In fact she said the NHS don't do that any more - everyone gets metformin! I also asked how long I'd be on it for - and she gave me a funny look and said "for life!" I asked - even if I lost a lot of weight (I've got a lot to lose!) and transformed my life - would I be able to come off it - she said no. I'm pretty sure that's not true.

I asked her to weigh me - we confirmed I've lost about 6kg in the last 2 weeks. I explained I'd (in the last week) cut pretty much most carbs out of my diet. She said that was a bad idea and I should be eating carbs each meal. I'm confused now. I'm actually doing ok at the moment, the weight is falling off and I'm feeling great. But I don't want to completely ignore her.

To be fair she did encourage me that diabetes was not necessarily progressive - if I managed it I could stay on metformin for the rest of my life and not necessarily progress to insulin.

I just wanted some hope and I didn't hear much. I explained (in a really nice way) that I thought it would be much better to give people hope rather than "the best you can hope for is that you won't get much worse".

Not really sure where to go from here. Any suggestions hugely appreciated

She is wrong about the NHS and metformin. They are supposed to follow the NICE guidelines, which say people can try diet and exercise for 3 months before the patient decides whether or not to use metformin. Never let a health professional make a treatment decision for you, that's your job. Their job is to give you the type and amount of info needed for you to give informed consent to treatment, or not.

There is plenty to be hopeful about with T2 diabetes. You can send it into remission (BGs in the non diabetic range) by reducing carbs to a low level.* It doesn't need to be a life sentence. But when people follow this erroneous NHS advice to eat plenty of carbs, then it does progress and they get complications and die before their time. It's a tragedy that they give this advice to people, and also that they deny their patient rights and treat them like children.



*Unless there is another medical issue that makes your case different from most. In that case you might need meds or insulin to control your BGs. But most people do not.

**Please continue to take medication prescribed for you until you discuss it with your HCP. It's still your choice, but it is prudent to discuss it before stopping, for your safety.

 

[GeoffersTaylor]

In short, ignore her and keep doing what you're doing.

Then you can turn up at your next review with more weight loss, lower bloods & lower cholesterol and then see what she says!

 

[Dillinger]

I explained I'd (in the last week) cut pretty much most carbs out of my diet. She said that was a bad idea and I should be eating carbs each meal. I'm confused now. I'm actually doing ok at the moment, the weight is falling off and I'm feeling great. But I don't want to completely ignore her.

Completely ignore her.

Is what you are doing working for you? It seems like it; so keep doing it.

There is no evidence at all that I've ever seen that even suggests that a low-carb approach is dangerous at all for anyone. On the other hand there is a great deal of evidence that it is especially beneficial for diabetics and especially Type 2 diabetics.

Best

Dillinger

 

[BlueTwist]

Your nurse sounds awful! I'm with the advice others have given you!

 

[alangarry]

I'm a newbie to all this and I have only been diagnosed for a week, my Doc told me to exercise, watch my diet, have little food but often, change my plate size and to lower my carb intake, avoid high crab food and eat healthy, I have had some great advice from this huge family on here, got the recommended book of count your carbs & calories and my blood sugar levels have come down to except-able levels, I was told that my condition if I choose to change my eating habits and to live more healthy may be reversed, I 'm type 2, on 2 twice a day Metformin, in the last week my weight has dropped ten fold. Diabetic nurse was really happy with me when I went yesterday for my foot check, Keep what you are doing, ask on here as many question you have. Welcome to the family, because on here they really are.

 

[Enclave]

I was given the same treatment and advice as you about .... Must be 2 years back now ... So I took the metformin for a few months (against the wife advice, as they could have been a problem with my heart meds) and went along with the diet advice my dbn gave me .. In three months I put on 2st ..sugars were through the roof and needless to say I felt dreadful.. Went back to see dbn .. She was very happy ! And said I can increase my meds ... I went home feeling like I had been kicked in the teeth by the NHS. I only knew my sugars were high as I had purchased a meter .. Did not tell my Dbn about the meter.
So the wife stepped in ... I did not stop the metformin, but did not increase it .. Went full into the LCHF diet and the weight started to go .. Went to see my heart failure nurse .. She stopped my metformin and reduced my statins.. Saying that my bloods are all in the normal range ... Adding why are you diabetic ? Then looked at my past sugar results and just said ...O .. Also saying ...whatever your doing ..keep doing it ... I have lost 5 stone now and look ( the wife says) amazing ..feel good, for the first time in many years !

So I would suggest if your feeling good on your LCHF diet, remember it's a way of eating not a quick fix .. Carry on .. I had to reduce the statin and metformin slowly as to not upset my heart medication.. So don't just stop them ... Metformin need not be for life .. Progression of diabetes can be halted with diet .. Yes things can progress, but if you crash into compilations ..at least you will know you did your very best to avoid them ..better than sitting back and thinking I followed the advice and I wish I could have done more.
As the wife always says .. It is better to be proactive than inactive ... Then I have to go and put the bins out

 

[geoffh]

Thank you all. That's pretty much what I thought, but it's hard to argue with someone you've just met and is extremely insistent. I guess I don't fit the mould of most other people she's been treating

In my rush to post I forgot to say - we've moved house recently and are actually being told to move GP surgery. So I have a chance to meet another DN for the first time, and be slightly more informed (and prepared) for what they might say. I'm tempted to just book another 'first diabetic' appointment with the new surgery and see what they say.

I'm really not against taking metformin - why would I refuse something which will help me - I just want to know what I'm taking, make sure it's not necessarily for life, understand the potential side effects (which she didn't go through) and then choose to take it.

I realise the low-carb thing is a life change. I've needed this kick up the backside for a while - and the way I ate before just wasn't healthy or sustainable. It wasn't even "normal" by other peoples' standards.

As an aside - I just had chicken, salad and homemade coleslaw (cabbage, red onion, grated carrot, full-fat mayonnaise and dijon mustard) for lunch and it tasted AMAZING.

Also made home-made curry with cauliflower rice last night and loved every spoonful. Not missing bread as much as I thought.

Not sure what I'll do for lunch in the winter though - I can't go on eating salad for lunch, can I?

 

[tim2000s]

Not sure what I'll do for lunch in the winter though - I can't go on eating salad for lunch, can I?

There are plenty of low carb soups you can make, and you can always add a nice large dollop of butter to it to make it even tastier!

 

[GeoffersTaylor]

Not sure what I'll do for lunch in the winter though - I can't go on eating salad for lunch, can I?

Good point - I haven't thought that far ahead yet. I currently have avocados and cheese but that'll need changing as the days get chillier.

 

[alangarry]

Good point - I haven't thought that far ahead yet. I currently have avocados and cheese but that'll need changing as the days get chillier.

I going to make home made chicken and leek soup to put in my flask on a cold winters day then come home to home made potato less shepherds pie replacing the potato with mashed carrot and swede with cheese.

I'm feeling hungry talking about all this food so I'm off to do my testing and then have salmon salad for dinner with a few peanuts mixed with a small serving of mayo, lol

 

[Enclave]

Half a stock cube with some grated vegetables make a quick soup if your short of ime .. A sprinkle of curry powder or saffron can make a lovely change in the soup flavour

 

[Wayne78]

Had my first diabetic nurse appointment today and I reckon it went about as badly as I feared.

The first thing she did was start to write out a prescription for metformin. No explanation of the test results, no explanation of what diabetes was or an official diagnosis. I explained that I'd assumed I was diabetic from the fasting glucose results (12) but hadn't managed to speak to anyone else. We are short-staffed at the surgery at the moment, so maybe I'd have normally seen a GP first. If it weren't for this website I would have known nothing!

I asked if I could start out by changing my diet and lifestyle, she said no. In fact she said the NHS don't do that any more - everyone gets metformin! I also asked how long I'd be on it for - and she gave me a funny look and said "for life!" I asked - even if I lost a lot of weight (I've got a lot to lose!) and transformed my life - would I be able to come off it - she said no. I'm pretty sure that's not true.

I asked her to weigh me - we confirmed I've lost about 6kg in the last 2 weeks. I explained I'd (in the last week) cut pretty much most carbs out of my diet. She said that was a bad idea and I should be eating carbs each meal. I'm confused now. I'm actually doing ok at the moment, the weight is falling off and I'm feeling great. But I don't want to completely ignore her.

To be fair she did encourage me that diabetes was not necessarily progressive - if I managed it I could stay on metformin for the rest of my life and not necessarily progress to insulin.

I just wanted some hope and I didn't hear much. I explained (in a really nice way) that I thought it would be much better to give people hope rather than "the best you can hope for is that you won't get much worse".

Not really sure where to go from here. Any suggestions hugely appreciated

Actually you do need a little carb in your diet but it must be the right one, just remember you can get carbs from vegetables. Look up low glycemic foods and that will assist you. Continue doing some exercise at least 30 minutes daily.

 

[ButtterflyLady]

Actually you do need a little carb in your diet but it must be the right one, just remember you can get carbs from vegetables. Look up low glycemic foods and that will assist you. Continue doing some exercise at least 30 minutes daily.

I'm not so sure about this. I don't eat veges because I'm trying to eat carbs, I eat them for the taste, fibre, bulk, vitamins and minerals. They happen to be low carb (the ones I eat are), which is a bonus.

 

[TyTy]

Hi @geoffh well i think you have got a very poor nurse. MY DN nurse has been fantastic, when i was diagnosed back in April, we talked about diet , exercise and medication. I informed her that did not want to take medication and wanted to try and see if i could control by diet and exercise. Well she was very supportive , 5 months down te line, not taking any meds, and my next HBC1A is in end of the month and then will decide if i need to take medication.
I think you need to have serious talk with your GP nurse, the advice she is giving seems to me that she has no understanding about diabetes.