'It's your Diabetes.'

Sam50

Well-Known Member
Messages
228
Type of diabetes
Don't have diabetes
Treatment type
Diet only
I totally get why your husband would refuse statins, as they can raise bg and cause other problems too. I have done the same. However Metformin is considered a very safe drug with minimal side effects beyond possible digestive upset, which can usually be minimised by starting on a very low dose and increasing very gradually. Personally, I fought very hard to be allowed to take it. Raised bg is known to be extremely harmful, even if it may not be the culprit for many of your husband's problems. If taking a very well-tested and benign drug can help lower bg, even by a little, why on earth not?
I think the decision whether or not to take drugs is a personal one. Metformin does cause massive digestive issues for many people and is known to only lower BG by a little (although it may have other protective benefits) Hubby never said that he wouldn't take it but that he preferred to try diet and lifestyle changes first to see if the required outcomes could be achieved naturally-without pharmaceuticals. Drugs are always a fallback position,:) So far his DN is very pleased with the progress he is making.

From what I have read on here it seems that Metformin is prescribed to everyone who is diagnosed as T2. I am surprised that you had to fight for it- out of curiosity what was your HbA1C when you were diagnosed ?
 

Biggles2

Well-Known Member
Messages
324
Which is why I always question everything. Doctors are only human after all.:)
This is a sound approach @Sam50!

There are various 'system factors' and 'human factors' that can threaten patient safety in the context of making a medical diagnosis. Doctors are responsible for making a medical diagnosis and a diagnostic error can have life or death consequences for an individual. It is a huge responsibility in a system where doctors have less and less time with their patients due to increasing production pressures (the need to see more patients in less time) as a consequence of budgetary constraints/limitations. This is an example of a systems factor that threatens patient safety.

A human factor would include the issue of a diagnostic error - including wrong diagnosis/failure to diagnose. A diagnostic error is a patient safety threat (obviously); diagnostic errors are also incredibly costly to the health system.

As humans, we all have cognitive biases, and diagnostic errors in primary care are associated with very specific cognitive biases including: 'premature closing & anchoring bias', 'confirmation bias' and 'status quo bias' to name a few. Here is a link to an article that describes the role and critical implications of cognitive bias in diagnostic errors:
https://psnet.ahrq.gov/webmm/case/350/anchoring-bias-with-critical-implications

On a positive note, the article also links to a piece on a computer-assisted diagnostic expert system - and includes a short clip from a BBC documentary on the usefulness of this system in medical diagnosis, as well as the story behind its development:
https://www.isabelhealthcare.com/
 

Alexandra100

Well-Known Member
Messages
3,738
Type of diabetes
Prediabetes
Treatment type
Tablets (oral)
I think the decision whether or not to take drugs is a personal one. Metformin does cause massive digestive issues for many people and is known to only lower BG by a little (although it may have other protective benefits) Hubby never said that he wouldn't take it but that he preferred to try diet and lifestyle changes first to see if the required outcomes could be achieved naturally-without pharmaceuticals. Drugs are always a fallback position,:) So far his DN is very pleased with the progress he is making.

From what I have read on here it seems that Metformin is prescribed to everyone who is diagnosed as T2. I am surprised that you had to fight for it- out of curiosity what was your HbA1C when you were diagnosed ?
Recently NICE has changed it's guidance to GPs on Metformin. They are now encouraged to prescribe it to pre-diabetics in the hope of preventing their progression to full diabetes. My latest A1c was 37, so as far as my GP is concerned I am worried well. However I have for years been suffering from a whole range of health problems, and I now think quite a number of them are attributable to raised bg. (From 2014 unbeknownst to me my A1c rose from 37 to 40 to 41. I then began to reduce the carbs I was eating and reduced it to 37.)

As you wisely pointed out, diabetes does not play by the rules or stick to a timetable. Also, many research studies have shown that the risk to the heart doubles as soon as a person has even low pre-diabetic levels of bg. I am at risk for heart problems, due to atrial fibrillation and also family history, so I take this seriously. I am due for another A1c soon and I am hoping against hope for 34. Given the daily test results I am getting, I probably won't get it. I am very strict about my LC diet, but my bg has not fallen in response nearly as much as I see with other people here who eat a lot more carbs than me. I think I am probably pre-LADA and will end up on insulin whatever I eat.

Here is some info. on blood glucose, normal and otherwise, from Jenny Ruhl's site:

"Normal Fasting Blood Sugar
Fasting blood sugar is usually measured first thing in the morning before you have eaten any food. A truly normal fasting blood sugar (which is also the blood sugar a normal person will see if they have not eaten for a few hours) is:

Between 70 mg/dl (3.9 mmol/L) and 92 mg/dl (5.0 mmol/L) .

This is the finding of a considerable body of research. People whose blood sugar tests at this level do not develop diabetes over the next decade or longer. Those with supposedly normal blood sugars above 92 mg/dl often do. Nevertheless, most doctors consider any fasting blood sugar below 100 mg/dl (5.6 mmol/L) as completely normal
Post-Meal Blood Sugar (Postprandial)
Independent of what they eat, the blood sugars of truly normal people are:

Under 120 mg/dl (6.6 mmol/L) one or two hours after a meal.

Most normal people are under 100 mg/dl (5.5 mmol/L) two hours after eating.

What A1c is Truly Good Enough for a Person with Diabetes?
Doctors have been taught that any A1c below 7.5% (58.5) is "good control" for people with diabetes. However, this is true only if you define "good control" as meaning "Very likely to get neuropathy, retinal damage, and heart disease." Those of us who have had diabetes for decades have found that when we keep our post-meal blood sugars below 140 mg/dl most of the time we see A1cs that range from the 5.7% (38.8) level down. This level appears to be good enough to avoid the classic diabetic complications.

Heart attack risk rises in a straight line fashion as A1c rises from 4.6% (26.8) but only becomes a significantly raised threat as A1cs go over 6% (42.1). You can learn more about the relationship of heart disease and blood sugar test results on this page: A1c and Post-Meal Blood Sugars Predict Heart Attack."

You can read more here: http://www.phlaunt.com/diabetes/16422495.php


 

Sam50

Well-Known Member
Messages
228
Type of diabetes
Don't have diabetes
Treatment type
Diet only
Recently NICE has changed it's guidance to GPs on Metformin. They are now encouraged to prescribe it to pre-diabetics in the hope of preventing their progression to full diabetes. My latest A1c was 37, so as far as my GP is concerned I am worried well. However I have for years been suffering from a whole range of health problems, and I now think quite a number of them are attributable to raised bg. (From 2014 unbeknownst to me my A1c rose from 37 to 40 to 41. I then began to reduce the carbs I was eating and reduced it to 37.)

As you wisely pointed out, diabetes does not play by the rules or stick to a timetable. Also, many research studies have shown that the risk to the heart doubles as soon as a person has even low pre-diabetic levels of bg. I am at risk for heart problems, due to atrial fibrillation and also family history, so I take this seriously. I am due for another A1c soon and I am hoping against hope for 34. Given the daily test results I am getting, I probably won't get it. I am very strict about my LC diet, but my bg has not fallen in response nearly as much as I see with other people here who eat a lot more carbs than me. I think I am probably pre-LADA and will end up on insulin whatever I eat.

Here is some info. on blood glucose, normal and otherwise, from Jenny Ruhl's site:

"Normal Fasting Blood Sugar
Fasting blood sugar is usually measured first thing in the morning before you have eaten any food. A truly normal fasting blood sugar (which is also the blood sugar a normal person will see if they have not eaten for a few hours) is:

Between 70 mg/dl (3.9 mmol/L) and 92 mg/dl (5.0 mmol/L) .

This is the finding of a considerable body of research. People whose blood sugar tests at this level do not develop diabetes over the next decade or longer. Those with supposedly normal blood sugars above 92 mg/dl often do. Nevertheless, most doctors consider any fasting blood sugar below 100 mg/dl (5.6 mmol/L) as completely normal
Post-Meal Blood Sugar (Postprandial)
Independent of what they eat, the blood sugars of truly normal people are:

Under 120 mg/dl (6.6 mmol/L) one or two hours after a meal.

Most normal people are under 100 mg/dl (5.5 mmol/L) two hours after eating.

What A1c is Truly Good Enough for a Person with Diabetes?
Doctors have been taught that any A1c below 7.5% (58.5) is "good control" for people with diabetes. However, this is true only if you define "good control" as meaning "Very likely to get neuropathy, retinal damage, and heart disease." Those of us who have had diabetes for decades have found that when we keep our post-meal blood sugars below 140 mg/dl most of the time we see A1cs that range from the 5.7% (38.8) level down. This level appears to be good enough to avoid the classic diabetic complications.

Heart attack risk rises in a straight line fashion as A1c rises from 4.6% (26.8) but only becomes a significantly raised threat as A1cs go over 6% (42.1). You can learn more about the relationship of heart disease and blood sugar test results on this page: A1c and Post-Meal Blood Sugars Predict Heart Attack."

You can read more here: http://www.phlaunt.com/diabetes/16422495.php

I can understand your worries relating to heart problems considering the family history but diabetes is only one risk factor when it comes to CVD. Other issues ( as I'm sure you know) are weight, BP, smoking, high cholesterol etc and many heart attacks/stokes are triggered by stress. Your HbA1C is very good !! I can understand why your GP didn't want to prescribe Metformin initially.

It sounds like you follow a very healthy LC mode of eating already. We all have our own personal levels, what is 'normal' for us as individuals and people are far more than merely a set of numbers. Stressing about lowering an already good HbA1C might prevent it going any lower.....(and does it need to ?)

Out of curiosity I tested myself (obviously on a fresh lancet) to see what my BG was as a non-diabetic, fasting was 3.5 )liver dump and all that) and after eating 2.9....on the day I experimented. According to current research that lower than normal and maybe I should eat more chocolate:happy:

Good luck for your next HbA1C- I think you are doing great xx
 

DavidGrahamJones

Well-Known Member
Messages
3,263
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Newspapers
Not everyone has illness by the textbook !

Agreed, makes the medic's job more interesting.

Which is why I always question everything. Doctors are only human after all.

It's good to ask questions to understand as much as one can. I once asked a previous GP what tests he was doing on my urine sample and he just said "you don't need to know". He was wrong, I did need to know, especially as I then had to pay £35 for the urine test sticks (not available on prescription) to continue the testing over the next week.
 

Lizzie2

Well-Known Member
Messages
67
Type of diabetes
Type 2
Hi Rachox- the consultant that Hubby saw last summer for a liver scan thought that it sounded like shingles so Hubby went back to see his GP. GP said 'that's not a shingles rash and shingles pain follows a particular nerve pathway and doesn't move from place to place.' So he ruled it out but then some people get shingles without the rash so who knows ?

I think shingles does tend to follow particular nerve pathways and it also stays on one side of the body. As a teenager I developed shingles and it started like a spot in the middle of my back - along my bra line. It ended up right round that side to the middle of my front. I didn’t know you can get shingles without the rash - you live and learn
 

Alexandra100

Well-Known Member
Messages
3,738
Type of diabetes
Prediabetes
Treatment type
Tablets (oral)
I think shingles does tend to follow particular nerve pathways and it also stays on one side of the body. As a teenager I developed shingles and it started like a spot in the middle of my back - along my bra line. It ended up right round that side to the middle of my front. I didn’t know you can get shingles without the rash - you live and learn
Yes, I got shingles in old age and as you say, it was on one side of my body only, and followed the bra line. I believe tnis is fairly typical.
 

ivorgreen

Newbie
Messages
3
Type of diabetes
Type 2
I have been on Metformin for nearly eighteen years and for the last three of four years have been fighting against it after all the bad remarks I have read on the forum. A month ago my doctor finally stopped them because of the damage they have done to my kidneys. A bit late what?
 

Angusc

Well-Known Member
Messages
115
Type of diabetes
Type 1
Treatment type
Pump
No offence taken :) both Hubby and I are aware of the consequences of uncontrolled diabetes and like many T2s he had probably been that way for a while before being made aware of the situation. Certainly as his BG started coming down, his eyesight improved.

I do appreciate that GPs can only work from the data in front of them. I had been under the impression that Hubby would have his HbA1C tested 3 monthly but this hasn't happened so I can see why the doctor expected to see more results.

Since last summer Hubby and I have learnt a huge amount about diabetes and how to treat the condition and I have read everything I could get my hands on concerning diabetic neuropathy. Almost without exception it talks about peripheral neuropathy in the fingers/toes which can progress to hands/feet and limbs if untreated. Hubby has been to the foot clinic and been checked out-all okay there and we know the importance of looking after feet.

I've yet to come across any reference to diabetic neuropathy manifesting after a fever and beginning with stabbing pains in the abdomen/side and spreading around the torso, ending with pain in the backside which feels like it's been sandpapered (sorry if thats' TMI !)

It's a mystery but one we are determined to resolve :)
I've got painful neuropathy? it moves all over the body and is normally between 3-9 on pain score averaging 6 but the not sure what it I, every one is different
 

Sam50

Well-Known Member
Messages
228
Type of diabetes
Don't have diabetes
Treatment type
Diet only
I think shingles does tend to follow particular nerve pathways and it also stays on one side of the body. As a teenager I developed shingles and it started like a spot in the middle of my back - along my bra line. It ended up right round that side to the middle of my front. I didn’t know you can get shingles without the rash - you live and learn
you certainly do @Lizzie2 you can get shingles bilaterally as well and also internally. The zoster virus which also causes chicken pox can affect internal organs. A friend of mine caught chicken pox off his young children when he was in his 40s and apart from being smothered in spots, it also affected his lungs. He was really quite poorly. Shingles can be a thoroughly unpleasant animal !
 

ickihun

Master
Messages
13,698
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Bullies
Totally totally agree!!! Or even, I would almost say, Nobody has illness by the textbook.
I agree @Sam50.
My GP missed me having diabetes all along my childhood. Type2 in a child. Unheard of in the 1970s.
I was offered paracetamol but taken to hospital and blood test confirmed a burst appendix. Again not text book.

I'm full of contradictions in my health.
 

JJFDiabetic

Newbie
Messages
4
Type of diabetes
Type 2
Treatment type
Insulin
No offence taken :) both Hubby and I are aware of the consequences of uncontrolled diabetes and like many T2s he had probably been that way for a while before being made aware of the situation. Certainly as his BG started coming down, his eyesight improved.

I do appreciate that GPs can only work from the data in front of them. I had been under the impression that Hubby would have his HbA1C tested 3 monthly but this hasn't happened so I can see why the doctor expected to see more results.

Since last summer Hubby and I have learnt a huge amount about diabetes and how to treat the condition and I have read everything I could get my hands on concerning diabetic neuropathy. Almost without exception it talks about peripheral neuropathy in the fingers/toes which can progress to hands/feet and limbs if untreated. Hubby has been to the foot clinic and been checked out-all okay there and we know the importance of looking after feet.

I've yet to come across any reference to diabetic neuropathy manifesting after a fever and beginning with stabbing pains in the abdomen/side and spreading around the torso, ending with pain in the backside which feels like it's been sandpapered (sorry if thats' TMI !)

It's a mystery but one we are determined to resolve :)
Dear Sam50 I am not an expert but I have lived with this monster diabetes of 16 years. At first I left the testing up to my doctors and I really did not feel better. About 6 years ago I started to test myself. I bought a glucometer and the strips. I started writing down the results and when I went to the doctor I showed him the results. He was then able to make a more informed decision about my condition. You cannot expect the doctor to know what is wrong with just one HbA1C result. Showing the doctor what has been going on every day over the last month. If the BG is controlled then he might look somewhere else, but if it is not controlled then he would look at neuropathy. I do not know but your chances are far better if you can give the doctor more information.
Yes the cost is a factor but how much will you guys loss if he ends up with kidney problems or heart condition, I think of it as an insurance. I also use those results to analyse the meals I have. If my reading is high my wife and I look at what was eaten and we work out how we can fix it and keep a record of what was done. It sounds a bit OCD but the more you know about how your body reacts to certain foods the safer you will be. Remember the more information you give the doctor the more he can help you. Now my diabetes is under control. I feel so much better all because I buy my own test strips. I also have one of those home Blood Pressure machines they are available at your local chemist or on the internet. It all helps the doctor. Yes it is not a clinical test but it is an indication of what is going on.
Thank you for taking an interest in your husbands diabetes it really helps.
 

Sam50

Well-Known Member
Messages
228
Type of diabetes
Don't have diabetes
Treatment type
Diet only
Dear Sam50 I am not an expert but I have lived with this monster diabetes of 16 years. At first I left the testing up to my doctors and I really did not feel better. About 6 years ago I started to test myself. I bought a glucometer and the strips. I started writing down the results and when I went to the doctor I showed him the results. He was then able to make a more informed decision about my condition. You cannot expect the doctor to know what is wrong with just one HbA1C result. Showing the doctor what has been going on every day over the last month. If the BG is controlled then he might look somewhere else, but if it is not controlled then he would look at neuropathy. I do not know but your chances are far better if you can give the doctor more information.
Yes the cost is a factor but how much will you guys loss if he ends up with kidney problems or heart condition, I think of it as an insurance. I also use those results to analyse the meals I have. If my reading is high my wife and I look at what was eaten and we work out how we can fix it and keep a record of what was done. It sounds a bit OCD but the more you know about how your body reacts to certain foods the safer you will be. Remember the more information you give the doctor the more he can help you. Now my diabetes is under control. I feel so much better all because I buy my own test strips. I also have one of those home Blood Pressure machines they are available at your local chemist or on the internet. It all helps the doctor. Yes it is not a clinical test but it is an indication of what is going on.
Thank you for taking an interest in your husbands diabetes it really helps.
Hi @JJFDiabetic Hubby has been testing himself since about 2 weeks after diagnosis, one of the first moves I made was to buy a BG monitor ( we already have a BP machine) so he has a very good idea of how his BG behaves. His Dr has 2 HbA1c results and another will be with the surgery by Monday. Telling the GP his own results from self testing cuts no ice at our surgery as they only work on the HbA1c results. The DN however is very pleased with his progress so far and as his numbers are coming down, seems to have no issue with him self testing. After all it isn't costing the NHS anything ! Hubby has kept a spreadsheet of his own BG and BP results for his own info more than anything else. Some surgeries might take notice of patients own records but ours isn't that trusting.

Hubby too uses his BG monitor to help plan his meals and work out what he can and can't eat. Why the NHS don't recommend that all T2s obtain one is beyond me. It's the most useful tool you could have x
 

JJFDiabetic

Newbie
Messages
4
Type of diabetes
Type 2
Treatment type
Insulin
Hi @JJFDiabetic Hubby has been testing himself since about 2 weeks after diagnosis, one of the first moves I made was to buy a BG monitor ( we already have a BP machine) so he has a very good idea of how his BG behaves. His Dr has 2 HbA1c results and another will be with the surgery by Monday. Telling the GP his own results from self testing cuts no ice at our surgery as they only work on the HbA1c results. The DN however is very pleased with his progress so far and as his numbers are coming down, seems to have no issue with him self testing. After all it isn't costing the NHS anything ! Hubby has kept a spreadsheet of his own BG and BP results for his own info more than anything else. Some surgeries might take notice of patients own records but ours isn't that trusting.

Hubby too uses his BG monitor to help plan his meals and work out what he can and can't eat. Why the NHS don't recommend that all T2s obtain one is beyond me. It's the most useful tool you could have x

Dear Sam 50 If the Doctor will not trust him then he is just silly.The important thing in this whole thing is that your husband knows what is going on. To me knowing what my reading is helps me sleep at night. Could he not ask to be refer d to an endocrinologist. He will look at those numbers, They really are important. He is entitled to a second opinion. You have to be happy with the doctor you have. He should also point out to the doctor the numbers are not his homework and this is school, if they are wrong then he will be the one who suffers. His life depends on them. The quicker you find someone you are happy with the better. Lots of luck.
 
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