Complications

[Pinkorchid]

Did anyone see the latest episode of GP's Behind Closed Doors yesterday. There was a diabetic man having a dressing put on his foot as he had recently had a toe removed it was the third one to be removed. The nurse said his diabetes is controlled but he gets infections that will not heal and could lead to him having his foot removed. It seems even with controlled diabetes some people are still more predisposed to complications than others

 

[SockFiddler]

"Controlled" meant what, though? That his medication levels had been stable or that he was self-testing and his BG was regularly in the safe-zone?

I wonder whether we don't have different definitions for these words?

 

[Deleted Account]

It's very sad but I think you are right that some people are more pre-disposed to complications.
I also think (but happy if someone proves me wrong) that good control now cannot stop complications resulting from bad control in the past. But, hopefully, it can stop it getting worse.

 

[Pinkorchid]

"Controlled" meant what, though? That his medication levels had been stable or that he was self-testing and his BG was regularly in the safe-zone?

I wonder whether we don't have different definitions for these words?

I am sure when nurses and doctors say controlled it is because the patient does not have high BG levels if they were high it would not be controlled. We do not have all the answers here as to how to control diabetes we are just a small minority who do it with lower carbs hundreds do it other ways

 

[bulkbiker]

hundreds do it other ways

And thousands don't do it at all..often those following their doctor's and NICE guidelines I too would love to know what "controlled" meant exactly. HbA1c of ?

 

[zand]

I am sure when nurses and doctors say controlled it is because the patient does not have high BG levels if they were high it would not be controlled. We do not have all the answers here as to how to control diabetes we are just a small minority who do it with lower carbs hundreds do it other ways

I think what the doctors call controlled is very different to what many of us here call controlled. We don't all follow LCHF here either, as you say there are different ways of doing it, what is important is that we aim to have non-diabetic numbers. The NHS don't seem to aim for or expect that.

 

[bulkbiker]

I think what the doctors call controlled is very different to what many of us here call controlled. We don't all follow LCHF here either, as you say there are different ways of doing it, what is important is that we aim to have non-diabetic numbers. The NHS don't seem to aim for or expect that.

Worse the NHS don't seem to believe it is possible.. or at least that was the impression our new diabetes nurse gave last week. She said she had looked at my HbA1c numbers and thought I was being overmedicated with insulin until she checked my repeat prescriptions and found nothing there at all. I'm afraid she was a bit shocked.. I did tell her how I had done it but I'm not sure it all went in.

 

[Bluetit1802]

I am sure when nurses and doctors say controlled it is because the patient does not have high BG levels if they were high it would not be controlled. We do not have all the answers here as to how to control diabetes we are just a small minority who do it with lower carbs hundreds do it other ways

Controlled to medics is not the same as controlled to us here on the forum. Controlled to medics is if the person keeps to his personal target as agreed with his doctors/nurse, and this could be an HbA1c in the 50s.

Without knowing any details of this man's medication and his history we cannot say if he was controlled or not. Someone who began the journey on diet only, progressed to Metformin, progressed to Gliclazide, then Forxiga, Januvia, and any of the other strong drugs, often in large doses and multiple medications, and then to insulin isn't seeing an improvement. His disease is getting worse, not better, even if he does return levels that are better than before and apparently under control. The damage may have already been done.

 

[serenity648]

My diabetic nurse considered numbers under 75 to mean well controlled in type 2's and a hbaic of less than 60 to mean borderline diabetic. I am going to ask further about her definitions next time i see her.

one of my friends father, who is 70 years old and been type 2 for only 10 years, is now losing his sight but is considered by her to be well controlled even though his hbaic was 78 last time he went. She just upped his insulin : (

 

[Bluetit1802]

My diabetic nurse considered numbers under 75 to mean well controlled in type 2's and a hbaic of less than 60 to mean borderline diabetic. I am going to ask further about her definitions next time i see her.

one of my friends father, who is 70 years old and been type 2 for only 10 years, is now losing his sight but is considered by her to be well controlled even though his hbaic was 78 last time he went. She just upped his insulin : (

This is exactly what I meant in my earlier post.

 

[ringi]

From https://www.nice.org.uk/guidance/ng28/ifp/chapter/blood-glucose-and-target-levels

The HbA1c target for most people with type 2 diabetes is 48 mmol/mol (or 6.5%),
​

From https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-1837338615493

Give more drugs if over 58 mmol/mol (7.5%)​

 

[noblehead]

Did anyone see the latest episode of GP's Behind Closed Doors yesterday. There was a diabetic man having a dressing put on his foot as he had recently had a toe removed it was the third one to be removed. The nurse said his diabetes is controlled but he gets infections that will not heal and could lead to him having his foot removed. It seems even with controlled diabetes some people are still more predisposed to complications than others

Recorded and hope to watch it tonight.

How very sad for the individual involved, diabetes can be so cruel............................

 

[serenity648]

This is exactly what I meant in my earlier post.

Yes, she seems to be ignoring the guidelines completely : (

 

[Bluetit1802]

From https://www.nice.org.uk/guidance/ng28/ifp/chapter/blood-glucose-and-target-levels
The HbA1c target for most people with type 2 diabetes is 48 mmol/mol (or 6.5%),

Or whatever the doctor agrees. This target of 48 is fairly new. It was 53. It was 53 when I was diagnosed in 2014, yet my diagnostic HbA1c was 53. I was told that was acceptable but not to let it go higher.

 

[Pinkorchid]

And thousands don't do it at all..often those following their doctor's and NICE guidelines I too would love to know what "controlled" meant exactly. HbA1c of ?

But how do you know thousands do not control their diabetes that's a bit presumptuous are you saying only those who follow LCHF can control their diabetes. Diabetes has been around for a very long time long before low carbs was ever thought about as a diet for weight loss let alone diabetes how did they control it or do you think it was impossible

 

[bulkbiker]

But how do you know thousands do not control their diabetes that's a bit presumptuous are you saying only those who follow LCHF can control their diabetes. Diabetes has been around for a very long time long before low carbs was ever thought about as a diet for weight loss let alone diabetes how did they control it or do you think it was impossible

So far as I know the first diet recommended for diabetes was low carb ...the condition used to be known as "Sugar Diabetes" after all...as well as the only way Type 1's could survive at all before insulin was discovered and manufactured.
And no what I meant was those following the doctors advice and those that are currently undiagnosed are those far more likely to suffer from complications. When HCP's claim control for the most part I think they mean not getting any worse.. Although of course if you have high sugars and are not getting any worse you are still far more likely to have complications than those without high sugars.

 

[zand]

But how do you know thousands do not control their diabetes that's a bit presumptuous are you saying only those who follow LCHF can control their diabetes. Diabetes has been around for a very long time long before low carbs was ever thought about as a diet for weight loss let alone diabetes how did they control it or do you think it was impossible

No we are saying that the NHS don't aim for good enough control. No-one mentioned LCHF. That was all you. (except for me when I quoted you earlier) This thread isn't about LCHF, it's about what is or isn't good control. Anything in the 50s is not good control whatever way you look at it, however the NHS seem to think that is just fine.

 

[Bluetit1802]

But how do you know thousands do not control their diabetes that's a bit presumptuous are you saying only those who follow LCHF can control their diabetes. Diabetes has been around for a very long time long before low carbs was ever thought about as a diet for weight loss let alone diabetes how did they control it or do you think it was impossible

Wrong about LCHF being a relatively new innovation. It was the only treatment available to diabetics as long ago as the 1800s. There have been several threads about this, with quotes from books written at the time. I have one published in 1936

Cookery and Household Management
Printed 1936

Diabetes

Those suffering from this ailment require carefully to avoid all foods containing sugar and starch. The following Must be avoided:

Milk, sugar, flour, cornflour, oatmeal, rice, sago, macaroni, the various pulse foods, fruits containing a high percentage of sugar, potatoes, beets, carrots, peas, parsnips, broad beans, spanish onions.

The following are allowed:

meat, soups, fish, poultry, game and meat of all kinds. Also eggs, butter, cream, cheese, certain vegetables. Light dry wines. Weak unsweetened spirits. Tea, coffee and cocoa which may be sweetened with saccharine. There may be plentiful use of butter, cream, fat and oils if the digestion will allow.

 

[Pinkorchid]

"Controlled" meant what, though? That his medication levels had been stable or that he was self-testing and his BG was regularly in the safe-zone?

I wonder whether we don't have different definitions for these words?

How do you define controlled ?

 

[donnellysdogs]

There are different levels of acceptable control though.

I asked years ago what would happen if I went in to a hospice. The answer was "well you would be dying so your control would be relaxed".. or what happens if I'm 74 (top of head age) and in a home with dementia.. again, care of blood levels would be relaxed.

His levels may have been ok but he may not have been checking his feet and wearing decent shoes and something on his feet at all times.

Seeing that my personal control is meant to be one of the top 5% in my hospital and all they really worry about is the hba1c and not daily swings in levels then nothing really suprises me anymore. Especially as I go to a tertiary care hospital.