Interesting Gp View.

[DavidGrahamJones]

I'm only posting this to give an idea of how a GP's brain might (might not) work. This particular GP just happens to be someone my wife knew from her days at Leeds University, even I've known her for 35 years. She came to visit over the weekend and although she was interested in my Freestyle Libre and my low carb diet one of her parting statements was surprising and probably explains an awful lot about what some GPs think. She actually said that I took my condition far too seriously, something that allowed me to monitor 24/7 was excessive and in fact unnecessary and that I shouldn't be quite so draconian with my low carb diet and "lighten up" and enjoy my food more. She suggested that frequent monitoring causes stress and is counter productive.

Luckily I didn't feel the need to justify my approach because there would have been a major argument. I was somewhat intrigued that someone who is quite clearly intelligent (apart from the fact she does a lot of swimming in rivers and the open sea) should adopt an opinion based on NICE guidelines, almost as if she has stopped thinking.

Even more luckily, she is not my GP, mine is much more open minded especially as my approach quite clearly works.

So, I was thinking, when your GP takes a similar approach, you will know that they are probably towing the party line, almost like parliament where MPs have to tow the party line.

 

[zand]

Oh dear, that is so sad, how can you take your health too seriously? But thanks, yes it will help me when I have my next review.

 

[Engineer88]

well done for biting your tongue, I would have caused the argument.

 

[kas16]

Mmmmm, at the risk of being shot down, I actually think she has a point. Of course we all want to remain healthy and this is a condition that requires constant monitoring but I sometimes think that for many it becomes an all consuming task, the joy is sucked out of life, every minute of every day is spent thinking about it, agonising about it, watching every mmol point and being thrown into a depression if it so much as rises, weighing every morsel that passes your mouth and on and on. Surely there is a balance and yes I know, we don't want to lose our eyes or a leg BUT I agree with that Doc partially, I believe we can manage it properly without the hysteria and also take it seriously.

 

[archersuz]

That's very sad. I have a much more enlightened GP who is really pleased with what I do, and actually prescribes the test strips for me. She advocates a low carb diet and I can have a 3 monthly HbA1c with no problem, as she knows that I use it to monitor how I'm managing this condition. I also get foot balm on prescription as she knows I'm looking after my feet! The diabetes nurse isn't so liberal in her views, but the GP said I don't need to see the diabetes nurse now, unless I have a problem or want to see her. I just see any nurse to have the bloods done then get my results online. Sorted!!

 

[zand]

As a T2 not on meds the only choice I have is to be careful not to eat the wrong things or to get depressed with bad HbA1c results. I prefer to be careful, that's not hysteria, that's common sense. I don't agonize and get depressed when my readings are bad, I feel elated when they are good.

 

[PenguinMum]

Mmmmm, at the risk of being shot down, I actually think she has a point. Of course we all want to remain healthy and this is a condition that requires constant monitoring but I sometimes think that for many it becomes an all consuming task, the joy is sucked out of life, every minute of every day is spent thinking about it, agonising about it, watching every mmol point and being thrown into a depression if it so much as rises, weighing every morsel that passes your mouth and on and on. Surely there is a balance and yes I know, we don't want to lose our eyes or a leg BUT I agree with that Doc partially, I believe we can manage it properly without the hysteria and also take it seriously.

Sorry Kas cant agree with you. In my opinion Diabetes is an illness that must be kept in line for future health and that means being “on it” all the time not just occasionally. It must be one of the very few chronic illnesses that can be improved by putting a bit of discipline into what we feed ourselves. I dont know why but some people just think its just an inconvenience but its way more serious than that. Btw I am not hysterical nor do I not have a great life. I just care very much about my future prospects.
PS. As you get older even moderately high BG can put you in hospital if you get an infection. It has happened twice in my family which led to premature death. What seemed like a bit of a chest infection became pneumonia and a dental infection very quickly became sepsis both with uncontrolled BG.

 

[zand]

I shouldn't be quite so draconian with my low carb diet and "lighten up" and enjoy my food more.

It amazes me when I hear people say this. Food is fuel for our bodies. Would you put unleaded petrol in a diesel tank occasionally just because it is cheaper? T2s are often portrayed as gluttons yet a T2 who looks after themselves by eating the right things is somehow weird and doesn't 'enjoy' their food. Huh?

 

[dbr10]

That's very sad. I have a much more enlightened GP who is really pleased with what I do, and actually prescribes the test strips for me. She advocates a low carb diet and I can have a 3 monthly HbA1c with no problem, as she knows that I use it to monitor how I'm managing this condition. I also get foot balm on prescription as she knows I'm looking after my feet! The diabetes nurse isn't so liberal in her views, but the GP said I don't need to see the diabetes nurse now, unless I have a problem or want to see her. I just see any nurse to have the bloods done then get my results online. Sorted!!

Brilliant

 

[Rachox]

Well I enjoy my food more than I did before going low carb! And as for monitoring at home causing stress, I’d be way more stressed waiting blind (excuse the pun) for 3, 6 or even 12 months for an HbA1c!

 

[rosco 2]

Good morning. As a fairly newly diagnosed T2 I tread carefully here. My GP is almost certainly experienced with care of diabetes. He is not keen I test myself regularly to check bg response to foods but I continue regardless as I need to know. He won’t fund more test strips at the moment. Equally, he is very supportive of my low carb diet and taking up exercise. He has been congratulatory re my efforts so far and I find him to be a decent guy. I think his sues with testing are some patients may well not be able to understand the results...and then of course there is the practice budget issue. Apparently the local CCG won’t fund testing stuff for T2. Hmmmm. To sum up, it’s hard to grasp the reality of a long term condition. Food is a joy but my reality is much of what I really enjoy is now off limits if I want a healthy trouble free future. Such is life, it’s always about choices.

 

[rhubarb73]

It sounds like you handled it correctly. When people say things like that they have your best interests at heart, even if we disagree with the advice they are giving advice which is seeking to balance physical and emotional wellbeing.
As a T2 community we do want to change attitudes and especially NHS advice but it doesn't pay to fall out with people in the process.

 

[Deleted Account]

I understand where she is coming from.
When asked what is the hardest thing about having diabetes, for me, it is managing the balancing between taking enough BG readings to know what is going on and getting on with my life.
Libre and CGMs are wonderful to tell us what is going on but it is easy to become obsessed with checking all the time and aiming for perfection.
I have trialled Libre and Dexcom. Even though I find they are often a long way off my finger prick readings (another story which I don't want to derail this thread with), I can't help myself from checking what they say.

I try to manage my diabetes by educating myself with what causing rises and falls, then working out how to manage them. And in between taking enough readings to know things haven't changed.
This requires days of lots of readings but also days with just 5 or 6 (minimum for me is when I get up, go to bed and before every meal).

 

[britishpub]

I must say that I can see where she is coming from in some respects.

Other than an "interesting exercise" I can't see the need for a T2D to use a CGM, nor can I see the need for frequent testing once you have gained control.

My last 2 Accu-Chek Mobile cassettes have decided to expire before I'd managed to use them all, because I rarely test even once a day nowadays.

I'm sure some people enjoy micro-managing their T2D, but for me I'd rather forget I have it altogether and just get on with my life. I know what I need to do to control my BG, and now that change in lifestyle and diet is the new normal, I'd rather not overthink it.

As for "lightening up" on diet, she clearly has no idea !!!!

 

[Mr_Pot]

If you are Type 2 on diet control then testing does not affect your BG. It is what you do as a result of the testing that makes a difference. I have noticed some very experienced members on here who claim to be still testing multiple times a day even after years of having their BG under control. What exactly are they doing with all these readings? If they are not making any changes to their diet then what is the point. So, I tend to agree that testing can become and end in itself and an obsession.
Testing is vital for those on diet control who are still experimenting with different foods and trying to establish what they need to do to control their BG.
If you are type 1 or controlling your diabetes with drugs that might cause hypos then of course you have to test frequently.

 

[Phoenix55]

I tested and tested for the first few months that I had the meter. Now I know what raises my bg I don't need to test so often. If I eat late or have something with grain flour my bg will be up, if I have a glass of water and avoid the grains my bg will be reasonable. The only exception has been the recent hot weather in UK and that put everything up but is beyond my control. I now test once a day, to keep a check on where I start, after a meal with something 'new' and the occasional day when I check more often. My diet is varied and seasonally appropriate and diabetes does not get in the way, just a little forethought and the application of common sense with regard to portion size, but then I count myself lucky at the moment that I do not have other problems that also need taking into consideration.

 

[Guzzler]

Oh My Days! We (patients) cannot win. We are told that we need to take responsibility for our own health but if we are pro active somehow this equates to becoming obsessed? We are 'blamed' if things go wrong and sometimes ignored if things go right. As long as I'm not demanding drugs/treatment that is inappropriate or that would cost the Practice money and as long as my mental health is not adversely affected by testing then why even comment on it?
HCPs are at times themselves the cause of stress, for me, and here I am not thinking testing but of pushing a particular family of drugs that I vehemently reject on a purely personal level.

 

[enzina]

As long as my GP believed i'm T2 he shared the same views! I even bought the test strips for a while and he said, he also wants me to have a life! Within a few month my bg levels were often in the twenties, GP said i should stop testing if that freaks me out..

 

[DavidGrahamJones]

Mmmmm, at the risk of being shot down, I actually think she has a point.

I won't be shooting anyone down. Like everything in this world our approach, and our opinions are based on our personal experiences. It's very easy for someone like my friend, skinny as a rake, even before she was swimming in rivers, to say "don't be so draconian about your diet", she has never gained weight, apart from while being pregnant, and then returning to dead skinny.

My wife and friends enjoyed a lot of food over the weekend, that's what it's all about. Had I enjoyed as much food as they had I would be in serious trouble. BG and weight wise. Losing weight is a big enough struggle even when doing all the right things (what are they?), so I can't afford to start gaining weight just for the sake of a "good" weekend.

Personally my weight experiences have been completely different. AT 12 I was underweight and worse still my mother was told I was under nourished. Forced to stay to school dinners I weighed 14 stone at 14 (also 6ft tall), 16 stone at 16 and leaving school helped me gain another 3 stone in the first year. Strangely, I dropped to a "healthy" 12 1/2 stone by the age of 24 by which time I had long left home, but started to gain again in my late 30s, in fact gaining 3 stone in 3 months when I moved in with my wife. Maybe that's the answer, I should live on my own and not let others dictate my diet. LOL

I sometimes think that for many it becomes an all consuming task, the joy is sucked out of life, every minute of every day is spent thinking about it, agonising about it, watching every mmol point and being thrown into a depression if it so much as rises, weighing every morsel that passes your mouth and on and on.

I'm lucky to have a Freestyle Libre, it is a game changer and a godsend. I don't watch every mmol and don't get depressed when it rises, mainly because my problems are a little bit out of my control in that I can keep between 5 and 7 all day every day, except for the start of the day. Dawn phenomena is a real pain in the backside and if my reading is correct, losing the fat around the liver will help that situation. My draconian diet has enabled me to have some days with no BG rise first thing but it's surprising how temporary that can be. Personally I only weigh food when I go through a period of monitoring food intake. I don't change my diet too much so I know it stays about the same.

I think my friend's opinions are based on what she'd expect of a diabetic patient taking all the drugs she could prescribe and eating what the NHS consider to be a healthy diet. My weight escalated to 27st while taking Rosiglitazone for BG and Citilapram for the anxiety of gaining weight. Stopping the Rosiglitazone (it messed up my liver function) helped my weight drop like a stone until it was decided I need Gliclazide. Not only did my weight loss stopped immediately, I gained 10 kgs. So, medication isn't an option for me if there's to be any chance of losing more weight.

I believe we can manage it properly without the hysteria and also take it seriously.

I had to look the word up because I often think I know what a word means and quite often will only be sort of right.

Hysteria - exaggerated or uncontrollable emotion or excitement.
an old-fashioned term for a psychological disorder characterized by conversion of psychological stress into physical symptoms (somatization) or a change in self-awareness (such as a fugue state or selective amnesia).

So probably not guilty although I do talk about it a lot.

Otherwise, I couldn't agree more, perhaps my talking about it was mistaken for hysteria. I follow a low carb diet by cutting out bread/pasta/rice/potato, I don't eat processed food. I have one "treat" which is toast on Sunday and because it reminds me every week how much my BG rises just on a couple of bits of toast, it helps me keep to the straight and narrow the rest of the week.

 

[DavidGrahamJones]

Other than an "interesting exercise" I can't see the need for a T2D to use a CGM, nor can I see the need for frequent testing once you have gained control.

I thought I had gained control, I cut out bread/pasta/rice/potato, threw away the Gliclazide and Januvia, HbA1c dropped to about 45 and you would have thought that was it, I had gained control. And yes I relaxed my testing regime and became complacent. Then, after 4 years I get an HbA1c of 64. Where does that come from? I'm still not eating bread/pasta/rice/potato or most things processed (I'm counting pickle as processed).

Based on my HbA1c most GPs would have just prescribed Gliclazide again, previously that had halted my weight loss and I gained 10kgs, so not what I want again. Also, because I use the FS Libre, I know that first thing in the morning, when I frequently don't eat and probably would do a finger prick test, my BG was going mental, dawn phenomena! Add to that my low carb diet I would be having hypos all the time, also not what I wanted. So, for me the FS Libre has been essential in knowing exactly what is going on. My GP knows me well and has allowed me to look at my diet more carefully and although my HbA1c came down to 48, it will still rise to 51 sometimes, despite having gained control.

If you don't think I need a CGM then you won't see the need for me to know my level of insulin resistance. I do, I've had it measured three times and it's been different each time, so obviously changes. For some reason mine has been 1.7, 2.4 and then 1.7 again. So I'm tempted to say that one never really has proper control because there's a variable that will change, we can fix diet and eat approximately the same all the time, but when your IR changes, so will your BG and eventual HbA1c.

So, although I may not need a CGM or need to test frequently, I'm happy that knowing what I do because of having a Libre, I can avoid just the basic problem of additional medication and hypos. By the way, eating more carb to prevent the hypos so that I can take something like Gliclazide isn't in my opinion a sensible option.