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DO YOU WANT TO JOIN ME TO MAKE A CHANGE TO CURRENT GUIDELINES?

Dr Snoddy said:
This would require additional training of facilitators and, probably the biggest problem, a change of mindset.
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Right on the money. One massive hurdle is getting know-it-all doctors to moonwalk back over all their previous advice and admit that, actually, they knew very little all along. Never underestimate the power of ego. Irrespective of policy, I imagine many of the old-guard will stick to their guns until they die our retire, whichever comes first.
 
The power of the ego. Indeed.
 
Dr Snoddy said:
I had my annual review yesterday and tried to sow the seeds of a more open-minded approach. I was up against the usual 'against NHS guidelines' and 'everyone is different'.
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That’s my experience at PPG level.
 
Debs I admire your determination, however I think alot more needs to be done with re-educating the NHS and public in regards to diet starting with the eatwell plate.

Handing out technology to willing participants is a good idea, but many folk are ignorant to tech and it's advantages and then to manage the information to help them, I know type 2's who bury their heads in the sand upon diagnosis and keep on eating the same diet without any idea as to the effect on their health, partly due to age, partly due to years of misleading information with low fat/high sugar, I think to make a difference you have to start with re-education and once people are empowered and finding their way to then help them further with testing, but under the care of their diabetic team so that they know how to handle the information, otherwise you're giving someone a formula one car with no idea how to drive it.
 

Hi Juicyj,
I can see your point about most people having no idea how to use a BG meter, especially as you have Type 1 experience which has to factor in 2 both short and long acting Insulin as well as the carb and protein in each meal.

However I would respectfully say that things are much simpler for Type 2's (assuming they are not on Insulin or something like Gliclazide). It seems as though newly diagnosed Type 2's (in the UK) are usually not put straight on medication, but are given misleading dietary advice and at best unhelpful advice about testing their Blood Glucose. I am sure that a significant proportion of newly diagnosed Type 2's would be motivated and pro-active about controlling their BG if they only had a little correct information and some encouragement.

Surely it is worth at least giving them the chance to do so!
 
Agreed there.
 

Yes.
It is very easy to forget how confusing and contradictory and downright intimidating it is when you first start testing.

We get thread after thread here on the forum with people who have got a glucometer, either from their surgery, or self funded, who post to ask 'when should I test?' and 'what are normal blood glucose levels?' and 'what does this reading mean?'

These are all perfectly reasonable questions, but unless the healthcare team has provided this info, they have to fall back on forums like this one for the answers, or scour the internet for reliable information. Often they are told to take their FBG with no explanation of why or what it means.

Very often that patient has been told to eat Weetabix for breakfast and carbs with every meal. So of course their readings are high, and they lack the knowledge to appreciate that levels rise and fall throughout the day, according to what we eat. Numerous posters have thought that their bg stays steady, and that their FBG reading is representative of the whole day. No one has told them differently - until they get here.

So unless the central message to T2s from the medical profession is that lower carb levels => lower blood glucose AND the healthcare professional is fully on board with it, and able to explain clearly to the patient when/how/why to test, handing out glucometers will not benefit the patient. Not everyone is as proactive as members of this forum, or has internet access, or is even interested in investigating the science. (I am thinking of 3 family members as I type. One won't test EVER because it will hurt. One has been shown how to test by myself multiple times, and doesn't do it because he 'forgets' to test before meals and then 'there is no point in testing after'. And I gave the third a test kit but it has never been used.)
 
I was diagnosed T2 way back almost 15 years ago. Those were the days! provided with a meter and strips. Shown how to test fasting and after each meal, then keep record of numbers. Also told to eat low fat, plenty of fruit and fruit juice, ‘healthy’ wholemeal bread, weetabix, pasta, brown rice, skimmed milk and low fat fruit yogurt. Then berated 3 months later because I was deemed tobe not following instructions as the BG levels had increased. The provision of test kit is useless without the correct diet advice, and I daresay the motivation to own the condition and learn how best to manage it. Alas, I fear that there are too many, (I have encountered them) who are not able or willing to do that, and only too happy to follow advice that meds, further progression are the only way.

Like any task that is seemingly enormous, it is best to break it down into manageable chunks. The drive to get Low carb way of eating for T2, such as that encouraged and drivenby this forum and enlightened GPs such as Dr Unwin is the first step. When more are on board with that then it would be a good time to consider education progammes and offer of test kits to motivated patients.

after all, I do remember seeing a lot of packs of test strips for sale on sites such as ebay when they were given free on prescription to some people.

I am happy to self fund test kit.
 
I’m happy to send letters to the powers that be in the nhs etc. When first diagnosed I was actually given a meter because I was put straight on Gliclazide. Not given any worthwhile advice though. Told my type 2 wasn’t diet related as I wasn’t overweight and ate a balanced diet - the eat well plate! I didn’t even know that carbs are the same as sugar. Education is the answer, starting with GPs and DNs, a lot of people do still just do as they are told by the professionals who they trust.
 
Errant thought.

There has been an enormous amount of publicity about "Smart Meters" and how seeing how much energy you are using minute by minute will make you use less energy.
How testing each appliance using your new display will show you which appliances are good and which aren't.

This does seem to overlap a great deal with sensors such as Freestyle Libre as well as finger prick testing to show how your BG is minute by minute and which foods are good/bad, so perhaps a message along the same lines could reach people and also have credibility with the organisers and funders.
 
Good analogy.
 

Hi @Juicyj

i agree retraining is the key
and the point of the thread is HOW do we make that happen ?

But, this diabetic team you speak of.

For me mine was...The doc who gave me 5 minutes to tell me i was ill.
a 2nd visit to tell me i got worse (6 weeks HClf :***
the DN's who breezed through the tests (x2)
one telling me all was good carry on following the good advice..(had rejected it and went LCHF)
the other telling me how good everything is going..(again eatwell=Good )
throw in the eye test and that in over one year makes around two hours If that
add in the two day desmonds...nice enough but info was not what i needed re food,
though meeting fellow sufferers was nce.

GP's just don't have the time for us, not moaning just a fact.
online is where i learnt the most about my condition, and got the most help in managing it from fellow sufferers on here, not from my doctors surgery..that is sadly i acknowledge, the real world.
so lets embrace it as part of the solution.

( I do feel that type 1's Do have, as is appropriate a 'care Team'
But that types 2's (at least in my case) that 'team' just doesn't seem to be there. )


as for the other points made in thread

Not sure, but if we all know it's money, why any authority would sanction the libre,
regardless of how useful it might be.
Much more likely to go old (aka cheap) tech and run with meters IF we are lucky.

as a self funder i couldn't sanction the costs of a libre, why would the NHS absorb it.
red herring in my opinion..sorry.

as for meters, and training...mmhh

if only there was a site that instead of following outmoded food plans had a more open policy on LCHF and other alternatives, that ACTUALLY were proving great success, in the real world. ?

DCUK, should in my eyes, be the De Facto option for type 2's.
Duk just seems to recite the current dogma that those same HCP we all moan about, dish out

Solution to the 'training' ..mmhh..
perhaps let DN's do a basic one, then Put the training videos up on here, with a "how /when /why /what the numbers mean" in FULL View...that would be most useful, so newbies can review and recap at will..
(if desmonds was anything to go by, by the time the DN gets around to doing that training , most will be proficient by then )

give newly diagnosed the link to THAT DCUK page, as part of the care package.() off site training sorted
(Those interested come here anyway, lets just make it official )

DCUK make it an integral part of the forum, so those arriving for the first time are met with
Good Information and the beginnings of their support network.

So... back to the original issue
HOW do we make that happen and who do we need to target the message to.?
 
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All I would like to see as a start is something that has almost zero cost! No real training required - just a leaflet stating the basics.
Just to tell all T2 Diabetics that:
1. Blood Glucose spikes and overall high BG levels can cause problems.
2. That different people have different tolerances, but that in general all carbs contribute to high Blood Glucose levels and spikes.
3. That for Type 2 Diabetics, the Eatwell plate and the 5-A-Day emphasising fruit are actually wrong.
4. That in the light of the above, it is suggested that it is good for T2's to test their BG, That all that is required initially is one of the cheaper meters with cheaper test strips - approx £20 plus postage for a full kit plus extra 50 test strips.
5. Give the basic instructions on testing: - Test to see the effect of meals on BG; Test before and the 2hrs after meals; Aim for BG below 7.8 and for no more than a 2.0 spike between the before meal and the after meal numbers.
 
I've just got back home from an appointment with my DN. Main aspects were:-

She was amazed by my progress and congratulated me on doing so well.
She didn't seem surprised, was polite but less than supportive when I told her how I was doing it.
She was amazed that I was 'self funding a meter and test strips'. She said that test strips are very expensive. I replied that mine cost around £8 for 50 - so not expensive in order to achieve good health.

Note that I took a leaf out of Dr David Unwin's book and decided that HF was too big a step, so only told her about Low Carbs.
She suggested that I have amazing will power and that most T2's could not give up eating something like bread. I replied that little willpower was involved since all I did was switch from eating certain things I like to eating other things that I also like.
 


I fear #3 is just too big a step. They can’t and won’t admit they got it wrong. Best we can realistically expect is a gradual shifting of their position as “new” science is discovered!
 
HSSS said:
I fear #3 is just too big a step. They can’t and won’t admit they got it wrong. Best we can realistically expect is a gradual shifting of their position as “new” science is discovered!
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I know it is a big ask.

Note that my point #3 doesn't ask them to admit that the advice is wrong for the general population - just specifically wrong Type 2 Diabetics, which should be obvious to even the most blindly arrogant medics anyway.

But from what I have read (not really researched it), all it needs is the old correct science to be re-discovered and some of the more recent false science to be put where it belongs - in the bin ! No new science is required.
 
It is the deception that really annoys me. When I was first diagnosed I was told it was important to record blood glucose levels several times a day, and suppliedwith the tools for doing so. I continued to be provided with the test strips, for a couple of years, ( expensive for NHS, which often is the case as suppliers see NHS as a cash cow, and charge premium rates) . Having failed to gain control following the diet advice given, and having found my own way to lose weight and regain non- diabetes levels, I was congratulated, and told that as I had ‘cured myself’ (nurse’s words) I no longer needed to test. I fell for that, because I wasn’t aware at the time that the mantra had changed. I have heard so many with T2 since repeat that script, almost word for word. “No need to test, as all that will do is give me bruised fingers, and make me obsessed and anxious”. That is really criminal to lie, rather than tell the truth, ‘Your care is too expensive’.

What I feel would be helpful would be re-education of HCPs to include the advice that it need not be expensive to test, and give the option of the patient purchasing the affordable test kit many of us here use, plus advice about the correct use of the test data for the individual. Also to include this in any patient education programme.
 
Which is why “new” was put in quotation marks ......

yep should be obvious but obviously isn’t.

I did note the difference (whole pop v t2) but still feel admitting that they caused or mistreated the diabetes/obesity epidemic would cause more than a red face or two and mean they couldn’t blame the patients anymore. No gov (of any flavour) will taken the fall on this one imo.
 
Testing provides all the evidence. Yes.
 
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