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

Discussion in 'Ask A Question' started by Debandez, Oct 7, 2019.

  1. Goonergal

    Goonergal Type 2 · Moderator
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    A number of posts have been deleted for derailing the thread. Please can we now get back to discussing the original thread topic:

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

    If in the course of a discussion on a thread a new topic comes up that you’d like to discuss further, please start a new thread.

    If a discussion begins which is largely relevant to only one or two participants in a thread, please move to PM.
     
    • Agree Agree x 1
  2. Listlad

    Listlad Prediabetes · BANNED

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    I didn’t get a chance to look at this yesterday. Very interesting. Thanks. A chance to influence change to current guidelines.

    https://www.eventbrite.co.uk/e/question-health-diabetes-registration-67503305203

    Hosted by UCLAN. To be shown on Sky TV
     
    • Agree Agree x 1
    #142 Listlad, Oct 12, 2019 at 6:52 AM
    Last edited: Oct 12, 2019
  3. Debandez

    Debandez Type 2 (in remission!) · Well-Known Member

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    Exactly what I was thinking. I've registered. You have to state what question you will be asking, I don't need to tell you what it will be!
     
    • Funny Funny x 1
  4. Listlad

    Listlad Prediabetes · BANNED

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    I am going to do the same.

    (I read that there will be a few experts on the panel. I wonder who that might be?)
     
  5. ickihun

    ickihun Type 2 · Master

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    Well done @Debandez. I appreciate your hard work.
    Keep pushing.
    I see changes. At GPs (older ones too) and with specialists dealing directly with diabetes.
    Not so much with cardiologists, from my angle. Although it's been 3yrs since I've spoken to one.
    I feel EVERY medic should know what it's like to be any type of diabetic.
    Unfortunately nearly everyone has someone around them with type2 IR.
    If they are willing to hear the CLEAR messages. We will all be far better off.
    Make it simple. The simpler the better.
     
    • Like Like x 2
  6. Pipp

    Pipp Type 2 · Expert
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    That would be my view, too.

    To see change of advice to T2s .. Stop telling them not to test, instead inform about inexpensive test meters and strips and how to use the data from them.

    Also stop the advice to eat ‘healthy, wholemeal’ carbs at every meal. Follow example of Dr Unwin.
     
    • Agree Agree x 5
  7. Debandez

    Debandez Type 2 (in remission!) · Well-Known Member

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    Sorry for delay in replying. I feel change is definitely coming. I'm just impatient. Want it yesterday! As we all do. We know what works and what doesn't. We want HCPs to at the very least understand this.

    T2d seems ubiquitous. Everywhere I go I have a conversation with a diabetic. Or pre diabetic. Or someone who knows someone that is struggling with it. Kiss. Keep it simple stupid. Works.
     
    • Agree Agree x 2
  8. Debandez

    Debandez Type 2 (in remission!) · Well-Known Member

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    Going to be drafting something in 1 to 2 weeks. Just so busy currently. Once drafted I will be winging it all over the forum and my social media platforms for anyone to use to send to their CCGs and GPs if they wish. A blank page can be attached to add personal notes. Watch this space.

    The program Eat Well for Less has spurred me on even more!!! Shocking and very sad.
     
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  9. ickihun

    ickihun Type 2 · Master

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    Its the same rubbish given to bariatric patients. Well, was.
     
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  10. Debandez

    Debandez Type 2 (in remission!) · Well-Known Member

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    I'm researching this now. It may take time to get letter together as so busy for a week or so.

    Got this reply from my surgery today. Sharing for info (and to give you a laugh). The first sentence made me choke on my cornflakes! Yes of course I'm joking......I wasnt choking ;-)

    We have recently had correspondence regarding BM machines.

    The following is the information the CCG meds management team have sent


    “Self-monitoring of blood glucose (SMBG) is of limited clinical effectiveness in improving blood glucose control in patients with Type 2 Diabetes Mellitus (T2DM) on oral therapies or diet control and therefore is unlikely to be cost effective.

    SMBG in T2DM is usually advised where a patient:
    · is on insulin or
    · there is evidence of hypoglycaemia or
    · the person is on oral medication that may increase their risk of hypoglycaemia (while driving/operating machinery)
    · or the person is pregnant, or is planning to become pregnant,
    and the patient has an understanding of the benefits of monitoring and how to interpret the results i.e. reinforce lifestyle changes or adjust therapy accordingly.

    Patients who gain no clinical benefit from SMBG should be discouraged from testing.

    Prescribing of BGTS should be reviewed to ensure that testing is appropriate. IF test strips are indicated, quantities & frequency of issue should be reviewed to avoid wastage. Please see LMMG guidance for frequency of monitoring & appropriate quantities to supply

    https://www.lancsmmg.nhs.uk/downloa...lucose-Testing-Guidance-V1.1-FOR-WEBSITE2.pdf

    Please also find attached up to date data for the prescribing of test strips in patients with T2DM who do not appear to be prescribed insulin, a sulphonylurea or a glinide.

    Kind regards

    Medicines Optimisation Team”

    Hope this is useful information.

    Best wishes,
     
    • Informative Informative x 1
  11. HSSS

    HSSS Type 2 · Expert

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    So basically the same as NICE guidance.

    Their strip allowance for type 2 on basal insulin or sulphonylaureas or glindies is less than one strip a day!!! (50/ 2 months).

    They have no idea of how to test and interpret the results for a diet controlled type 2 and that is blatantly obvious.
     
    • Agree Agree x 3
  12. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    In other words there are highly influential organisations that don’t want anyone to know that choking on Cornflakes is the safest option besides using them as loft insulation :shifty:
     
    • Like Like x 1
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  13. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    How on earth are they able to determine if testing is appropriate when they don't know how (frequency & times) to test in the first place !
     
    • Agree Agree x 3
  14. Pipp

    Pipp Type 2 · Expert
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    I would be inclined to use the statement to turn the discussion back in our favour, @Debandez. This part could be used as evidence to support an individual requesting monitoring supplies, if that individual can explain the rationale behind their use. I.e., using testing to see how various foods impact their BG levels, then adjusting their diet accordingly.

    “the patient has an understanding of the benefits of monitoring and how to interpret the results i.e. reinforce lifestyle changes or adjust therapy accordingly.

    Patients who gain no clinical benefit from SMBG should be discouraged from testing.”

    That last sentence, I would suggest that to ascertain whether or not a person has ‘gained clinical benefit from SMBG’ they would need to have opportunity to do so.
     
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  15. HSSS

    HSSS Type 2 · Expert

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    I like your thinking @Pipp

    Self-monitoring of blood glucose (SMBG) is of limited clinical effectiveness (response: not none, and only limited by understanding how to apply it to type 2) in improving blood glucose ........

    SMBG in T2DM is usually (response: not only or limited exclusively to. This doesn’t preclude a well motivated patient educated effectively on its uses and interpretation) advised where a patient:
    · is on insulin or
    · there is evidence of hypoglycaemia or
    · the person is on oral medication that may increase their risk of hypoglycaemia (while driving/operating machinery)
    · or the person is pregnant, or is planning to become pregnant,
    and the patient has an understanding of the benefits of monitoring and how to interpret the results i.e. reinforce lifestyle changes or adjust therapy accordingly. (response: this sentence backs up previous response )

    Patients who gain no clinical benefit from SMBG should be discouraged from testing. (response: therefore those that can gain benefit should be encouraged and as pipp points out how are you to know until they try it!)
     
    • Agree Agree x 1
  16. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Unfortunately, the stipulation for the last sentence of point #4 is "AND" the patient has an understanding of the benefits of monitoring. In other words, not relevant unless they're pregnant or planning on becoming pregnant.
     
    • Useful Useful x 1
  17. satindoll

    satindoll Type 2 · Well-Known Member

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    Looks like I'm going to have to have words with my GP/DN as according to those guidelines I'm being short changed on my allotment of strips...........I get 3 boxes of 50 strips per month........as I was told I only need to test 5 times a day regardless of being ill or driving, so to cover any extra strips I need I have been buying them myself from Amazon.........:mad:
     
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  18. Pipp

    Pipp Type 2 · Expert
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    Thanks, @HSSS . I was in a hurry to go out earlier, so rushed post, but you have clarified what I meant, just perfectly.
     
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  19. Pipp

    Pipp Type 2 · Expert
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    Ah, semantics. So, we have to hope those making the decision based on the criteria miss that, just as I did.
     
  20. HSSS

    HSSS Type 2 · Expert

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    I think the final qualifier of “understanding benefits” bit applies to any of the listed conditions ie insulin, hypo, or pregnancy

    maybe those biologically capable should all be claiming to want to fall pregnant !
     
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