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An appointment with my Diabetic Nurse

T

Tootse

Well-Known Member
Messages
65
Hi all,

Sorry if this as a little long but i need some advice

A little background info:-
I was diagnosed as type 2 early July this year and prescribed 500mg Metformin 3 times a day. Needless to say I went straight on pc to research what I could. It wasn't long before I found this site, among others, and from extensive reading came to the conclusion that low-carbing would be the way forward. A fortnight later I saw the Diabetic Nurse who immediately rubbished my plans. She gave me a monitor to be used a maximum of twice a week until I had my HbA1c at end of August.

I went for my HbA1c then started the 6 week Xpert programme. When I tried to make an appointment to get the result of the blood test the receptionist told me the test was satisfactory. I asked if I could speak with the doctor because I wanted the result. The receptionist asked it I would like the doctor to call me. This she did later the same day and told me that my result was 51 and that I would not be eligible for free test strips. She also said I had a fatty liver!

With the Xpert programme complete early Oct (mainly trying to convince me to use the 'healthy eating plate') I am of the conclusion that I'm not going to be given much support from my surgery regarding low carbs.i had already bought a tester, after speaking to the DN in July, that has far cheaper test strips, and have continued to aim for minimum carbs testing pre and post meal. Unfortunately, I am still a little concerned that I rarely get readings below 7 whatever time I test, whether I have remebered to take my tablet or not.

I have now made another appointment with the nurse for next Thurday 15/11/12 and have started writing a list of question to put to her. I know that I can get answers to a few of them here but I would like to hear what she what she has to say. The questions are:-

Why was I told to have my HbA1c 6wks from start of tablets 31/08/12 and not 3 months, then not another now for a year?
 
How do you know if it was the tablets that were instrumental in the result reading of 51, 6.8, as I have drastically cut down my carb intake since discovering I had diabetes in July? Maybe my HbA1c result had more to do with cutting carbs rather than metformin?
 
The reason I ask the above question is because trying to keep my BG on an even keel is a constant daily struggle. Why do I keep having have high readings, particularly whenever I eat even the smallest amount of carbs, especially now that I have been taking 500mg Metformin tablets 3 times a day since July?
 
Keeping with the fact that I am on Metformin, why do I still have an impossibly dry mouth during the night that it wakes me up because I can’t swallow?
 
Another point, how come my readings do not differ greatly whether I remember to take the Metformin tablet or not? Speaking to other type 2's on medication, who do not seem that concerned with their carb intake, their readings are usually around 5.4. Rarely are my readings below 7.8 pre meal, let alone after food. Post meal is usually not much higher if I have kept carbs as low as possible, although it can rise to 12.5 on occasion if bread (even soya & linseed) etc is added. How in heavens name am I supposed to ever get down into the 5's if I eat complex carbs as you suggest? I have not yet ever got that low having drastically reduced carb intake.
 
Why haven’t I been informed by anyone at the surgery that I have been fully entitled to free prescriptions since July 2012 and why haven't I been given instructions on how to apply?
 
Did I have a BG tested when I had my blood test in Nov 2010 & if so, what were my results?
 
Reason for the question above is because for longer than 2yrs the tips of both my big toes have felt kinda numb/tingly. Could this be peripheral neuropathy connected to diabetes and if so, could it be that I have had diabetes longer that originally thought?
 
Another reason for the 2010 BG test question is because when I had my retinopathy eye test on 20/09/12 I was subsequently informed that I have background retinopathy. Now having googled extensively, it appears that background retinopathy is usually detectable some 6 or more years after onset of diabetes (I said onset not diagnosed). If I was clear of diabetes in Nov 2010 isn’t it rather it rather early to already have background retinopathy less than 2yrs later?
 
I know that I am supposed to eat when I take Metformin 3 times a day, but how regular should I take the tablets? Initially, I was taking them evenly at 8 hour intervals (8:30am, 4:30pm & 12:30am) but it was difficult to arrange meals at those times. The Xpert tutor then told me to take them with regular meals, as the tablet helps keep BG levels even after meals, but that would mean around 8:30am. 12:30pm then again anytime between 7-9pm during the week. Unfortunately, at the weekend my eating times vary greatly and often miss the afternoon one (due to long lay-ins and late breakfast). What is the correct way to take them and why?
 
Because I often forget to take Metformin, or find it difficult to eat (weekends) 3 times, why can’t I have slow release tablets like others type 2 I know?
 
Why was I given a tester that has very expensive test strips, £22 per 50, when I know that there are testers and strips for less than a quarter of that price? And why do other type 2s that live in the same town get test strips prescribed? In fact I was rather annoyed when the Dr informed me of my HbA1c result of 51, which I have googled to be informed that this means 6.8, she immediately said, in almost the same breath, that the result means that I do not get entitlement to free strips on the NHS!
 
When I had my blood test in June the Dr told me that my cholesterol read 4.6. I wasn’t told what my HDL, LDL and triglycerides readings were. Is that information available? When I had HbA1c 31/08/12 was my cholesterol levels also checked, if so, were they any different to my June test?
 
The Dr also informed me over the phone that I had a fatty liver, but did not give me any recommendations on what to do about it. What should I do?
 
After googling Fatty Liver, I came across the term ‘Metabolic Syndrome’. I appear to have had a large number of symptoms of this disease for a number of years, high blood pressure (managed with medication), overweight, large waistline, insulin resistance etc. So is it possible that I may have this syndrome? If so, why wasn’t it recognised earlier, before onset of diabetes (I have been having regular 6monthly bp checkups and 2 yearly blood tests for a number of years)?

I’m obviously overweight and have been for most of my adult life (54 now). Evidently diets that I have tried have not had a lasting impact, apart from probably causing many of the problems I face today, so how come I haven’t been offered regular check-ups with the diabetic dietician to record any weight loss and give guidance to ensure I work towards the primary aim of reducing future complications and other health risks?
 
I have been doing aqua zumba classes since May, but class has recently closed, what recommendations do you suggest, bear in mind that I have problems with back, knees, feet etc.?
 
I feel that it's ultimately my life that they are dealing with so I need answers. I would be gratful if anyone can give me some guidance on what the DN is likely to say in response to my questions so I can prepare replies and argue my case coherently. Also, I'm not sure I've covered everything, so if anyone can suggest questions or arguments I may have neglected I would really appreciate your input.
 
Hi. I won't try to answer all of your questions, but a few salient points in my opinion:

1) Metformin only ever has a small impact on blood sugar e.g. 1-2 mmol but does reduce your appetite as well which helps. Drs often don't prescribe Met SR as it's more expensive. You could ask for it? If you are not having any stomach problems changing may not be needed but yes the SR version is less critical on when you take it if you forget. Sadly you can't easily tell whether it's diet or the Met that has helped you but probably both with diet being very important.

2) If you find that even with a good low'ish carb diet and the Met that your BS remains too high then the Dr may want to add more tablets such as Gliclazide, Sitagliptin or similar (see my siggie). We're all different and some of us have large spikes associated with meals and others have a higher general background sugars as we have different diabetes causes and mechanisms. The HBa1C is a good test but meds such as Sitagliptin can help with those who spike a lot but have lowish average.

3) You are entitled to be told all of your test results in detail if you ask at reception; don't take No for an answer. I recently asked for my mid-term HBa1C as my Dr didn't send me the results and was given it by the receptionist. HBa1cs are oftern given for the 1st time 3 months after diagnosis and then annually if the result is reasonable. I'm currently on 6-monthly as my results are too high.

4) It's disappointing that no one told you about the fatty liver but if your surgery is like mine I never trust that they will report 'bad' results as my wife found out a while back.

5) I would certainly discuss your numb/tingly feet with the Dr as it could be early neuropathy. Many of us suspect we have had diabetes for some time before diagnosis and there is no easy way to tell. All you can do now is manage the blood sugar and talk to the Dr about suitable treatment for any conditions.

6) Ref exercise I go the local gym 3 times a week. I'm lucky as we have one nearby and I can afford to be a member. If you are able to join a gym or similar do consider it.

Hope the above helps a bit.
 
Thanks for your input Diaibell, it will be a great help when I see the nurse next week.

I have been reading the thread regarding meter reding accuracy that was started by Bellx15. As I have an SD Codefree it could be that the readings I've been gettng are a lot higher than they actually are... I'm sure the nurse will take great delight in telling me that testing is a waste of time. We'll just have to see.
 
Tootse.... While different meters may read high or low with respect to a lab test the point of regular testing is to see the difference in readings before and after meals. While you may not be able to accurately estimate your HbA1c readings from your meter, you certainly can find out which foods spike your sugars and that makes testing VERY valuable to anyone who is actively trying to control their glucose levels. My meter says that I am on schedule to get an HbA reading of around 36 or 5.4%. It may be that my HbA test comes back at something much higher but I will know that I have done everything I could do to keep it from being even higher.

Kenny :thumbup:
 
Tootse said:
Thanks for your input Diaibell, it will be a great help when I see the nurse next week.

I have been reading the thread regarding meter reding accuracy that was started by Bellx15. As I have an SD Codefree it could be that the readings I've been gettng are a lot higher than they actually are... I'm sure the nurse will take great delight in telling me that testing is a waste of time. We'll just have to see.
Click to expand...

Could you possibly buy a few strips for the meter you were given and then do a few post meal tests to see if they are anywhere near what you get with the codefree (as they all vary). If you still can't get low readings then you can definitely argue your case.

Good luck
Angie
 
I can only sigh as I have read stories like yours time and time again. For whatever reason, diabetics are not being given the care we need and deserve in some area's/practices. Is there any possibility you could change practice? Perhaps seeing your GP sitting him down and making him hear your concerns. Fatty liver and the like needs to be investigated, you're spot on about metabolic syndrome, fatty liver can indeed be a symptom. I agree with all that has been said above, try keeping a food and BG diary and showing them to your GP. My last HbA1c was 4.9% I get strips prescribed, it really is a postcode lottery.

I think you will have to try being firm, if not change your GP. I do think you need some extra support.

Good luck.
 
Tootse,

a quick reply to some of your post (some already covered, so excuse repetition)

Metformin should only have a slight effect on your BS levels. Controlling carbs more so.

How were you diagnosed - glucose tolerance test ? If so, after only one HbA1c, waiting a year seems too long. How can they know how your control is going ? Push for another in 3 months. Some here seem to get 3 monthly as a matter of course. Some don't.

We're all different in the speed at which we respond to changes in our treatment. Some achieve miracles in months. Others take much longer. Please be patient with yourself.

Cholesterol breakdown (lipid profile) - this is only possible when the blood test has been fasting, and the main reason you'd get asked to have a fasting test.

Fatty liver - excess weight tends to get stored as fat, often around the liver, so losing weight should help with this, and improve your insulin resistance.

Good luck with the appointment !

Geoff
 
I have an SD Codefree.

I do not worry about comparing the reading to another meter. I take my blood just before a meal, and 2 hours after. Providing I have kept to within around 2 points of my pre-meal test, I am happy.

That way, I know what makes my blood sugar levels spike, and can adjust my amount or type of food in my meal, which is the important bit.

I am usually around 5.8 before a meal, and 7.5 or so 2 hours afterwards if i dont have much carbohydrate.

I hope that helps.
 
librarising said:
Fatty liver - excess weight tends to get stored as fat, often around the liver, so losing weight should help with this, and improve your insulin resistance.



Geoff
Click to expand...

This is so true and the main reason I did the Newcastle diet earlier this year. We build up visceral fat around our organs, and that's where fatty liver comes from. Glad you posted that Geoff.
 
Thanks for all your replies, much appreciated.

Librarising, you say that cholesterol breakdown (lipid profile) is only possible when the blood test has been fasting, and the main reason you'd get asked to have a fasting test. So they will only check cholesterol when I have my 2 year fasting blood test (assuming that they will be continuing with the test **note to self - put that on list of questions to as the nurse**) and not when I have the hba1c test?

As I have cut down the carbs in my diet quite drastically whilst increasing my protein and fat intake, how do I know I'm not storing up trouble from all the protein (meat like bacon etc) and fat (double cream, oil, cheese etc) I eat in replacement? I've been given to understand from various threads here and from other sites that eating fats may not have the impact on cholersterol as previously thought, but maybe I have been taking too much of an advantage of this information. Without the test how will I know? I did lose around 1 & 1/2 stone initially but for last 3 weeks it has stayed the same. I'm still size 22 in clothes and my waist remains unhealthily very large.

I will look at the Newcastle diet Defren, but when you say 'did the Newcastle diet' do I asssume you are no longer on this diet? How long was the diet necessary and how do you now keep the weight down? I ask because, like a lot of members here, I have been on diets of one sort or another all my life. None of them sustainable and none that offered a maintenance plan that worked. Now I am convinced that many of my health issues and the weight gained over the years are directly connected to the diets that I have been on. Diets have not been my friend.

Thanks again everyone. I must say I get a far better response to my concerns here that I have ever had from my doctor. :thumbup:
 
Tootse said:
I will look at the Newcastle diet Defren, but when you say 'did the Newcastle diet' do I asssume you are no longer on this diet? How long was the diet necessary and how do you now keep the weight down? I ask because, like a lot of members here, I have been on diets of one sort or another all my life. None of them sustainable and none that offered a maintenance plan that worked. Now I am convinced that many of my health issues and the weight gained over the years are directly connected to the diets that I have been on. Diets have not been my friend.

Thanks again everyone. I must say I get a far better response to my concerns here that I have ever had from my doctor. :thumbup:
Click to expand...

Hi Tootse, the Newcastle Diet is an eight week diet. It is based around meal replacement shakes. I did a day by day diary while I was on the diet, this is it: viewtopic.php?f=27&t=28731
 
oo-er... That looks a bit drastic. Very much like the Cambridge diet I did a few years back. After 2 weeks I found it quite easy to not eat. But one day around 8 weeks in, a sneaky piece of caulieflower passed my lips and the latent hunger pangs that had all but died after the first fortnight rose up in protest. My stomach realised that my thoat hadn't been cut afterall. I never found the willpower to go without proper food for any length of time since. Maybe I could just have the shakes for breakfast, or will I have to replace all meals?
 
Tootse said:
oo-er... That looks a bit drastic. Very much like the Cambridge diet I did a few years back. After 2 weeks I found it quite easy to not eat. But one day around 8 weeks in, a sneaky piece of caulieflower passed my lips and the latent hunger pangs that had all but died after the first fortnight rose up in protest. My stomach realised that my thoat hadn't been cut afterall. I never found the willpower to go without proper food for any length of time since. Maybe I could just have the shakes for breakfast, or will I have to replace all meals?
Click to expand...

You are allowed veg each day as well. I did it a bit extreme just having three shakes a day for the first four weeks, then two shakes a meal the last four. It worked really well for me, I lost loads of weight which I have kept off, and indeed keep losing. It's not an easy diet, but I was taking in so few calories due to exceptional appetite suppressant actions of Metformin, it meant I was taking in more with the shakes. When I finished the diet I just went back to low carb, and as I say keep losing. It worked for me, so I think it's great. :lol:
 
Tootse
you have some good answers there already,
but I'd like to add a couple of comments [difficult, because I have a 2 year-old rifling through my desk at the moment :lol: ]
First
Metformin really doesn't reduce blood glucose by much. . I think it does a little bit more in controlling gluconeogenesis [making glucose in the liver]
secondly
Aqua exercise is the BEST. I've been doing aqua mobility 3 times nearly every week for several years. I have no real mobility problems, but it helps keep me fit.
Hana
 
When I used to use slimfast on another past diet, I mixed the powder with skimmed milk. aret the atkins/tesco/asda shakes mixed with water or would I still need to use milk?

I'm on 3 x 500mg Metformin a day and yes, now I think about it, my willpower with regards to going without my favourite starchy carbs has been amazing. But my weight gain has never really been about being hungry. It was more habit, opportunity & deprivation/greed, ie chocolate biscuits in the house = opportunity, clearing food off plates = habit, giving myself large portions = deprivation (I know it's really greed but in my mind I always felt that I was depriving myself if I didn't give myself a large portion). This habit/opportunity/greed cycle, along with days/weeks/months of sporadic dieting and deprivation has been my lifestyle since childhood.

Psychologically, I'd need to adjust my mindset from 'I'm depriving myself of tasty and immediate food' to 'I am greatly improving my long lerm life chances''. Something I have tried and failed to do for over 45yrs.

As this mindset has been with me for a long time, if I was successfully in keeping to the drinks for 8 weeks, how will I manage when I start introducing food again? Already I'm thinking along the deprivation/negative lines again. There are number reasons for not doing it fighting for superiority in my thoughts at this moment like; 'it won't work , you've done liquid diets before', ' what about the party in a couple of weeks time?', Christmas is coming up, you have no hope of keeping it up', 'how will you cope with cooking for others?'. I need some positive thoughts to fight back with. :think:
 
Yes Hanadr, I agree Aqua is best, but the place I was attending has closed. The only other place is the local, and very expensive, leasure centre. But it is my health afterall, I will check it out there.
 
Tootse,

As I have said on other threads, this change of life style for me parallels my smoking habit of many years. I truely believe that the refined carbs are physically addictive. They create and energy/energy crash cycle that is always looking to be refreshed, much like nicotine and the frequent 'need' to have a cigarette. That cycle is relatively easy to break as they only last for a week or less BUT the mind doesn't see it that way as it combines the 'need' with the 'want'. I only managed to get rid of cigarettes when I realized that I was approaching the problem from the wrong direction. I used 'lite' cigarettes and secession, patches and almost overdosed on gum..... none of them help you deal with the 'want'.... the pleasure of that cigarette after a meal for instance. It was only when I realized... No... Understood, that I was gaining much more than my perceived pleasure of smoking that I finally stopped forever. It did not come overnight. It took me about a year before I no longer had the occasional impulse of what it would be like to have a cigarette again but each and everyday of greater activity and easier breathing made those thoughts less an less frequent.

Diabetes is a lot like smoking in that the end result is not a pleasurable one regardless of ones like of sugars and fast release carbs. I know that I will think about a piece of chocolate cake and fresh breads and soft scrummy cinnamon rolls with rich uzzy icing..... but as I have lost weight to a level not seen in years, as my blood pressure comes closer to normalizing and as my ability to move farther for longer improves..... I'm not giving up all that much.

Your on the right track... just replace all of those negative positives with real positives... You will do fine.

Kenny :thumbup:
 
Defren, I've just been reading the various posts, and you state that you have done the Newcastle Diet.

You then referred to your diary ... I did a day by day diary while I was on the diet, this is it: viewtopic.php?f=27&t=28731... but I don't see it there.
 
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