Diabetic care...... is it another postcode lottery?

Hi @Phuppetty_
Three points ..
1. Yes it is something of a lottery but what you have described about your experience so far is pretty much the norm rather than the exception
2. A useful strategy to deal with this is ..
# Listen
# Nod
# Smile and say thankyou
# Ignore
3. Go with your instinct .. start self testing and LCHF

That said, you have made a good move coming here. Since joining this forum the folks here have given me so much info, advice and support that I am now much more confident about the journey ahead. So ask your questions and be assured that you will receive the answers that you need .. in my experience, it gets easier .. very quickly.

Managing and controlling your diabetes through exercise, diet and testing your Blood Glucose seems to be the best way forward for many people. For me, committing to an LCHF (Low Carb High Fat) lifestyle and testing 3-5 times a day seems to be working and you'll find that there is a wealth of info, relevant advice and positive support about LCHF on the forum ..

I see that you have already received the valuable info from @ daisy1 and I would suggest that you re-read the Low Carb Program in the information that she has sent you. You might also find the discussion on the Low Carb Diet forum helpful .. and the following Diet Doctor websites ...
Low Carb Intro and Information
Low Carbs in 60 Seconds

I strongly recommend that you get yourself a meter for testing .. I suggest that you try the website at:
https://homehealth-uk.com/product-category/blood-glucose/
for the SD Codefree meter, which costs £12.98 (you don't pay VAT) or:
http://spirit-healthcare.co.uk/product/tee2-blood-glucose-meter/
who distribute the TEE 2 meter, which is free.
I have both for comparative purposes and I have never found any significant difference between them. Unless you are prescribed test strips by your doctor (unlikely), the costs of testing comes down to the ongoing charges for test strips and lancets. I'm testing 3-4 times a day which works out at around £10 to £12 per month for either of the two packages above but, more importantly, I now know what my BG levels are .. and I can now manage them
Hope this helps

I do believe there is postcode lottery involved, but all surgeries should follow the Diabetes care pathway as laid down by NICE.
This should involve a lot of things, including things you have already received. That is a follow up HbA1c following your high finger prick test, an initial discussion with the nurse with some dietary advice followed by a review in 3 months, and suitable medication according to your HbA1c results.

You should also have been put on a waiting list for a course of some sort (these vary from area to area and you often have a long wait) and a referral sent for you to have retinal eye screening on an annual basis. Again you may have a wait for this. You should also receive an annual foot check from your nurse.

The NHS dietary advice is poor. You will get much more valuable information on this forum.

As for knowing if you are on the right track, the only way you can check this is by buying your own glucose meter and strips. The majority have us have to do this. Without one you are working blind.

These are some of the NICE guidelines
https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

Hi @Phuppetty_
I was diagnosed a few weeks ago and was given similar advice .. After weeks of floating around not knowing what I'm supposed to do I found this forum I made one post and found out so much more information than I could get from the nurse or work out online.
I did receive a diabetes care pack from Lloyds chemist today with my meds with loads of information in which backed up everything these guys had told me..
it's still hard but I believe it will get better and I will get this under control and so will you.. good luck with your journey

Phuppetty_ said:

I was diagnosed with type 2 after a finger prick test at the surgery was 22.6 and a follow up HBA1C was 80. I still haven't had the figures explained to me at all, and so far my 'care' has been Metformin (bad reaction now to both regular and slow release), a lecture from a nurse (with an order to eat less sugar) and an instruction to have a further blood test in 3 months time. Surely that can't be right? I have been on a low carb/low sugar diet since diagnosis but have no idea if I'm doing the right thing. I was diagnosed with a heart condition on the same day and have been in A&E twice with chest pain, while I was there they did a fingerprick cvery 2 hours and it was steady at 8 (higher than it should be but a vast improvement on 22.6).

Is this typical of the diabetic care provided? Our surgery has a poor reputation so I'm not sure if it is just them being their usual incompetent and uncaring selves, or if this is the correct procedure! I don't feel in the least bit supported and I am tempted to go down the route of self-testing and a low-carb diet for 3 months before my next HBA1C. I wanted to discuss this option with the nurse but she didn't let me ask any questions or discuss my care with her. I am sensitive to many drugs so a non-drug or limited drug approach would be great for me...

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Hi. Good advice above. No, it's not "right"..it's not even a minimalist approach; it's shoddy. The advice I received (in Scotland) was, by comparison, remarkably good...except for general dietary rubbish). In an ideal world, all professionals would be bang-up-to-date and well managed, our NHS wouldn't be watching its pennies to the ridiculous levels it is/has to be (so that, for example, it could be up front abut the importance of self-testing and actually issue all diabetics with meters and prescriptions for strips), and we would be safe from lazy approaches where people in key positions stop dealing with it like the whole problems is to do with eating too much cake! That said, you sound like you are pretty capable of taking control for yourself. Don't be tempted to get a meter - just get one! I would never have been able to get my levels under control without one (as it is the only way to know which foods are having what impact on you as an individual..and it lets you know your approach is working). This place, is where you want to be...a lot of expertise and sound advice. I have tagged the wonderful @daisy1, who will be along with some very important key information. Have a look at the chart below..it should help you get your head around the figures a bit. Your HbA1c of 80 pretty much means that your average level over the preceding 3 months was around 12.5mmols (ie. the level a sit is measured by a self-testing meter..in mmols). Your 22.6 (mmols) was not therefore, your average or even close to it...but still way too high (I was around that when diagnosed). You are aiming to get into that HbA1c of 41 or less area (an average of 6.8)...what some may call "remission" (others rather thinly call "reversed"). Honestly, it is through the low carb (and high fat...with enough fibre and oily food), and keeping notes of what you eat and the meter levels before and 2 hours after eating, that you will get these levels down and keep them down. Good luck. let us know how it goes.

Phuppetty_ said:

I was diagnosed with type 2 after a finger prick test at the surgery was 22.6 and a follow up HBA1C was 80. I still haven't had the figures explained to me at all, and so far my 'care' has been Metformin (bad reaction now to both regular and slow release), a lecture from a nurse (with an order to eat less sugar) and an instruction to have a further blood test in 3 months time. Surely that can't be right? I have been on a low carb/low sugar diet since diagnosis but have no idea if I'm doing the right thing. I was diagnosed with a heart condition on the same day and have been in A&E twice with chest pain, while I was there they did a fingerprick cvery 2 hours and it was steady at 8 (higher than it should be but a vast improvement on 22.6).

Is this typical of the diabetic care provided? Our surgery has a poor reputation so I'm not sure if it is just them being their usual incompetent and uncaring selves, or if this is the correct procedure! I don't feel in the least bit supported and I am tempted to go down the route of self-testing and a low-carb diet for 3 months before my next HBA1C. I wanted to discuss this option with the nurse but she didn't let me ask any questions or discuss my care with her. I am sensitive to many drugs so a non-drug or limited drug approach would be great for me...

Click to expand...

I think I would get a meter, test before meals and two hours afterwards; then see which foods cause the biggest spikes and try to eliminate them. Try the LCHF diet to see if things improve. They should. I was told not to test, like most of us are. I ignored this because you obviously can't have any kind of control over blood glucose if you don't know what's happening. I realised that the diet advice was wrong and that the treatment was inadequate. Two months after diagnosis my faith in the NHS to look after me was just about destroyed. Someone will post the post prandial targets. I try to aim for a post meal reading of less than 6 if possible and eat very few carbs. I do take metformin. Avoid bread pasta root vegetables and cereals. Good luck.

AM1874 said:

Hi @Phuppetty_
Three points ..
1. Yes it is something of a lottery but what you have described about your experience so far is pretty much the norm rather than the exception
2. A useful strategy to deal with this is ..
# Listen
# Nod
# Smile and say thankyou
# Ignore
3. Go with your instinct .. start self testing and LCHF

That said, you have made a good move coming here. Since joining this forum the folks here have given me so much info, advice and support that I am now much more confident about the journey ahead. So ask your questions and be assured that you will receive the answers that you need .. in my experience, it gets easier .. very quickly.

Managing and controlling your diabetes through exercise, diet and testing your Blood Glucose seems to be the best way forward for many people. For me, committing to an LCHF (Low Carb High Fat) lifestyle and testing 3-5 times a day seems to be working and you'll find that there is a wealth of info, relevant advice and positive support about LCHF on the forum ..

I see that you have already received the valuable info from @ daisy1 and I would suggest that you re-read the Low Carb Program in the information that she has sent you. You might also find the discussion on the Low Carb Diet forum helpful .. and the following Diet Doctor websites ...
Low Carb Intro and Information
Low Carbs in 60 Seconds

I strongly recommend that you get yourself a meter for testing .. I suggest that you try the website at:
https://homehealth-uk.com/product-category/blood-glucose/
for the SD Codefree meter, which costs £12.98 (you don't pay VAT) or:
http://spirit-healthcare.co.uk/product/tee2-blood-glucose-meter/
who distribute the TEE 2 meter, which is free.
I have both for comparative purposes and I have never found any significant difference between them. Unless you are prescribed test strips by your doctor (unlikely), the costs of testing comes down to the ongoing charges for test strips and lancets. I'm testing 3-4 times a day which works out at around £10 to £12 per month for either of the two packages above but, more importantly, I now know what my BG levels are .. and I can now manage them
Hope this helps

Click to expand...

Brilliant response.

The good news is that if you can keep your BG readings below 8 then they might even improve over time. I saw my levels falling week by week, my waist has narrowed, my feet have shrunk.
I am eating low carb meals I love and have a good excuse for buying new clothes and shoes.
Strawberries and cream with high cocoa chocolate grated over the top - normal blood sugars, lower weight - I can live with that.

dbr10 said:

I think I would get a meter, test before meals and two hours afterwards; then see which foods cause the biggest spikes and try to eliminate them. Try the LCHF diet to see if things improve. They should. I was told not to test, like most of us are. I ignored this because you obviously can't have any kind of control over blood glucose if you don't know what's happening. I realised that the diet advice was wrong and that the treatment was inadequate. Two months after diagnosis my faith in the NHS to look after me was just about destroyed. Someone will post the post prandial targets. I try to aim for a post meal reading of less than 6 if possible and eat very few carbs. I do take metformin. Avoid bread pasta root vegetables and cereals. Good luck.

Click to expand...

I completely agree. That said, I think a post meal reading of less than 6 is pretty ambitious at least initially. I seldom manage that...and aim for less than 8mmols (which I generally achieve). I am, however, not on Metformin or any other meds for diabetes, so that obviously plays apart. If I was hitting less than 6mmols after every meal, I'd be delighted...don't get me wrong.

pleinster said:

I completely agree. That said, I think a post meal reading of less than 6 is pretty ambitious at least initially. I seldom manage that...and aim for less than 8mmols (which I generally achieve). I am, however, not on Metformin or any other meds for diabetes, so that obviously plays apart. If I was hitting less than 6mmols after every meal, I'd be delighted...don't get me wrong.

Click to expand...

Well it's not all the time of course. And I don't think it would be possible without the metformin.

I have to be honest I was diagnosed in March this year and have had a eye check at the local hospital and have been on a Desmond course so that part was first rate (SW) UK As I should be diet controled I was told not to buy a monitor as the results could stress me ?? and the infomation on the course was poor on the diet side . I would also say that the Eye test at the Hospital whilst important, if you ask your Opticians if they use a camera which many do now you will get almost as good check as at the hospital. I think you will learn more from this web site /forum and doing you own research than any course .