Interesting reading - gp handbook info re diabetes

[Mr_Pot]

I was told I was t2d after one hbalc of 53. No other tests. Have never seen a gp about this or the other 2 diagnoses I received at the same time. I dont think all gps even know that there is a handbook.

I have made an appointment ( for October, made t h is last week and it was the first bookable appointment for chronic conditions) to talk about my diagnosis, but as I could . Only book a single appoint I must decide which ofmy 3 problems I need to talk about.

I find it is best to be reasonable and polite but firm with receptionists. If you need an extended appointment, or more than one, just tell them. If you don't get anywhere and your appointment turns out to be too short get the doctor to make another appointment while you are there.

 

[Prem51]

Strange, although I wouldn't have known about my FBG and random tests without the print outs I asked for. I was only told the HbA1c result - another incidence of HCPs filtering out information!

I just checked my online test results and they show that there was a Plasma Fasting Glucose Level of 7.5 mmol/L when my HbA1c was 48, so that must be why I was diagnosed T2.
Apparently Plasma Fasting Glucose Levels were taken every 3 year previously and they has shown results of 5.8 -6.1 mmol/L, and my HbA1cs then were at 47.

 

[ringi]

@Prem51 it looks like you were cearly on the road to Type2 for along time, and hence the doctor did not need much comformation before giving you the news.

 

[ringi]

It will be interesting to see when this handbook gets updated to take into account the resent studies that show an increase cardiovascular risk when there is a above normal level of insulin in the blood, regardless of the source of the insulin. (Low carb people have been saying this for a very long time, but without the large scale studies to prove it.)

Likewise for low carb being better then low fat, and the cardiovascular risks of low fat. (Research paper only published last week.)

Likewise for Low Carb working a lot better in real life as people find it easier to stick to. (There seems to be no funding for a large scale GP baseed study of this in the UK.)

There also seem to be new research coming out on different SGLT2 inhibitors most months showing there benefits in reducing cardiovascular risks – unlike insulin and most type2 drugs that increase cardiovascular risks. So when will NICE put SGLT2 inhibitors towards the start of the "drug ladder"?

The “Newcastle Diet” is also likely to be well proven with a study published at the end of this year showing it works in a GP setting. (Long term results will take 2 more years before they are know.)

 

[Prem51]

@Prem51 it looks like you were cearly on the road to Type2 for along time, and hence the doctor did not need much comformation before giving you the news.

Often a random BG test is done on the same blood sample as the HbA1c - mine come back as 34, hence no need for a 2nd HbA1c test.

Yes you were right, I didn't know about the random fbg test being done with the HbA1c test. My GP did say to me I was in danger of becoming diabetic the year before I was diagnosed, but I didn't really take much notice thinking it was the usual HCP scare story.

 

[Bluetit1802]

It will be interesting to see when this handbook gets updated

The current one covers winter 2017.

 

[Bluetit1802]

Yes you were right, I didn't know about the random fbg test being done with the HbA1c test. My GP did say to me I was in danger of becoming diabetic the year before I was diagnosed, but I didn't really take much notice thinking it was the usual HCP scare story.

Hopefully, with all the media hype about diabetes and doctors being told to screen for and treat pre-diabetes, all this has changed. I don't know how far back your pre-diabetes goes, but presumably in the times when it was generally ignored by doctors. So this is one good change for the better.

 

[Bluetit1802]

I find it interesting that a random plasma test has to be 11.1 before it can be used for possible diagnosis. This is also the 2 hour cut off for the OGTT. Why then are we told non-diabetics never (or rarely) go above 7.8?

 

[ringi]

I was told to eat less fat ect when I was "pre-diabetes" its only after the fact that I did my own research (starting with the BBC Doctor in the House blog etc) that I discovered Low Carbs and this site.

 

[ringi]

I find it interesting that a random plasma test has to be 11.1 before it can be used for possible diagnosis. This is also the 2 hour cut off for the OGTT. Why then are we told non-diabetics never (or rarely) go above 7.8?

I think it is based on when it becomes cost effectative for the NHS (etc), e.g. when the risk of eye damage etc becomes a factor. Also random plasma test are random depending what someone had to drink on the way to the GP, a lot of none-diabetics will get above 8 a few times in their life's.

 

[Bluetit1802]

I think it is based on when it becomes cost effectative for the NHS (etc), e.g. when the risk of eye damage etc becomes a factor. Also random plasma test are random depending what someone had to drink on the way to the GP, a lot of none-diabetics will get above 8 a few times in their life's.

Or could it be some sort of calculation based on research we know nothing about, or just a figure plucked from the air? I am well aware a lot of non-diabetics rise to double figures on occasions. My own husband reached 10.2 at an hour, 8 at 2 hours, and 7.3 at 2.5hrs. after a traditional Sunday roast dinner with rice pudding to follow. He is not diabetic, his FBGs are always low 4s and his last HbA1c was 36.

 

[Bluetit1802]

I was told to eat less fat ect when I was "pre-diabetes" its only after the fact that I did my own research (starting with the BBC Doctor in the House blog etc) that I discovered Low Carbs and this site.

I still have all my early food diaries on my spread sheet. Just had a look at them and literally cringed! My nurse had told me low fat, plenty of baked beans and mushy peas (I am a northerner!) any cereals, wholemeal bread, fruit, potatoes except chips. This was one of my first entries, before I discovered LCHF and didn't have a meter.

15g cornflakes
100ml semi skimmed milk
150m orange juice
200g baked beans
1 wholemeal toast
light Bertolli 2tsp 10g
125g baked fillet cod
4 new potatoes
peas
light Bertolli 2tsp 10g
med banana

 

[nebraska_beauty]

https://www.gp-update.co.uk/files/docs/GP_Update-Spring_2013_diabetes.pdf

I agree. My doctor is so authoritarian and is like "do as I say or else". he never listens to my opinions and if I tell him of new research he simply poo pooh's it. I live in fear before every check up

 

[JohnEGreen]

Or could it be some sort of calculation based on research we know nothing about, or just a figure plucked from the air? I am well aware a lot of non-diabetics rise to double figures on occasions. My own husband reached 10.2 at an hour, 8 at 2 hours, and 7.3 at 2.5hrs. after a traditional Sunday roast dinner with rice pudding to follow. He is not diabetic, his FBGs are always low 4s and his last HbA1c was 36.

"
If you wait for your doctor to give you a diabetes diagnosis, the chances are good that by the time you are diagnosed you'll already have one or more serious diabetic complications. These include retinal damage, nerve damage, and early kidney damage. It is now known that these diabetic complications only develop after years of chronic exposure to high blood sugars. But, tragically, the way that today's doctors are forced to diagnose diabetes ensures that you will get no warning that you are experiencing those chronically high blood sugars until they have reached a level so high they have already done irreversible damage.

This is not an accident. Years ago a committee of medical experts whose task was to decide how diabetes should be diagnosed decided it was better to avoid diagnosing patients with diabetes than to give them early warning that they were suffering from elevated blood sugars. As a result, these medical experts intentionally set the standards for diagnosing diabetes artificially high, so that most patients do not get diagnosed until their blood sugar has reached a level where they may soon develop the diabetic eye disease that leads to blindness."

Quoted from here http://www.phlaunt.com/diabetes/14046782.php

The above is mainly about the USA but what applies there generally often applies here.

 

[heli2010]

I found it all very interesting, especially the section on blood pressure controls, the section on Aspirin, and the section on Metformin and heart benefits.

Metformin - from how I read it, this is beneficial for the heart COMPARED WITH other diabetes drugs. This could mean it is the other drugs causing heart problems whereas Metformin doesn't, rather than Metformin being beneficial in itself.

Blood pressure - it seems the 140/80 target appears too tight and more people die with BP under 110/70, and the bottom figure should be not much less than 70.

Aspirin should not be prescribed to diabetics, full stop.

I need to read it all again.

can I ask why aspirin should not be given to diabetics?

 

[Bluetit1802]

can I ask why aspirin should not be given to diabetics?

Because NICE say so, and they are very clear about it. I have no idea what the reasoning is.

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

1.5 Antiplatelet therapy
1.5.1 Do not offer antiplatelet therapy (aspirin or clopidogrel) for adults with type 2 diabetes without cardiovascular disease. [new 2015]

 

[badcat]

Probably the increased risk of bleeding and some kinds of stroke ( burst blood vessal stroke rather than the clot related one platelet therapy can offer some protection against)
http://www.mayoclinic.org/diseases-...depth/daily-aspirin-therapy/art-20046797?pg=2

 

[JohnEGreen]

I am taking Aspirin daily as I have had a stent grafted in for an AAA which can lead to an increased risk of blood clots.

I suppose it is a question of which risk outweighs the other as is often the case.

 

[Alexandra100]

https://www.gp-update.co.uk/files/docs/GP_Update-Spring_2013_diabetes.pdf

Thanks - extremely interesting and useful.

 

[heli2010]

Because NICE say so, and they are very clear about it. I have no idea what the reasoning is.

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

1.5 Antiplatelet therapy
1.5.1 Do not offer antiplatelet therapy (aspirin or clopidogrel) for adults with type 2 diabetes without cardiovascular disease. [new 2015]

cheers I thought there might have been another reason, my GP said they used to prescribe aspirin but are now told not to because of the risk of bleeds yet at the same time saying glucose makes the blood thicker or something
once again its all about the money