Levels

You can find the nice guidelines here. The target for diet controlled type 2 diabetics or those on drugs which do not cause hypoglycaemia is an HbA1c of 48.

The info in the nice guidelines seems to support your nurse suggesting medication, but as your recent HbA1c of 54 is just slightly above the medication threshold of HbA1c 53, and due to your reluctance to start medication, the nurse could be giving some leeway. Have you been given a target to aim for, @John 2 ? Also a date for another HbA1c test? Your levels need to be monitored.

It is not clear whether or not you brought the level down with or without medication. It would help to give more specific advice if you made that clear in your profile.

John 2 said:

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Level down without medication , next test prob 3 months but not stated , that is why I am asking , it’s all a bit hit and miss I think , I get the feeling it’s about pushing me onto meds , do they get a cash bonus fo doing it .

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Hi - bear in mind that normal HbA1c levels - where almost all non-diabetic people are - range from around 36 to 42.

GPs do not get a cash bonus simply for putting you on meds. They are rewarded for various things to do with type 2 , for example identifying anyone with an HbA1c of 48 or above. The new Quality and Outcpomes framework targets were published in the last couple of days and here's a link to them. The diabetes ones start "DM".

https://www.england.nhs.uk/wp-conte...ity-and-outcomes-framework-guidance-26-27.pdf

The QoF paper has links to the relevant NICE guidelines which go into more detail about the "target levels" for HbA1c. The targets are nowhere near normal BG levels.

@John 2 , I go with the concept that the higher your blood sugars go, the more likely you are to suffer the consequences of high blood sugars like damage to your vascular system , the nerve endings , your heart and kidneys. Obviously the closer one is to normal blood sugars the less likely damage may occur. And to complicate matters, not everyone suffers consequences the same. So some people can have symptom's associated with raised blood sugars at lower levels, even at prediabetic levels (rarely) and others may have no symptoms even when their blood sugars are high. Numbers are just numbers, they are used as means of addressing risk.

As for medications, some people choose medications over diet. They prefer to eat a diet with some carbohydrates , whilst others choose to control their blood sugars through diet, restricting their carbohydrate intake. One means is no better than the other. It’s just a choice. If you don’t want to take blood sugar lowering medications, choosing instead to use diet, then talk to your Dr.

John 2 said:

One other thing that does bother me and I am aware this actually happens , I have never been offered real help in terms of a diet that would help , I understand this site offers advice on that subject and some people have helped in that area , but my practice never has , which surprises me to be honest , I did attend Desmond back in 2010 when I was told I was a diabetic (48 mol ) , but that was a basic thing to explain diabetics and what contained sugar and what did not ,like Diet Coke for example , I think the fact that I have managed it for 15 years shows I try to control and have to a degree , but that has not been with the help of the NHS or my practice .

My concern is that the basics is not really been dealt with , I am more than aware a lot of you on this site will be , that people will just take the pills and if not helped in other ways (which is my point ) things can get worse and they end up on insulin , so , to casually mention things like exercise and carbs , whilst a point in the right direction , it’s not the best and correct me if I am wrong , but I understand more help can be offered on the NHS, I feel that has been the case for me and in other comments I have made on this site such as can I be monitored to find out what really raises my blood sugar and some better encouragement from the Doctors and nurses rather than what I have experienced , being talked to as if I am an idiot or not bothered does not help .

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I think your experience is typical. Since my diagnosis in 2019 I have had exactly no "help" regarding my T2 from the NHS. Yes, I turn up for my annual blood tests and checks FWIW but nobody has ever advised me about anything. 95% of how I manage my condition I learnt from this forum - the rest from reading (books not internet).

The "NICE guidelines" approach to managing T2 for GPs is all about medication, how to prescribe and when to prescribe - there are a couple of passing references to "lifestyle changes" and "diet and exercise" but these are not suggested as a, or the, treatment option. The guidelines and the associated Quality and Outcomes Framework targets do not envisage anyone being encouraged to aim for normal blood glucose. They also (for example) do not support people monitoring their own blood glucose.

The link below is to the guidelines - these are official advice on how T2 is to be treated in the NHS. They aren't compulsory but essentially there's very little difference.


Dietary advice, if given, would have to be the same as is given for other people - the NHS approved carb-heavy "Eatwell Plate".

Fortunately there are a few practices that don't go along with this - most notably Dr David Unwin's in Southport, and the Freshwell group. The number of newly diagnosed people on here who report their DN advising them to cut carbs has increased, but is far from a majority. You might want to look at Dr David Cavan's (an NHS consultant endocrinologist) book on reversing diabetes/pre-diabetes: