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Advice, pls, before Appt to see Diabetes Nurse again

Discussion in 'Type 2 Diabetes' started by Energize, Nov 6, 2016.

  1. Energize

    Energize Type 2 · Well-Known Member

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    Hi

    I'm due annual review and have appt with the DN on this coming Thursday. Although I've seen myGP in Feb this year, I haven't seen any of the DNs since last Nov. During this last year, I've totally turned around my control of diabetes and so I'm looking forward to seeing how the nurse will react.

    I'd appreciate some help in understanding some of my blood results, please. HbA1c is fine, down from 6.5 (previously, 8.5 as far as I can remembver) to 6.0 this month - due to LCHF - thanks to this forum :)

    These are from a NON-fasting blood test (all mmol/L)
    Serum Cholestrol - 4.9 [slightly up on Feb 16]
    Serum HDL - 1.92 [normal range 0.9 - 1.45] good ?
    Serum Triglicerides - 1.23 [0.3 - 1.8] - seems OK?
    Serum Cholestrol/HDL ratio - 2.6
    Calculated LDL cholestrol - 2.41 [0.0 - 4.0]
    Serum non high density lipoprotein cholesterol - 2.98

    So, can I take it that these are all acceptable? I appreciate Serum (total ? ) Cholestrol is not down to the 'required' 4mmol/L but I am not prepared to take Statins (previoiusly tried but got unwanted side effects) but, as my Cholestrol is up from 4.6 in Feb, I suspect the nurse will want me to try statins again. I keep telling them 'No' each year AND I've discussed it many times with GP, so I still say NO. At this level, I don't feel they're necessary - what does anyone think/

    I understand the important ratio is actually HDL / Triglycerides, which I calculate to be 0.64 now [down from2.08 in Feb] I've calculated this by taking the HDL and dividing by Triglycerides. Is this way of calculating correct, please? Is my understanding that this is a better measurement than Total/Serum Cholestrol correct?

    Other results, that I don't know how relevant they are, so would appreciate your opinions if you have knowledge, are -
    Vit B12 - below range at 165.3 ng/L [197.0 - 771.0]
    Folate - above range [>20.0 ug/L [4.6 - 18.7]
    I understand higher levels of Folate can have a negative impact on Vit B12 but, again, I'm not confident this is correct. As these blood tests were carried out about three weeks ago, if these results are particularly relevant, I would have thought I'd have been asked to make an appt to see the GP to discuss them.

    So, I appreciate I'm asking a lot here. I would really love to go 'armed' with better information and understanding, particularly as I always feel 'palmed off' by the Diabetes Nurses, in particular, so I'd like to be more confident in my expectations ;)

    Many thanks.
     
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  2. Brunneria

    Brunneria Other · Guru
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    OK, I am not an expert on this, but to my eye, your cholesterol results look good. You may get nobbled by the standard Eat Statins gumph, but in your situation I would stand firm!

    Have a look at this link. If you enter your cholesterol numbers, the calculator will work out your ratios and grade them on scale up to OPTIMUM.
    http://www.hughcalc.org/chol-si.php
    Maybe a print out of the page, waved under your nurse's nose, might stave off The Statin Pressure ? ;)

    There is definitely a relationship between folates (folic acid) and B12. From memory, they should be harmoniously balanced, and some people blame the rise in B12 deficiency on the folic acid that has been added to certain foods including flour for the last few years.

    I would check what level of B12 requires injections, and what level will respond to supplementation. Are you on Metformin? That can block B12 absorption. I don't know how long people need to come off Metformin before their B12 absorption comes back on line. :)
     
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  3. Energize

    Energize Type 2 · Well-Known Member

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    Thanks Brunneria :)

    I'll check out the link re Cholesterol when I get a minute. I agree, that could be useful should the nurse start on the 'Statins' line, as per usual. I don't want to take statins again and, also, I'm on so many meds that I really don't want to add more, increasing the risk of interactions etc. Apart from that, I don't believe the stuff that the professionals spout, t be honest ;)

    Yes, I'm on metformin 1G twice a day, and have been for a few years now so, yes, I understand Metformin can have this effect. Yes, I also take MultiVit tablets, including iron, which include 100% RDA of Vit B12, interestingly enough. I've checked the foods where we get Vit B12 from and I do eat meat, some fish, lots of vegs and salads, plus some fruit when blood glucose allows etc, or incorporated with a meal (usually with cream :) ) So, on that basis, the iron could be supplementing an otherwise lowering level, I suppose. I do have other problems that I have discovered can be caused by Vit B12 deficiency so I wonder if this could be more symptomatic than appreciated but, on the other hand, could be due to many other things too, of course. It will be interesting to see what the nurse says, or doesn't say, about this. I don't find them particularly helpful or supportive and feel they just want to 'tick the boxes' and get on with something else :(

    Thanks again for your comments :)
     
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  4. Indy51

    Indy51 Type 2 · Expert

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    I wouldn't supplement with iron unless you have a diagnosed deficiency - it's one of those "Goldilocks" nutrients - too much is at least as bad as too little. Iron overload can cause real problems for men and post-menopausal women.
     
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  5. Energize

    Energize Type 2 · Well-Known Member

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    I've just been to the Cholestrol Calculator in your post, Brunneria, and my most recent results show only one 'Desirable' (Total Cholesterol), LDL and HDL both 'Optimal, Trigs 'Normal' and the three ratios are all 'Ideal' so I dare the nurse to have a go at me, eh? I'll be up for that challenge :)

    Yes, I've done a 'snip' and saved it, so will print it out to take with me - just in case it's required ;)

    Many thanks
     
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  6. Energize

    Energize Type 2 · Well-Known Member

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    Again, thanks, It was my GP that suggested I take Multivit tabs - specifically 'with iron' although I've never been anaemic in all my life (long though it's been ;) )

    When (and not 'if') I see the GP, I'll make a point of discussing this, amongst other things ;)
     
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  7. Indy51

    Indy51 Type 2 · Expert

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    If you check "men's" multivitamins, they usually don't have iron. Here's a link on iron overload which is quite common among people with a northern European ancestry:

    http://haemochromatosis.org.au/symptoms/

    You might want to check into B12 injections or sub-lingual activated form. A lot of the B12 in supplements is of the poorly absorbed variety (cobalamin).
     
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  8. ickihun

    ickihun Type 2 · Master

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    I'm led to believe too much iron for men more dangerous, more common too. Mind u may be because medics assume men are eating beef steaks and women all having monthlies?!
     
  9. amgrundy

    amgrundy Type 2 · Well-Known Member

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    Hi my cholesterol was 4.3 in Jan this year when I was diagnosed type 2 now been on metformin x 2 daily 500g for months. Went last week to see doc and diabetic nurse my readings were good but my cholesterol had gone up to 5.5 told doc I didn't want to go on statins as I had heard others saying they had some side effects. Asked her if I could try t get it down with a bit of a change to my diet [ cutting down on fats a bit. She said yes try and come back in 6 months. ] Looks like your doing fine.
     
  10. Energize

    Energize Type 2 · Well-Known Member

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    Thanks for the link. I've had a quick look at the print out o f my results and can't see anything relating to ferritin levels. However, although not anaemic, my Hb is in the lower end of range, in spite of taking vits with Iron. It's definitely going to be interesting to see what transpires on Thursday when I see the nurse and also when I see the GP (yet to make appt) I'm sure the nurse will avoid bringing this up during the appt and, when I ask, she'll say to see the GP. I don't understand why I haven't been asked to make appt with GP, which is normally the procedure if bloods are a bit out of range etc.
    Thanks again
     
  11. Energize

    Energize Type 2 · Well-Known Member

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    Hmm, past that stage ;) As I've just mentioned, will be interesting on Thursday ;)
    Thanks for the info :)
     
  12. Energize

    Energize Type 2 · Well-Known Member

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    Umm, presumably you changed your diet since being diagnosed but I wonder what you now eat, that you didn't before diagnosis? What are your other ''numbers/ratios' re lipids as it could be your 'cholestrol is up but maybe your other numbers have changed. Check out the link http://www.hughcalc.org/chol-si.php as given in Brunneria's post above for a Cholestrol Calculator - it's really useful if you've got all the breakdown of your Cholestrol results :)

    As mentioned in my post above, my 'total cholestrol 'number' has gone up a bit but the other numbers have also changed and so, overall, my 'choletrol' is pretty good now. I don't eat processed foods if I can help it so I make my own bolognaise sauce, cook fresh chicken and other meats rather than buy Shepherd's Pie etc and I think that's helped perhaps. Also, I do have double cream and don't necessarily avoid fats now so clearly eating fats isn't too bad a thing, eh? :)

    It's your body so if you don't want to take statins, then just tell them you don't want them. They can't force you to take them. Also Just seen an article re statins in the Telegraph today - http://www.telegraph.co.uk/science/2016/06/12/high-cholesterol-does-not-cause-heart-disease-new-research-finds/ so there will probably be more upcry to come :)

    Good luck - keep posting :)
     
  13. amgrundy

    amgrundy Type 2 · Well-Known Member

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    Hi thank you for your reply and information links. I am on the lchf diet have been since Jan this year, if you go on the What have you eaten today thread you will see my posts on what I now eat, like you all fresh food no processed foods. I do eat certain fruit and cream / cheese so it is just cutting back a bit on the fats but I do not intend to cut them out all together. We are all different in to what foods we can and can not tolerate too. Good luck to you I will keep you posted and see if my cholesterol will have come down in 6 months time.
     
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  14. Energize

    Energize Type 2 · Well-Known Member

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    Hi again

    Well, Arrgh!!! I had my appointment with the Diabetes Nurse this afternoon - NOT impressed! Talk about 'jobsworth'!!!

    I'd not come across this particular nurse before. As soon as I walked in the door, I was asked to stand on the scales (before sitting down). I did say that the DN usually took my own weight recording as I weigh myself regularly but, no, she wanted to weigh me. Great, as that will suggest I've put on loads of weight ;)

    I had to ask her who she was as I'd not seen her before - no name badge, only the ID tucked away in a pocket out of sight, apart from the lanyard. After this, as soon as I sat down, took my blood pressure! Since when has this been a good time to check blood pressure? I did question this and she offered to take it again at the end of the session but I suggested it would be a waste of time as I was wound up now. Needless to say, it was higher than it normally is. As usual, I had to ask for the reading so was told 'It's fine!' So, I asked for the 'numbers'.

    Then she did the check list and ticked the relevant boxes, so to speak. After that, she asked if I had anything to ask. I clarified that she had finished her part of this consultation, to which she agreed. So, no questions regarding how things had been going, no questions regarding whether I might be experiencing hypos, particularly in view of loosing over 2.6 stone, so no change to any medication suggested.

    I asked her about my low Vit B12 and high Folate level but she said it wasn't part of the Diabetic check as nothing to do with Diabetes and so not her job!!!. I suggested it was very much part of Diabetes as Vit B12 is known to be associated with taking Metformin. She asked if I was taking Metformin!!! Then she started to look through my prescriptions and asked me if I was taking 2 x 5mg Glipizide in the mornings and 1 x 5mgs in the evening to which, seeing as she'd asked, I volunteered that I'd actually reduced the Glipizide to 1/2 tab in am and 1/2 tab at tea time. She was clearly taken aback by this (quite naturally) and I could see her trying to workout how to respond. She then asked if the tablets were scored, so I confirmed that they were and, had I had any doubts, I would have checked with a pharmacist. I did say that I'd only done this since having the blood test. She then said I could stop them altogether then. I tried to explain that I'd tried none for almost a week but felt that I was running a bit higher than I'd like so had tried the half tablets. However, I really felt she hadn't listened to what I'd just said and said she would recommend to the doctors that I be stopped the Glipizide.

    I just wish I'd kept my mouth closed and not volunteered anything, after this conversation. I didn't feel she had any idea, really, of what goes on. Probably not unusual. So, I felt this appointment was a total waste of time. Apart from saying my HbA1c was 'good', she gave no other encouragement; she clearly had no idea of the struggle I've had over the past few years and now, in the past year, a total turnaround. I would have expected a Diabetic Nurse to have at least asked how I did it and to be pleased for me. All that's happened is that she will now assume I'm an awkward and non-compliant patient with an 'attitude' In fact, all I'd like is a bit of credit for some intelligence, especially as I'm a better qualified nurse than she is ;) I don't think she even knew I had nursing experience, let alone a long career, with specialist training, in nursing.

    So, I'm debating whether to arrange to see the Practice Manager, especially as this is not the first time I've felt I've been treated as a total idiot - to which I don't respond well to, of course ;) Not once did she smile or say 'please' or 'thank you' etc. I just didn't feel relaxed at all. I'm very tempted to say I'll do my own Diabetic checks and then see my GP instead of all this 'attitude'. Oh, and she didn't even ask me for my specimen at all - so, I left it on her desk as I left (didn't want to take that home again, eh? ;) ) Sbe made no comment re the speciment as I left the room. Fortunately, I've 'got over it' this evening but I was absolutely livid after leaving. Sbe made no comment re the speciment as I left the room.

    So, next appt is with the GP in a couple of weeks to discuss medication further.

    Cheers
     
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  15. Brunneria

    Brunneria Other · Guru
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    It is utterly amazing how differently appointments go depending on the attitude and personality of the staff.

    I don't go into appointments (or meetings, or shops) with any intention to be arsy. I really don't. But sometimes, you know, they just kind of provoke it. And even then, 99% of the time I smile sweetly and try and make the best of it.

    Very tiresome though, isn't it?

    - if you got her name, you can try and manipulate your next appt for someone with a different name. ;)
     
  16. donnellysdogs

    donnellysdogs Type 1 · Master

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    I had anaemia... and hB showing it too.

    My GP and I discussed because of my limited eating and decided that I should have overcooked broccoli, spinach only in smoothies and 30g of rice crispies on days of no natural iron. Altjough this is a very low intake essentially it has avoided needing iron supplements. Gp and I dead against them because of the effects on stomach and mines already bad.

    I also got declared with pernicious anaemia iaround 2006 and having jabs for it. Both folate and b12 low.
    Then changed address and welsh gp refused injections. Then paid privately to an anaethetist in Bridgend to give me infusions of vitamins!!
    Moved back to England and decided to let levels go liw and insist GP treats. After 4 years off jabs my levels climbed so high they thought it possible ai had luekaemia.....I waan't supplementing at all. Turned out I had breast cancer. Since mx levels have stayed absolutely perfect without supplements for b12 or folate.

    I know that lack of b12 can make you feel awful-tgey tjought I had a stroke as my memory was shot to pieces...

    Agree that you should be asking for injections. Supplements don't do anything if that low.

    Your tarrget range from test centre is quite high with the upper limit of 190+... my testing centre lower limit before injections were allowed by my GP was 167 and my results came in at 166 and 1.2 for folate.

    The only difference in my actual diet then was: I had 2 processed meals or one takeaway a week and I ate meat. Now every crumb of my food is non processed except milk and cheese. I have no meat at all. No bread, pasta or rice.
    I did eat rice with my weekly takeaway.

    I think overall balance of nutrition can lower B12 a lot but more than anything, possibly side effects of medication too.. i am OTT on my vitamins and minerals now and get B12 tested 6 monthly to keep an eye on it as I am utterly convinced my highest 1597 b12 level was due to cancer and I am convinced if it starts to go high again then I would be asking about cancer returning and checks to be made..

    My folate also went to 18 and has dropped.... mine have kept in balance with each other.

    There was a good pernicious anaemia forum at one time 2010?? Its prob still going and may be worth while looking at it?
     
  17. Enclave

    Enclave Type 2 (in remission!) · Well-Known Member
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    O dear .. your DSN sound a lot like most I have seen ... don't give up on them, as I did get one good one .. once !!
     
  18. Energize

    Energize Type 2 · Well-Known Member

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    Thanks to you, Brunneria, donnellysdogs and Enclave
    My apologies for not replying sooner. I was very busy last evening and have been out (shopping in Cambridge) all day today so not long home, had something to eat and a hot drink now. :)

    Your comments have been very supportive. I was wondering if I was just being too fussy and expecting too much ;)

    Thanks for your comments. Donnellysdogs, your information regarding your experiences regarding B12 is very interesting. I, too, have had surgery and radiotherapy for breast cancer (almost 5 yrs ago now) so your reference to levels changing re cancer will be very useful. Thank you. Also, well done for coping with all you clearly have to ;)

    Well, I have to laugh - coz if I didn't, I'd be so depressed and frustrated. I don't know what the Diabetes Nurse has told my GP as a result of my review yesterday. The GP has been trying to ring me all day. I had THREE messages left from him on my answerphone when I got in this evening (having been in Cambridge enjoying myself all day :) ) I got a call, on my mobile, just before getting home, while I was in the Fish and Chip shop!!! I had to laugh!!! In fact, for those getting concerned about the F&C shop, I got only a piece of fish (no chips) and, once home, ate the fish and only a tiny portion of the batter. I was too tired to get myself my tea, hence the rare decision to get the fish. :) It has only raised my glucose level a small amount and was lovely :)

    So, the GP had clearly been told I was driving, not testing beforehand and having hypos, assuming while driving so he was very concerned, naturally enough. So much for accurate information being passed on and so much for the Nurse actually listening, let alone 'hearing', what I had said. He also asked if I had been unconscious due to a hypo! Yeah, great - I live alone! That would have been fun, eh??? I wouldn't have known much about it, maybe ;)

    He also pointed out that I must test before driving - Yeah? Doh! I must have something close by when driving to treat hypos - yeah? Doh!!! Needless to say, this would have been funny if I hadn't realised he was being very serious and concerned. So, what on earth did the nurse tell him??? I have an appointment on 24 Nov, the earliest I could get appt with him, so will, hopefully, be able to discuss it all with him. Hopefully, he will give me a bit more credit for some intelligence then, more so than the nurse clearly does.

    Oh, isn't life fun??? I've got better things to do than having to rectify incorrect information given him by the nurse, who didn't listen in the first place. Oh well, cei la vie?
     
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  19. donnellysdogs

    donnellysdogs Type 1 · Master

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    @Energize.

    Total envy!! I love Cambridge. Magnificient beautiful place. Total, total envy... just find negotiating the cyclists at college/school/uni in and out times to be quite testing!! Oops sorry to mention restin with driving!!!LOL!!!

    I wld especially keep eye on b12 if BC like me..

    Keep nutritionally balanced overall.

    Glad to hear you are 5 years on!!
     
  20. Energize

    Energize Type 2 · Well-Known Member

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    @donnellysdogs, what were your B12 levels before you started treatment, please? I suspect my GP might try to tell me that it's not particularly low and he'll keep a watch on it :( I'd like to be ready with answers, and the confidence re information etc, so I feel I can respond accordingly, rather than feel 'dismissed' (probably as being neurotic ;) ) I agree that B12 deficiency is very significant and effects can be irrepairable :( Looking at the list of signs and symptoms, I have a considerable number of them already although I appreciate it doesn't necessarily have to be due to Vit B12 too low, of course.

    These results are in spite of taking Multivit with iron tablets - and my Hb is only within the lower end of the normal range, in spite of the extra iron, plus all the green veg and salad that I eat daily and meat etc. Just minimal carbs! Interesting and I feel it needs further investigation, to be honest ;) So, yes, I feel I'm otherwise well balanced nutritionally, to be honest :)

    Thanks for your response :)
    Julie
     
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