Do I need to pester for an earlier appointment?

[Lollygaggle]

I had a raised HBa1c level of 80 on a routine blood test. The surgery took a second test to confirm and said if type 2 diabetes was confirmed I would probably need medication to start off with and various appointments etc.

I received the letter end of last month to confirm that I am indeed diabetic. However when I phoned the practice to make the appointment with the diabetic sister they informed me there are no appointments available until the New Year. They are supposed to contact me to try to get me in sooner but nothing has happened yet.

I have quite a bit of weight to lose so weeks before diagnosis I started a low carb diet and have lost 7 pounds so far , I have radically upped my exercise. I have also started using a blood glucose meter and this is where the problem is.

Routinely in the mornings before I get up my blood glucose is 11 . (I eat at 7pm) . During the day I am getting no lower than 7 .

Given that I have utterly revamped my diet and cut out carbs to a greater extent and upped my exercise levels and I understand that metformin is only an aid in my endeavours , should I be exerting whatever pressure I can to get my appointment sooner? Or waiting until possibly the New Year will do no harm and give time to see what effect diet and exercise make?

 

[Redshank]

They deal with thousands of patients, you deal with one. Phone them again, ask them for an earlier appointment. If you don’t manage to get one you are in the same position, but you might get one!
You are doing the right thing in cutting out carbs and increasing exercise so well done.
Welcome to the forum

 

[JMK1954]

Tell them you can take a cancellation, adding 'at short notice' if this is appropriste for you. That has sometimes avoided a long wait for me. It might be worth trying.

 

[Bluetit1802]

You are tackling this admirably, doing all the right things. Improvement doesn't happen over night, it is a long journey. If you carry on as you are there is no need to worry about not seeing a nurse - what can she do anyway? You are already doing it.

However, you should be having another HbA1c 3 months after your last one, so you do need to chase that up to make sure you are on the correct care pathway, and that should be followed by a full review and general check with the nurse, and you should be invited for a retinal eye screening test, or at least be on the list for one, so you need to ask about that.

 

[Resurgam]

If my surgery is any guide, I'd say don't bother.
By the time you go to your appointment you could be well on your way to being back to normal, as long as you stick to the low carbing, and not even need medication.
Some people - I am one - react very badly to Metformin, and a statin was added for me - in a few weeks I was only fit for a care home and considering suicide on a number of occasions. Some people report not the slightest trouble, but it isn't possible to know beforehand.

 

[sally and james]

HI @Lollygaggle and welcome to the forum. Good advice above and a huge well done for getting started on your recovery. We all make mistakes at the beginning of our Low Carb journeys. There are hidden ones in places where no carb should be! Are you testing before and two hours after each meal and keeping a food diary? Also, you might like to tell us what your typical food intake is over the course of a day. It's just possible that something you are having is letting you down.
Best of luck with it all, sounds as if you'll be "in remission" before you get an appointment.
Sally

 

[TriciaWs]

It's good you are getting to grips with this, but your GP surgery is appalling.
In the first 3 months after I was diagnosed last year I had so many medical appointments I joked I didn't have time for anything else.
I was given the diagnosis face to face, I can't believe they sent you a letter!
By the third week, I'd had a foot check at the surgery, and then my first appt with the surgery diabetic nurse.
In less than 3 months: an eye check at the hospital, a full foot check at the podiatry clinic, plus a session with a dietitian after I declined the Desmond course (I could have done without this one as she was anti low carb).
I had a further set of blood tests at 3 months after the initial test (not the retest) and another full session with the DN.
All in line with official NHS guidance.

At the initial meeting, I was expecting the diagnosis, so went prepared to discuss options, and told my GP that I wanted to try low carb instead of metformin and statins - he agreed. The DN I saw a couple of weeks after thought he'd forgotten to prescribe them and was about to remind him and get a prescription. She wasn't happy when I explained, but my numbers were so much better at 3 months that she was converted.

Also, since I joined the lowcarbprogram, the NHS can now prescribe this in many areas - you get a voucher to cover the cost.

 

[JoKalsbeek]

I had a raised HBa1c level of 80 on a routine blood test. The surgery took a second test to confirm and said if type 2 diabetes was confirmed I would probably need medication to start off with and various appointments etc.

I received the letter end of last month to confirm that I am indeed diabetic. However when I phoned the practice to make the appointment with the diabetic sister they informed me there are no appointments available until the New Year. They are supposed to contact me to try to get me in sooner but nothing has happened yet.

I have quite a bit of weight to lose so weeks before diagnosis I started a low carb diet and have lost 7 pounds so far , I have radically upped my exercise. I have also started using a blood glucose meter and this is where the problem is.

Routinely in the mornings before I get up my blood glucose is 11 . (I eat at 7pm) . During the day I am getting no lower than 7 .

Given that I have utterly revamped my diet and cut out carbs to a greater extent and upped my exercise levels and I understand that metformin is only an aid in my endeavours , should I be exerting whatever pressure I can to get my appointment sooner? Or waiting until possibly the New Year will do no harm and give time to see what effect diet and exercise make?

They told you in a letter? Seriously? Sheesh... And then no time for you, because hey, what's diabetes? No more serious than a stubbed toe, right?

Unbelievable.

You're off to a good start with the low carbing. What's your aim per day, in grams? You might want to go a little lower, but it's early days and your body needs to adjust to the new normal. The high blood sugar reading in the morning could just be the usual liver dump of glucose, that's the last thing to come down. Focus on the pre and post meal readings, if you get those down, the fasting bloodsugars will follow suit eventually.

https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ might help in sussing out possible things in your current diet that might be tripping you up, but.... I have to say you're doing really well, not just taking things lying down, but taking an active part in your health. Good on you!
Jo

 

[VashtiB]

Hello and welcome to the forum,

I'm really sorry that your medical practise is not giving you more information and support. Having said that my personal opinion is that you will find more support and information here than from most doctors.

It's great that you've already started making changes. While the numbers themselves are important the most important thing is that they are going down, It can take time for the levels to come down and stay down, Google dawn phenomena to see why the morning readings are high (I was really stressed about this before someone told me about dawn phenomena

Hopefully by the time you see someone you will be on the way to having stabilised your readings in the non-diabetic levels.

Welcome!

 

[mouseee]

I was the same. Dxd this July, first diabetic nurse appt October. I did get my hba1c done just before that as I wanted to see how I'd reduced it. All my reduction was done because of this forum!
Nurse pretty much did a double take at results.

 

[Deleted member 308541]

I phoned my GP's surgery up on Monday morning asking for a an appointment to see my regular GP on Wednesday the 6 Nov, at 10:20 am approx, the receptionist said "No worries how does 10:50 sound", that will do me thanks.

I am pleased I do not have to put up with the ^%$# you Brits. have to with the NHS...

 

[Marie 2]

Just keep in mind if you are doing everything right and it doesn't make sense you could be a type 1 and not a type 2. 40% of us are misdiagnosed as a type 2 at first, I was. I just like to warn everyone just in case.

 

[Bluetit1802]

I am pleased I do not have to put up with the ^%$# you Brits. have to with the NHS...

Not all of us!!! (and certainly not me )

 

[ringi]

At this point in time, all you are missing out on is the possibility of a metformin prescription, you have taken care of everything else yourself. Have a read about metformin and if you wish to try it (in addition to low carb), any GP can prescribe it in a normal 10 minutes appointment. Ask for a flexible prescription that allows you to slowly increase the dose to the max level you body can cope with, remember to take it with food, starting on the lowest possible dose. Most people find the IG side effects stops after a few weeks, but some people find the side effects from metformin reduces their quality of life, and hence stop taking it.

Remember metformin should not be for life, but it can help until your A1c has been truely normal for a few years. But lowcarb, very low carb, intermittent fasting and if possible HIIT, and resistance training all give more benefits then just taking metformin, so don't think of metformin as being "the solution".

Personally at this stage I think you should be very hesitant about starting any drugs other then metformin, so try to deflect the GP if he/she talks about satins.

The eye and foot checks should be done once a year, and are unlikely to find anything that needs action unless someone has had poorly controlled BG for years. If you get any issues with your eyes or feets, request an emergency appointmentm otherwise they should be OK.

I assume you have found the information on this site about how to use a BG meter to discover meal you should not eat again, and you already know about low carb. Dietdoctor.com is one of the best websites on lowcarb, also consider https://smile.amazon.co.uk/Diabetes-Weight-Loss-Cookbook-life-changing/dp/0857836226 along with "The Diabetes Code" book. However just eating beaf and eggs with a little green veg can give great results so it does not need to be complex.

 

[Lollygaggle]

Thank you for all the advice.
I am trying to go as low carb as possible , I only drink water, chamomile tea or occaisional decaf coffee milk , no sugar.
Typical days meal
Breakfast either omelette or 2 slices home baked low carb bread (almond flour psyllium eggs ) spread with peanut butter (peanuts nothing added)

Lunch mixed salad , 2 slices cheese, olives, sun dried tomato, tablespoon guacamole , thin slice ham

Dinner eg chilli con carne with cauliflower rice , roast chicken with vegetables , no rice no grains no potatoes , no bread except low car.b , no fruit , no sugar/honey , no baked goods

I am trying not to carb count as I am trying to establish an eating pattern that I will keep to for life. Basically if it is protein, vegetable , salad ,fat I eat it. If it is carb , sugar , fruit , I try to avoid it .

I am walking around 8000 to 10000 steps every day. I have had an ankle fusion so cannot run or do any high impact exercise. Added to that I have mernieres disease , which I believe has a link to diabetes , so have unpleasant dizzy spells which come on out of the blue.

I am losing weight at a steady pace and am using glucose monitoring before and after meals to try to get a feel for what food is good. I have read that eating a small amount of protein before bed may help with morning glucose levels. I will give that a try.

The gp practice has not got back yet about getting me in before the new year but I have said I will take a short notice cancellation , but as a new diabetic patient I need a one hour appointment so will wait and see.

 

[EllieM]

The gp practice has not got back yet about getting me in before the new year but I have said I will take a short notice cancellation , but as a new diabetic patient I need a one hour appointment so will wait and see.

Honestly with your attitude you have a good chance of putting yourself in remission by the time you get your first appointment. However, as @Marie 2 said, if your levels start to go up you should consider an emergency appointment to rule out the possibility of LADA. (GPs tend to assume that anyone over a certain age or weight is T2, but this is not necessarily so.)

 

[Lollygaggle]

Thanks for all the advice , I have lost another 5 pounds since I first posted but even better my fasting glucose is now down to 8 from 11 and mostly my food spikes are around 2 , after making a few rookie low carb mistakes (kidney beans , porridge) .

Still havent got an initial diabetes appointment but feel better than I seem to be making some progress.

 

[JayAmerican]

Try to be patient as you are doing the right thing while still feeling in the dark. Most medical practitioners will not do HBA1C tests more often than once every 3 months, the point of them is to get an average over 3 months. In the meantime, checking your blood is useful to learn what spikes your levels and what doesn't, what times of day, etc. The reason your glucose readings are higher in the morning is because Type 2 diabetes is more of a liver problem (rooted there, anyway) in that it is creating glucose when the body doesn't really needed it which forces the pancreas to make more insulin which then eventually the cells start refusing, leaving higher levels of glucose in your blood.

While you're sleeping, the liver creates glucose and for diabetics it is spilling out more than necessary prior to waking in the morning - it's known as the dawn phenomenon. You can Google it.

So dealing with diabetes (and reversing it) requires 4 main efforts. Diet is the biggest one but here are the 4 I have determined for myself:

* Low carb diet (aka keto diet but don't go by names, cater to your own needs) and overall better nutrients into your diet to balance out the bad carbs and sugars
* Exercise to help burn off excess glucose and increase muscle mass which can help to turn cells to be more insulin-sensitive
* Reduce inflammation (bad carbs and sugars create inflammation in the body which increases insulin resistance) so things that can help with that other than lowing carb/sugar intake are: supplements, and boosting your immune system, relaxation, avoiding stress
* Re-programming the liver to stop leaking so much glucose

The last one is really the hardest. The first 3 are absolutely in most people's control, I am doing all 3 (well, the exercise still needs effort). I believe the most common drug prescribed for Type 2, Metformin, does the trick with the liver but not in a "teach it" way but rather just triggers signals to make it behave differently - so stopping Metformin will just get it back to doing what it was. I've been looking into natural alternates and the main one seems to be Berberine which is a supplement based on similar flower extracts that Metformin originally was discovered from. I found a source for it today and will see how well it supplements my own efforts. As a reference, my morning readings are typically right now in the 180-195 ml/DL range and later in the day after a low-carb meal and after working in the garage for 2-3 hours it is 140-150. Still high but better than 250-300 where I started 3-4 weeks ago. If the Berberine works the way I hope it does, I am hoping to be in the 140-150 range most of the time and exercising and further diet reductions to push it down even further.

It will take time. Here's why it will take time:

This is not by any means verifiable science, but it makes sense to me and it's a simple way to view things. New cells are created in your body all the time while old cells die off. A cell is born with the same genetic code as the original. As a cell matures, it "learns" things about the body that differ than its expected programming. For example, high insulin levels make it learn to ignore insulin a lot of the time. Having too much glucose in the system will also make a lot of cells have to carry the extra burden and also refuse the insulin. So as you change your diet and habits, as new cells replace old ones, they are going to be reacting and behaving to a body that is becoming more and more normalized to match its expected programming. After enough time passes, you have enough new cells throughout your body that are behaving healthy. This doesn't happen overnight.

This is why I believe the last of the 4 aspects I listed, teaching the liver to behave properly, will take the most time. It's also why morning levels for Type 2 diabetics is often higher than the rest of the day even with a good diet.

 

[Lollygaggle]

Just an update, finally got a cancellation appointment with diabetic nurse , awaiting eye appointments , foot appointment etc but have at last been prescribed Metformin and given a glucose meter, strips etc so no longer have to buy them .

However I have lost another 7 pounds since the last posting and even better my morning glucose level has dropped from 11 to 7. I'm starting to feel less tired and low carbing has been easier than I thought. Thanks to this site I was able to start taking some positive action before my diabetic nurse appointment

 

[jjraak]

Brilliant, so your now seeing the HCP, and probably know more then they expected and are deffo doing better then most they see already

@JayAmerican ... Most interesting post and viewpoint.
Hadn't really looked at it like that, but the learning thing does make some sense. Cheers.

As for me.
IF it was a case of only being able to know ONE set of numbers... For me the METER test would be THE ONE.

Nice as knowing what the HBA 1c is...

Just that on its own, and we could be banging into the walls of the corridor of safety we are trying make for ourselves.
Meaning the HBA1c... Could be good.. Could be bad.. And without a meter we wouldn't really know and so in all honesty have little in the way of affecting it.

However, with a meter, we KNOW.. Good or bad foods. How they affect us, and for how long.

So we start the first throw out of bad foods ( for us)
Bring in good food and begin the review and improvements of our diets .. Which inexorably lead to a better HBA1c.

It's like that corridor of safety I mentioned.

The HBA1c, is a dim light at the end of a dark hallway... We might get there safely but we might also pick up a few bruises as we bump into things or take the odd tumble.

But get a meter and start using it... Is like floodlights in that hallway,.. Much easier to see the pitfalls and stumbling points to avoid

Great works, @Lollygaggle ... Looks like you got this.