Is my GP doing enough?

Mervyn · Jul 18, 2011

Hi,
I am 61yrs old and have had Diabetes type 2 for at least ten years. I was on 2 x 500mg of Metformin twice daily. I also suffer from coronary heart disease and other health problems meaning I have been taking 17 tablets a day. Over the last 18mths I have felt that my diabetes has not been under control as I have been feeling extremely tired and lethargic,but with our local PCT not allowing test strips I was not able to check it. I bit the bullet and got a meter and purchased the strips privately.
My readings are averaging 15mmol first thing in the morning, that is before food or even a cup of tea. In the evening at between 2 and 3hrs after eating my glucose has been as high as 24.3 but is averaging 19.9. My GP started me on 2x 80mg Gliclazide in the morning on top of my Metformin and I have been taking it for 3 weeks without a decrease in glucose readings. He thinks I may benefit from insulin and has made an appointment with the specialist diabetic clinic....but that is not until 28th September. I am obviously concerned about the wait for this clinic!! Surely he should be able to prescribe Insulin (not that I wish to go on it) himself?? especially if that is going to be the only way to get my glucose levels down.
What more damage can be done to my health whilst I wait this length of time?? Any suggestions on what I can or cannot do about this??
I am very nervous about my short/long term health at the moment.

Mervyn

daisy1 · Jul 18, 2011

Hi Mervyn and welcome to the forum I know you are having your medication adapted, but I wonder if your diet needs looking at as well. Have you tried reducing the carbohydrates in your diet? Although you are not newly diagnosed I think you might benefit from reading this basic information, written by former monitors Sue and Ken, for new members and see what you can do to help yourself. You did the right thing to get yourself a testing kit. I suggest you test before and 2 hours after meals to see what individual foods do to your levels. Then you can either reduce the portion until you find out how much you can eat of a certain food, or cut it out completely.

Here is the advice that Ken and I, as Forum Monitors, usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

For more information on CARBOHYDRATE see here:

viewtopic.php?f=3&t=20306

This is NOT a low carb diet suggestion, just a reduction in your intake of carbohydrate. You have to decide yourself how much of a reduction will keep your blood glucose levels in control.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.

As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try!!

For TIPS FOR STRIPS see here:

viewtopic.php?f=20&t=19002#p173253

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2011 NICE guidelines for Bg levels are as follows:
Fasting (waking and before meals).......between 4 - 7 mmol/l...(Type 1 & 2)
2 hrs after meals........................no more than 8.5 mmol/l.....( Type 2)

2hrs after meals......................... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do at least 30 minutes moderate exercise a day, it can be split into 10 min sessions to start with. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Finally a few QUESTIONS TO ASK AT DIABETES CLINIC.

viewtopic.php?f=20&t=17091

Sue/Ken.

Mervyn · Jul 19, 2011

Thankyou for your reply..it makes interesting reading. I must admit I am not counting carbs..even so my diet has not changed in ten years. I have a light breakfast and then nothing,except may be a piece of fruit and tea or coffee, then dinner between 5pm and 6pm which mainly consists of meat and two veg. I have up to four slices of bread per day.
The diabetes just seems to have become resistant to Metformin and the Gliclazide does not seem to have made any difference. I did a small test where I did not eat for 22hrs apart from tea/coffe and my blood glucose was still 8.9. Will not go without food again though.

Mervyn

daisy1 · Jul 19, 2011

I may be wrong but in my opinion you are not eating enough. When your level goes low your liver dumps glucose into your blood stream so you get a high reading. This explains your high reading when you didn't eat all day and also on other days.

Mervyn · Jul 19, 2011

Hi,
yes makes sense as my Wife is always complaining that I do not eat enough or regularly! The problem is with my "other" health problems and a very sedantry lifestyle because of this..I do struggle to eat a "proper" diet...even so with the gliclazide I have even put on extra weight :-O without the extra food. Will have to have a serious think and maybe chat with the GP....maybe worth thinking about having shakes during the day??
Thanks for your help

viviennem · Jul 19, 2011

Hi Mervyn, and welcome!

It might be worth you having a look at the diet I use, which is on a thread called 'Viv's Modified Atkins Diet', on the Low-carb Forum on this site. I'll 'bump' it so you can find it easily.

It is not suitable for everyone, and may well horrify you, because it goes against much of what is standard advice in the NHS. Dr Atkins was a heart specialist in the USA, and the diet does work, even for heart patients.

However, I am not recommending that you follow the whole diet unless you want to! But you may get a few ideas about low-carb foods from the list of allowed foods on this stage of the diet, and you could maybe adapt your present diet by reducing your bread and potato intake, and increasing your salads and vegetables from the list given here.

I agree with Daisy1 - I'm not a doctor or a dietitian, but I too don't think you are eating regularly enough, and in your place I would spread my food more evenly across the day. I eat 2 eggs for breakfast, or maybe a small portion of cereal (Lizi's Granola is my favourite), or live natural yoghurt with a few berries; a salad for lunch; and meat and veg for evening meal. I make sure I eat fat as described in the diet - but it's your choice!

I too am fairly sedentary at the moment, with back problems, and I have lost a stone since January on this diet. My cholesterol is fine, my blood pressure coming down as I lose weight, and my blood glucose is well under control - with 3 x 500g Metformin daily, and the diet, nearly at non-diabetic levels.

You may have had some suitable exercises given to you by a physio. I use a book by Rosita Evans, called 'Rosie's Armchair Exercises', which is designed for people like me, with my present mobility problems. It does just what it says - a programme of exercises you can do from your armchair! I find it useful. I got mine from Amazon.

I've made myself sound in a dreadful state! :lol: There are many people much worse off than I am, but just at the moment I have a few problems; don't waste any sympathy on me! :lol: .

You could always ask your doctor to refer you to a diabetic dietitian to discuss your eating patterns.

Best of luck

Viv 8)

Mervyn · Jul 19, 2011

Hi Viv,
Thanks for your reply. I will have a look at your link. The problem that I have with eating more regularly is that if I have lunch then invariably I am unable to eat my dinner. I have had this problem for many years. My body obviously gets enough as I am nearly 13 and a half stone although I was a lot bigger than this at one stage. Because of the amount and type of medication I am on I suspect this has something to do with my appetite.
I am seeing my GP Friday so will have a word with him.
Once again thanks.

Mervyn

viviennem · Jul 19, 2011

I wish I had that problem, Manny (only joking!)

Try eating very small meals - even snack size - more often, say 5 times a day, just to keep your levels stable..

There is a problem with delayed stomach emptying that I believe occurs more frequently with diabetics. I can't remember what it's called - someone else may know, or I'll look it up and post again later. It's worth considering everything, just so you can rule things out.

Viv 8)

Mervyn · Jul 19, 2011

That sounds like a good idea to try Viv...will discuss with GP on Friday.

Thanks
Mervyn

daisy1 · Jul 19, 2011

viviennem said:
There is a problem with delayed stomach emptying that I believe occurs more frequently with diabetics. I can't remember what it's called - someone else may know, or I'll look it up and post again later. It's worth considering everything, just so you can rule things out.

Viv,
The word you're looking for is gastroparesis

viviennem · Jul 19, 2011

Thanks, Daisy1 - I can always rely on you to help me out of my senior moments!

Yet another lovely furry avatar! :wink:

Viv 8)

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