Worst GP Appointment I have had…ever

Klangley

Well-Known Member
Messages
153
Type of diabetes
Type 2
Treatment type
Diet only
Just finished my GP appointment today to follow up on the results of my HbA1c test and Liver Function Test. As discussed on a separate thread, my intention was also to ask to try Metformin.

This wasn’t my normal GP, in our local surgery you wait a week for an appointment and 2 weeks if you want to see a particular doctor. The meeting started off pleasantly enough. She reviewed and then read out my results. My HbA1c has fallen from 79 mmol/mol to 56 mmol/mol. My LFT (Serum ALT) level had also fallen from 95 u/L to 66 u/L. There wasn’t any acknowledgement of the improvement, just a statement that they are below target levels. But actually as wasn’t there for a pat on the back, I knew the results already and was pleased with them.

Then the conversation went something like this:

Me, ‘so I wanted to discuss Metformin’

Doctor, ‘yes I am putting you on Metformin and a statin’….started typing on the computer

Me (after a pause), ‘yes I will try Metformin but, no I am not taking a statin’

Doctor (quite stroppy), ‘You do realise you are a diabetic don’t you. I mean, that was made clear to you. We recommend all diabetics over 40 to take a Statin’

Me, ‘Yes and you also recommend the healthy eating plate and good carbs like wholemeal bread and pasta and you should see what they do to my blood sugar levels.’

OK in retrospect probably not the best response, but I was a bit taken aback by her attitude. It was clear she didn’t expect a debate. And it all got even more frosty when I also politely declined the ‘Spotlight Course’…..I think that was what she called it. I presume it is some sort of Diabetes awareness course although I don’t think I have seen it mentioned on the forum.

We continued the discussions on statins and she asked why I was against them. I said I thought I had read they can increase Type 2 diabetes and cause liver damage. I wanted to know more about them before I committed to taking them for the rest of my life. She said there were known to be moderate side effects but returned to the party line of recommending them for all Type 2 diabetes. She them measured my blood pressure and stated it was ‘high-side of normal’ (I can’t remember the exact figure). The truth is there was a bloody good reason why my blood pressure was high….it was her attitude! Anyway I agreed to do one of the 24hr monitoring exercises over the next few months.

I have rattled on long enough, but a lot of other ground was covered. The ‘highlights’ were….I would be a diabetic for life, reversal just doesn’t happen in practice, complications are inevitable and eventually I would probably be on insulin. The general vibe was also you only have yourself to blame.

Sorry for off-loading guys. But I left feeling probably the worst I have felt since my diagnosis. I have worked very hard in the last 2 months. I am a pretty resilient person (I like to think) but I walked out thinking what’s the point.
 
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Lamont D

Oracle
Messages
15,797
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Welcome to the club and the GPs who know nothing about blood glucose disorders.
 
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zand

Master
Messages
10,784
Type of diabetes
Type 2
Treatment type
Diet only
And they know nothing about cholesterol or statins either.

Well done, you've done amazingly so far. Keep it up and prove her wrong.:D

Oh and 'The Cholesterol Myths' by Uffe Ravnskov is very good at exposing the fallacy that cholesterol causes heart disease. You could quote a bit from it next time.

I'm looking forward to your next set of results. :)

Well done on your weight loss too. :)
 
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Redsnapper

Well-Known Member
Messages
257
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Count to ten! Then count to ten again!
Remember she can prescribe you whatever she likes but this does not mean you HAVE to take it. G.P.s are supposed to explain the advantages of new medication to you and then you agree together to use the medication.It appears this consultation fell a bit short of this.
I do recall a story from here of an elderly lady who was adamant that her medication had changed,when her GP asked her why she was so sure of this she apparently replied "Well they don't flush down the toilet the same as the other ones".

Really well done on your HbA1c and other stats that is a great result.Consider that a pat on the back from me.

I am not sure I would go on metformin with your results.I do take it but have this week got down to an HbA1c of 42 so am arranging to see my G.P. to come off them and statins.I will be telling him what I intend to do,and give him the opportunity to persuade me otherwise.

Anyway well done!!
 
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Klangley

Well-Known Member
Messages
153
Type of diabetes
Type 2
Treatment type
Diet only
I do recall a story from here of an elderly lady who was adamant that her medication had changed,when her GP asked her why she was so sure of this she apparently replied "Well they don't flush down the toilet the same as the other ones".

Thanks @Redsnapper. LMAO
 
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Enclave

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Retired Moderator
Messages
2,602
Type of diabetes
Type 2 (in remission!)
Treatment type
Diet only
Sadly your Dr sounds a bit like my Dr .... I just think stuff um ..and I do my own thing ..don't let them get you down ... I don't take advice from people who don't even know my name.
 
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4ratbags

Well-Known Member
Messages
3,334
Type of diabetes
Type 2
Treatment type
Diet only
It can definately be deflating when you go to see your GP. I personally just dont bother, its not worth the stress. I just book in with the nurse every 3 months or so to keep track of my numbers.
 
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Enclave

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Retired Moderator
Messages
2,602
Type of diabetes
Type 2 (in remission!)
Treatment type
Diet only
It can definately be deflating when you go to see your GP. I personally just dont bother, its not worth the stress. I just book in with the nurse every 3 months or so to keep track of my numbers.
Gosh .. my diabetic nurse is far more patronising and hostile than the Dr !
 

Klangley

Well-Known Member
Messages
153
Type of diabetes
Type 2
Treatment type
Diet only
Thanks guys. Next time I will try a different Doctor for sure. It is a shame the approaches and mind-sets can be so different. I talked about the changes to diet and exercise I had undertaken but really she wasn't interested. She said if I wanted to discuss diet she would refer me to a dietician, she was a Doctor! She had no view one way or another on low-carb.

@Redsnapper I guess my thought was to try Metformin for a month or 2 and then gradually phase it out. The consultant I saw said it was a good treatment for fatty liver, would help with weight loss and could actually protect me from heart disease. This guy is one of the top guys in the UK in his field and he just said I should consider it.....not definitely do it. Incidentally he said he had seen hundreds of patents 'reverse' diabetes and was all for low carb.

@4ratbags only problem is hear the attitudes of some of the DNs can be just as bad. Awesome progress by the way 29kg loss and a HbA1c of 34....I can only dream!

@zand Thanks for the kind comments, I will definitely check out the book you suggest.
 
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Redsnapper

Well-Known Member
Messages
257
Type of diabetes
Type 2
Treatment type
Tablets (oral)
In terms of helping with fatty liver the metformin may be helping me.I have dropped the specific measurement for this ( can't actually recall which one it is at the moment) dramatically over the last couple of months on metformin.I wasn't aware it helped with this and assumed it was to reduce appetite and slightly reduce glucose production by the liver.
I would be interested if anyone knows more about his as I am considering coming off metformin.
 
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abbz_H1998

Newbie
Messages
2
Type of diabetes
MODY
Treatment type
Tablets (oral)
I do think if you are feeling better about yourself in a medical prospective then do what you think is right for your body
 
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Administrator

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Administrator
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1,593
Type of diabetes
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I do not have diabetes
Sorry to hear about your bad experience. It happens to (an unlucky) few, it seems.

Me, ‘Yes and you also recommend the healthy eating plate and good carbs like wholemeal bread and pasta and you should see what they do to my blood sugar levels.’

Would be fascinated to know what the GP's response was to ^^^

I have rattled on long enough, but a lot of other ground was covered. The ‘highlights’ were….I would be a diabetic for life, reversal just doesn’t happen in practice, complications are inevitable and eventually I would probably be on insulin. The general vibe was also you only have yourself to blame.

Some GPs just don't know because that isn't their interest and/or expertise. Some are just downright stubborn/rude though. Suppose it questions why people get into medicine in the first place.
 
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Lamont D

Oracle
Messages
15,797
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
In terms of helping with fatty liver the metformin may be helping me.I have dropped the specific measurement for this ( can't actually recall which one it is at the moment) dramatically over the last couple of months on metformin.I wasn't aware it helped with this and assumed it was to reduce appetite and slightly reduce glucose production by the liver.
I would be interested if anyone knows more about his as I am considering coming off metformin.

As I'm not aware of how you were diagnosed and what meds if any you are on, I really doubt it would be the metformin that has helped with your fatty liver. Did you get your latest liver function results?
The probable reason is you have started low carbing, this would help your loss of insulin production and the amount of glucose in your blood. Less insulin, less turning into fat, that goes to your organs and your insulin resistance improves and your liver improves.
That's without too much science, is how it works.
And that is why you lose weight on a low carb full fat lifestyle!
Full fat loses weight!
Low fat gains weight!
 
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Redsnapper

Well-Known Member
Messages
257
Type of diabetes
Type 2
Treatment type
Tablets (oral)
As I'm not aware of how you were diagnosed and what meds if any you are on, I really doubt it would be the metformin that has helped with your fatty liver. Did you get your latest liver function results?
The probable reason is you have started low carbing, this would help your loss of insulin production and the amount of glucose in your blood. Less insulin, less turning into fat, that goes to your organs and your insulin resistance improves and your liver improves.
That's without too much science, is how it works.
And that is why you lose weight on a low carb full fat lifestyle!
Full fat loses weight!
Low fat gains weight![/QUOT

I was diagnosed as T2 in July and started metformin and LCHF on 1st August.Just had full bloods done HbA1c down from 75 to 42 and all four liver function tests now within limits,a couple have more than halved.All lipids down dramatically except HDL which is up a notch.So I am pleased.I was really just wondering whether the Metformin x2 per day may have helped with my fatty liver as I was unaware it could be effective in that regard.I think you are probably right it is the other things I have been doing!!
 
Messages
2
Type of diabetes
Type 2
Treatment type
Insulin
I've all but given up on Dr's in general - reason - after spending 17 days in hospital for a large variety of 'heart' symptoms and very nearly discharging myself after seeing Dr's from Cardiac, Diabetic, rheumatology, balance Dr's etc together with their Registrars and interns etc (dozens of them!) with ultimately NO diagnosis but just given more and more pills, I discovered by chance, when seeing a private consultant heart specialist, that All my symptoms were the side effects caused by my taking a blood pressure medication !! Totally unbelievable - I stopped the medication and within a week I was back to normal !! What a joke ! They nigh on killed me with their drugs !! So I see my GP as little as humanly
Possible - having said all of the above, there are very good and dedicated Dr's around - sadly I am yet to find them !!!!
 
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4ratbags

Well-Known Member
Messages
3,334
Type of diabetes
Type 2
Treatment type
Diet only
@Klangley it can take time for the numbers to drop. Its a marathon not a race and you are doing great. My Hb went from 100 down to 52 in the first 3 months and the Dr told me "You are doing great but you will end up on insulin one day". I changed Drs.

@Enclave it is really hard to find a DN over here, they are a bit scarce. Its just a normal practice nurse that I see, thankfully, DN's sound horrible.
 
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zand

Master
Messages
10,784
Type of diabetes
Type 2
Treatment type
Diet only
@Klangley re your liver results. Mine have improved dramatically on LCHF, but still aren't within normal range. I found that cutting out diet drinks also helped mine and milk thistle is a good supplement to take for a while too.
 
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G

graj0

Guest
We recommend all diabetics over 40 to take a Statin’

This is straight from the NICE guidelines, they might recommend but I don't see a mention of "over 40", it's possible I missed it, or . . . . . . . .

Offer
atorvastatin 20 mg for the primary prevention of CVD to people with type 2 diabetes who have a 10% or greater 10‑year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool.


So, NICE actually say that you should be given a risk assessment, you can do one for yourself, http://qrisk.org/ is the one they mention. The next step before prescribing is that the patient should be consulted, having said all that, you've probably seen the statin thread.

OK in retrospect probably not the best response

I say that was bang on the money, that was thinking on your feet, RESPECT. I always think of a good answer . . . . . . on the way home.

Anyway I agreed to do one of the 24hr monitoring exercises over the next few months.

Not such a bad thing, my GP now knows that white coat syndrome comes into play whenever she takes my BP and so long as I remember to take my own BP 3 or 4 times a week, she's more than happy to take that into account, especially as I bought the same machine as they use in the surgery.

. . . . . . complications are inevitable and eventually I would probably be on insulin.

If my 88 year old father who has poor BG control can get to his age with just a toe missing (his own fault for not seeing GP soon enough) I think the future is bright. I'm not suggesting that we shouldn't take things seriously but with good BG control and sensibly getting issues sorted when they arise the jobs a good'n.

Sorry for off-loading guys. But I left feeling probably the worst I have felt since my diagnosis. I have worked very hard in the last 2 months.

No problems offloading, that's what it's all about. Try not to feel too bad, feel very fortunate that you have done well on your own, hopefully Metformin will help a bit more. Ask for a c-peptide test, see what they say. You are showing the results of your hard work and deserve a big pat on the back, well done you. As for Dr. Death, try and forget her. I'd like to think that going to a Dr shouldn't end up being a battle of wits, I've told my GP that I'm fully aware that a little knowledge is a dangerous thing, but it's easier than ever to get a little knowledge. I think she's just grateful that I don't walk in with The Daily Mail or The Express demanding this, that and the other, like some elderly patients do.

On the statin question I told my GP that I'd read my wife's copy of the BMJ (she's has a working interest in medical matters) and saw the straw done where 500 GPs were asked if they would prescribe statins for themselves or a family member, 60% had replied "NO". My GP just grinned cheekily and said "I can think of one of my family". She's on my side about not taking them . . . . I hope.

All the best, keep up the good work and don't let that particular GP get you down, see another one.

Found the graph http://biohackyourself.com/wp-content/uploads/2013/01/Mortality-v-Chol1.pdf

Then here's something that shows that as cholesterol levels have fallen the incidence of CVD hasn't.
CholesterolHeartDisease_zps76xr9llr.jpg



.
 
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