GP - Low Carb Supporter

[clairy clutterbuck]

Well done Xyzzy. Its nice to have a good result for once at the GP.

I too had a diabetic chat with my GP last week and am now awaiting my blood results and another trip to see her next week. I also had a very positive discussion and lots of helpful advice.

1. She totally agrees with the lower carbohydrate diet - she suggested 50-100g, she didnt feel I needed to go lower with results of 6.2, 6.4 and 6.5 in recent months.
2. She feels that if my weight continues to decrease I stand a good chance of maintaining non diabetic levels one day without any meds at all.
3. She took me off Victoza as she said she didnt feel I needed it any more and she doesnt believe it continues to work long term and she didnt like the risks, however slight. She thinks I am now doing this on my own with diet and exercise.
4. She doesnt agree with testing but is continuing to prescribe me some strips as I wanted to test.
5. She praised my efforts on exercise and diet and results. "Delighted" was the term used. She said there is new advice coming out that getting your heart really pumpng and getting out of breath each day kicks the pancreas into working for up to 48 hours - still being researched, but she suggested I get on the cross trainer for 5-10 minutes when I could.

All good, BUT she did confuse me as I said that I was aiming to get my HBA1C results into the 5's and why was 6.2 too low. I mentioned some of the discussions regarding other countries attitudes on this website and she said (and I am sorry as I know her comment is going to cause a bit of annoyance, but I would like some opinions) that getting your HBA1C as low as possible is now old advice and the latest research is showing mortality rates drop once levels go below 7 and down to mid 5's but they start to increase again once HBA1C levels drop below this and into the 5's. What do other people think? It is very hard when we are all getting conflicting advice. I must add she is very well thought of locally, is a dibetic specialist GP and is very forward thinking. But am unsure what I should do....

xx

 

[xyzzy]

Well done Xyzzy. Its nice to have a good result for once at the GP.

I too had a diabetic chat with my GP last week and am now awaiting my blood results and another trip to see her next week. I also had a very positive discussion and lots of helpful advice.

1. She totally agrees with the lower carbohydrate diet - she suggested 50-100g, she didnt feel I needed to go lower with results of 6.2, 6.4 and 6.5 in recent months.
2. She feels that if my weight continues to decrease I stand a good chance of maintaining non diabetic levels one day without any meds at all.
3. She took me off Victoza as she said she didnt feel I needed it any more and she doesnt believe it continues to work long term and she didnt like the risks, however slight. She thinks I am now doing this on my own with diet and exercise.
4. She doesnt agree with testing but is continuing to prescribe me some strips as I wanted to test.
5. She praised my efforts on exercise and diet and results. "Delighted" was the term used. She said there is new advice coming out that getting your heart really pumpng and getting out of breath each day kicks the pancreas into working for up to 48 hours - still being researched, but she suggested I get on the cross trainer for 5-10 minutes when I could.

All good, BUT she did confuse me as I said that I was aiming to get my HBA1C results into the 5's and why was 6.2 too low. I mentioned some of the discussions regarding other countries attitudes on this website and she said (and I am sorry as I know her comment is going to cause a bit of annoyance, but I would like some opinions) that getting your HBA1C as low as possible is now old advice and the latest research is showing mortality rates drop once levels go below 7 and down to mid 5's but they start to increase again once HBA1C levels drop below this and into the 5's. What do other people think? It is very hard when we are all getting conflicting advice. I must add she is very well thought of locally, is a dibetic specialist GP and is very forward thinking. But am unsure what I should do....

xx

Well some really good stuff going on there looks like we're on a bit of a roll

Now just to cheer you up some more you'll be able to go back and tell her the thing about mortality rates rising as you drop below 7% is itself now out of date and has been discounted by later studies. She's referring to this study UK 2009/10 study.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/fulltext

The trouble was when the data was analysed further the selection of patients they used was found to be very biased towards out of control, overweight insulin using diabetics who inconsiderately kept dying of heart attacks. For example in their 2011 health target guidelines the Swedes said of the study and others have similarly disputed or rejected the findings.

A recent observational UK General Practice Research Database
(GPRD) study has reported increased risk of total mortality with
lower HbA1c with lowest risk for HbA1c 7.5%, and also a 49% higher risk of total mortality with insulin treatment versus oral agents
(17)
. However, this was not verified in the NDR study, showing no
J-shaped risk curve for total mortality in patients treated with insulin or oral agents, and that the increased risk of total mortality with
insulin was due almost exclusively to an increased risk of non-CVD
mortality, and that HbA1c was not at all associated with non-CVD
mortality
(2)
.

http://www.healthcare-bulletin.com/...ascular_Disease__in_Diabetes_Care_-_2011_.pdf


The 2012 Joint American European T2 management doc "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach" states.

More stringent HbA1c targets (e.g., 6.0–6.5%) might be considered in selected
patients (with short disease duration, long life expectancy, no significant CVD) if this can be achieved without significant hypoglycemia or other adverse effects of treatment

So next time you see the doc you know what to say!