My GPS advice!

[Chiefy]

Well, just had a visit to my surgery and met the new GP; 38year old, very sure and confident chap. Anyway, I had to go for an unrelated diabetic condition but he said he wanted to chat about my recent diagnosis. I told him I had tried to meet this head on, bought myself a meter and regularly check myself. Told him my average BG over 10 weeks was 5.8 from an initial 11.1 and had lost some 17kgs (which he said was good). However, he said I shouldn’t be on 3 x metformin but the standard issue is 6 per day! I said hopefully when he sees my next blood results he’ll reduce my current dosage. Well, ‘don’t believe the blood meters as we don’t use them anymore and the only result I should be interested in is the 3 month Hba1c test. I agreed but I told him it helps me to identify which foods cause a spike and it gives an indication of where I am and it’s recommended by so many diabetic professionals. ‘They are just not accurate and you’re wasting your money’, and simply dismissed it. He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

 

[urbanracer]

Well, just had a visit to my surgery and met the new GP; 38year old, very sure and confident chap. Anyway, I had to go for an unrelated diabetic condition but he said he wanted to chat about my recent diagnosis. I told him I had tried to meet this head on, bought myself a meter and regularly check myself. Told him my average BG over 10 weeks was 5.8 from an initial 11.1 and had lost some 17kgs (which he said was good). However, he said I shouldn’t be on 3 x metformin but the standard issue is 6 per day! I said hopefully when he sees my next blood results he’ll reduce my current dosage. Well, ‘don’t believe the blood meters as we don’t use them anymore and the only result I should be interested in is the 3 month Hba1c test. I agreed but I told him it helps me to identify which foods cause a spike and it gives an indication of where I am and it’s recommended by so many diabetic professionals. ‘They are just not accurate and you’re wasting your money’, and simply dismissed it. He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

You're a better man than me, I might have lost my rag in that situation.

 

[Bodewhin]

If the meters aren't accurate then why would Type 1s use them to dose insulin? What a dolt. I don't think I could have even explained things as well as you did. I would have been speechless!

 

[JoKalsbeek]

Well, just had a visit to my surgery and met the new GP; 38year old, very sure and confident chap. Anyway, I had to go for an unrelated diabetic condition but he said he wanted to chat about my recent diagnosis. I told him I had tried to meet this head on, bought myself a meter and regularly check myself. Told him my average BG over 10 weeks was 5.8 from an initial 11.1 and had lost some 17kgs (which he said was good). However, he said I shouldn’t be on 3 x metformin but the standard issue is 6 per day! I said hopefully when he sees my next blood results he’ll reduce my current dosage. Well, ‘don’t believe the blood meters as we don’t use them anymore and the only result I should be interested in is the 3 month Hba1c test. I agreed but I told him it helps me to identify which foods cause a spike and it gives an indication of where I am and it’s recommended by so many diabetic professionals. ‘They are just not accurate and you’re wasting your money’, and simply dismissed it. He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

Folks here know I am scared of people. Timid doesn't cover it. But I've stormed out of offices while still loudly proclaiming someone's incompetence for less.

If you have some of that cool calm to spare, do feel free to ship some over to me, haha.

And yeah... If it wasn't clear already: You're rocking this, and you stick with it, because you're doing an amazing job!

 

[JohnEGreen]

How patriarchal Daddy knows best, well not always.

 

[Mrs T 123]

Well, just had a visit to my surgery and met the new GP; 38year old, very sure and confident chap. Anyway, I had to go for an unrelated diabetic condition but he said he wanted to chat about my recent diagnosis. I told him I had tried to meet this head on, bought myself a meter and regularly check myself. Told him my average BG over 10 weeks was 5.8 from an initial 11.1 and had lost some 17kgs (which he said was good). However, he said I shouldn’t be on 3 x metformin but the standard issue is 6 per day! I said hopefully when he sees my next blood results he’ll reduce my current dosage. Well, ‘don’t believe the blood meters as we don’t use them anymore and the only result I should be interested in is the 3 month Hba1c test. I agreed but I told him it helps me to identify which foods cause a spike and it gives an indication of where I am and it’s recommended by so many diabetic professionals. ‘They are just not accurate and you’re wasting your money’, and simply dismissed it. He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

Yeah I get exactly the same from my DN and she has actually said to me that she doesn't know why anyone would prick their fingers when they don't need to and then she continues saying you don't need to do this but I know you will so you should only test blah blah blah ....... I think if it was them who had it they would be more interested in doing the right thing for their body - just like someone who has an allergy/reaction to something - they don't eat it do they. My GP\ couldn't believe I reversed it and actually asked me to tell her exactly how I done it - so they don't know the obvious - although I have to say she mentions it every time I go to her and has even told a trainee who was in the consultation at the time of my success - so they must not have many success stories - on the plus side DN said she would give me a gold star if she had one and it is encouraging my GP does praise me and also comments on how I have kept the weight off (although a little had crept back on). Keep your chin up, you know better than them - we all do don't we and .... keep smiling.

 

[mike@work]

Well, just had a visit to my surgery and met the new GP; 38year old, very sure and confident chap. Anyway, I had to go for an unrelated diabetic condition but he said he wanted to chat about my recent diagnosis. I told him I had tried to meet this head on, bought myself a meter and regularly check myself. Told him my average BG over 10 weeks was 5.8 from an initial 11.1 and had lost some 17kgs (which he said was good). However, he said I shouldn’t be on 3 x metformin but the standard issue is 6 per day! I said hopefully when he sees my next blood results he’ll reduce my current dosage. Well, ‘don’t believe the blood meters as we don’t use them anymore and the only result I should be interested in is the 3 month Hba1c test. I agreed but I told him it helps me to identify which foods cause a spike and it gives an indication of where I am and it’s recommended by so many diabetic professionals. ‘They are just not accurate and you’re wasting your money’, and simply dismissed it. He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

Hmm - as a T1 I do not only have 1 meter, I actually have 2. One at home and one at work. I could think about donating one of them, til next time you are going to meet that GP. Ask him to put the meter, where it should be, even if it at that point, really could give false readings...

I think I haven't used any foul words, or so, but may I stand corrected ...:

 

[bulkbiker]

He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

The arrogance and unwillingness to learn of some GP's never ceases to amaze.

Then there are others like Dr Unwin who are willing to not only learn from their patients but adopt the methods they use for others.

Truly a postcode lottery.. thankfully you are here and have a plan!

 

[Tophat1900]

Yes, keep doing what you are doing. Part of your success is because you are using a blood glucose meter. Your gp does not know what he is talking about and is incredibly uneducated on the subject. Don't let someone dismiss your success who is too arrogant to even acknowledge it.

Keep up the good work.

 

[Resurgam]

I'd have asked if they'd got a speedometer in their car when they don't need one - just wait for the fines to roll in or the driver of the vehicle behind to start to honk at them.
The standard issue of Metformin is usually prescribed at 4 a day, as that is the maximum recommended dose - check on the information sheet in the box though.

 

[Daibell]

Hi. What a moron your GP is. I'm sure 4 x 500mg/day is the max Metformin? Your average figure of 5.8 is very good and to lose that weight is amazing so well done. Hopefully you can avoid this arrogant GP and just see the nurse. My nurses have all been good but my two diabetes GPs not good. As for the meters which are +/- 15% accurate which is not bad what on earth would we do without them. The old adage is you can't manage what you can't measure. So, carry on managing your own condition.

 

[Chiefy]

Thank you all for your very positive (and humorous responses which made me chuckle) and for reaffirming my approach to my T2.

One question I do have is this; he has given me some strong steroids (oral) which I have to take for at least a week and probably two. That’s fine, but he said this will effect my diabetes whilst I’m on them, presumably by spiking my BG - which they have. Tonight my BG is 8.1, the highest it’s been in over 10 weeks and that’s only after 1 dose. My crux is he wants me take take my first blood test at the end of the course of steroids to check my hba1c and although I asked if I could wait a week or two after the course finished he said it would make absolutely no difference. I am worried that if I have the blood test my result may not be what I hope - or am I unduly worrying?

 

[Bluetit1802]

Steroids can actually cause a healthy non-diabetic to cross over to diabetes. This is a well known fact. I seem to remember reading that as many as 25% of non-diabetics on long term steroids will become diabetic. There is a class of diabetes called Steroid induced diabetes - and some members of this forum are in this group.

The HbA1c is a sort of average over the previous 2 to 3 months, but is weighted towards the last 2 or 3 weeks of this period, so your HbA1c may well be raised depending how long you are on them, and what the dose is. I imagine your doctor wants to check whether the steroids are doing more harm than good. My non-diabetic friend is on long term steroids at quite a high dose, more or less for life, and she has 6 monthly HbA1c tests because of this - and so far has not become diabetic.

 

[Chiefy]

Thank you, that’s very useful to know. I’ll try and delay the test by a week or two if I can as I’d hate my test to show a false positive (if that’s the term!). Many thanks BT1802.

 

[JohnEGreen]

Been on steroids for years that's why I'm here short term treatment with steroids of just a few days or weeks though it will upset your blood sugar management will usually not result in any lasting disruption and in time after you have stopped taking them things should return to your normal levels.

 

[KK123]

They are just not accurate and you’re wasting your money’,

What he means is that he knows they are pretty much crucial but he's following the guidelines and trying to justify on behalf of the NHS, WHY they don't prescribe them to type 2s. 'Oh, they're not accurate/useless/make no difference', let's face it, if those 'guidelines' actually changed they would have to give meters to 4 million people, can't have that can we! x

 

[NicoleC1971]

Well, just had a visit to my surgery and met the new GP; 38year old, very sure and confident chap. Anyway, I had to go for an unrelated diabetic condition but he said he wanted to chat about my recent diagnosis. I told him I had tried to meet this head on, bought myself a meter and regularly check myself. Told him my average BG over 10 weeks was 5.8 from an initial 11.1 and had lost some 17kgs (which he said was good). However, he said I shouldn’t be on 3 x metformin but the standard issue is 6 per day! I said hopefully when he sees my next blood results he’ll reduce my current dosage. Well, ‘don’t believe the blood meters as we don’t use them anymore and the only result I should be interested in is the 3 month Hba1c test. I agreed but I told him it helps me to identify which foods cause a spike and it gives an indication of where I am and it’s recommended by so many diabetic professionals. ‘They are just not accurate and you’re wasting your money’, and simply dismissed it. He also said that whilst he could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

Keep up the good work with the meter. The GP should understand that the hba1c gives a mean average but the after meal tests tell you useful stuff that helps you get rid of the spikes which ultimately lower the hba1c. If you do go back with a better hba1c and reduced meds ask him how many other of his newly diagnosed type 2s have pulled that trick off. I would hope he is a young dog that can be taught new tricks by his patients.

 

[Brunneria]

Regarding the Metformin dose, PLEASE do not think of metformin in terms of number of tablets.
That can be very misleading.
Metformin comes in different doses of tablets, usually 500mg or 850mg, and in a normal and slow release version.
You (and your doc!) would need to carefully consider whether you were on multiple 500mg normal release, or multiple 850mg slow release - because the consequences could be significant, for blood glucose impact and potential side effects!
https://www.drugs.com/dosage/metformin.html#Usual_Adult_Dose_for_Diabetes_Type_2

This article gives different max dose levels depending on whether the patient is given normal or slow release
https://www.nps.org.au/australian-prescriber/articles/safe-prescribing-of-metformin-in-diabetes

Regarding the total/max dose, there is a study somewhere (will try and find it for you) showing that Metformin is a drug of diminishing returns. In other words, the 1st gram is more effective than the 2nd gram, and after that, there is less and less benefit to adding more, and more and more chance of side effects. Size of patient may have an effect on this.

For this reason, I believe that many docs tend to 'wack it up to max, and leave it there'.
Please note that I am not quoting anyone specific when I say that, it is just an impression I have got.

This is an article about Metformin in general
https://care.diabetesjournals.org/content/35/2/446

This is a study of Japanese men, on varying doses of Metformin, showing varying efficacy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934269/

Ed. For typos

 

[DavidGrahamJones]

He could see I was trying to deal with my diabetes, I have to listen to the health professionals as they know best.

To be honest, I’m quite flabbergasted......and shall continue doing what I’m doing.

It's very strange how GPs can vary so much. I, like you I expect, have always felt that knowing there's a problem with a particular food when it happens rather than waitt three months.

It doesn't sound as if he's read the NICE guidelines available at https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2. They seem OK with people doing their own monitoring.

1.6.16 If adults with type 2 diabetes are self‑monitoring their blood glucose levels, carry out a structured assessment at least annually. The assessment should include:

• the person's self-monitoring skills
• the quality and frequency of testing
• checking that the person knows how to interpret the blood glucose results and what action to take
• the impact on the person's quality of life
• the continued benefit to the person
• 
  the equipment used. [2015]

If he's so sure doctors know best, he better read them, take him a copy.

Edited to correct spelling mistake weight/wait where on earth was my brain?

 

[Chiefy]

It's very strange how GPs can vary so much. I, like you I expect, have always felt that knowing there's a problem with a particular food when it happens rather than weight three months.

It doesn't sound as if he's read the NICE guidelines available at https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2. They seem OK with people doing their own monitoring.

1.6.16 If adults with type 2 diabetes are self‑monitoring their blood glucose levels, carry out a structured assessment at least annually. The assessment should include:

• the person's self-monitoring skills
• the quality and frequency of testing
• checking that the person knows how to interpret the blood glucose results and what action to take
• the impact on the person's quality of life
• the continued benefit to the person
• 
  the equipment used. [2015]

If he's so sure doctors know best, he better read them, take him a copy.

Brilliant, thnakyou!