Episode 3 of ‘things the practice nurse has said to terrify me’

WelshSailor said:

I know you can’t tell me what to do here, but I’m sorely tempted to cancel my A1C appt

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What about keeping this appointment?
With your BG's, it should be smack in non diabetic territory, which may make her stop bothering you.

WelshSailor said:

I had a 8.8mmol random BG three weeks taken within about an hour of a completely uncharacteristic high carb breakfast. What can I say - it was freezing, the cafe porridge looked lovely, nostalgia hit and I basically went for it. 3 weeks of spiralling anxiety later, I can say it definitely was not worth it. Anyway, had a fasting BG last week, back today to get results - 4.0mmol/l. I’ve been testing regularly since I got the high reading as I do have a family history of T2 and my range over about 10 tests a day for the last 17 days is 3.6-5.8 with a mean of 4.5. She was really cross about the testing (unnecessary/anxiety provoking/not recommended for T2)

Then she asked for a pee sample and as I eat low carb all the time (apart from that porridge)) and do IF (6 hour eating window from 2-8pm) I of course had lots of ketones. She then terrified me about DKA, and something she called metabolic acidosis - is that the same as DKA - and reminded me that she’d already told me last week that low carb was dangerous, and said she thought I was eating to ‘cheat the test’ as I was trying to avoid a T2 diagnosis but that there was no hiding from it. I don’t do full on keto - probably eat too much veg for that, but I have been fairly strictly low carb since my brother was diagnosed 5 years ago. I realise I am probably walking a tightrope to some degree but surely that’s better than not knowing what’s going on with my BG and eating what I like (the route my brother has taken). She wants me back next week to do an A1C test.

I’m so confused and anxious and she’s now managed to convince me that all I’m doing is masking a T2 diagnosis. Any advice or reassurance? I actually don’t ever want to see her again but she’s the only nurse in the practice and the next F2F GP appointment is in late January. I know you can’t tell me what to do here, but I’m sorely tempted to cancel my A1C appt till I calm down, carry on testing and assume no harm will come to me meanwhile. I just can’t face much more of this hounding

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The nurse is just an out and out grade one scare monger with only enough knowledge to be able to use terms which sound dangerous.
Others have reported similar tactics from the uneducated so you are not alone.
If you do not have the symptoms of DKA then it is most likely you don't have DKA. Some medications and conditions can do things - but as you were there sitting in front of her, - well I won't go on - but honestly.....
Do go for that Hba1c test, but if you are controlling your BG by eating low carb she should be encouraging, not making things up.
What you are doing is not in any way cheating or masking - it is controlling your BG levels to keep yourself safe from any complications (I also find myself more energetic and cheerful when on low carb) and it reads as though you'll be better off not being diagnosed with a nurse like yours.

So far I haven't been asked to see the Diabetic nurse. Don't think I shall bother after your attempt. Still have my blood tests though.
Ketones through diet is not the same as DKA.
Just get as informed as you can so that you have an answer for her.
I am permanently in Ketosis as eat very very low carb.
Also Protein in wee since my pregnancy and my son was 46 last week.
Hoping when I go in the my surgery they won't test my wee!
Best of Luck.

WelshSailor said:

I don’t do full on keto - probably eat too much veg for that

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You don't say exactly what you are eating but just from this sentence it's obvious that you are eating real food and avoiding the highly processed, high carb rubbish that is so prevalent in the modern diet.

Carbs are broken down into glucose, fats are broken down into ketones. As far as your body is concerned its just another source of energy. Our ability to store energy as fat to keep us going when food is scarce would be pointless without a way to use it.
Ketoacidosis only becomes a problem when you have high blood sugar and a high level of ketones,

WelshSailor said:

told me last week that low carb was dangerous,

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It's true that we do need a little glucose in our diet but just incase we couldn't find any fruits or roots lying around. Our bodies developed a neat trick of making it from fat and protein, its called gluconeogenesis.
So of the three macronutrients, fat and protein are essential but we can live quite happily without carbohydrates

WelshSailor said:

She was really cross about the testing (unnecessary/anxiety provoking/not recommended for T2)

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From the advice she's given you so far it's quite clear that being well informed and possessing up to date knowledge is not something she thinks is important. Its no surprise that she doesn't agree with self testing.

I would not cancell the A1C test next week.By the proper information you have been given
here it looks like you will be much better informed than the DN by next week.

Deep breaths.
sounds like your nurse is a bully.

metabolic acidosis
and
happens after kidney disease has been well established.
I simply cannot understand why she thought mentioning it to you was relevant - unless you actually do have a history of kidney disease?
It can also result from ketoacidosis, which happens in uncontrolled diabetes, where there is insufficient insulin - for instance, a Type 1 insulin dependent who hasn’t taken their insulin AND has high glucose readings.

Since you have normal blood glucose readings (yes, even that 8.8 reading falls into what is considered ‘normal’ by most healthcare professionals), and your body is happily turning out enough insulin to keep you bg levels normal, then ketoacidosis doesn’t apply to you either.

At my doc surgery, I get blood test appointments made by doc or nurse. Then when I turn up, I see a completely different staff member who knows nothing about me beyond the slip of paper giving the test request. The blood is drawn and I disappear.

Then, because I have internet access to my test results, I get to check those results at least 2 days before someone (never the person who requested the tests!) gives me a call. I can look up the results, understand them before speaking to the surgery and have my next steps planned.

When the surgery does eventually call, they either say ’results in normal range. No further action’.
or ‘results back, out of range, doc wants to schedule a phone appt/another test in a month/a prescription.
it is about as personal as visiting a fishmonger. They can’t get me off the phone quickly enough.

All perfectly simple and straightforward - since covid, the staff at my doc’s surgery seem to bend over backwards to avoid any actual face to face exposure to their patients.

As far as I can see, the only downside to having your A1c test done is that you are unlikely to get an opportunity to thumb your nose at that disapproving nurse when your results come back normal and her doom mongering melodramatic gas lighting is exposed as the nonsense it is.

WelshSailor said:

I had a 8.8mmol random BG three weeks taken within about an hour of a completely uncharacteristic high carb breakfast. What can I say - it was freezing, the cafe porridge looked lovely, nostalgia hit and I basically went for it. 3 weeks of spiralling anxiety later, I can say it definitely was not worth it. Anyway, had a fasting BG last week, back today to get results - 4.0mmol/l. I’ve been testing regularly since I got the high reading as I do have a family history of T2 and my range over about 10 tests a day for the last 17 days is 3.6-5.8 with a mean of 4.5. She was really cross about the testing (unnecessary/anxiety provoking/not recommended for T2)

Then she asked for a pee sample and as I eat low carb all the time (apart from that porridge)) and do IF (6 hour eating window from 2-8pm) I of course had lots of ketones. She then terrified me about DKA, and something she called metabolic acidosis - is that the same as DKA - and reminded me that she’d already told me last week that low carb was dangerous, and said she thought I was eating to ‘cheat the test’ as I was trying to avoid a T2 diagnosis but that there was no hiding from it. I don’t do full on keto - probably eat too much veg for that, but I have been fairly strictly low carb since my brother was diagnosed 5 years ago. I realise I am probably walking a tightrope to some degree but surely that’s better than not knowing what’s going on with my BG and eating what I like (the route my brother has taken). She wants me back next week to do an A1C test.

I’m so confused and anxious and she’s now managed to convince me that all I’m doing is masking a T2 diagnosis. Any advice or reassurance? I actually don’t ever want to see her again but she’s the only nurse in the practice and the next F2F GP appointment is in late January. I know you can’t tell me what to do here, but I’m sorely tempted to cancel my A1C appt till I calm down, carry on testing and assume no harm will come to me meanwhile. I just can’t face much more of this hounding

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I've been on zero carbs since May 2021.

Resurgam said:

The nurse is just an out and out grade one scare monger with only enough knowledge to be able to use terms which sound dangerous.
Others have reported similar tactics from the uneducated so you are not alone.
If you do not have the symptoms of DKA then it is most likely you don't have DKA. Some medications and conditions can do things - but as you were there sitting in front of her, - well I won't go on - but honestly.....
Do go for that Hba1c test, but if you are controlling your BG by eating low carb she should be encouraging, not making things up.
What you are doing is not in any way cheating or masking - it is controlling your BG levels to keep yourself safe from any complications (I also find myself more energetic and cheerful when on low carb) and it reads as though you'll be better off not being diagnosed with a nurse like yours.

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In the UK the NICE guidelines start at the bottom step with treatment by diet and lifestyle only. so you are following NHS guidelines, not cheating.

https://www.nice.org.uk/guidance/ng28

Secrion 1.6.16 is relevant to your conversation. section 1.3 is diet and lifestyle.

WelshSailor said:

CatInAHat said: ‘You don't say exactly what you are eating but just from this sentence it's obvious that you are eating real food and avoiding the highly processed, high carb rubbish that is so prevalent in the modern diet.’

I don’t think I’ve done the quote thing right - apologies. Basically I eat two meals a day. Eggs/fish/chicken mainly. Loads of herbs and spices. Red meat one or twice a week. Loads of veg (at least three kinds) or salad with every meal. Olive oil dressings (lots of). Small amounts of dairy a couple of times a week, mainly as cheese or full fat yoghurt. A few Brazil nuts now and then. Berries or square of 85% choc maybe once a week, probably less. I never eat bread, potatoes, flour, sugar, grains, fruit. I’ve worked really hard to try and sort my mind out with regards to food and see it as fuel rather than expecting it to be my best friend and provide me with entertainment or comfort. I was a carb fiend till my brother got T2. I’d think nothing of having pasta AND bread at the same meal. Now I never touch them. What scares me is that if this hasn’t been enough, I’ve nowhere to go with regards to diet I don’t think.

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Apart from the restriction on red meat - (which is not required by the way, it is perfectly healthy for you and the planet too), your diet is very like mine.
Oh - I get the 95% chocolate bars from lidl - I also get their frozen stir fry which is tasty and convenient, and very low carb, and I favour hazelnuts.
I was fully diabetic and now I'm fully reversed and feel a lot better for it.

As the old joke goes: "It's an exercise in mind over matter. You don't mind, and nursie doesn't matter". Of course at the moment you do mind, but you are not responsible for her ignorance or her attitude. You are responsible for your own health, and you've aced it! Terrific! Well done.

I can't help with how you feel about nursie, because she really isn't worth it, but there are bullies in every sphere of life, and a lot of them take jobs where they can give free rein to their problems (they are her problems not your problems). Luckily, we can (with help from real-life friends and cyberfriends on here) hold our heads high while making an appropriate gesture in her general direction.

It's another saying that when you go in loaded for bear that you don't need it. My own nursie, who was scornful and dismissive, this time just muttered "well your blood glucose seems to be all right" not interested in what went to achieve it, and not commenting on my four-sizes-down weight loss (I was freezing having gone in there in a T shirt and sleek trousers to maximise the impact) and saying I didn't need another blood test or appointment until 9 months' time, and then it would be over the telephone (what use is that?).

Keep having the tests, access whatever freebies you can in the way of testing gear, stay with us because we've been there too and many of us need stories like yours to keep on the road. And be proud of what you have done.

WelshSailor said:

I had a 8.8mmol random BG three weeks taken within about an hour of a completely uncharacteristic high carb breakfast. What can I say - it was freezing, the cafe porridge looked lovely, nostalgia hit and I basically went for it.

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A one off reading of 8.8 means nothing.
Health non-diabetics spend 30 mins per day >7.8 so an hour after eating porridge is exactly when you'd expect to see the highest spike.
https://www.diabetes.co.uk/forum/th...ine-normal-glucose-the-results-are-in.182221/

WelshSailor said:

Anyway, had a fasting BG last week, back today to get results - 4.0mmol/l. I’ve been testing regularly since I got the high reading as I do have a family history of T2 and my range over about 10 tests a day for the last 17 days is 3.6-5.8 with a mean of 4.5.

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With a FBG of 4.0 & an average BG of 4.5 then you're about as far from diabetic as you could be.

My advice would be stop worrying & ignore your nurse.
She's giving you anxiety, not your testing.
Get the HbA1c done & that will put it all to bed.

W hat got me the most after really trying. And going to see the DN and she said 'eat the potatoes and the carbs
they are good for you . I though to myself does this nurse really care. Obviously not. That is what Hurt the
most be cause you expect care from the caring profession.
nearly told her to stuff a potato in her mouth.But did not because I though what if I complained too
Much and then maybe they would say 'Just find another GP.
So I will always go back with my own knowledge. Just take all the tests etc. And the just leave
To wait for the results.

No point worrying about their ignorance. Maybe they don't even know that they are ignorant
So to everybody who encounters this 'Hold yur head up high' and just don't be afraid
Of the storm.That is the storm of ignorance.

Sadly, even the ones that care with a capital K are all bound by the rigidity of the guidelines, in my case NG28 which define the patient care strategy. Any move away from that plan may incur legal action for neglect or error that the NHS does not wish to lay themselves or their staff open to. We live in litigative times.

While they are bound to the Eatwell mantra and T2D do not benefit from self testing mantra, then they cannot accept that the patient may actually be right once in a while. it is an arrogance that has dogged the health profession for centuries. Doctors can sign passport applications and sick notes. its a power they treasure. It makes them important and above mere plebs like me. (actually, as a Chartered Engineer, I too can sign passport and driving applications, but shhh!)

I’ve had two diabetic nurses in last year, an excellent one who pointed me to this site and encouraged hba1c down from 71 to 49, then her replacement since she left surgery, whose attitude when hba1c was now 41 was excellent control on diet but you know it’s progressive don’t you? Just what I wanted to hear and totally unhelpful and thank god for the support I got here. You sound like you’ve got wonderful control on your blood sugars, 8.8 an hour after porridge is pretty good and ongoing sugars as low as the rest is going to give you a non diabetic hba1c. I’d go for the test to get her off your back as others have suggested and continue doing what you’ve been doing which will probably mean you never get a diagnosis of diabetes. I’m a big believer of modern processed diets loaded with carbs(and other ****) causing the disease. Continue on this path you’re remaining healthy. After this test perhaps arrange to see gp afterwards instead for future testing

And a lot of other people don't really care either went to the local chinese.
ask the assistant what they had that was really low carb. Chips she said.
so choose a mushroom and pork dish and asked her to ask the Manager just in
case if it was allright. She came back and said.

He is saying that it is all carbs. Why bother I told myself(their business,their loss)

Went next door to the Indian. Had a lovelly Tandoori.

And a lot of other people don't really care either went to the local chinese.
ask the assistant what they had that was really low carb. Chips she said.
so choose a mushroom and pork dish and asked her to ask the Manager just in
case if it was allright. She came back and said.

He is saying that it is all carbs. Why bother I told myself(their business,their loss)

Went next door to the Indian. Had a lovelly Tandoori.