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Ethical issue: Profesional vs. gut feel

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patientman

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Hi all,

Sorry to intrude on this forum once more. I am a carer for my wife and would like to gather thoughts on a real dilemma that I am in.

My wife is absolutely convinced that she has T2 diabetes. She has many of the symptoms consisted with this including being thirsty, needing toilet regularly, some hair loss, dry skin, migraines, some redness on hands and soles of feet, diarrhea reflux. plus heart palpitations & hyperventilation at times - esp. after food. She also has a huge fear of diabetes, and feels she needs to counteract her diabetes "putting her diabetes in remission" this with an extreme diet of fasting, often going for days at end without eating at all, and when she does it's usually just one meal of chicken and eggs.

The challenge however is that doctors keep telling her that she doesn't have diabetes. She has been checked by multiple NHS doctors (both GP's and in hospital) who all have said that she doesn't have diabetes, and should just eat a healthy balanced diet. As a result she has lost all faith in the NHS. She shes them as being totally dismissive of her symptoms (they rely mainly on blood tests), and they keep referring her for mental health treatments as opposed to addressing diabetic concerns. They see she has having "confirmation bias" (where the brain will only see evidence that supports what you want to believe, and dismisses everything else).

For reference - her current HBa1C is 33, and FBS is normally around 6 when she eats (less on days when doesn't eat)

Due to her distrust of NHS doctors (she sees the NHS in collaboration with big Pharma) she has also engaged a private Endocrinologist who specialises in reversing diabetes. He advised doing a fasting oral glucose tolerance test, which also came back in non-diabetic range. He also advised she to stop monitoring her blood sugars, since this was probably just fueling her anxiety (she insists on using a CGM, as well as measuring finger pricks with 2 different brands of machine) and making things worse.

He also advised her to eat a more normal diet and gain weight (she is underweight). He has also refused to see her again unless it is done in collaboration with a psychiatrist.

I am now in the completely unenviable position of needing to pick a side between my wife and professionals

My gut feel is I should trust the professionals - and 1) put lots to pressure on her to eat more 2) not buy her any more test strips / CGM sensors 3) pursue mental health treatment for her

She is accusing me however of not being caring for her, and wanting her to reach diagnostic levels. She says
1) all diabetics need monitors (totally ignoring most diabetics are diagnosed by doctors, not themselves), and I'm putting her health at jeopardy if I don't
2) the partners of other people on this forum are supporting them though their diabetes - I'm being obstructive and non-supportive

Am I a bad husband if I trust the professionals over my wife instincts?

Am I being unreasonable? What you would you do if you were in this situation? (I just feel so lonely - its a truly awful position to be in )
 
Hi, I'm so sorry you are in this very tough situation and sorry I don't have time to write all I would like to say on the subject right now.

I too don't always trust the professionals. Some have been great and have saved my life, others not so great and I feel they should have picked up on things which they just ignored.

Having said that, one of the things that is great about doctors is they give us access to blood tests. These don't lie, especially if they have been redone a few times. With an HbA1c of 33 and readings of around 6 after eating, your wife is not diabetic.

I guess they must have done other tests? Like thyroid for instance?

Eating disorders (whether eating too much or too little) are complex. I feel your wife needs to see a doctor who specialises in this area as there is something wrong, but it's not diabetes.
 
I am so sorry you are in an impossible situation. The tests clearly show she is not in even pre-diabetic range.
Her eating pattern sound to me like an eating disorder?
Maybe a compromise would be to get her on low carb for now until she can get more professional help? It would prevent weight loss if done properly, ie plenty of good quality fats in addition to protein and a little carbs.
I know of people who do low carb even though not diabetic because they think the current western diet includes too many carbs and too much refined carbs in particular.
 
Hi I am so sorry to read your situation. I am not medically trained in any way but you really sound at your wit’s end, so some ideas that may or may not help. Can I ask is her HbA1c of 33 based on her diet of fasting and mostly chicken and eggs? If so, is this her reasoning for not wanting to eat more? Would she do an experiment and eat more if she then had another HbA1c? See how much higher it is? Hopefully if it’s still low then she really isn’t diabetic, if it’s crept up too much then she would get her diagnosis but without eating more ‘normally’ no one will ever know. I am not suggesting going heavy on carbs but a healthy lower carb diet for a limited time as an experiment? It might make things clearer for her too as the brain needs nutrients. Personally I would ask for a full range of thyroid tests TSH T4 T3 and TPO antibody tests as she clearly has a lot of physical symptoms that could be caused by a few things, Hashimotos disease or anxiety are a couple that come to mind. I am sure there are more. Although some symptoms may be malnutrition or lack of food? How about food counselling? A friend of mine who was overweight did this and found it extremely helpful. I am sure they cover a range of diet issues. If I were you I would seek counselling of some sort, I think she is really suffering from a condition Whether it’s an eating disorder or something else might be tricky to find out.
Diabetes.org run a free counselling helpline. Would she speak to them? Or you could. They are trained counsellors
https://www.diabetes.org.uk/how_we_help/helpline
You may have looked into all of this already but just wanted to offer at least a little support. I would ask the GP for some counselling for yourself as it must be a real strain.
 
Am I right in thinking you and/or your wife have posted on here before? In which case a number of people have already explained to her that a low carb high fat diet will not increase her blood sugars?

Reading your post it sounds as if different doctors have done every possible test and have indeed proved your wife is not diabetic. I would trust their decision and the science on that.

it is also clear (from an independent viewpoint) that your wife is likely to have an eating disorder which is a very difficult thing to overcome without professional help.

I think you are a supportive husband in a very difficult place. Perhaps withdrawing all her testing equipment would just cause her to eat less in fear of her blood sugar levels going up. I really agree she needs professional help for her diet and it is hard to know what else to suggest without risking making the situation worse.
 
I remember your previous threads, and those made by your wife. At this point, I have two suggestions.

1) focus on quantity of food. She feels safe with low carb, so support and encourage her in eating as much low carb as she can, and fats if she is willing to have them too. At this point addressing her low weight is the priority, and you will be seen by her as supportive.

2) address her mental health issues in a way she feels safe with. Drop the whole diabetes or not discussion, approach councelling for her from the angle of helping her feel less anxious and having a neutral person just to talk things through with.

I am using the word 'safe' deliberately as, until she feels safe and supported she may not be able to move forward. You can be supportive without outwardly agreeing with her fears. Fear is fear, rational or not. Logic and reason won't work. Address the fear. For now the food groups she feels safe eating are not important, eating anything is important. If testing helps her feel safe until professional support kicks in, I would go with it without judgement or comment except a noncommittal grunt of acknowledgement, so she knows she is heard.

Finally, get some support and councelling for yourself, alone, to advise and support you through this. You need professional help, both of you, we can offer ideas, but are no substitute for professional personal support and advice.
 

Hi,

I feel it's what sounds like an eating disorder with your wife & her inability to come to terms with it has taken a toll on your own emotional well being..
Many of those syptoms can be associated with eating disorders.
Her "distrust of NHS doctors (she sees the NHS in collaboration with big Pharma)" bares no logic if they have suggested your wife is not diabetic, there is nothing to prescribe?

Your wife needs pro help.. But not for Diabetes as the HCPs seem to suggest.

Best wishes.
 
patientman said:
I am now in the completely unenviable position of needing to pick a side between my wife and professionals
Click to expand...

Hi there, I truly feel for you because what you seem to be dealing with is a person who is absolutely convinced she has a specific health condition that she doesn't have. I would say she certainly does have a health condition though and it's one that is making her ill and needs addressing. None of us can diagnose anything of course but I would say you are actually being a very good husband by 'refusing' to blindly go along with her beliefs which would be enabling her to continue. If a person has a mental health issue that is telling them they are this or that, then no amount of logic is likely to help, they will always come up with their own rebuttals to anything you say. Personally, I think your wife needs some professional help because unless she addresses that then she may well become ever more ill both physically and with the mental stress too. I know this makes it sound easy as access to such help is slim if available at all. You are in a horrible position but she is lucky to have you, many people don't have such support.
 
patientman said:
They see she has having "confirmation bias" (where the brain will only see evidence that supports what you want to believe, and dismisses everything else).
Click to expand...
There is a lot of this happening in the world, no matter how many tests your partner has she will deny they are correct.

A bit like Donald Trump does with his claims that he is still POTUS after numerous recounts / court cases etc.

I hope you get the problem solved one way or the other
 
If a person is a true type two diabetic, plain and ordinary, nothing exciting or added in, then a diet of protein and fats with whatever carbohydrates tolerated would be both healthy and benign.
Eating such a diet would/should remove any need for monitoring, once it was established.
Perhaps you could gently challenge your wife to eat a diet which is normal for a type two diabetic and should enable a person to maintain a normal eating routine and normal numbers.
Many of the symptoms your wife seems to associate with diabetes are surely seen more usually in those suffering anorexia.
I can only suggest that you continue to maintain your position regarding your wife's fasting and restricted menu and try to keep her in touch with reality in a calm and considered manner.
As a full blown type two I have no need to fast to have normal numbers, my weight is stable, my stamina was much improved over pre diabetic levels.
I wonder if your wife can take the exercise recommended for type two diabetics of walking some distance several times a week, or some other gently exercise. If she finds it exhausting then it might bring home the reality of a lack of nutrition.
 
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