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doctor want's me marked as in remission

P

piersie

Member
Messages
8
Type of diabetes
Type 2
Went to doctor this morning for an infection. Received a call this afternoon from Diabetic nurse saying doctor wanted to mark me as 'resolved' so that I only needed HBA1C test every 12 months was that alright ? No I replied, if I carried on eating chips and chocolate cake, took the metformin and gained weight I would be supported but if I control my diabetes with diet you want to cast me adrift. She seemed to buy the argument and suggested a second call with another doctor. Of course I can get my test strips on line but it is a matter of principal. My HBA1cs have been 36-40 since diagnosis 42 months ago with weight loss and low carb diet ( I refused metformin until I had tried life style change) so I kinda understand their point, but this surely puts me at prediabetic level even with severely restricted carbs. Should I suggest an Oral Glucose Tolerance test before they set me loose ? Last home administered one I went very high but back to normal within two hours so it might be interesting to see what is going on with my insulin. Thoughts ?
 
Unfortunately, NICE guidelines dictate that GP intervention begins above hba1c 41.

I had this very conversation today with my doctor. When I mentioned that I have diabetic fasting levels most mornings she said they don't even acknowledge fasting any more other than to justify doing an hba1c.
 
My GP has a slightly different take on things when my A1c went down to 38 he said at this moment you are not diabetic but you are and always will be a diabetic though in remission. As it happens in a letter the other day my neurologist noted that my diabetes is in remission but my latest A1c was 40 so it's creeping back up.
 
My lowest HBA1c was 37 my last was 40 so again creeping up. Have been laid up with a bad knee for 3 months so no real exercise. I would have thought that a rise in my blood sugars would have been an alarm but obviously not. Also if I am 1 point below intervention having previously been full blooded diabetic, why the hell would they want to stop giving me test strips ! I despair.
 
My nurse nagged me to come off the diabetic register on my last 2 annual reviews. My HbA1c was 42 the first time and 41 the second time, and I am unmedicated. In the previous 18 months I had been in the pre-diabetic range. She said I would be put on the "at risk" register and have annual blood tests rather than 6 monthly. I declined both times because I want to keep the 6 monthly tests. Not for the HbA1c. I can live with that annually, but I like to keep an eye on my cholesterol and lipids, plus my other blood markers. I know that if my HbA1c continues to fall or stay stable she will be nagging me again.
 
I would prefer to stay on the diabetic register for 2 reasons.

1. To make sure I continue to get all the relevant health checks
2. Diabetics can be given favourable rates if they purchase annuties because they are deemed to have a shorter expected lifespan than the general population - great for 'good diabetics' who keep control of their glucose levels
 
1 - definitely agree with that
2. - interesting - I didn't know that
 
I am have been in the non-diabetic range for over 3 years now and have never heard the word "remission" mentioned by my GP or nurse. Not that I'm complaining, I just find it interesting that doctors have different opinions.

Well done @piersie I would want to keep up annual eye and blood screening if I were in your shoes.
 
Don't forget to take up smoking 60 a day before you answer that annuity questionnaire..
 
Same here - I've been in the non diabetic range for a similar period and when I asked if I was now classed as being in remission or reversed my diabetes I was told "once a diabetic always a diabetic.". Being cynical I think GPs may get extra funding for diabetics so if they have some well controlled ones on their list they don't cost too much but they still get the funding!
 

Not sure if that rings true, otherwise why would a good number of us be invited to come off the register? Or maybe the amount they receive per diabetic is less than the cost of more frequent blood tests and reviews? Or maybe they get a bonus for knocking someone off!
 

You really think with the rising number of diabetes, the NHS could afford not only the treatment, but a bonus payment for every diabetic on top?
 
Well done with improving your Hba1c!

At least your nurse seems open to reason and has offered you an alternative. I was threatened with withdrawal of glucose testing strips when I reduced my Hba1c a few years ago but the doctor accepted my argument, backed up by my endocrinologist, that monitoring my blood glucose was essential for keeping levels under control. The GP changed my records to "controlled by diet". My Hba1c went even lower when I switched from low fat to low carb!
 
Daphne917 said:
S Being cynical I think GPs may get extra funding for diabetics so if they have some well controlled ones on their list they don't cost too much but they still get the funding!
Click to expand...
Nothing cynical about that.

Rearrange the following
Nail
Hammer
Head
 
douglas99 said:
You really think with the rising number of diabetes, the NHS could afford not only the treatment, but a bonus payment for every diabetic on top?
Click to expand...
Well thats how GP's are funded. They get a 'capitation' payment for every patient on the books. They receive additional payments for patients with cronic conditions. They also get payments for meeting targets, such as MMR takeup. Every patient (who fits the criteria) who is prescribed statins also triggers a payment
 

Do they get a payment for diabetes patients who go into remission sufficiently to come off the register? They must have targets for this sort of thing, I would have thought.
 
Bluetit1802 said:
Do they get a payment for diabetes patients who go into remission sufficiently to come off the register? They must have targets for this sort of thing, I would have thought.
Click to expand...

Well no because as we all know so well Type 2 is a progressive disease and we'll all end up injecting insulin.. didn't you listen to anything your nurse told you!!!! Come on...
 
Bluetit1802 said:
Do they get a payment for diabetes patients who go into remission sufficiently to come off the register? They must have targets for this sort of thing, I would have thought.
Click to expand...
I don't know the exact detail, but there are spreadsheets available online detailing the payments made to each GP business in England & Wales. I am also asthmatic, the prescribe some drugs and in order to get the payment have to see me once a year for an asthma review - its like afternoon tea but without the tea. I no longer attend as it costs me lost earnings. In order to qualify for a payment they have to send me two reminders. Rest assured they do not hesitate to send those out, post haste! There is no doubt that some patients cost the surgery more than others. Indeed I did not see the inside of my Drs from 1988 to 2002, so they got 14 years payments for nothing. When they mutter about cost I remind them of the days when I contributed to their profits.

Edit: http://www.pulsetoday.co.uk/your-pr...s-than-a-sky-tv-subscription/20009191.article
 
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Yes it is strange/worrying how different GP's and HCP's appear to have such differing opinions.

My original GP and DSN never mentioned anything much about my results, other than saying that my A1c was probably too low.

I move to a new part of the country and immediately I was told my T2D was "resolved"
 
Hi @Jamesuk9, well done on your A1c.
 
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