NHS Preventing Type 2 Diabetes service

[geekesse]

My local health care team has just signed me up to the NHS Preventing Type 2 Diabetes service. Jolly nice of them. I had a high HbA1c in November 2022. I couldn’t get any response from the local team at that time, so followed advice from these forums and my own medical knowledge to address the problem.

Since then, I have lost nearly 6 stone, taken up regular gym and swimming sessions averaging over an hour and per day, including both cardio and muscle building, made permanent changes to my diet (low carb, minimal UPF, mostly plant based), reduced my blood pressure to within normal limits, lowered my cholesterol to good…and sustained all these things long term. Last HbA1c (Nov 2023) was 37. I have also retired from a very stressful, more-than-full-time job, and now have a very pleasant routine of a few hours of consultancy type work and a lot of leisure and cultural activities. I rarely drink alcohol - just an occasional glass of wine.

My Mum had LADA and my ex-husband was type 1, so I am fairly well informed about diabetes, and of course, I can tap into the vast experience of this forum - thanks, everyone.

I am now supposed to engage with this Preventing Type 2 service. But I don’t need to change my diet (already done that), learn to cook low carb (I’m a good and knowledgeable cook), do more exercise or do an e-learning course about “Understanding High Risk of Type 2”. I don’t want to come across as being awkward or resistant, and I genuinely support a properly funded programme to help people who are struggling, but there’s nothing there I can usefully engage with.

Should I enrol on one of the e-learning courses just to show willing?

 

[becca59]

I would contact the health care team, thank them for the offer very much but that whilst waiting you have addressed the issues yourself and no longer need to do the course. You can say that you feel it would be more appropriate to hand your place to someone waiting and desperate for help.
Well done on your huge lifestyle changes and excellent results.

 

[jjraak]

Bravo @geekesse .

Marvelous results & outcome

Similar here, I keep getting invites to such clubs.

Odd, really given how little notice they take of the few (I imagine) who completely disrupt the trend they expect, yet no one at my GP seems that bothered to find out HOW ....

I suppose the initiatives show maybe someone somewhere is actually listening.

A pity that none seem to think inviting those in who have had such good results and just maybe listening to how they actually managed it might be a better use of their time.

Sadly I'm cynical that it just ends up being the same old same old as the Desmond course I went on.

Back then I was new to this, and was a bit quieter about questioning the theory and ideas promoted.

Not sure I'd hold my tongue so easily and just end up being a disruptive element on the courses.

On the Desmond course, I did speak to the tutors at end & discussed why the didn't just promote lchf a little bit more as I had found it SO effective

I think dogma was the outcome & a nod to its "not what the majority want"

Which judging by my small group, seemed pretty spot on, sadly

Cakes, biscuits, etc for their lunch break ..oh dear

I think there's an argument to joining in which I think more salty members might describe as better weeing out of the tent, than into it

But I just don't have the patience for such efforts.
There's enough on my plate already.

Good luck letting them down gently.

 

[In Response]

A colleague was invited to join one of these "clubs" recently.
Until then, he took little interest in his health apart from attending annual check ups since his recovery from cancer.
The "Club" provided the motivation he needed to lose weight, do exercise and cut down on confectionary.
He did not follow a low carb diet but was able to significantly reduce his HBA1C so he is no longer pre-diabetic and looks much healthier and happier. Yes, I know looks are not everything.

Whilst they may not be for everyone, they do work and, possibly, more importantly, provide motivation to some to take their head out of the sand and make life much more enjoyable for themselves.

 

[Outlier]

I'd go out of pure curiosity, and wouldn't have any trouble keeping schtum during the lectures because one gets so much practice at that in the real world. However I wouldn't keep the same level of schtum at the tea (cake, biscuit - thank goodness they don't tempt me) and lunch breaks, IF anyone there was interested in what I had done. But I have never been asked by any medical person what I have done to get my BG in the non-diabetic range, and I don't see that changing any time soon.

So it's a "know thyself" - do you get pleasure out of being subversive, or will the inaccuracies really annoy you?

 

[JoKalsbeek]

My local health care team has just signed me up to the NHS Preventing Type 2 Diabetes service. Jolly nice of them. I had a high HbA1c in November 2022. I couldn’t get any response from the local team at that time, so followed advice from these forums and my own medical knowledge to address the problem.

Since then, I have lost nearly 6 stone, taken up regular gym and swimming sessions averaging over an hour and per day, including both cardio and muscle building, made permanent changes to my diet (low carb, minimal UPF, mostly plant based), reduced my blood pressure to within normal limits, lowered my cholesterol to good…and sustained all these things long term. Last HbA1c (Nov 2023) was 37. I have also retired from a very stressful, more-than-full-time job, and now have a very pleasant routine of a few hours of consultancy type work and a lot of leisure and cultural activities. I rarely drink alcohol - just an occasional glass of wine.

My Mum had LADA and my ex-husband was type 1, so I am fairly well informed about diabetes, and of course, I can tap into the vast experience of this forum - thanks, everyone.

I am now supposed to engage with this Preventing Type 2 service. But I don’t need to change my diet (already done that), learn to cook low carb (I’m a good and knowledgeable cook), do more exercise or do an e-learning course about “Understanding High Risk of Type 2”. I don’t want to come across as being awkward or resistant, and I genuinely support a properly funded programme to help people who are struggling, but there’s nothing there I can usefully engage with.

Should I enrol on one of the e-learning courses just to show willing?

It does sound like you have all your bases well and thoroughly covered... Personally I'm with @becca59 , politely decline, say you've already gotten things sorted in the interim, and to give the spot to someone who still is flaundering and needs it. So many people out there do need help and can't get it. And you're rocking this thing already.

 

[geekesse]

Whilst they may not be for everyone, they do work and, possibly, more importantly, provide motivation to some to take their head out of the sand and make life much more enjoyable for themselves.

I think this is why I’m cautious about just opting out. If I had had access to the support when I started out, it would have helped enormously. Instead, I had to feel my own way through the lifestyle changes, trying things out and learning by trial and error how to navigate the journey away from type 2. I do believe that many people who are now where I was two years ago might have a better chance of addressing their health issues if they have information and support. I am eternally grateful to the many posters on here whose experiences have inspired and encouraged me.

I also agree with @jjraak that no-one seems very interested in how I did what I needed to do successfully. I think there’s a case for asking people to share their experiences - what motivated us, how we did it, what helped us stick to it, and how we maintain healthy habits. A lot of random women ask how I lost weight, but mainly because that’s the only really visible outcome, and women and weight is a thing. But more importantly, I reduced bp from 153/94 (on two medications) to 120/71 (one medication - had to drop one because bp went too low); HbA1c down from 46 to 37; total cholesterol down from 6.2 to 4.7. I suspect there are loads of people like me who responded to the wake-up call. We may be seen as no longer having a problem, but it may be that we are part of the solution to the problem.

 

[KennyA]

I'm glad I went on my course. It showed me the options really clearly. Big contrast between a diabetic nurse pushing the "base all your meals around starchy carbs" who hadn't heard of dawn phenomenon; and a dietitian who promoted low-carb/keto, this particular forum, and was a great source of useful info.

 

[MrsA2]

I had something similar pop up and thought I'd play along if only for amusement. After following all the prompts, log ins etc etc it told me "not available in your area"
At least if they hound me for non attendance I can genuinely say why

 

[Melgar]

I'm getting the impression that diabetes nurses, in many instances, do not have the knowledge base to discuss in any depth, and/or are unable to answer basic questions outside of what they have been told to say. They cling on to their brief like their very lives depended on it. I signed up for a 3 day T2 diabetic initiation course, for want of a better word. This was in Canada. Suffice to say I went to the first one, we were treated like we were 5 years old and still in primary school. One of the nurses was very aggressive. I will never get that 6 hours back plus the 3 hours travelling time. Useless. I know I'm sounding negative, but really it was worse than useless. I never went back.

 

[Pipp]

Seems it is a bit of a lottery based on geography.
@geekesse , I am curious as to which solution you will choose. Decline the offer of a place, (but would you wonder what you could have learned there.. good bad or indifferent)? Go along, and either be pleasantly suprised or have it confirmed that in your area, T2 Diabetes education is very outdated and possibly halmful. Or even a bit of a combination?
Twenty years after my own T2 diagnosis , I have never been seen by a specialist nurse, or HCP. Or offered a course. If I were invited, which is unlikely now I am old and managing without having had complications, and only diabetes med is Metformin, I would be very tempted to go just out of curiosity. Three people I know who went on a course around 10 years ago, told me about the tea breaks, the biscuits cakes on offer etc. They were told they could still have ‘treats’ such as a Mars bar a day, and that they would be cared for by the health team, with increasing meds. They would not be cured but could be treated.

I would hope there has been improvement in the education programmes, but fear that is very optimistic.

 

[jjraak]

I think there's a good portion trying hard @Melgar but in my view the vast majority are of the ilk we've both suffered.

To be fair, I do think it's only them repeating what they have been told by others repeating what they have been told., ad infinitum.

If I had the power they would all be immersed in the ways of LCHF, just so they can offer the option to newly diagnosed.

Likely won't happen.

But god alone knows why someone, anyone in power at each health authority &/or preferably GP surgery can not just take the time to check out this site, listen to those who have had success in the short medium AND long term, and offer an assessment as to why the current way, proven not to work over decades, is still preferred over a method many on here have found effective, viable & sustainable.?

Science & medicine is moved forward, largely by those who believe & are willing or desperate to trying new ways.

Here we have a huge well of people, of various viewpoints, from " it's ok" , to "they are doing their best" to "it's just not good enough."

And regardless of that viewpoint, all finding worth being on here.

I would ask if they do nothing , at least point people to the alternatives & this forum in particular.

God how I wished the option to try this forum had been given me.

A month of floundering, finding Eatwell & die, actually made me worse ..AND starving.

And a short while on the 'other' forum.

The change once here was as immediate, from the welcome to the forum type right through to the hand holding guidance of those first tentative steps in lchf

I think it's almost criminal its not offered as one of the choices at dx .

 

[KennyA]

I agree. But LCHF does not sit well with the current Eatwell orthodoxy, and many of the people currently in practice will be sticking to how they were trained 15, 20, or 30 years ago. Of course professionals should be reading up on developments in their field but while the official line is still that >300g carb/day is good for you and that T2 is a progressive and inescapable slide, I don't see a major change coming.

And don't forget the Quality and Outcomes Framework GP reward system does not reward anyone for preventing diabetes developing, or for returning BG to normal levels.

 

[Melgar]

In all honesty I think there are two things going on. Firstly, as @jjraak points out their hands are tied. Healthcare systems are hierarchical in structure. They are told what to say by those more senior or the head of the unit. Only the nurses that have some clout, whether that is through their own 'pay grade' or seniority, break rank and give sound advice. Then there are the nurses themselves. Most likely these latter nurses have been placed in that position and have very little knowledge of diabetes and or are not interested and would rather be in another position. Either way they are ineffective and dishing out the wrong advice. There are clearly some good ones, knowledgeable people who know what they are talking about as attested to by people on this site. Ed I missed the end of a sentence out.

 

[jjraak]

that T2 is a progressive and inescapable slide, I

On the level of
"it's an inescapable truth that cheese graters are dangerous.....FACT ! .

Our research had shown that of a hundred people using a cheese grater in the dark, the majority have incurred serious grating injuries and cuts, making the loss of use of their fingers an inevitable conclusion"

It's that sort of advice, Where they advocate NOT to turn on a light, as seeing the dangers causes TOO much anxiety.

I doubt I trust in their advice

And when decades of such advice IS the sum total of their knowledge aka "it's what normally happens, when people do what we advise them to do "...

The kind of knowledge that means, they'll always be right about cheese graters.

But Only as long as we let them tell us what to do,
Of course if we do, thats when the old adage about madness kicks in
if we do as they advise, the conclusions will always be the same.
Proving it's pointless even trying ....

It only changes when someone turns on a light and proves it's not inevitable AND could actually be safer doing so.

Only when the weight of proof is too much, will they listen & change.

I for one can't wait for this decades LCHF adherents to be the proof that is the tipping point.

Let US be the ones that turn on that light for everyone.

 

[Daibell]

Don't under-estimate the influence of the food industry lobby which was the main cause of the Eat Well Plate nonsense. The research done for that was funded mainly by the food industry who make most of their profits from Carbs. You will see carbs rarely mentioned by the NHS or the Celebrities promoting the harm from SFS (Sugar, Fat, Salt). Why Sugar and not Carbs? Why Fat when it doesn't make you fat, or clog the arteries or affect Blood Sugar. Salt mainly affects those with genetic conditions and doesn't affect BS or weight. So, as many of us on this forum know, we have to do our own research, ignore much of the popular advice and try to help others thru the mis-information.

 

[littlebrownbird]

My previously good HbA1c (42 in June 2023) tipped in to the prediabetic zone (45 in Jan 2024) and I was offered the Liva programme for prediabetes. While the aim is for me to lose weight, exercise more and get my HbA1c back in range, I'm 3 months in and despite my request for an HbA1c test to check my progress at the 12-week point, the program only allows for a test at the 6-month point. (The program is 9 months long with an initial 30-minute Zoom with a health coach - a qualified dietician, weekly video messages from her for the first 12 weeks and then fortnightly for the remainder of the program - there is no opportunity to chat - ask advice mid-week).

The kicker is the "chat group" on the Liva app. Some of the photos of peoples' supposedly healthy meals are triggering - much brown UPF bread, dried fruit, cereal, honey, "treats", lack of vegetables though the "Liva plate" is 50% vegetables for each meal - the whole thing is carb and low-fat skewed. I have benefited from doing strength training at a local gym but the diet advice is demoralising.

I'm ploughing on with it - building muscle and losing fat v e r y slowly - and have decided to pay for a test for my HbA1c, an iron panel as I'm prone to anaemia and CRP-hs to check if I've managed to lower my inflammation.

While I have to give the NHS credit for this program, there is not sufficient coaching time for me and I feel like participants are left to their own devices.