Anyone else feel their Doctor(s) let them down ?

kitedoc · Jan 17, 2019

Bi @chris66, there is a blood test which can tell how high one's blood sugars have been over the past 3 months. It is called HBA1C, or glycosylated Haemoglobin A 1 C.
Until recently the results in numbers that are part of the range of this blood test (HBA1C) were very close to the numbers found in blood sugar readings although the units were quite different. It was like saying 5 apples and 5 tyres,
Because of this problem the 3 month blood test result is now quoted in a different way but the 'old' way is still there until staff get used to the changeover.
So so from your description I suspect 5.8 is a HBA1C reading and expressed as a %). This would be best to clarify with the nurse involved so as to avoid misunderstanding. And maybe ask her to use the new system so there is no mistake in future.
If in fact I am mistaken please forgive me. But it would be good for your nurse and your good self to be absolutely on the same wavelength.

Charis1213 · Jan 17, 2019

My doctor has known me since i was 18 , he has been very good over the years. He even called me when i was diagnosed with type 2, he knows my anxiety he knows all about my phobia of medications and he said ' Charis you are diabetic but you can reverse this by changing your diet ' He gave me the name of a doctor who reversed his own diabetes and said not to worry and that it can be reversed .
I had no anxiety about type 2 diagnosis as I felt encouraged by my doctor . Even the nurse she was so happy and genuinely proud of my weight loss and that I am doing LCHF , I have a great doctor and the bonus is that ours is not appointments we just walk in and wait to see a doctor .
I'm very lucky I think .

Bluetit1802 · Jan 17, 2019

chris66 said:
Thanks again Jo, when i saw diabetic nurse she mentioned the figure 5.8 which i assume was my blood and said it was high

If this was your HbA1c, it is not high enough to be called high. It is in the non-diabetic range.
I wonder if it could have been your cholesterol?

In future, after every blood test, you need to ask for a print out of the results. Once a doctor has seen the results, the receptionist will be able to print it off for you. If you live in England you can also ask to see your test results (and other things) on-line as all surgeries in England are supposed to offer this service. You have to register for this service. The receptionist should be able to help you. I mention this because it is very, very important that we know what our results are - the actual levels - which tests we had, and what all the levels were. In addition to blood glucose it will include cholesterol. lipids, liver & kidney functions and any others thrown in. They are all equally important markers for us.

chris66 · Jan 17, 2019

kitedoc said:
Bi @chris66, there is a blood test which can tell how high one's blood sugars have been over the past 3 months. It is called HBA1C, or glycosylated Haemoglobin A 1 C.
Until recently the results in numbers that are part of the range of this blood test (HBA1C) were very close to the numbers found in blood sugar readings although the units were quite different. It was like saying 5 apples and 5 tyres,
Because of this problem the 3 month blood test result is now quoted in a different way but the 'old' way is still there until staff get used to the changeover.
So so from your description I suspect 5.8 is a HBA1C reading and expressed as a %). This would be best to clarify with the nurse involved so as to avoid misunderstanding. And maybe ask her to use the new system so there is no mistake in future.
If in fact I am mistaken please forgive me. But it would be good for your nurse and your good self to be absolutely on the same wavelength.

Thank you for that in many ways its all new to me so lots to learn and understand.

chris66 · Jan 17, 2019

JoKalsbeek said:
I think the 5.8 may have been your HbA1c (an average of 3 months), which is measured differently from a spot test with your fingers. Could it have been 58? In any case, 4, 5, 6, and 7 are perfectly fine... Wouldn't worry overmuch over an 8 either. But yeah, get a meter, wash your hands so you can be dead certain nothing skewed the numbers, check before and after a meal, and if you're so inclined, share the results. The first time I did a rading throughout a day, the day after I found out about the T2, I hit 18.-something-or-other after eating two white rolls with cheese for lunch. You could've mopped me up, I was crying so much and was terrified to eat anything. It was obvious that food was messing with me, but I didn't know what part of it was responsible. And when metformin made me really ill, I read whatever I could get my hands on to find out how I could tacle this. Turns out remission was a possibility. And I have been in remission for about 2 years now. (Was diagnosed +/- 3 months when my numbers came back as non-diabetic.)

First of all well done for being in remission, i will get used to new ways of going about things and am determind to learn and do what is needed to get things into perspective and look forward to one day, like yourself i can also post i am in remission.

JoKalsbeek · Jan 17, 2019

chris66 said:
Thank you for that in many ways its all new to me so lots to learn and understand.

All of us were in your shoes at some point or another, none of us came to this with a degree in T2. It's a lot to take in and I read so much, I probably forgot way more than I remember... But take your time, take notes if you need to (it does help!), and give yourself a break if it becomes too much. If you're on information overload, it's not going to stick anyway. Only things you really need to remember: Carbs spike me. And Everything will be okay. That's all most nessecary bases covered.

chris66 · Jan 17, 2019

Bluetit1802 said:
If this was your HbA1c, it is not high enough to be called high. It is in the non-diabetic range.
I wonder if it could have been your cholesterol?

In future, after every blood test, you need to ask for a print out of the results. Once a doctor has seen the results, the receptionist will be able to print it off for you. If you live in England you can also ask to see your test results (and other things) on-line as all surgeries in England are supposed to offer this service. You have to register for this service. The receptionist should be able to help you. I mention this because it is very, very important that we know what our results are - the actual levels - which tests we had, and what all the levels were. In addition to blood glucose it will include cholesterol. lipids, liver & kidney functions and any others thrown in. They are all equally important markers for us.

Thank you for that, i did actually see a sign in the surgery waiting room reguards being able to register for medical records, but half the time reception seems twice as busy as the Dr's but will ring them and enquire.

chris66 · Jan 17, 2019

JoKalsbeek said:
All of us were in your shoes at some point or another, none of us came to this with a degree in T2. It's a lot to take in and I read so much, I probably forgot way more than I remember... But take your time, take notes if you need to (it does help!), and give yourself a break if it becomes too much. If you're on information overload, it's not going to stick anyway. Only things you really need to remember: Carbs spike me. And Everything will be okay. That's all most nessecary bases covered.

Thank you Jo, appreciated

Patrick66 · Jan 17, 2019

JoKalsbeek said:
I think the 5.8 may have been your HbA1c (an average of 3 months), which is measured differently from a spot test with your fingers. Could it have been 58? In any case, 4, 5, 6, and 7 are perfectly fine... Wouldn't worry overmuch over an 8 either. But yeah, get a meter, wash your hands so you can be dead certain nothing skewed the numbers, check before and after a meal, and if you're so inclined, share the results. The first time I did a rading throughout a day, the day after I found out about the T2, I hit 18.-something-or-other after eating two white rolls with cheese for lunch. You could've mopped me up, I was crying so much and was terrified to eat anything. It was obvious that food was messing with me, but I didn't know what part of it was responsible. And when metformin made me really ill, I read whatever I could get my hands on to find out how I could tacle this. Turns out remission was a possibility. And I have been in remission for about 2 years now. (Was diagnosed +/- 3 months when my numbers came back as non-diabetic.)

I think my hba1c will be about 7.2 when they test me next week. In fact I expect it will be higher...so no operation for me. We will see. I simply haven't had time to turn it around.

Diawara · Jan 17, 2019

JoKalsbeek said:
I wasn't on yesterday, so thanks for the tag! Would probably not have found this otherwise.

i knew you wouldnt mind !

HSSS · Jan 17, 2019

Jim Lahey said:
Yup. Finding my optimal protein requirement,

Tophat1900 said:
I'd have to say, finding that optimal protein amount is very important in terms of bg control and avoiding liver dumps for me.

How do you do this? Does it involve eating the same foods repeatedly only varying the protein amount whilst testing? I fail badly whenever there’s repetition of foods, my biggest struggle possibly

Member496333 · Jan 17, 2019

I just kept reducing it until I no longer experienced dawn phenomenon. I have since found I’m now less sensitive to it as my insulin sensitivity has improved over time, but I intend to stay that way so haven’t really increased it. I just try to stay at around 20-30g per meal and ideally always accompanied with plenty of fat

Robinredbreast · Jan 17, 2019

I managed to get a phone call from diabetes nurse this morning, who apologised to me about being kept waiting.
I told her actually I how I was feeling ( I have had enough really) and about my latest high 3 month BS and higher cholesterol too.
Nurse talked about the Criteria for getting a CGM and in April, I could be given one for a 2 week trial to see how I get on, but there is a waiting list. Also you have to of been on a recent Carb counting course, mine was a few years ago, so she said she would email me an online carb course to do, all other criteria I fit. So, here's to a possible, positive spring.
I am keeping everything crossed

garyb888 · Jan 17, 2019

Jim Lahey said:
I just kept reducing it until I no longer experienced dawn phenomenon. I have since found I’m now less sensitive to it as my insulin sensitivity has improved over time, but I intend to stay that way so haven’t really increased it. I just try to stay at around 20-30g per meal and ideally always accompanied with plenty of fat

Jim:
Now i'm a little confused. I would have thought that if there's not enough glucose or protein in the blood to "feed" the dawn phenomenon, then one's system would start burning fat. But from what you are saying it seems that doesn't happen, and the dawn phenomenon simply starts disappearing.. Is that really the case?

Member496333 · Jan 17, 2019

garyb888 said:
Jim:
Now i'm a little confused. I would have thought that if there's not enough glucose or protein in the blood to "feed" the dawn phenomenon, then one's system would start burning fat. But from what you are saying it seems that doesn't happen, and the dawn phenomenon simply starts disappearing.. Is that really the case?

Burning stored fat for energy in place of glucose is exactly what one wants if attempting to treat diabetes.

Dawn phenomenon occurs in everyone. The issue with most of us is that our livers are somewhat insulin resistant and don’t stop releasing the glucose. Add in the fact that most of us are generally insulin resistant anyway, and the blood glucose concentration climbs above normal. The trick in mitigating this effect is in trying to ensure that the body doesn’t really have the tools with which to manufacture the glucose.

Primarily this is achieved by keeping the body purged of glucose and glycogen (stored glucose). Protein is an inefficient fuel source and requires a lot of energy to be converted to glucose. Its primary role is for cell repair and maintenance. Unfortunately, unlike glucose, the body has no mechanism by which it can store the “excess” protein. The unused amino acids must either be excreted by the kidneys in urine, or reconstructed into glucose by the liver and sent out into the bloodstream.

By ensuring that you don’t have much liver glycogen available and that you don’t ingest “excess” protein - that which has not been used for cell maintenance - you ensure that your liver doesn’t have the necessary means to put glucose into the blood when you don’t want it to. Additionally, by consuming enough dietary fat, you also ensure that your body is running effectively on beta-hydroxybutyrate - the predominant ketone body that is used for energy when in the state of nutritional ketosis.

Now, I respect and understand that opinion is very much divided on the protein topic, but speaking only for myself, everything outlined above has proven to be true for me, and was the final piece of the puzzle in me truly fixing my diabetes and getting off meds. I haven’t scratched my head at a meter reading ever since, and in fact can correctly predict exact trends in blood glucose when I do small experiments on myself.

Sorry for the ramble

Shiba Park · Jan 17, 2019

Christoforo said:
Incidentally, another local surgery charges £5 for a copy of blood test results and, when challenged about this extortion, said they can charge whatever they like!

The NHS, ICO and GDPR legislation say otherwise. They are breaking the law and the ICO will 'educate' organisations that do this. If you point out to the surgery that they are violating the GDPR then they are legally bound to report themselves...

A chat with their nominated Data Officer (if they don't have one, that's another offence!) should yield the information at no cost.

Shiba.

Bluetit1802 · Jan 17, 2019

garyb888 said:
Jim:
Now i'm a little confused. I would have thought that if there's not enough glucose or protein in the blood to "feed" the dawn phenomenon, then one's system would start burning fat. But from what you are saying it seems that doesn't happen, and the dawn phenomenon simply starts disappearing.. Is that really the case?

Protein is a weird one. It affects some people and doesn't affect others. I eat far more protein than the recommended daily amount but have never suffered with dawn phenomenon to any significant degree, right from my diagnosis, and it really does not affect my glucose levels. Protein takes hours and hours to have any effect on anyone - unlike carbs that metabolise quickly. So testing after a protein meal will not show a rise, or shouldn't show a rise. It is individual as to whether it affects us or not. For clarity, I am female, currently aged 71, and do very little exercise other than dog walks. I am a strong believer that it is essential and especially so as we age. We need it for cell repair and strength among a multitude of other things. I want to know that if I fall over I can get back up again.

Member496333 · Jan 17, 2019

Bluetit1802 said:
Protein is a weird one. It affects some people and doesn't affect others. I eat far more protein than the recommended daily amount but have never suffered with dawn phenomenon to any significant degree, right from my diagnosis, and it really does not affect my glucose levels. Protein takes hours and hours to have any effect on anyone - unlike carbs that metabolise quickly. So testing after a protein meal will not show a rise, or shouldn't show a rise. It is individual as to whether it affects us or not. For clarity, I am female, currently aged 71, and do very little exercise other than dog walks. I am a strong believer that it is essential and especially so as we age. We need it for cell repair and strength among a multitude of other things. I want to know that if I fall over I can get back up again.

I have never seen a post meal rise in glucose from eating lots of protein. It’s always at least 24h after the fact and manifests as a slow upward creep that can last days if the eating trend continues.

I would think the differing reactions in different people are threefold;

1/ we all have differing requirements for protein based on lean mass, activity and age.
2/ we all have varying degrees of insulin sensitivity.
3/ the ratio between reconstruction into glucose and urine extraction varies from person to person.

That’s my own take on it. I agree that protein is most definitely essential to support life, I just don’t like using it as an energy source. As always we are all different

BloodThirsty · Jan 17, 2019

Jim Lahey said:
Burning stored fat for energy in place of glucose is exactly what one wants if attempting to treat diabetes.

Dawn phenomenon occurs in everyone. The issue with most of us is that our livers are somewhat insulin resistant and don’t stop releasing the glucose. Add in the fact that most of us are generally insulin resistant anyway, and the blood glucose concentration climbs above normal. The trick in mitigating this effect is in trying to ensure that the body doesn’t really have the tools with which to manufacture the glucose.

Primarily this is achieved by keeping the body purged of glucose and glycogen (stored glucose). Protein is an inefficient fuel source and requires a lot of energy to be converted to glucose. Its primary role is for cell repair and maintenance. Unfortunately, unlike glucose, the body has no mechanism by which it can store the “excess” protein. The unused amino acids must either be excreted by the kidneys in urine, or reconstructed into glucose by the liver and sent out into the bloodstream.

By ensuring that you don’t have much liver glycogen available and that you don’t ingest “excess” protein - that which has not been used for cell maintenance - you ensure that your liver doesn’t have the necessary means to put glucose into the blood when you don’t want it to. Additionally, by consuming enough dietary fat, you also ensure that your body is running effectively on beta-hydroxybutyrate - the predominant ketone body that is used for energy when in the state of nutritional ketosis.

Now, I respect and understand that opinion is very much divided on the protein topic, but speaking only for myself, everything outlined above has proven to be true for me, and was the final piece of the puzzle in me truly fixing my diabetes and getting off meds. I haven’t scratched my head at a meter reading ever since, and in fact can correctly predict exact trends in blood glucose when I do small experiments on myself.

Sorry for the ramble

What an excellent explanation. You described the process very succinctly.

I am going to copy and paste this into my personal notebook as I have been fretting about my own dawn phenomenon for 9 months since starting LCHF.

There's no effect at the moment while I'm on my water fast, but I must confess to wondering what will happen when I return to normal low carb eating.

I will take guidance from your own observations and adjust protein intake accordingly.

garyb888 · Jan 17, 2019

Jim Lahey said:
By ensuring that you don’t have much liver glycogen available and that you don’t ingest “excess” protein - that which has not been used for cell maintenance - you ensure that your liver doesn’t have the necessary means to put glucose into the blood when you don’t want it to.

Jim:
So are you saying that if you're not carrying excess protein, and don't have excess glycogen in the liver, then 1) the dawn phenomenon does not happen, or is reduced, and 2) stored body fat doesn't get used in that case to fuel the dawn phenomenon?

And thanks for the detailed explanation in your post.

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