Diabetic Review with Doctor

EllieM said:

BUt havingsaid that, there are good nurses and less than good ones, just as there are with consultants, so there's an element of luck of the draw as to whether you get someone who can help you.

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Which is why we all need to vote for @CassellCath in the RCN Patient's Choice Award!
https://secure.rcni.com/nurse-awards/patients-choice-voting.asp
If a DN - who is brave enough to do what's right for her patients - receives this award from the UK's largest professional nursing organisation, it will send a loud and clear message to other DN's throughout the country that there is another, better way. This is our chance to have our voices heard on this issue on a national platform. Please consider voting for Catherine if you have not done so already! @NewTD2 we all deserve better, let's help make it happen!

EllieM said:

I think T1s and T2s get treated very differently by the "professionals".
T1s - we're all on insulin, so as long as we can convince our specialists we're numerate we get help to manage the disease ourselves rather than lectures.

T2s- never get to see a specialist (maybe if they move to insulin?), rely on competence of GP's nurse, who handles diabetes along with lots of other things. There are so many of them that there's no time other than to hand out metformin and tell them that they shouldn't blood test as it will only worry them? (Though to be fair, my father's T2 and has been told this, and his condition has been stable for the last 7 years on 1500mg metformin per day.He's 87, has a moderately but not very low carb diet, and it's not going to be diabetes that kills him.) Also, it's automatically assumed that younger (under 50,60?) T2s are going to progress to insulin eventually (which totally sucks IMO as they have to have huge quantities compared to T1s, and they still can't metabolise carbs properly).

BUt havingsaid that, there are good nurses and less than good ones, just as there are with consultants, so there's an element of luck of the draw as to whether you get someone who can help you.

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If they exclusively get to see people who don't specialise in it, it makes a bit more sense, but still doesn't(I think) excuse calling them idiots or incompetent as they need to know and stay up to date(medical knowledge changes rapidly, it is literally impossible to stay on top of all of it) on so many different things that it is impossible to know a lot in many different areas, expecting them to treat you to perfection is unreasonable. You are not the centre of the universe, whoever is treating you(or according to you, not treating you) may well have different things that they think are much more important. Or they may simply have a bad day, as most people should be able to relate to really but may lack the empathy to get.
Being asked not to test is blatantly just a cost cutting move from the NHS whether they would admit it or not, much like how people don't get Libre sensors because they're expensive despite it making a huge impact in management.

(not meant as a personal attack on you @EllieM , you just happened to write the most quotable post)

Petaluk said:

Wow, well done with your results!

I don’t know enough about T2 yet but I’m learning from everyone on here, thank you

So now you are in remission, does that mean that if you wanted to say have a roast dinner with all the trimmings or a pizza or even go out and get drunk, that would be okay as long as it was very occasionally??!

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I would not even want to know - if 'all the trimmings' involve high carbs, no thanks, give me heaps of the good stuff thank you, and pizza is mostly bread - I'll have the toppings and not the bread perhaps, and as for getting drunk - well, it never did appeal to me, having seen the state some people get into, but I could take a bottle of my excellent dark rum and drink some anytime.

Resurgam said:

I would not even want to know - if 'all the trimmings' involve high carbs, no thanks, give me heaps of the good stuff thank you, and pizza is mostly bread - I'll have the toppings and not the bread perhaps, and as for getting drunk - well, it never did appeal to me, having seen the state some people get into, but I could take a bottle of my excellent dark rum and drink some anytime.

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Thanks for responding
Wishful thinking I guess - I just really miss a carvery and a drunkish night out with friends!

Mel dCP said:

I was thrilled with my 43 and was told over the phone to bring it up to 50. I’m going in for my proper face to face telling off next week

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Have fun telling them off for giving rubbish advice face to face next week!

Antje77 said:

Have fun telling them off for giving rubbish advice face to face next week!

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I’ve just printed (and laminated) a full colour copy of the NICE chart that says 43 is “excellent” to give them

Petaluk said:

Thanks for responding
Wishful thinking I guess - I just really miss a carvery and a drunkish night out with friends!

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I don't understand - I don't eat out very often, but have never had any trouble in getting food I can eat safely - and when I decline the Yorkshires I say I am diabetic eating low carb and often get more meat on my plate. At the pub I either have a half pint of a good beer, and a pint of fizzy water, or a pint of fizzy water and a double rum. I do sometimes take some squash concentrate with me and add it to the water, as I don't trust diet flavours coming from their dispensers. I have had full sugar lemonade instead of water in the past. Other than the odd little glitch, though I don't have any bother at all.

Resurgam said:

I don't understand - I don't eat out very often, but have never had any trouble in getting food I can eat safely - and when I decline the Yorkshires I say I am diabetic eating low carb and often get more meat on my plate. At the pub I either have a half pint of a good beer, and a pint of fizzy water, or a pint of fizzy water and a double rum. I do sometimes take some squash concentrate with me and add it to the water, as I don't trust diet flavours coming from their dispensers. I have had full sugar lemonade instead of water in the past. Other than the odd little glitch, though I don't have any bother at all.

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Sorry to confuse you! I guess Yorkshire puddings are high carb then from your response? My local carvery has yummy roast potatoes, mash and cauliflower in cheese - so I guess these too will be no go
I’m not a great drinker but a couple of my friends love a good drink, so I feel our friendships and social life will deteriorate :/ Also I am on metformin, only 500mg, I read drinking should be moderate because of side effects. A lot of ppl off meds enjoy a occasional red wine, merlot is a favourite by some. I used to drink Diet Coke and vodka when I used to do the Atkins before being diagnosed as T2. I’m not sure if this will be okay with the metformin either. I just need to sit it out I guess until my weight is drastically reduced, so that I can cease taking medication. Do you ever have a cheat day, now you are in remission?
Congratulations btw for getting there, excellent result

Oh sorry - I'd forgotten about the drinking and Metformin - even though I suffered so much with it.
I suspect that once the HCPs have you on it they don't want you to stop - but lowering weight doesn't come into it as a definite improver of BG levels - low carbing dropped my levels to 47 with very little weight loss - but I have lost over 40lb since my levels dropped to normal. I am now working on getting more muscle so I don't become old and feeble.
I am a long time low carber, and quite honestly I prefer the foods I can eat to those considered 'normal' these days. I have devised a Yorkshire pudding made with cream and water rather than milk and I do eat several of those, on the few day's a year I make them - but even after Christmas dinner my BG level was 5.6 - so I can't really call that a cheat day - I had a similar meal on Christmas Eve and got the same reading without the Yorkshires. I know that I can eat more carbs and keep a low BG level - but I start to regain weight as fat, which is not something I want to do.

Drinking and Metformin is not a real risk unless someone drinks a lot, and has poor liver or kidney function (very likely for someone who drinks a lot.). Unlike a few drugs, having a glass of wine while taking Metformin is very unlikely to be harmful to most people.

bulkbiker said:

They believe rather foolishly that you are overmedicating. That's what the nurse said to me.. she had assumed that my HbA1c of 28 was down to hypos and was most surprised when she realised I wasn't on insulin (or indeed any meds) once she looked at my prescription records. They are so unused to anyone being in control that they freak out and say completely ridiculous things rather than looking at their own stupid advice and thinking that could be at fault. Remember that if most of us had followed what our doctors said we should do our HbA1c's would probably be in the 60's or higher.
As you may be able to tell it annoys me just a little!

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That's exactly what happened to me , first HBA1c -60 , following the eatwell plate to the letter next test came back at 61! Advised to eat lots of fruit ( canned was ok too )and brown bread. Now doing low carb and hoping for better results.

Lynn74 said:

That's exactly what happened to me , first HBA1c -60 , following the eatwell plate to the letter next test came back at 61! Advised to eat lots of fruit ( canned was ok too )and brown bread. Now doing low carb and hoping for better results.

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Which I can be pretty confident in saying you will get.

Lynn74 said:

That's exactly what happened to me , first HBA1c -60 , following the eatwell plate to the letter next test came back at 61! Advised to eat lots of fruit ( canned was ok too )and brown bread. Now doing low carb and hoping for better results.

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Was it okay for the canned fruit to be in syrup?

There is a fast food/sandwich shop up the road from me and for a few pounds they do a salad box with choice of topping ie tuna chicken or other meat. I was talking to the lady who runs it the other day and she mentioned they were going to start doing burgers soon I said very good but not for me being diabetic she said well we will do a bread less version for you if you like just have the burger and fillings and such thought that was very help full.

NewTD2 said:

I just had a meeting with my GP (General Practitioner) about the results of my last blood test.

The doctor confirmed that my HBA1c has gone up from 38 to 39. This was due to the fact that he suggested way back in February to have 2-3 fruits daily in my diet.

I told him afterwards that I should now eliminate fruits in my diet to lower my HBA1c.

He became quite upset and angry and suggested that I should eat more fruits and expects my HBA1c to go up even higher between 45 to 48 which is the "normal range", according to him, for a diabetic.

I was just ABSOLUTELY HORRIFIED and I was just thinking I might as well shoot myself now and drop dead.

This has just confirmed my fears that my doctor do not necessarily understand diabetes / diabetic control to avoid horrific complications later on.

Two large-scale studies - the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT) demonstrated that improving HbA1c by 1% (or 11 mmol/mol) for people with type 1 diabetes or type 2 diabetes cuts the risk of microvascular complications by 25%.

If I were the NHS Registrar / Senior Consultant in the area, I would have sacked him straight away for giving irresponsible, careless and appalling advice!!!

I'm just going to ignore my doctor and continue doing I know what's best for my health and future.

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Wow, what an incredible post, this is appalling as you say regards contents as explained therein, and circumstances,I hold you in high esteem and applaud your decision to ignore your doctor continue doing what you feel best for your own health. the saying goes, the best medicine of all "is to look after ones own body as we know it best of all", no doubt that comment will not be met viewed well and frowned upon by many, depending on their circumstances, its just a general comment, having said that, the reason I relate to your situation of raised A1C is I had the exact same situation, I was informed one or two fruits a day were acceptable, I introduced after 6 months not eating fruits fructose, even sticking to berry fruits strawberries and no tropical, I blame myself, my negligence naive for trusting the advice, and yes gave a higher result of one A1C exactly as you experienced. I stopped all fruits to the discontent of my doctor, not a happy chappy I was not following his recommendations, with the exception I continue to eat ONE strawberry once every 3 months, the restult A1C reversed down levels to 5% no fruit in sight!

Your situation indicates as no doubt many out there have doubts upon, although one should respect the medical advice given by our doctors, but not always those advices may be correct and /or outdated, or this, one would get second opinion if the need be, in my case, I sacked my doctor of 30 years, as when I raised could the adding of fruit have raised my A1C his reply was shocking too, I quote, No fruit has nothing to do with it you have not exercised enough, and probably been nibbling carbs convince yourself your diabetic! considering I had not eaten bread potatoes pasta, rice for 1 year, low carb keto x 1 year, exercising walking 9klm a day and surfing, did I trust his advices of raised A1C No, my new approach I too ignored my doctor, I do not work for the doctor, a doctor works for me, not always they are right.

If of any interest due to your situation, I would recommend getting a copy of Dr. Jason Fung new book Diabetes code how to reverse diabetes 2 naturally, I also take the liberty to attach link of an interesting video with Dr. Andreas of diet doctor, wherein Dr Fung explains clearly and simply and puts diabetes into simple perspective, which you also may find useful. I agree the concern question is how many doctors actually know and uptodate 100% on diabetes and how to guide, I am sure there are some who are experts but many give old school advice not updated, and for this, my opinion every doctor on this planet should have a copy of Diabetes Code by Dr. Fung on their shelves in their surgery, and also view the undermentioned video it speaks volumes and probably puts into perspective to clear any questions we all may have and have not been perhaps explained sufficiently or as simply indepth explained as video shows.

THE PERFECT TREATMENT FOR DIABETES 2

Very sorry to hear your experience, situation,I think everyone who reads your post, should take note, be aware and take the contents on board overall. You have taken wise choice taking a positive decision which way to go from this experience, well done I applaud you. Thank you for sharing.

Good luck, hope enjoy video of Dr. Fung, if not already viewed?

JohnEGreen said:

There is a fast food/sandwich shop up the road from me and for a few pounds they do a salad box with choice of topping ie tuna chicken or other meat. I was talking to the lady who runs it the other day and she mentioned they were going to start doing burgers soon I said very good but not for me being diabetic she said well we will do a bread less version for you if you like just have the burger and fillings and such thought that was very help full.

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Its slowly catching on.. even Tom Watson (newly thinner Labour deputy leader) was extolling the benefits of butter in coffee in the Grauniad.

Crocodile said:

Unfortunately, I blame the health system rather than the doctor. It's the same here down under. At least I get on well with my GP and talk to him. The whole public diabetic support network ( and just about everything else from cancer to VD ) is underfunded and looks only to the short term. Public diabetic education is appalling here. The doctor is between a rock and a hard place as the majority of sufferers are poor at self management. The lack of resources means that they treat everybody the same and aim for the generic case.

By the way, I would have thought that the difference between 38 and 39 would be well within the margin of error.
Glenn

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Just a thought, I would like to hope whatever the old school training of any doctor on any area he may not specialize, diabetes included, uptodate sound knowledge gained before passing recommendations guidance should be within the role responsibility of the Doctor in question, irrespective what the Health system may put forth criterias for doctor to follow, I may be wrong in my viewing, but I would expect my doctor not to put old or backdated guides to myself, rather, state, it "recommendations used to be..............however, I believe there are different recommendations from my training days,and as I am not 100% sure, I will make searches to establish what is the best guide recommendation for you", instead of perhaps passing out advices, which may not be suitable or correct for the individual patient. Its a difficult and delicate line of info, but overall to solution this, one should perhaps follow gut feelings along with other info gained overall.

I think for us all, there needs more transparency and indepth explanations from the professionals as when this is not given time fo diagnosis to give the patient a picture of diabetes, perhaps, this is because they cannot do so, as they dont know sufficient information themselves, that is not excuse, and for this, Doctors I feel have an obligation to be 100% updated on diabetes and changes, prior to handing out professional advices which may be incorrect and outdated not in best interests to assist at the ned of the day yes or No?

ringi said:

Your doctor is getting confused, as it is true that someone with type2 should not have a A1c much below 50 if they are taking drugs other then metaformin. The is due the drugs doing harm, hence reducing the drugs is called for when A1c is below about 50.

But when diet controlled with or without Metformin, lower is always better. (Unless it is due to red blood cells not living long, hence the need to comfirm a low A1c with other testing if it does not much a persons own BG testing.)

But as your A1c is now so low eating a little fruit may not be a bad option provided you avoid all added suger and fruit juices, along with not gaining any weight. That just depends on what you wish to do, as there is no health benefit from fruit compared to above ground veg, for example red/yellow peppers.

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Excellent post overall. If I may mention chat re fruit, generally overall, there is little health benefit as you say, this probably is the case, there may be some exceptions, i.e. couple of benefits to my understanding may be wrong? a granny smith apple due to acid content is supposedly excellent for digestive cleansing naturally, as often on Low Carb some experience IBS or stomach issues, some experience disappearance, generally, regards stomach, fruit can be of beneficial dietary use, i.e. as above the apple, and/or pineapple, grapefruit also as I understand the University of California researches found out last year, seeming grapefruit eaten in moderation daily half or quarter a day no sugar added, has indicated researches show, can work as effectively or better than metformin regards control of sugars? Interesting and great to see someone bring up red blood cells situation A1C, as sometimes also re this area, if non candy sticking on red blood cells if one has longer living cells, can result in an unexpected and falsely RAISED A1C result, point well raised in your post.

EllieM said:

BUt havingsaid that, there are good nurses and less than good ones, just as there are with consultants, so there's an element of luck of the draw as to whether you get someone who can help you.

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When it come to managing long term conditions, I'd take a good nurse over a bad doctor any day.

Biggles2 said:

Which is why we all need to vote for @CassellCath in the RCN Patient's Choice Award!
https://secure.rcni.com/nurse-awards/patients-choice-voting.asp
If a DN - who is brave enough to do what's right for her patients - receives this award from the UK's largest professional nursing organisation, it will send a loud and clear message to other DN's throughout the country that there is another, better way. This is our chance to have our voices heard on this issue on a national platform. Please consider voting for Catherine if you have not done so already! @NewTD2 we all deserve better, let's help make it happen!

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Hi Ellie, I’ve only just seen your kind words-thank you! I’m actually a practice nurse but my passion is diabetes. Here’s an article that Diabetes Times did on me! I’ve had so much support from social media and on here-I can’t thank everyone enough! http://diabetestimes.co.uk/low-carb-nurse-advocate-up-for-top-health-award/