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Consultant meeting today.

Discussion in 'Type 2 Diabetes' started by Fleegle, Jun 23, 2017.

  1. Fleegle

    Fleegle Type 2 · Well-Known Member

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    So I decided to take advantage of private medical insurance to get to see a consultant having been newly diagnosed.

    So a couple of things before I start - I am not judging his opinions no matter how I feel about them. He is a professional with 30 years experience and having seen thousands of patience and is well qualified to say what he said. I had my list of question so off we went. Doesn't make me consider that they might not be right for me and annoy me somewhat.

    Firstly - good news BP 130/80 and I suffer massively from white coat syndrome so brilliant. Heart in good shape - no thyroid problems visible and a full foot test revealed no problems their either. So all good. Pleased with my weight loss - didn't want me to continue to lose at that rate though - and this was the first warning sign when he said the faster you lose it the quicker you put it all back on. I thought that theory had been kicked into touch?

    Q1 - Can we measure how much Insulin I am producing?
    Long discussion about T2s being diagnosed really late, that 50% of beta cell production lost. Then no. No point in testing doesn't change treatment.
    Q2 - Can we measure my insulin resistance.
    Long discussion about what resistance is and how complex the test was (I might have mixed the tests up with Q1). Then no. No point in doing the testing doesn't change treatment.
    Q3 - Can we do a liver scan to look how fatty it is - and here I drifted into Newcastle diet, clearing liver than pancreatic fat.
    Long conversation about Newcastle diet. Not a fan, it is a bit of a myth, all you do is shift the issue right - cannot sustain that diet and possibly not that weight - you will be back to square one quite quickly. Long term weight lose and a low fat diet are much healthier ways of achieving the same thing but it will still progress to a point you need multiple medication.
    When I pressed him on the 8weeks to clear both he said - well you know you read about those people who have surgery and that cures it for a very short time before it is back. And no long term studies to support any of these clear the fat theory at all. I did point out that I was willing to try new things given that I probably couldn't wait for 30 year case studies to show in fact they were right!

    I showed him some of my graphs of how I react to carbs the 2mmol peek and slow decline from very small amounts of carbs.
    Why are you worried - if it peeks at 10 that is ok as long as you HBA1C gets down to about 50 you can avoid long term complications. What you have is progressive and at some point you will need a combination of drugs including insulin to control it. Indeed he went on, and not that I am suggesting it, you probably should of gone straight onto insulin given your original HBA1C was over 95. When I said I wake up sometimes in the hot weather with a BG of 6.5 he said that was still very good - what am I worried about. And he would not even entertain it when I talked about a 2mmol or more increase to 6.5. going on for 2 hours or more might cause long term damage. HBA1C is your best measure - aim for the 50-60... BTW I know that any number below my original diagnosis is good - but there seemed to be a bit of a don't worry about trying to get it down attitude. When I said I ate just a few carbs a day - less than 20 - he said it isn't the carbs but the GI and I should eat more and let my BGs go up after a meal.

    I will not carry on - emphatic no to every question that didn't fit with current guidelines which he was a strong advocate of.

    Very disappointed - was looking for a good chat about apple cider vinegar and cinnamon - Yoga.
    I did challenge him and asked whether he had heard of Dr Jason Fung and he didn't seem to want to discuss that particularly when I said that he said that " Diabetes being described as a chronic progressive disease is a lie". I think that kind off ended my meeting. You wouldn't believe I had to pay for that. And when he said I should go on the Desmond training...

    As I say - I realise he may know best in general - but I think I know best for me and my body and am still considering going it alone on Newcastle diet later this year. Until then LCHF to control and reduce BG!
     
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  2. bulkbiker

    bulkbiker Type 2 · Oracle

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    I think you hit the nail on the head when you said 30 year experience.. That probably means 35 year old training.
    It is however disappointing when you go private and they still wont do the tests that you ask for.
    Im not quite sure I understand when you say that

    Didn't he tell you exactly that before..

    So he's lying to himself.

    Also the levels that he thinks you should be comfortable at imply that he has never seen anybody lower their blood sugar through diet alone as most get much better readings.. sounds like a bit of a waste of your time.
     
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  3. AM1874

    AM1874 Type 2 · Well-Known Member

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    Hi @Fleegle ..
    Apart from one doc at my surgery who supports LCHF, exercise and intermittent fasting, what you have experienced pretty much sums up the various responses that I have had from my Doc and HCPs. However, the nonsense that they have blurted to me has, in fact, helped me a little in that it has led me on to developing a useful mantra that I now employ each time that I am with either Doc or Nursie. Now, when they babble on, I simply ..

    # Listen
    # Nod
    # Smile and say thankyou
    # Ignore
    .. works for me

    In your case, though, having paid for this drivel from your consultant .. well, I would be asking for either an explanation of his comments or a refund
     
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  4. badcat

    badcat · Guest

    When I first went low carb I kept quiet in the consultant appointment until after she had commented on how good my bloodwork was in the most recent tests - then I dropped it into the conversation and her face was a picture! Her first reaction was "OMG I hope you're not doing Atkins, eating large amounts of fat is very very unhealthy". I reassured her a little by saying I was doing LCHF but focusing the HF pert of it on good fats, but also insisted this is what I wanted to give a try despite the warning
    We came to a compromise agreement that I would follow it for 4 months, then we would have a look at the new bloodwork and "revisit" the issue
    4 months later when she saw the new bloodwork resulte together with the blood pressure and blood sugar recordings I had been keeping, she finished the appointment by saying " low Carbohydrate is the way to go for all diabetics, but its hard so I suspect most of them will never keep to it". That was 6 or 7 years ago and weve never looked back
    So my advice on dealing with consultants around the issue of low carbing is 1) make the change but dont initially tell them, 2) keep a diary of BS& BP readings, and give them that information but only after they have reviewed your bloodwork - If nothing else consultants and other medics are so deeply into the "scientific paradigm" that its v hard for them to argue with data
     
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  5. Nicksu

    Nicksu Type 2 · Well-Known Member

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    30 years experience - and a completely closed mind to anything new! Frustrating I can only say.

    My HBAC1 at diagnosis - 102! Before all the drugs were invented - what did they think people used?! All the remedies have been used for a long time in the far east and other places, I use Glymnena Sylvestra, cinnamon, ginger and also apple cider vinegar to great effect. I find that if I want to make sure my morning BS is controlled, I have 3 or 4 teaspoons of ACV in hot water before bed.

    I am unfortunately also on Gliclizade (40mg twice daily) but this is to control the spikes caused by the steroids I have to take to keep my MG under control. I'm also taking artichoke tablets to control my cholesterol which had snuck up due to the LCHF diet so I've switched to medium fat instead. We'll see if it has helped when I have my next test in a few weeks.

    I've lost nearly 4 stone due to carb and sugar control in the last 9 months. I am considering doing the 8 week Newcastle diet to get the last of the weight shifted - its stubbornly hanging in on the stomach! All I can say is, keep posting and ask if you have any questions. I found the forum gave me more information and help than my doctors/diabetic clinic ever has. All they keep doing is whinging on about my taking statins (or not in my case!).

    Keep well and cheerful!
     
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    #5 Nicksu, Jun 23, 2017 at 2:50 PM
    Last edited: Jun 23, 2017
  6. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    And this was private???? What is he a consultant of? Dinosaurs? Blimey, you didn't half waste your money on that particular dinosaur. So sorry you didn't get a more enlightened consultation.
     
  7. Deleted Account

    Deleted Account · Guest

    Excuse my ignorance but I was intrigued by your first two questions:
    Q1 - Can we measure how much Insulin I am producing?
    Q2 - Can we measure my insulin resistance.

    How do you alter your treatment based on this knowledge?
     
  8. Fleegle

    Fleegle Type 2 · Well-Known Member

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    It is a good question and I think it is very much about my personality.
    In my own self, if I knew that my beta cell production was low and my liver fatty then I would give the Newcastle diet a go and I would start today. I am not saying I wouldn't do that anyway later but, I want to see the what LCHF will do for a slower trajectory.

    If they said my insulin production was perfect then I think I would focus a little less on weight loss alone but add in quite a big muscle building programme. I would join a gym and put in a good 2 hours a day. I would also over index on herbal remedies which are good for lowering BG and resistance but exercising for bulk would where the majority of my time would be spent.

    So it isn't that I wouldn't do all of these things anyway - but it would make me focus my energy because like us all - I have a full time job which takes 14 hours a day and I need to prioritise and plan my interventions in the little time around the edges.

    Finally - in my life, I have never found that too much information has been a problem, always the lack of - but that is probably my research and engineering background coming through of experiment test and learn.
     
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  9. ringi

    ringi Type 2 · Well-Known Member

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    Remember that consultants mostly only see people with T2 that are not well controlled, and claim they are keeping to "eating plans" but are not in real life.

    Even a large long scale study of "low carb" would have lots of people laying about doing "low carb" so very mixed result.
     
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  10. Chook

    Chook Type 2 · Expert

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    Its irritating that you had to pay for the same kind of 'advice' that you would have got on the NHS - like you I would have expected better and I definitely think that if you're paying for them he should have done the tests you requested.

    It sounds to me like he's following the usual guidelines. I think @ringi is right in that most health care professionals don't expect their patients to take an active part in their health care - most people are happy to sit back, take the tablets and then carry on as they did before with their diabetes getting progressively worse.

    From personal experience I know that even people that know T2 can be controlled with diet will still carry on like before including a beautiful, vibrant young woman (I used to work with her) whose BG runs in the mid to high 20s. She thought I was absolutely nuts eating a low carb diet as she 'couldn't possibly live without her carbs' - and she knew the possible complications!
     
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  11. Daibell

    Daibell LADA · Master

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    Hi. Low insulin implies T1 and the need for stimulants such as Gliclazide or insulin if very low. High insulin implies T2 and insulin resistance which needs a very low carb diet, Metformin and possibly weekly injectables. I'm generalising but the treatment regime is different for T1 versus T2 and the c-peptide test can be useful to differentiate.
     
  12. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    Which is why it is so wrong of NICE to recommend insulin stimulants such as Gliclazide for T2s without first testing their actual natural insulin levels and any insulin resistance. Seems pretty pointless to me, and runs the risk of burning out the pancreas.
     
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  13. pamK

    pamK Type 2 · Well-Known Member

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    Nicksu What does Apple Cider Vinegar do for diabetics ?
     
  14. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    @Fleegle you are right to question the fast loss fast regain - that only happens if after being successful the diet is then abandoned in favour of the diet which cause the gain in the first place. One reason when I used to tell anyone wanting to lose weight to do Atkins is that there are four stages, the last one being maintenance of weightloss.
    I think that I am seeing a bit of weightloss now is that my Hba1c is down into the normal range - just - but it was 91 seven months ago and I was 20 lb heavier.
    Although I suspect I have had problems with my metabolism for a very long time, I feel confident that things will normalise as long as I keep on eating low carb, not forgetting the strawberries and cream.
     
  15. ringi

    ringi Type 2 · Well-Known Member

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    The first item on the NICE flow chart is life style changes including food. (If only GPs believed in low Carb)
    Then it Mat
    Then Gliclazide

    I was given a little Gliclazide for 14 days to get by BG down quickly, as Mat takes some time to work. (At least having Gliclazide gave me a meter etc, but it stopped me tracking the effect of different foods due to not having a stable base line to work to.)

    I think the risk of high out of control BG to overall health is a lot more then the risk of burning out the pancreas.

    The real issue is that GPs are not doing everything possible to teach the clients how to reduce insulin resistance using all the methods that are well known to post people on this website.
     
  16. ickihun

    ickihun Type 2 · Master

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    @Fleegle I think the problem is lchf doesn't work for all. I felt ill on it and it didn't help me lose weight. It just retrained my mind into accepting fat in my diet again. Although I have kept the lower carb meals. By doing lower carb, lower fat I'm losing weight now. I lost 2lb on months of lchf. So far I've lost just under 2 stone since xmas doing the diet best for me. Unfortunately lchf wasn't for me.
    I guess what comes with 30yrs experience is one diet doesn't fit all but many respond to metformin and insulin. Obviously their forte is medication not diets. You need a nutritionist not an endocrologist's experience?
    If all diseases only needed a new diet there would be no need for consultants?
     
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    #16 ickihun, Jun 23, 2017 at 11:55 PM
    Last edited: Jun 24, 2017
  17. ringi

    ringi Type 2 · Well-Known Member

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    Once problem is that lchf is named wrong, I think it should be call "low carb, so what about the fat", e.g. a large increase in fat is not what gives the benefit
     
  18. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    I think that there is a need to think about adding fats as so many of the things which are cut out when eating low carb contain a lot of fat - crisps and chips and roast potatoes just as a start, but ice cream, cake and biscuits too, so we are lowering the amount of fat eaten quite drastically from the amount eaten when on a 'normal' diet.
     
  19. ickihun

    ickihun Type 2 · Master

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    Some people don't eat rubbish and still don't lose weight. Whilst anyone eating rubbish with bad fats in, add weight. So why would continuing to eat said fat benefit some sufferers? I know the concept of lchf to burn fat but if that doesn't work then if something different does, what is the harm? Especially when its hugely documented obesity inflames insulin resistance.
    Get rid of obesity by whichever diet works for you and get a hold of the IR is far more beneficial than scraping around looking for medics to approve one diet over another.
    My advice is to get the weight off first and foremost to control IR then work on reversal/remission. The IR is the more dangerous symptom of type2 diabetes, in my opinion.
    A diabetic with no sugar related complications can still die of obesity, like none diabetics.
    Why spend your whole life fighting diabetic complications to find morbid obesity killed you anyway?
    Weight loss has to come first, which helps with meds etc to stop other problems arising. E.g pcos from IR is made unbareable in obese patients but none over weight pcos sufferers can control testosterone side affect better with the pill which has a huge risk of dvt in over-weight patients. In fact refused to them even though an excellent med for pcos. The perfect med for it.
     
  20. CaliforniaGal

    CaliforniaGal Type 2 · Member

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    Dr. Fung says the disease is curable. And I believe him. And I am living proof that it is curable. I followed his book on fasting. And now I am completely in the normal range and I will stay in the normal range. As far as I'm concerned, I am cured. I believe Dr. Fung; every word in the book is true. But now I have to maintain, and therefore I must stay within the guidelines of the book that he wrote on fasting. You can choose how you want to fast. So every day I must look at the eating chart that he put together and follow it exactly, in order to maintain. It's not easy, but you can do it!
     

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