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Double standards

Mep

Mep

Well-Known Member
Messages
1,461
Type of diabetes
Treatment type
Insulin
I've lived with type 2 diabetes for some time now. When I was first diagnosed they only required me to test a couple of times per week until my next hbA1c 3 months later showed I was still a bit high (my hbA1c was 8.2% on diagnosis, so the next one was just over 7 from memory and they weren't happy with that) so they changed it to say I had to test every morning and every night. Then small amount of time later that changed to you must test at least 3-4 times per day.

I currently work with a couple of type 2 diabetics and recently I found out that neither of them test their sugar levels at all, and one doesn't even own a meter. One of them recently told me they're doing really well as they recently got a hbA1c of 8.1% The other said they're also doing well as had hbA1c around the same value. Also what surprised me is that neither of them have ever seen an endocrinologist, they were just diagnosed by their GP apparently. I'm not sure how that works as I was told I had to be referred to an endocrinologist for diagnostic testing (c-peptide and GAD test) when I was first diagnosed. That's how I was also diagnosed with PCOS on the same day as diabetes by the endocrinologist. My guess is that maybe they're not doing the diagnostic tests and just assuming people are type 2 based on the hbA1c result.

So I find there is double standards even where I live about how people are treated. Why was it with me I was referred to an endocrinologist and told to test multiple times per day because I didn't get below 7% on hbA1c within 3 months.... and others are sailing along on higher hbA1c and their docs don't seem too fussed.... not only that but they've never seen an endocrinologist either. Maybe the standards have dropped or something? I'm not sure. It could be that I was young at the time of my diagnosis maybe that is why I was treated different as my colleagues are older than I was at diagnosis. I just wished though that they had the same standard of diagnosis and treatment for everyone.
 
I was 65 when diagnosed, I have not seen my doctor since - there was a rubbish three session course, with some really bad advice and misinformation, the last one was at three months from diagnosis. I have had an eye inspection, a foot inspection and a strange doctor try to persuade me to take statins - but that is all. I got another blood test at 6 months, and was told everything was normal. It is a year since diagnosis and I am not due to get any blood tests until next year some time.
 
Sadly, there are still GPs out there who think a high count in the young can only be attributed to T1. Some of them hardly look at new research/statistics since they finished basic training.
 
First off Mep, well done for trying to tackle your T2, particularly with that 'War and Peace' list of other ailments.
Am I being thick here or is being happy with 8%+ just plain crazy - both medics and your colleagues. Or maybe you use different measurements over there?

P.S. If you're anywhere near the WACA please pop in and slip a Mickey Finn in the Aussie bowlers' soup. There's a couple of dollars in it for you.
 
Guzzler said:
Sadly, there are still GPs out there who think a high count in the young can only be attributed to T1. Some of them hardly look at new research/statistics since they finished basic training.
Click to expand...

Yes, when I was diagnosed I was told I had "mature onset diabetes" and I was too young to have it. There was no mention that they thought I was T1 though... I think it was just they wanted to find out what was going on and quick. As it turns out I had the PCOS first apparently which put me at very high risk of getting diabetes. Only recently one of my specialists who is a professor told me about a study where it shows people diagnosed with type 2 at a young age is because of auto immune problems. He seems to think my GI motility issue could also be auto immune because he believes my diabetes is (obviously not the same markers as T1 though).
 
Jo_the_boat said:
First off Mep, well done for trying to tackle your T2, particularly with that 'War and Peace' list of other ailments.
Am I being thick here or is being happy with 8%+ just plain crazy - both medics and your colleagues. Or maybe you use different measurements over there?

P.S. If you're anywhere near the WACA please pop in and slip a Mickey Finn in the Aussie bowlers' soup. There's a couple of dollars in it for you.
Click to expand...

Haha.... I'm not near the WACA. I've heard a little about the cricket though. lol.

Yes that's what I thought about the hbA1c too.... I know my docs aren't happy with that number. I currently have 7.1% hbA1c but they know I've had a rough time with pain and car accidents which is included in that result... so all things in perspective they're happy with that number (just saw my endo this week). But I always think I could do better. I've got a few challenges I'm facing though that impacts the diabetes. My endo is happy I've not been having hypos recently as I was getting a few of those at one point. The highest on my meter is 15 and he said yeh it's high, but a good thing you haven't been getting that regularly. When I'm in pain my bsl likes to sit between 8-11 which I don't like. If I wake up in pain, I'm starting my day on figures like 8.4 which means I'm in for a rough day. :( But I will persevere. My pain is unpredictable that's the problem... they like to say I need better pain management but at the same time they talk about keeping me on minimal meds as possible.
 
P.S. If you're anywhere near the WACA please pop in and slip a Mickey Finn in the Aussie bowlers' soup. There's a couple of dollars in it for you.[/QUOTE]

Don't worry @Jo_the_boat ... rain coming on 4th and 5th day so a tough ask for the baggy greens
 
There seem to be a heck of a lot of different standards (I'm not going to say 'double' because there are far too many for that!)

Although you may have been treated differently because of your age, your rapid need for insulin, your other health conditions, your weight, and so on.

Also, the background and awareness of the health care professional seems to make a huge difference. I mean if the doc is just used to referring all his D patients to the practice nurse (happens v often in the UK) then s/he will just treat the patient as per his/her training, with is largely based on T2s. Some practices seem to refer T1s to a D clinic immediately. Others don't. T2s seem to only get referred when things get worse enough to need a higher level of care - by which time terrible damage may already have been done.

And of course, referrals cost money, which affects the practice budget.

As for different standards on HbA1c targets... sadly I think a heck of a lot of health care professionals see T2s as fat, lazy and incapable of change. Also, often non-compliant, because if they followed the dietary guidelines and took their medicine, then of course they wouldn't have high HbA1cs, would they?

Going to stop now, because my blood pressure is rising.
 
Mep said:
I've lived with type 2 diabetes for some time now. When I was first diagnosed they only required me to test a couple of times per week until my next hbA1c 3 months later showed I was still a bit high (my hbA1c was 8.2% on diagnosis, so the next one was just over 7 from memory and they weren't happy with that) so they changed it to say I had to test every morning and every night. Then small amount of time later that changed to you must test at least 3-4 times per day.

I currently work with a couple of type 2 diabetics and recently I found out that neither of them test their sugar levels at all, and one doesn't even own a meter. One of them recently told me they're doing really well as they recently got a hbA1c of 8.1% The other said they're also doing well as had hbA1c around the same value. Also what surprised me is that neither of them have ever seen an endocrinologist, they were just diagnosed by their GP apparently. I'm not sure how that works as I was told I had to be referred to an endocrinologist for diagnostic testing (c-peptide and GAD test) when I was first diagnosed. That's how I was also diagnosed with PCOS on the same day as diabetes by the endocrinologist. My guess is that maybe they're not doing the diagnostic tests and just assuming people are type 2 based on the hbA1c result.

So I find there is double standards even where I live about how people are treated. Why was it with me I was referred to an endocrinologist and told to test multiple times per day because I didn't get below 7% on hbA1c within 3 months.... and others are sailing along on higher hbA1c and their docs don't seem too fussed.... not only that but they've never seen an endocrinologist either. Maybe the standards have dropped or something? I'm not sure. It could be that I was young at the time of my diagnosis maybe that is why I was treated different as my colleagues are older than I was at diagnosis. I just wished though that they had the same standard of diagnosis and treatment for everyone.
Click to expand...
Are your work colleagues on insulin too? - if not that would influence different approaches to testing and to interpretation of hba1c. As to why an hba1c of 8% would be seen as acceptable rather than an indicator of a need to intensify treatment, I have no idea - think 8% equates to an average blood sugar around 10mmol
 
My Grandsons paternal grand parents both T2 both under same GP both treated entirely differently by same doctor incredible.
 
I get a bit confused with the hba1c conversions...can I ask a question? (hope you don't mind @Mep) If the results of your last 3 month blood test came back as 46 that's still not normal is it? Is that around 7.6 on the conversion...wondering if I've worked it out correctly?
My GP's receptionist said it was normal and that the GP said no further action was required. I've given up with my doctors surgery anyway and just trying to battle on myself!
 
upload_2017-12-13_10-22-3.jpeg

Here you go, @oh_dear_me

The blue numbers above the arc are the HbA1c units usually used in the UK nowadays, and the white % above the arc are the older %HbA1c numbers (still used in the US, I think).
These correspond with the number on the bottom of the graph that shows the average finger prick test reading which corresponds with the HbA1c numbers.

So 31 and 5% HbA1cs = and average of 5.4 mmol/l over the last 2-3 months.
 
Boo1979 said:
Are your work colleagues on insulin too? - if not that would influence different approaches to testing and to interpretation of hba1c. As to why an hba1c of 8% would be seen as acceptable rather than an indicator of a need to intensify treatment, I have no idea - think 8% equates to an average blood sugar around 10mmol
Click to expand...

No, they're not on insulin. They're both on metformin.

I should also clarify, I wasn't on insulin for 12 years.... I did 7 years of diet control and 5 years of oral meds. I was placed on insulin in Feb 2010 as a result of diagnostic tests being done again. So I wasn't placed on insulin quickly after diagnosis... I was diagnosed when I was 25.
 
Brunneria said:
There seem to be a heck of a lot of different standards (I'm not going to say 'double' because there are far too many for that!)

Although you may have been treated differently because of your age, your rapid need for insulin, your other health conditions, your weight, and so on.

Also, the background and awareness of the health care professional seems to make a huge difference. I mean if the doc is just used to referring all his D patients to the practice nurse (happens v often in the UK) then s/he will just treat the patient as per his/her training, with is largely based on T2s. Some practices seem to refer T1s to a D clinic immediately. Others don't. T2s seem to only get referred when things get worse enough to need a higher level of care - by which time terrible damage may already have been done.

And of course, referrals cost money, which affects the practice budget.

As for different standards on HbA1c targets... sadly I think a heck of a lot of health care professionals see T2s as fat, lazy and incapable of change. Also, often non-compliant, because if they followed the dietary guidelines and took their medicine, then of course they wouldn't have high HbA1cs, would they?

Going to stop now, because my blood pressure is rising.
Click to expand...

Yes true... more than double really. I'm just gobsmacked though at the lack of consistency. But then also I see the same thing amongst people I'm interacting with for my other diseases. You just have to visit a few specialists to find out they all have different ideas on the same set of symptoms. I'm thankful I was treated how I was to start with and my doc at the time said I needed to be diagnosed correctly. Come to think of it I probably wouldn't have found out I had PCOS either if that wasn't done. I didn't know any different as I'd always had the symptoms and thought it was the norm. I remember being taken to a doc by my mother to question my symptoms once and the answer was it's normal, everyone is different. Of course the endocrinologist said no it's not normal and here's why... also that's why you've got diabetes. ugh.
 
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