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Know your rights!

F

fergus

Well-Known Member
Messages
1,439
Type of diabetes
Type 1
Hi everyone,

This is intended to discuss an issue I raised on manxangel's thread in the Food Forum, but I think needs its own thread.

As you may know, I try pretty hard to have certain issues properly discussed within the health profession and within Government agencies. With that in mind, I had a meeting this morning with my MSP and an eminent Professor in the field of diabetes. More on that another time, perhaps.

One thing I discovered surprised me. The British National Formulary essentially sets the rules for the way in which medicines are to be prescribed in the UK. On the subject of prescription medicines for diabetic patients, it says this:

'Oral anti-diabetic medications are only to be prescribed if a patient fails to respond after diagnosis to at least 3 months of dietary energy and carbohydrate restriction.

Now, my experience of the NHS is one where, not only has a low carb option not been offered, it has been actively discouraged. I'm not on oral medications and so it could be argued, however illogically, that the guidelines do not apply in my case.

My question is this. How many type 2's have been offered this option? I know of at least one who suffered significant weight gain following a prescription for sulfonylureas. Without having been offered the option as described in the BNF, could this not be described as malpractice?

To those diagnosed in recent years, were you given this option? To those who are newly diagnosed, could you keep this in mind and let us know how the issue of diet is presented to you? Know your rights, people!

All the best,

fergus
 
I set out restricting my own carbs,Fergus.Didn't seem like rocket science,intolerant to carbs =don't eat some much of them! Got standard dietary advice from nurse/dietician but kept to my own diet.Found Diabetic.co.uk and found like minds.Was offered the standard package of simvastatin and aspirin but refused politely because I prefer not to take medication unless absolutely necessary.
When I did tell the nurse about being low carb I got the 'look'.then the raised eyebrow and 'you should be careful what you read on the Internet' lecture!
I am still not on any medication (so far).
 
Link to BNF aka British Nuclear Fuels

6.1.2 Antidiabetic drugs

Oral antidiabetic drugs are used for the treatment of type 2 (non-insulin-dependent) diabetes mellitus. They should be prescribed only if the patient fails to respond adequately to at least 3 months’ restriction of energy and carbohydrate intake and an increase in physical activity. They should be used to augment the effect of diet and exercise, and not to replace them.

For patients not adequately controlled by diet and oral hypoglycaemic drugs, insulin may be added to the treatment regimen or substituted for oral therapy. When insulin is added to oral therapy, it is generally given at bedtime as isophane insulin, and when insulin replaces an oral regimen it is generally given as twice-daily injections of a biphasic insulin (or isophane insulin mixed with soluble insulin). Weight gain and hypoglycaemia may be complications of insulin therapy but weight gain may be reduced if the insulin is given in combination with metformin.
Click to expand...
I wonder how many Drs & dietitians - & consultants - are aware of this recommendation?
 
Interesting that! I have a copy of the BNF and never actually thought to read that bit.Thank you for printing that.
 
I read that, open-mouthed, Fergus. As a Type 2, I was most certainly not advised any such thing. Quite the opposite. I was put straight onto Gliclazide and then went onto insulin within a year. NO mention was ever made of reducing carbs at all and I don't remember any mention of exercise being made either. It was my own decison to join a walking group, which I stumbled upon by chance and I still belong to.

Thinking about this further, I actually remember asking the D.N. if I could not try dealing with things by diet alone first and she said no because my reading was 15, so going onto tablets was my only option!
 
Fergus - something of a thunderclap, i have a blood test results session on Tuesday and will certainly test the waters with my GP.

Many thanks
Dave P
 
I think that you might find that current wisdom, like that when I was diagnosed 13 months ago, is that the research shows that starting T2s on oral medications early slows down the progress of the condition.

Pity they did not mention the low carb advice - I decided for a variety of reasons that I would go low carb rather than follow the dietary leaflets that were handed out. Maybe that''s why I surprised the Consultant with the fast reversal in glucose levels and a similar weight loss in the 3 months between being diagnosed and meeting her. She prescribed 2*500 Metformin. She added that because I was over 60 I should have a statin, ramipril and a soluble aspirin in the interests of reducing the chance of stroke - despite the fact that my GP considered that my blood pressure and Cholesterol readings were acceptable.

When I asked my GP why the non-diabetic medication was necessary he replied 'that's ****** she tends to go a bit over-the-top'.
 
Hi,

i was given metformin straight away and yesterday was given Gliz. and told my my diabetologist that a Lo Carb diet was definatly the way to go. It did surprise me.

However i am going back tommorow for a meds change again but hey. but at least on the Isle of Man the one Diabeologist is a Lo Carb promoter!
 
Hi Fergus
Perhaps some of the sceptics will change their tune now, low carbing certainly benefited me.

Keep up the good work
Graham
 
Great detective work Fergus,
So all the high carbohydrate claptrap is simply down to the fact that GPs and DSNs just haven't read their own manual!
 
I was never offered that option. Execise was out of the question in my case as i was paralysed by a sroke at the time of diagnosis, but I have heard the local diabetologist call low carb a "faddy diet".
I'll show your info to my GP when next i see him. he's recently completed a diabetes dourse, which I think he actually believess in
 
I was amazed, frankly, to read something enshrined in the BNF which is completely at odds with the typical advice given on diet. The words malpractice and medical negligence immediately spring to mind.
We regulars been at this for a while of course, and proven to ourselves that the 'claptrap' as Dennis describes is precisely that. I'm pretty sure that I would have avoided the starches, the medication and the weight gain that I endured while following what I was lead to believe was a healthy diet.
What I hope is that the newly diagnosed become aware of this and are spared the starchy carbohydrate nonsense that is still the staple of dietary advice today.
To any newbies out there who have an introductory diet / medication session with their health professionals - I hope some of you can find the time to let us on the forum know what is said post-diagnosis.

All the best,

fergus
 
When hubby woke up in bed next to me this morning, I was staring at the ceiling, feeling angry and he asked me what on earth I was thinking about. "It's negligence. Pure negligence." You can guess what I was thinking about!!!

Just re-read my posting and realised it can be read two ways....... :oops: I was of course, meaning I was thinking about Fergus's findings.
 
Is there some way that this can be put to good use ??? I ask myself. IE we have a body of experience that could actually be used to boulster what we know to be valid and does what it says on the tin.
I cant say that i know how to do that, but i suspect it would need someone knowledgable enough to put the case, and probably well connected. Or in other words strike whilst the iron is hot.

Dave P
 
ah fergus I wondered where that came from - the phrase carb restriction is very woolly could mean anything. Do you know how the BNF is used - it sits in every gp consulting room and is generally used to look up drugs! It is not policy .
 
Ally the BNF may not be policy but it is certainly extensively quoted and consulted by doctors.A doctor may take more notice of something quoted from the BNF than just your ordinary man in the street.
 
but tbh sue the term means nothing - gps have protocols they use. they only use the bnf to look up drugs honestly!
 
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