NICE Guidelines

[Concordjan]

Just got back from a visit to my GP, went at his request to discuss my medication. I take 1 Gliclazide each day, have about 30 grams of carbs and my HbA1c is 38. I’m quite happy with that, it works for me. He said my HbA1c was too low and wanted me to stop the Gliclazide. I explained that I still get a high morning reading, eg 6.5 bedtime, 8.9 this morning and that doesn’t seem to go down of its own accord, even if I don’t eat until lunch time. (Continues to rise).
I used to be on 4 Gliclazide a day when I followed their advice re diet. Not had a hypo for a long time. Been low carbing for over 3 years now.
He quoted me the nice guidelines, if a patient is on a drug associated with hypoglycaemia HbA1c should be 53. He even gave me a copy of the guidelines. I managed a great deal of self control and refrained from telling him where to shove his nice guidelines!
Apparently if taking no medication HbA1c should be 48.

 

[Rachox]

I’m speechless, your GP should be congratulating you on your good control!
Why on earth is he advocating going up to a pre diabetic level when you don’t suffer hypos?
Time for a change of GP I think.

 

[JoKalsbeek]

Just got back from a visit to my GP, went at his request to discuss my medication. I take 1 Gliclazide each day, have about 30 grams of carbs and my HbA1c is 38. I’m quite happy with that, it works for me. He said my HbA1c was too low and wanted me to stop the Gliclazide. I explained that I still get a high morning reading, eg 6.5 bedtime, 8.9 this morning and that doesn’t seem to go down of its own accord, even if I don’t eat until lunch time. (Continues to rise).
I used to be on 4 Gliclazide a day when I followed their advice re diet. Not had a hypo for a long time. Been low carbing for over 3 years now.
He quoted me the nice guidelines, if a patient is on a drug associated with hypoglycaemia HbA1c should be 53. He even gave me a copy of the guidelines. I managed a great deal of self control and refrained from telling him where to shove his nice guidelines!
Apparently if taking no medication HbA1c should be 48.

*jaw dropped*

That must've taken quite the effort, not telling him where to stick the guidelines... Oh my.

 

[Concordjan]

I’m speechless, your GP should be congratulating you on your good control!
Why on earth is he advocating going up to a pre diabetic level when you don’t suffer hypos?
Time for a change of GP I think.

It’s a group practice so will avoid him in future, but to be honest the others aren’t any better. Did manage to persuade him not to withdraw my one tablet, but feel I shouldn’t be telling him what to do. Clueless!

 

[Rachox]

It’s a group practice so will avoid him in future, but to be honest the others aren’t any better. Did manage to persuade him not to withdraw my one tablet, but feel I shouldn’t be telling him what to do. Clueless!

I’m so glad he let you carry on with the gliclazide. If it ain’t broke don’t fix it!

 

[ianf0ster]

Just got back from a visit to my GP, went at his request to discuss my medication. I take 1 Gliclazide each day, have about 30 grams of carbs and my HbA1c is 38. I’m quite happy with that, it works for me. He said my HbA1c was too low and wanted me to stop the Gliclazide. I explained that I still get a high morning reading, eg 6.5 bedtime, 8.9 this morning and that doesn’t seem to go down of its own accord, even if I don’t eat until lunch time. (Continues to rise).
I used to be on 4 Gliclazide a day when I followed their advice re diet. Not had a hypo for a long time. Been low carbing for over 3 years now.
He quoted me the nice guidelines, if a patient is on a drug associated with hypoglycaemia HbA1c should be 53. He even gave me a copy of the guidelines. I managed a great deal of self control and refrained from telling him where to shove his nice guidelines!
Apparently if taking no medication HbA1c should be 48.

Hi Concordjan,
If the NICE guidelines actually say that, then I sincerely hope that it's just that the wording was a mistake!
We know that there are crazy guidelines ( discouraging testing for those not on a drug causing a risk of Hypos, still pushing a Low Fat Higher Carb diet, and telling patients to eat enough Carbs to match their Medication dose- instead of the other way around), but this one is a even more crazy.

How can a target for a patient on medication be worse control than for a patient taking no medication? Surely (if the medication works) then it should reduce the HbA1C - not increase it! Now I could understand it if it said that the Glic was only advised for patients with an HbA1C of 53 or over. But, if you are correct, then it doesn't say that and is another 'cart dragging the horse'.

Edited to say: Having an HbA1C of under 53 when on even 1 Gliclazide per day is not the same thing as having an HbA1C of under 53 when newly diagnosed and on no Diabetes medication at all!

 

[HSSS]

I’m assuming this is what got quoted
https://pathways.nice.org.uk/pathwa...tes.xml&content=view-node:nodes-hba1c-targets

note in the last paragraph

If adults with type 2 diabetes achieve an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it.
​

I’d be highlighting that line and sending it back to him!

 

[Concordjan]

I think they worry about hypos more than highs. I suppose if I started eating enough carbs to push my HbA1c up to 53 there would be little chance of a hypo. Or stopped the Gliclazide and bs levels went up, still no hypos. But as I explained to GP I haven’t had a hypo in a very long time.

 

[HSSS]

I think they worry about hypos more than highs. I suppose if I started eating enough carbs to push my HbA1c up to 53 there would be little chance of a hypo. Or stopped the Gliclazide and bs levels went up, still no hypos. But as I explained to GP I haven’t had a hypo in a very long time.

So if he’s concerned about following guidelines and you haven’t hypo’d then he was supposed to encourage you! Can’t have it both ways.

 

[Concordjan]

So if he’s concerned about following guidelines and you haven’t hypo’d then he was supposed to encourage you! Can’t have it both ways.

Pretty useless, I had a read of the nice guidelines once I got home. It was 12 months since my last blood test and that was only at my request, so it seems they ignore a lot of the guidelines.

 

[Rachox]

Pretty useless, I had a read of the nice guidelines once I got home. It was 12 months since my last blood test and that was only at my request, so it seems they ignore a lot of the guidelines.

Indeed it should be 6 monthly once stable!

 

[Norfolkmell]

It’s a group practice so will avoid him in future, but to be honest the others aren’t any better. Did manage to persuade him not to withdraw my one tablet, but feel I shouldn’t be telling him what to do. Clueless!

I had my diabetic review today, first with the health care assistant who asked if I ate three balanced meals a day, told her I followed LCHF and she told me I'd got that the wrong way round. I told her that in that case so had my GP and as I'd now officially lost 6+stones since diagnosis I thought that both my GP and I had got it right. She quickly led my into the adjacent room to see the nurse practitioner. Who on looking at my results (OK BG up a bit but not worrying and put down to stress not diet, potassium another story more investigation as almost non existent) she said you must be the patient Dr A holds up as a shining example on LCHF! Same surgery rooms a wall apart. You couldn't make it up.

 

[Thomas the Tank]

Now I know why I just get my blood test results on line every 6 months and never bother with talking to a practice nurse.
Hb1 been 39 for 18 months (3 tests) on LCHF (max 50gm carb/day) but I have to control total cals to about 1200 /1500 per day keep my weight stable after loosing 20Kg in the first 6 months on 600 cal "Newcastle" type ultra low carb diet. I do rattle from all the supplements and vits i take to make up for restricted food types.

 

[Alexandra100]

potassium another story more investigation as almost non existent)

Have you tried LoSalt? Not a substitute for official tests / prescription strength potassium supplements, but it might help. This is from the LoSalt website:
"Original LoSalt is made by our unique blending method, combining sodium chloride with potassium chloride to create a great tasting, healthier alternative to regular salts. With only one third of the sodium content of regular salt, it's also a great way to lower your sodium intake which can help maintain a healthy blood pressure.
Ingredients…
66.6% (min.) potassium chloride
33.3% (max.) sodium chloride
anti-caking agent"

 

[Norfolkmell]

Have you tried LoSalt? Not a substitute for official tests / prescription strength potassium supplements, but it might help. This is from the LoSalt website:
"Original LoSalt is made by our unique blending method, combining sodium chloride with potassium chloride to create a great tasting, healthier alternative to regular salts. With only one third of the sodium content of regular salt, it's also a great way to lower your sodium intake which can help maintain a healthy blood pressure.
Ingredients…
66.6% (min.) potassium chloride
33.3% (max.) sodium chloride
anti-caking agent"

Strangely enough my second potassium blood sample was well in range and I hadn't changed a thing that I ate. Never have added salt to anything as my Mum had always been salt free so as a family we never used it. My Aunt Ethel always carried a large filled silver salt shaker in her handbag so that she could add what seemed like several ounces to whatever she was eating. She lived to be 92. She didn't even taste what she was eating before she put the salt on.

 

[Koalajane]

At diagnosis I was put on gliclazide due to taking steroids. 6 months after my diabetic nurse was advised to take me off gliclazide as my hba1c was 39. I stopped taking it. This was 2 years ago and my hba1c is 41. It doesn’t worry me that I have stopped taking gliclazide.

 

[ringi]

Unlike metformin, gliclazide have little or no research showing a real benfit other then reducing BG. Hence I can see way a GP would wish to reduce risk by stopping Gliclazide if BG was well controlled.