@Kimbo 1962
I purposefully held back from contributing to this thread as I wanted to think about what you wrote a bit more first.
You were obviously unsettled and upset by your doctor's visit and I am sorry this was the case but, in all honesty, when first reading your original post I could not find too much fault with your doctor. So I did not want to post something for the risk of upsetting you further and preferred to wait until both of us had the time to consider the issue more coolly.
As I understand it there were a number of things about the visit that upset you, probably perfectly understandably from your point of view.
Firstly, you appear to have been shocked by the view that diabetes is a degenerative disease, that the gradual deterioration over time is inevitable and that eventually you will need to go on insulin.
This though is probably the widely accepted view of our disease based on the doctors experience and statistics. It may not be a wrong view. As far as I know there is no evidence that if we can maintain good glycemic control we will not deteriorate over time or that we do not still face increased risk of complications compared to non diabetics.
But it is important to realize that both the doctors' empirical experience and the statistics are influenced by the majority of diabetics ( two thirds in the UK according to recent data) that are not well controlled.
Also, there is a lot of evidence that by maintaining good glycemic control we can slow down the progression of our disease and improve our odds of avoiding complications, hopefully beyond the point of our natural lifespans.
So whether they are right or not about the degenerative nature of our disease, the way forward for us remains the same and that is to do everything we can to maintain good sugar levels.
Which brings me to the second thing I think has upset you, which is the reference your doctor has made on your levels, at high 4s low 5s, possibly being too low. I do not share this view, as to me these levels are perfectly normal non- diabetic levels, but it is not the first time I have heard doctors wanting diabetic patients to maintain their levels a bit higher. I believe that some studies have shown that too low an hba1c may involve health risk as well as too high. Discussing the merit of these studies is probably beyond the scope of the present discussion and to be honest beyond my own level of knowledge.
Finally you were upset by your doctor's criticism of the medication you are now on, with which you are happy and his suggestion that you give a try to a period of diet and exercise only.
His point that Forxiga brings about a higher risk of urinary truck infections appears to be a valid one, if the online information on the medication is to be believed; probably a consequence of higher concentration of glucose in the urine, as it is through preventing reabsorption of glucose at the kidneys and elimination via urine that Forxiga works.
As others have stated, you can try for a while without medication and assess whether you need to go back on it, according to how you get on. This seems a good thing to me and is a sign of the wonderful progress you have made in terms of both your Hba1c and your weight loss.
Perhaps you should count yourself lucky he did not seem to object to your lchf diet, as this is another issue on which the NHS view goes against what is frequently advised on this site.
I wish things were a bit more clear cut and that the medical profession and the advice you received from your fellow diabetics was more aligned but things are unfortunately not so.
Regrettably, we are all at some point forced to make our own difficult choices regarding how best to treat our disease by selecting between options the relative merit of which is not universally accepted.
The important thing is to then have the courage to move forward with our choices, while maintaining an open enough mind to any alternative ideas that may prove more beneficial.
I hope that you are feeling more settled now and a bit clearer about what lies ahead
All the best
Pavlos