Another One Of Those Conversations With GP

I always leave these diabetes doctors appointment, feeling as if my adult self has been left somewhere, and I can't find her. I can imagine a doctor telling you that you aren't capable of handling data from blood glucose strips, may add a whole new layer to that infantilised feeling.

However there is this research

http://www.cbc.ca/news/health/type2-diabetes-blood-sugar-overtesting-1.4157581

The argument is that no value is added, except when you are first diagnosed, or if you are changing medication, and it may just create anxiety.

I suppose if you know how many carbohydrates you can eat at a meal without too high a spike, and if you know which foods have a lower GI index. It might, possibly, be better to create a pattern, test it for a few days, then stick with it, for a bit, without testing. Then maybe after a month, go back and check. But beyond that not worry too much? Just get on with stuff.

I suppose.

That piece of research in your link @Alison54321 is, of course, nonsense. It has been posted on here before some time ago. This is why

To conduct the study, the researchers tested 450 adult patients with Type 2 diabetes in North Carolina. None were being treated with insulin and all had baseline A1C levels (glycated hemoglobin) between 6.5 and 9.5 per cent, considered fair.

The patients were then divided into three groups:

• No self-monitoring of blood glucose.
• Once-a-day monitoring.
• Enhanced once-a-day monitoring, with the meter delivering automated messages of encouragement or instruction.

One year later, there were "no significant differences" across the groups when it came to glycemic control, health-related quality of life, or hospitalizations or ER visits.

"We were not able to find a difference in the health outcomes we were looking at," says Donahue. "We did not find harms, nor did we find benefits."

Of course there were no benefits. Once a day monitoring is a waste of time and teaches you nothing at all. I'm fairly sure most of us on this forum know that. Had they been asked to test their meals and eat to their meter it would have produced different results. And one has to wonder what the automated messages said!

Bluetit1802 said:

That piece of research in your link @Alison54321 is, of course, nonsense. It has been posted on here before some time ago. This is why

To conduct the study, the researchers tested 450 adult patients with Type 2 diabetes in North Carolina. None were being treated with insulin and all had baseline A1C levels (glycated hemoglobin) between 6.5 and 9.5 per cent, considered fair.

The patients were then divided into three groups:

• No self-monitoring of blood glucose.
• Once-a-day monitoring.
• Enhanced once-a-day monitoring, with the meter delivering automated messages of encouragement or instruction.

One year later, there were "no significant differences" across the groups when it came to glycemic control, health-related quality of life, or hospitalizations or ER visits.

"We were not able to find a difference in the health outcomes we were looking at," says Donahue. "We did not find harms, nor did we find benefits."

Of course there were no benefits. Once a day monitoring is a waste of time and teaches you nothing at all. I'm fairly sure most of us on this forum know that. Had they been asked to test their meals and eat to their meter it would have produced different results. And one has to wonder what the automated messages said!

Click to expand...

The article says quite clearly that none of them were treated with insulin, and that people using insulin should test their blood sugars.The article is quite clear that it DOESN'T apply to people taking insulin. However the research looked at three different options, not just one a day testing or nothing, but also more intensive.

Obviously, people should do what they want to do. But @AdamJames asked if there was a case for what the doctor was saying, so I'm trying to, objectively, explore whether or not there is.

Alison54321 said:

The article says quite clearly that none of them were treated with insulin, and that people using insulin should test their blood sugars.The article is quite clear that it DOESN'T apply to people taking insulin. However the research looked at three different options, not just one a day testing or nothing, but also more intensive.

Obviously, people should do what they want to do. But @AdamJames asked if there was a case for what the doctor was saying, so I'm trying to, objectively, explore whether or not there is.

Click to expand...

I agree with you. The GP will also see a large number of diabetics, in my practice alone I think he has around 1300 patients. Well over 1000 of them will be type 2 and he told me himself during one of our discussions that the vast majority of them are really not bothered by having diabetes, adopting a head in the sand attitude. People likely to contribute to this forum are in a very small minority and will also be the ones who do want to take control and take personal responsibility for their conditions and for whom blood testing is very important. For the large majority they can be prescribed all the strips and meds they like but it won't make a single bit of difference to their diabetes. It won't make a difference because they are likely not to take their meds and hence wouldn't test their blood either. I guess it's harsh on those of us who do want to test but personally I'm happy to self fund. I don't think anyone has anything to lose by asking but the general NHS line particularly for established and stable diabetics who have good control would be the same answer. I think there is a case for say monitoring for the first 6 months but given the cost of strips to the NHS and the vast number of type 2s it isn't going to happen any time soon!

AdamJames said:

That's a good point - it doesn't have to be all or nothing. Even just a loan of a meter for a month with 100 test strips could do so much to educate and motivate someone that it could make real differences to outcomes.

Click to expand...

The point I think is that giving people a meter and telling them to test without explaining what they should be looking for and how to adjust what they eat is pointless. I think that is where these studies fall down. If you don't tell people how to adjust their diet to cutting carbs (and lets be honest that really isn't the dietary advice given out anywhere yet) then it's pretty bl**dy obvious they won't get any better results.
However as so many of us have found educated testing pays huge dividends if you then change what you eat based on the results.

I manage my own medical conditions and the best way to describe my GP is bemused, I think. I am a member of several different patient group forums relating to my various conditions and am a very keen advocate for lifestyle modification and avoiding medication if at all possible.

I used to try to ‘educate’ him, but it really is a waste of time, I would say that he pays lip service to lifestyle modification, and for that matter to avoiding medications.

But, I go along once a year with my spreadsheets and he signs me up for the repeat prescriptions required for anticoagulation. He is a good man and a nice man, much younger than me. He is concerned and considerate and kind, but he never seems to query the ‘standard treatment’ for anything. I would say that he doesn’t have an enquiring mind, it’s a shame really, they miss so much!

So, the pre- diabetes, the GERD, that used to cripple me, the high BP that I’d had for years, the arthritis and AF were all resolved by a LCHF diet, but none of it interests him at all, he thinks it’s all just coincidence.

I’d say keep doing what you’re doing, listen intently and nod wisely, with a smile! Maybe the tide is just on the turn and Doctor’s will become more accepting of patient experience.

Many people have success with adding intermittent fasting to drive HbA1c down further, Tim Noakes is now advocating resistance training also and credits his present, no medication, normal HbA1c to taking part in ‘Crossfit’ Training and building muscle mass. Haven’t tried that yet, but you never know, never say never!

AtkinsMo said:

Tim Noakes is now advocating resistance training also and credits his present, no medication, normal HbA1c to taking part in ‘Crossfit’ Training and building muscle mass. Haven’t tried that yet, but you never know, never say never!

Click to expand...

He looks pretty good on it..

bulkbiker said:

The point I think is that giving people a meter and telling them to test without explaining what they should be looking for and how to adjust what they eat is pointless. I think that is where these studies fall down. If you don't tell people how to adjust their diet to cutting carbs (and lets be honest that really isn't the dietary advice given out anywhere yet) then it's pretty bl**dy obvious they won't get any better results.
However as so many of us have found educated testing pays huge dividends if you then change what you eat based on the results.

Click to expand...

Fair point but even with education around testing most patients still wouldn't do it. Sadly those who take personal responsibility for their health and diabetes are in such a tiny minority. I do agree with you that good education is the key but not everyone thinks like we do. I think the GPs try to do their best for each patient but as they come under more and more pressure they simply don't have the time to sit and discuss with patients. I work in a different field with vastly higher levels of patient adherence to treatment and we have just introduced a structured on going education session covering all sorts of areas and through evaluation of a pilot we did, we noticed significantly better adherence just on that small number of patients. Maybe a similar thing should be done with type 2 diabetes current diabetes education is a one off session no wonder it doesn't get great results?

Lally123 said:

I think the GPs try to do their best for each patient

Click to expand...

I'm afraid I don't agree.. I'm not blaming all the GP's, some Dr David Unwin for example are a huge inspiration, but others just seem happy to write the script for the pills.
To be honest I never saw my GP when diagnosed but the nurses I did see were automata for the mantra "chronic, progressive, end up on insulin" which was no help to anyone. Met with that message when diagnosed who would want to try to do anything about it?
I was so lucky to have already found this forum so knew beforehand what they were claiming was not necessarily the case. They made me so angry that I completely changed my diet. If people aren't given that information about dietary modifications when they are diagnosed then how can anyone expect them to do anything about it. If you aren;t informed then you can't make informed decisions.
If proper dietary information was available with all the options laid out at least new patients could make more informed decisions rather than be faced with the "Eatwell Guide" which as we all know probably will lead to a chronic, progressive downward spiral ending up injecting.
As an aside when I did finally see the GP about getting a dexa scan (which he hadn't heard of) I happened to mention the Newcastle Diet and Prof Roy Taylor. He had never heard of either. He was the head of diabetes care for our surgery. Is he doing the best for his patients? I really do wonder.

bulkbiker said:

I'm afraid I don't agree.. I'm not blaming all the GP's, some Dr David Unwin for example are a huge inspiration, but others just seem happy to write the script for the pills.
To be honest I never saw my GP when diagnosed but the nurses I did see were automata for the mantra "chronic, progressive, end up on insulin" which was no help to anyone. Met with that message when diagnosed who would want to try to do anything about it?
I was so lucky to have already found this forum so knew beforehand what they were claiming was not necessarily the case. They made me so angry that I completely changed my diet. If people aren't given that information about dietary modifications when they are diagnosed then how can anyone expect them to do anything about it. If you aren;t informed then you can't make informed decisions.
If proper dietary information was available with all the options laid out at least new patients could make more informed decisions rather than be faced with the "Eatwell Guide" which as we all know probably will lead to a chronic, progressive downward spiral ending up injecting.
As an aside when I did finally see the GP about getting a dexa scan (which he hadn't heard of) I happened to mention the Newcastle Diet and Prof Roy Taylor. He had never heard of either. He was the head of diabetes care for our surgery. Is he doing the best for his patients? I really do wonder.

Click to expand...

Completely agree. If I hadn't found this forum and been recommended to read Bernstein and Rhule's books, I reckon I'd have deteriorated already.

When you have the DN telling you that your diabetes (type 2) is not serious and progresses very slowly, then of course you arent going to take it seriously and make drastic lifestyle changes and prick your fingers several times a day.

and when you are actively discouraged from testing, it take a certain mindset to overcome that.

I have to say, with genuine love and good wishes to you all, that most of us on here are rebels, independent thinkers, and bl**dy minded so-and so's, not the average sheep. I think that mind set makes a difference.

This testing malarky is one of the few times in my life when i dont mind being known to be a prick!!

edited to change 'which' to 'with'

bulkbiker said:

I'm afraid I don't agree.. I'm not blaming all the GP's, some Dr David Unwin for example are a huge inspiration, but others just seem happy to write the script for the pills.
To be honest I never saw my GP when diagnosed but the nurses I did see were automata for the mantra "chronic, progressive, end up on insulin" which was no help to anyone. Met with that message when diagnosed who would want to try to do anything about it?
I was so lucky to have already found this forum so knew beforehand what they were claiming was not necessarily the case. They made me so angry that I completely changed my diet. If people aren't given that information about dietary modifications when they are diagnosed then how can anyone expect them to do anything about it. If you aren;t informed then you can't make informed decisions.
If proper dietary information was available with all the options laid out at least new patients could make more informed decisions rather than be faced with the "Eatwell Guide" which as we all know probably will lead to a chronic, progressive downward spiral ending up injecting.
As an aside when I did finally see the GP about getting a dexa scan (which he hadn't heard of) I happened to mention the Newcastle Diet and Prof Roy Taylor. He had never heard of either. He was the head of diabetes care for our surgery. Is he doing the best for his patients? I really do wonder.

Click to expand...

Probably a huge variation between GPs though. Unfortunately all GPs are not equal even those with a speciality which could mean a little bit of training. Or a lot. My own GP is great, I'm not convinced of the depth of his knowledge but because he and I go back a long way, some of which time working together, he is happy to go along with my choices ( and ignore his recommendations on.statins). But we do have to remember that they are generalists and will always stick to the NHS guidelines which are there to do the most good for the most people. In your opinion, and that of the doctors you follow, a low carb diet is the way forward and personally I think lower carb diets are hugely beneficial. I believe you do keto though which I can't do, and I really can't see the NHS recommending that restrictive a diet to the millions of people with type 2 diabetes out there. If people with diabetes generally are bad at taking their meds and taking responsibility for their health, I would hold out no hope that they would happily accept the restrictions of a keto diet. So I guess the answer lies somewhere in the middle and not sure we are there yet though.diabetes UK 2018 guidelines do seem to be beginning to address the carb issue. I suspect that we will end up with GPs/dietitiàns/nurses recommending a lower carb version of the eat well plate in the near future. But until a keto diet is proven safe in the long term, and there are no long term studies available as of now, how could it be recommended. Likewise and back to the original point, testing for all is prohibitively expensive and unless it can be proven in a large scale study involving hundreds of thousands of people, that issuing bg meters and strips can improve health and reduce dependence on meds in type 2s then it's not happening. GPs have a hard job, it's difficult to be all things to all people, and they will never get it right.for everyone. But like most people they go to work to do the best job they can.

Resurgam said:

I usually use just the fats from the meats I cook for cooking veges eggs etc. but recently I bought a small bottle of groundnut oil and was in agony from aches in my hips and knees, my sciatica flared up too - then I did a couple of roasts, got to the end of the oil and started to use fat again - and now the pains have gone - well almost, but I was doing some demonstration Maypole dancing and morrissing too now I think about it so a twinge or too is to be expected at my age - 67, should know better.
As my normal menu is the one I have been using for years the oil was the single alteration, and I certainly will not be buying it again, nor any seed oil.

Click to expand...

I have noted the difference in my knees since going back to butter and lard. The loss of weight (only 2-3 kg) on lchf will no doubt have helped too. I was beginning to think I needed knee surgery, but now they are much improved.

AdamJames said:

Pretty obvious if the research was in North Carolina. "Ya'll doin' just fine. Have a nice day!"

Regardless of the reading, presumably.

Click to expand...

I have family in North Carolina. They are just as intelligent and decent as any of us.

AdamJames said:

Haha! There's no way my mum will be running to she shops. She doesn't even walk to the shops any more, she's in so much pain when she moves. That's part of how we were able to persuade her to reduce carbs - we order her shopping online to be delivered to her - she tells me what she wants while she's on the phone to me and I'm adding stuff to the order in real time (she doesn't do technology / the Internet) so I can steer her in the right direction.

That's a very encouraging story from you anyhow, well done you.

If my mum ever walks to the shops again that will be a definite sign of improvement.

Click to expand...

Does your Mum take any medication for her arthritis? Has she been advised on all her options for managing the condition?