Are Doctors really up to speed with T2?

Like you @Mysson99z , my husband came home from his diagnosis with a leaflet on what to eat, which pretty much described the diet we had been on for many years. This, to me, suggested that the recommended diet (the, so called, healthy balanced diet that we are all told to eat) could, just possibly, be less than ideal. Even as long ago as 2013 it didn't take me long to find out about Low Carb and only a day or two longer to introduce a low carb diet to our house.
Now I don't wish to belittle your HbA1c of 70, but James' was bigger than yours, quite a bit bigger, but with low carb it took 9 days to bring his blood sugar levels down to non-diabetic. (I don't, of course, mean the HbA1c, which is a three month average, I mean the finger prick readings). He soon dropped the Metformin, with no increase in blood sugar levels and has maintained non-diabetic numbers ever since.
Can I suggest that you look into low carb, my favourite site is https://www.dietdoctor.com/ and there is lots of info on here, too. It just might work for you too.
Best of luck,
Sally

I can only say that I completely agree with what Sally has posted above. In my view (some may say I bang on about this all the time) diet is key for 90% of Type 2's. Cut out as many carbohydrates as you possibly can (there are none that are essential) and see if your blood sugar numbers come down.

Mysson99z said:

Hi everyone. I live in West Wales and was finally diagnosed with type 2 back in January of 2017 with an HBa1c of 70. I was sent home with a low dose Metformin prescription and a leaflet showing me what to eat.
I must say I was a more than a little confused at this stage, as I already ate a well balanced diet and the leaflet they gave me only confirmed that. Having been told that I had likely been diabetic for a couple of years, I was already suffering with the added problems of neuropathy and retinopathy, and of course the usual suspects, such chronic fatigue, aches and pains, sleep disorders, etc; etc;
After complaining to my GP on several occasions about the metformin upsetting me, she referred me to the diabetic nurse for a chat. She then referred me to the 'specialist practitioner' at the surgery. A mild mannered man with virtually no people skills and even less interest in my personal issues. He reluctantly changed my meds to Gliclazide and sent me back to the nurse, who then issued me with a BG meter along with a very basic tutorial on how to use it. [basically, she hadn't got a clue either] "Only use it now and then" she said. "The strips are expensive and you'll end up like a pin cushion." I was also told that I would still have to see the other GP about my depression, and all she wanted to do was double my anti-mad pills. I thought that depression and diabetes were inextricably linked?
I managed quite well with the gliclazide for a few months, until I experienced several Hypo's in quick succession, at which point and with an HBa1c of 55, my GP told me to come off all meds, as I didn't need them any more.
Thanks Doc. That lasted all of 3 days, before I was in a terrible state and had to go back. He then prescribed a low dose Pioglitazone, which seemed ok for a while until my symptoms got worse over time and my HBa1c had risen to 60, and my depression was unbearable. It was clear that he had under prescribed the dosage. At this point [ I ] suggested that we double the dose and that [ I ] start monitoring myself more regularly.
Since then I have been testing myself up to 6 times a day, and now I have a good set of results to start working on. I managed to blag some more pills and upped my dosage as my BG was still over 10 average. This is not working either and now I'm stuck. I do not trust the practise, yet I still need their help. I hear of many diabetics who have a designated specialist, who monitors new patients closely and works with them until they find their feet and can cope on their own.
I feel let down by my Doctors surgery. Are they all like this in Wales??

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Most are not.

Hi @Mysson99z and welcome
I will tag @daisy1 for her helpful info pack which will include links to a low carb program. I used my meter to work out what foods I could eat or which ones were better avoided.

In my experience of nearly twenty years dealing with so many GPs and of course dsns and two specialists. Out of all of them, I would definitely say that all but one knew anything about how most types of metabolic conditions including type two diabetes had any in depth training about how the body metabolises carbs. And how dietary management is crucial in dealing with early diagnosis and treatment.

Like you I didn't get any useful advice or help from GP or diabetes nurse. Got a lot more help from this site.

I was diagnosed Jan 17 with my HBa1c of 101.
Took 2 months to see the DN as the "other one" quote is not worth seeing.I was given a good plate guide,that was used to put my shoes on.
June 17 for my eye examination,to find I had retinopathy.
They are great,NOT.

I also think that GP's are very lacking in knowledge of T2 Diabetes and most of the surgery nurses I have seen also don't seem very genned up on it either. Because of bowel problems my GP told me to stop Metformin altogether for 6 weeks - No replacement was given or suggested she just said providing my morning readings were below 10 not to worry about it/ I had previously been told the morning readings should be below 7 so felt very confused and worried at stopping meds altogether. I went back to see her after the 6 weeks and said my readings had crept up over the 10's and she told me to see the Diabetic Nurse at the practice. Saw her and she said my HBa1C was up and so she would consult with GP Phoned in and they said GP had left a prescription for Sitaglyptin but not saying whether to take this only or what. It is no wonder so many T2 patients don't know where they are, what to take, what to eat etc. Can't get appointments etc., useless.

It is said that the training in nutrition that GPs get at uni can be measured in hours. As the metabolism obviously revolves around nutrition then this lack of training would account for a lack of knowledge of metabolic dysregulation. The nutrition training at uni is also said to be decades out of date. Only those HCPs who care to keep abreast of the latest research can hope to treat their patients using a more enlightened approach. There is also the question of time spent with patients and sometimes a fear of stepping outside 'accepted norms' re treatment.

My 2 GPs are. They are very very good. Older GP is very zealous which is great to see in this day and age.
Practice nurse still mindstuck thou. My hospital dn is superb.

@Mysson99z

Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it both interesting and useful. Ask as many questions as you like and someone will help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

I don't think it's limited to Wales, more like a worldwide epidemic. Unfortunately they are usually going off what they learnt in med school because that is always right of course.

I've seen both sides: my surgery hasn't a DN, I'm winging it (with the fantastic help of the Forum); on the other hand I go to a support group run by a DN from another surgery who is absolutely amazing, and has such passion for low-carbing that it is rubbing off onto the doctors at the practice. Yet, on Saturday she was telling us that she was on a nurse forum and having a conversation about low carb which she was promoting, and had a "well, as if that's going to work" response from a senior nurse! So it's not just us struggling, it's also within the profession, as can be seen from the same reaction that enlightened doctors get. But I do think the message is, slowly (like glacier creep slowly) getting out there.

Sue192 said:

I've seen both sides: my surgery hasn't a DN, I'm winging it (with the fantastic help of the Forum); on the other hand I go to a support group run by a DN from another surgery who is absolutely amazing, and has such passion for low-carbing that it is rubbing off onto the doctors at the practice. Yet, on Saturday she was telling us that she was on a nurse forum and having a conversation about low carb which she was promoting, and had a "well, as if that's going to work" response from a senior nurse! So it's not just us struggling, it's also within the profession, as can be seen from the same reaction that enlightened doctors get. But I do think the message is, slowly (like glacier creep slowly) getting out there.

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It must do eventually because more people will be ignoring what they've even told when they see it doesn't work.

In The U.K. General practitioner's are just that they are the first line of defence who overtime know you and your body best. all I suspect are overworked the system was designed so that you could be referred to a doctor who specializes in different diseases and have a wider knowledge. As we all know the NH's is underfunded under staffed and hospitals have long waiting lists .I think in the old days doctors would get a medical paper the LANCET which would keep them up to date in general the specialists would get a more detailed update. In this computer age I suspect they just look up at the time of your visit and maybe some get complacent. The computer system is only as good as the information put in. I suspect a committee sits to decide what gets in and they are very slow to change hence all the moans here

In there defence they are responsible for there treatment advice. Contributors to this forum can give advice without any responsibility even though we all know we react differently to foods diets etc I find this forum Helpful and Informative but I Still check things with my doctor and then make my own mind up

bangkokdiabetic said:

In The U.K. General practitioner's are just that they are the first line of defence who overtime know you and your body best.

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Some good points in your post @bangkokdiabetic. However your first sentence gave me a wry smile - long gone are the days when your doctor almost knew you from cradle to grave (some actually bringing you into the world). It is common now to see a different GP every time you visit the surgery - although you can ask to see yours, you will most likely be offered an appointment with another GP. So, off you go and although all your details are supposed to be on-screen, you usually end up repeating what you said to the last one and thereby easily snaffling up your allotted 10 mins.

Sue192 said:

Some good points in your post @bangkokdiabetic. However your first sentence gave me a wry smile - long gone are the days when your doctor almost knew you from cradle to grave (some actually bringing you into the world). It is common now to see a different GP every time you visit the surgery - although you can ask to see yours, you will most likely be offered an appointment with another GP. So, off you go and although all your details are supposed to be on-screen, you usually end up repeating what you said to the last one and thereby easily snaffling up your allotted 10 mins.

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My point/intention was to highlight the difference between what was meant to happen and what is happening and without being rude to suggest that continually knocking Doctors is not helping solve the problem If the NHS is failing to provide the service we want then ask yourselves why ?
Funding Tory Govt Policy shortage of Medical staff. Lack Of Funds. Bad Management possibly funding but also need for serious overhaul and computerisation
For Example here in Thailand get to hospital 8.15 am check in 8,30am Blood Test.
Then Breakfast 9.o'clock back to see Diabetes Doctor have blood pressure temp weight taken by nurse 9'15 see doctor blood tests available No Rush 9.45 go to Heart Doctor 10 15 see heart doctor full check up also has relevant blood test results10 45 may see eye doc or foot doc etc this happens 4 times a year NHS from reading posts see GP makes app to see doc at hospital wait 2 months see doc at hospital who makes apt for eye test wait 2 months.et al

My philosophy don't moan on here Make Your MP aware of your concerns if enough people did this and followed through it would be apart from Brexit the no 1 issue at next election then keep pressure on it will take time for change to work through and some changes may not work so change again Jus A question does the NHS Use Generic drugs ??
I Could go on forever but YOU have to make a bigger noise than the Drug Companies and other vested interests

sally and james said:

Like you @Mysson99z , my husband came home from his diagnosis with a leaflet on what to eat, which pretty much described the diet we had been on for many years. This, to me, suggested that the recommended diet (the, so called, healthy balanced diet that we are all told to eat) could, just possibly, be less than ideal. Even as long ago as 2013 it didn't take me long to find out about Low Carb and only a day or two longer to introduce a low carb diet to our house.
Now I don't wish to belittle your HbA1c of 70, but James' was bigger than yours, quite a bit bigger, but with low carb it took 9 days to bring his blood sugar levels down to non-diabetic. (I don't, of course, mean the HbA1c, which is a three month average, I mean the finger prick readings). He soon dropped the Metformin, with no increase in blood sugar levels and has maintained non-diabetic numbers ever since.
Can I suggest that you look into low carb, my favourite site is https://www.dietdoctor.com/ and there is lots of info on here, too. It just might work for you too.
Best of luck,
Sally

Click to expand...

Mysson99z said:

Hi everyone. I live in West Wales and was finally diagnosed with type 2 back in January of 2017 with an HBa1c of 70. I was sent home with a low dose Metformin prescription and a leaflet showing me what to eat.
I must say I was a more than a little confused at this stage, as I already ate a well balanced diet and the leaflet they gave me only confirmed that. Having been told that I had likely been diabetic for a couple of years, I was already suffering with the added problems of neuropathy and retinopathy, and of course the usual suspects, such chronic fatigue, aches and pains, sleep disorders, etc; etc;
After complaining to my GP on several occasions about the metformin upsetting me, she referred me to the diabetic nurse for a chat. She then referred me to the 'specialist practitioner' at the surgery. A mild mannered man with virtually no people skills and even less interest in my personal issues. He reluctantly changed my meds to Gliclazide and sent me back to the nurse, who then issued me with a BG meter along with a very basic tutorial on how to use it. [basically, she hadn't got a clue either] "Only use it now and then" she said. "The strips are expensive and you'll end up like a pin cushion." I was also told that I would still have to see the other GP about my depression, and all she wanted to do was double my anti-mad pills. I thought that depression and diabetes were inextricably linked?
I managed quite well with the gliclazide for a few months, until I experienced several Hypo's in quick succession, at which point and with an HBa1c of 55, my GP told me to come off all meds, as I didn't need them any more.
Thanks Doc. That lasted all of 3 days, before I was in a terrible state and had to go back. He then prescribed a low dose Pioglitazone, which seemed ok for a while until my symptoms got worse over time and my HBa1c had risen to 60, and my depression was unbearable. It was clear that he had under prescribed the dosage. At this point [ I ] suggested that we double the dose and that [ I ] start monitoring myself more regularly.
Since then I have been testing myself up to 6 times a day, and now I have a good set of results to start working on. I managed to blag some more pills and upped my dosage as my BG was still over 10 average. This is not working either and now I'm stuck. I do not trust the practise, yet I still need their help. I hear of many diabetics who have a designated specialist, who monitors new patients closely and works with them until they find their feet and can cope on their own.
I feel let down by my Doctors surgery. Are they all like this in Wales??

Click to expand...

Mysson99z said:

Hi everyone. I live in West Wales and was finally diagnosed with type 2 back in January of 2017 with an HBa1c of 70. I was sent home with a low dose Metformin prescription and a leaflet showing me what to eat.
I must say I was a more than a little confused at this stage, as I already ate a well balanced diet and the leaflet they gave me only confirmed that. Having been told that I had likely been diabetic for a couple of years, I was already suffering with the added problems of neuropathy and retinopathy, and of course the usual suspects, such chronic fatigue, aches and pains, sleep disorders, etc; etc;
After complaining to my GP on several occasions about the metformin upsetting me, she referred me to the diabetic nurse for a chat. She then referred me to the 'specialist practitioner' at the surgery. A mild mannered man with virtually no people skills and even less interest in my personal issues. He reluctantly changed my meds to Gliclazide and sent me back to the nurse, who then issued me with a BG meter along with a very basic tutorial on how to use it. [basically, she hadn't got a clue either] "Only use it now and then" she said. "The strips are expensive and you'll end up like a pin cushion." I was also told that I would still have to see the other GP about my depression, and all she wanted to do was double my anti-mad pills. I thought that depression and diabetes were inextricably linked?
I managed quite well with the gliclazide for a few months, until I experienced several Hypo's in quick succession, at which point and with an HBa1c of 55, my GP told me to come off all meds, as I didn't need them any more.
Thanks Doc. That lasted all of 3 days, before I was in a terrible state and had to go back. He then prescribed a low dose Pioglitazone, which seemed ok for a while until my symptoms got worse over time and my HBa1c had risen to 60, and my depression was unbearable. It was clear that he had under prescribed the dosage. At this point [ I ] suggested that we double the dose and that [ I ] start monitoring myself more regularly.
Since then I have been testing myself up to 6 times a day, and now I have a good set of results to start working on. I managed to blag some more pills and upped my dosage as my BG was still over 10 average. This is not working either and now I'm stuck. I do not trust the practise, yet I still need their help. I hear of many diabetics who have a designated specialist, who monitors new patients closely and works with them until they find their feet and can cope on their own.
I feel let down by my Doctors surgery. Are they all like this in Wales??

Click to expand...

Many primary docs are not well-versed in diabetes - I am lucky that mine is and he works closely with me. I follow a low carb diet and with exercise (try for at least 30 mins walking daily if nothing else) and an oral med, my A1c is 6.2 (avg between 5.7 & 6.2 last few quarters).
Here in the US we have RDN's - registered diabetes nutritionists - they can be very helpful setting you up initially with diet & testing guidelines and BG goals. If you have access to any nutritionist, try to take advantage of it. On your own you can do a lot of research and alter your diet gradually to lower carbs and increase fat & maybe protein as a % of your caloric intake. Try to make the carbs you do eat, and you do need to eat some, high fiber carbs that are nutrient dense - the less refined the better.
A low carb diet is a lifestyle change and not a temporary fix, but more and more research supports the benefits of such a diet. Good luck.