Right, missus is watching Dr. Pimple Popper so now is as good a time as anyway.
Firstly, I'd like to apologise about his comment on the educated vs those who didn't achieve a high academic level.
One of the first questions he asked me was "what was my profession", I informed him I was a design engineer so he knew he was talking to someone academic. I think this was further enforced by me quoting all the main studies, knowing relevant metrics & units.
Anyway, onto the good stuff.
I described visceral fat as being described as chewing gum in pathology reports on cadavers.
He asked me if I liked foie gras, which I don't, he said "that's duck fatty liver created by force feeding them grains & that's what your liver is coated in".
I quoted my early Kellogg's Shreddies test where I hit 13.3 at the 1 hour, "That's diabetes" he loudly declared leaning forward" . . . then I told him I repeated the test 4 months later & only reached a 7 & he burst out laughing, think he was happily surprised.
I asked him if he believed in Taylors theory on beta cell dedifferentiation & recovery being dependant on restoring original cell function. He was non-committal, said it was a plausible hypothesis but may just be the effect of the remaining cells working harder. I thought about asking about Dr. Longo's FMD but decided to leave it.
I asked him about IF & while he didn't declare himself a fan he was in favour of whatever kept the weight off. Said he was frustrated by private clients who he sees every 3 months who may have only lost a kilo & are delighted with themselves. This Endo was a huge fan of bariatric surgery or weight loss pharmaceuticals. Encouraged me to take Ozempic it to further my weight loss, said it suppresses all appetite cravings. Although he was impressed by Taylors 15kg weight loss in his best responders he claimed bariatric surgery can produce double that & most importantly maintain it for longer remission. On the subject of weight loss I dissed Slimming World & their high carb foods but he defended it on the ground that he's seen results.
On the subject of Ozempic he said there's a game changer injectable in Phase III trials that surpasses it's results. Should be on the market in 2022.
I covered his low belief in long term remission in my first post but there were a few incidentals I left out. He said I was always predisposed to develop T2, it was my lifestyle choices that hastened it to my age of 47 at diagnosis. He did say he has seen bariatric surgery patients delay it into their 70s but did say it would return regardless of weight loss. In other cheery news he told me that as my wife had GD on our 3rd child she would also get T2 & because both of us had it then our children were 80% likely to get it.
On the subject of CGMs he was a big fan though did believe that the Dexcom was far more accurate than the Libre. His problem with the Libre was the lows read too low & the highs read too high. He wasn't aware of the 2019 study I mentioned where 153 non-diabetics wore a Dexcom to establish normal non-diabetic glucose levels, he asked me to email him on the links.
On the subject of Desmond, Xpert & other dietary courses advising the food pyramid/Eatwell plate/wholegrain carbs he glanced it off saying people should tailor their own balanced plan. I did tell him that was a rubbish answer & he laughed. I pushed the idea that all newly diagnosed T2s should be a CGM to show them the effect of carbs but said not all patients would even put it on. His experience was that most patients think that tablet allows them to eat their previous diet, even finding a T2 who regularly pricked their finger was an oddity.
I did quiz him on a full Kraft 4 hour OGTT with insulin but he said even his private clinic don't run them. He did give me the name of a private company which I've since forgot but said they were expensive & needed to be interpreted correctly.
On my FBG being low 4s & my average glucose on the CGM being 4.6 he was very impressed, more impressed when I told him some days were upward of 200gs of carbs. He did pick up however that I spike up to 8 sometimes, especially on breakfast or lunch, said it looked more dramatic on the graph cause it came from such a low baseline. I did ask him if I could be doing any microvascular damage & he shook his head stating that at my levels damage was impossible.
As you can see we had a report & he repeated to me that I was an outlier, the type he's lucky to see once every 3 months. As we departed I joked that I appreciated his honesty & would attend his private clinic in the future if I needed but hoped I never see him again unless to bring him for a pint of carby Guinness.
So that was it, only had 30 mins so I think I did well to remember 90% of it. I remember seeing posters going blank when they had their consults & I had notes prepared, luckily on the day it flowed because of what I schooled up on thanks to this forum.