Daibell said:
Hi. Good explanation, Grazer. In fact the number of tablet medication choices that increase insulin for T2s is fairly limited so the DSN doesn't have the control she thinks she has. It's really only gliclazide and to some extent sitaglipton or glitazones that can extend insulin. The downside of glic is that it does 'hit' the pancreas and can cause hypos. Does the DSN want to encourage hypos? Glitazones are known to add to heart problems and water retention; great. The DSN thinks she is in control when she isn't. Diet (lower-carbs) CAN be used to control T2s but HCPs seem to be unable to grasp the obvious. There's none so blind......
As so often before I quite agree with Daibell. Not surprising really as he and i have had much the same ecxperience of medication etc.
Superb explanation Grazer -as always - but probably totally wasted on most pracice DSNs. My GP even stated last week that the nurses were all too rigid and should learn to treat patients as individuals.
This will never happen . The Nurses can never be drs they just enforce the "rules" and take them as gospel. I think many GPs are unhappy with he reatment of diabetics but because here is little they can do about it they find it easier to leave it all to the
Practice DSN.
I posted on the TImes aricle thread yesterday about daibell's other point re T2"s on medication but I don't think my post disappeared into the ether{I often miss the little notification about another post having been made because of my visual problems}
I have notivced both Grazer and yzzy often drawing a distinction between T2 on diet and metformin only and those on other medicaion. I understand why his is - they are thinking of hypos etc but I am with Daibell here. There really is not a huge difference . T2s on medication but not on insulin can suffer nasty and unpleasant hypos . If this happpens often they are either over-medicated or exercising wihout taking proper precautions.
If they are over-medicated hen they will be aware of hs because of hey hypos and the medication should be reduced or withdrawn . this is a GOOD thing as it will help the pancreas to function for longer.
There is no merit in T2 medicaion - it has no purpose except to lower blood sugar. if this can be done in other ways then great!
Noone will argue with this. The HCPs all seem terrified of hypos . I was aking a high dose of glimepiride when i was firs given sitagliptin and when I decided to reduce my sarchy carbs. The diabetes consultant said i might be able to ditch the glimepiride
if my HBA1 c came down. The sitaglptin dealt with the spikes bu the starchy carbs reduction and a little increase in exercise mean that i had o stop taking them wihin a few weeks because I was hypo=ing several times a day. This in turn led to an immediate loss of the weight i had gained with the glimepiride {over 3 years] and a return to my pre-diagnostic underweight status.
So while true hypos are not pleasant even fot T2 s on medication they are not the end of the world and the situation can be resolved/ very easily. It should be stressed that T2 on medication SHOULD NOT try to eat to their medication but adjust their medication once they have found a sustainable regime. Balance is he key o any kind of diabetes mangement.
Everyone should be able to find a way of balancing food and exercise with medication . If hypos are a problem at one part of the day and hypers at the other then it should be possible to tweak. If hypos are still a problem then celebrate , visit your HCP and have them reduced.
I understand that it is necessary not to read on anyone's toes , if possible, but to make t2s on medication feel that hey are very different to those on diet only or diet and metformin is counter-productive. These are the very people who could benefit more from something so simple as reducing starchy carbs Many here have done so and have been able o reduce or come off medication.
Once again - geat explanation Grazer but if those given the responsibility of treating diabees haven' worked this out for themselves - and many haven't- then that nmust be because hey either don' want to know {very common] or are incapable of working it out -ever{also very common}.