More Support, less Advice for Newbies

[CherryAA]

I thought about that. But (knowing the doctor quite well, having unfortunately seen him far too many times this year) I think it very likely that the patient, had he been concerned about this, would have felt empowered to ask the doctor to intervene immediately -- with drugs or whatever -- and the doctor would have been more than happy to help in whatever way appropriate.

The doctor did tell me that the patient took the news of his elevated A1c as being totally unexpected. To me this implies that the patient was fairly unlikely to be suffering T2D symptoms or complications, but again, I don't have details and it would have been inappropriate to ask any questions. (You could fault the doctor for indiscretion, although obviously no identifying details were given.)

As for "a strict week of not eating carbs before his marriage," I am too new to diabetes to know how this works. Let's say his A1c had recently risen to nearly 13%, and assume for the sake of the argument that he really did have ED, is it really possible that a week of strict low-carb would have "cured" the ED? Furthermore, the doctor did tell me that this patient was fully diet-controlled until the latest A1c. In that case, my assumption is that the guy was one of the less lucky T2Ds who could need drugs/insulin to buttress the low-carb diet given that he did manage a period of diet-only control which has now "failed." Or, alternatively, that (as an earlier poster speculated), this guy "fell off the wagon" of his low-carb diet in recent months because of the momentous change of getting engaged and preparing to get married.

Again, please forgive me if I am off-base here. I was diagnosed less than 10 months ago and am still learning.

You might be totally right and we have no idea what the doctor actually asked, though one assumes that he did more than just pat him on the back and say there, there! My point is that in practice living at 13% is generally awful and represents daily high blood sugars that will make the patient likely feel ill. Thus if there was ANYTHING at all that the doctor or the patient could have done to help him bring down those high daily blood sugars in the days before his marriage and holiday, then those things should have been done.

 

[CherryAA]

Interesting take on 1.3.9. but I suspect this means a level of carbohydrate content the HCP (hospital dietitian ?) recommends.In a sort of Harry Enfield 'loadsacarbs' approach.
Doesn't say consistent with patient's previous dietary choices
Especially when they're also talking low-fat, controlled fats, and 'encouraging' carbohydrates.
https://www.nice.org.uk/guidance/ng28/chapter/1-recommendations(1.3.3.)
Geoff

Whilst I agree, it would be an interesting argument to have in the context of simply refusing the carbs served up on the plate if one cannot get low carb. foods !

 

[Grateful]

Thus if there was ANYTHING at all that the doctor or the patient could have done to help him bring down those high daily blood sugars in the days before his marriage and holiday, then those things should have been done.

I completely agree with you, of course. I personally have not experienced 13% and was symptom-less at diagnosis, so -- as I said earlier -- don't have insight into what that might feel like.

The main issue I wanted to convey in my original post about this conversation with my doctor was that this was an example of "support" being given, with the medical side coming later if medically appropriate to delay. I did leave out some context and in retrospect I should have provided it. It actually started as a general conversation about low-carb, diet-only T2D control. We started talking about diabetes drugs. Then (not verbatim, but close):

Me: I guess it's possible that, further down the road, I might need drugs in addition to the low-carb diet?
Doctor: Yes it could happen. Drugs are good, when you need them! I had a patient come in recently who was diet-controlled but his last A1c came in at nearly 13%. He asked me: "What am I going to do? I'm getting married in a few days and going on honeymoon!" I told him: "Congratulations! Get married, go on your honeymoon. I'll see you afterwards and we'll sort it out!"

In other words, the context was: "Drugs are good when you need them." This patient, like me, had (in the past) achieved control with low-carb only (my doctor told me he prescribes low-carb/no-meds to T2Ds on diagnosis, unless they have an extremely high initial A1c). I further assumed that the doctor was ready with his Rx pad, but felt that this could be postponed until the guy got back from his honeymoon. (The doctor is both friendly and professional, and I am sure he would have been willing to intervene immediately if the patient had requested it.)

Does that make sense?

(Edited later to delete redundancy and improve presentation of quotations.)

 

[paulus1]

im amazed that at those levels you were symptom free. at 11.4% i was conking out. you must be a lot tougher than me.

 

[Grateful]

im amazed that at those levels you were symptom free. at 11.4% i was conking out. you must be a lot tougher than me.

Maybe I did not write clearly enough. The conversation about 13% A1c referenced another patient of my doctor's ("I had a patient come in recently who....") -- not me. I was 8.3% (67) at diagnosis and symptom-free.

 

[paulus1]

i see. i was think i was a wimp again. consider yourself lucky the constant toilet visits do get a drag. and the thrush is most interesting. i was quite relieved when i was diagnosed i thought i had some weird illness

 

[CherryAA]

I completely agree with you, of course. I personally have not experienced 13% and was symptom-less at diagnosis, so -- as I said earlier -- don't have insight into what that might feel like.

The main issue I wanted to convey in my original post about this conversation with my doctor was that this was an example of "support" being given, with the medical side coming later if medically appropriate to delay. I did leave out some context and in retrospect I should have provided it. It actually started as a general conversation about low-carb, diet-only T2D control. We started talking about diabetes drugs. Then (not verbatim, but close):

Me: I guess it's possible that, further down the road, I might need drugs in addition to the low-carb diet?
Doctor: Yes it could happen. Drugs are good, when you need them! I had a patient come in recently who was diet-controlled but his last A1c came in at nearly 13%. He asked me: "What am I going to do? I'm getting married in a few days and going on honeymoon!" I told him: "Congratulations! Get married, go on your honeymoon. I'll see you afterwards and we'll sort it out!"

In other words, the context was: "Drugs are good when you need them." This patient, like me, had (in the past) achieved control with low-carb only (my doctor told me he prescribes low-carb/no-meds to T2Ds on diagnosis, unless they have an extremely high initial A1c). I further assumed that the doctor was ready with his Rx pad, but felt that this could be postponed until the guy got back from his honeymoon. (The doctor is both friendly and professional, and I am sure he would have been willing to intervene immediately if the patient had requested it.)

Does that make sense?

(Edited later to delete redundancy and improve presentation of quotations.)

Yes it does. it sounds like the doctor is a nice guy, however unless one has experienced it yourself, high blood sugars doesn't seem like a " here and now" issue - more of a focus on - its a debilitating progressive disease- which you can treat gradually so we will deal with it next month.
I'm just a bit surprised the doctor thought it could wait, or the patient was well enough to simply carry on with a reading of 13%. At 10.3% I was finding it hard to stand up enough to wash the dishes and deciding I needed to sleep all afternoon . I was coughing constantly and not sleeping at all at night. Within one week of changing diet a lot of that stuff had got measurably better. So whether his blood sugar had been brought down through either drugs or low carb if he had simply fallen off the wagon, he would probably have had a better honeymoon with fast treatment. I suppose my point is that " tough love" can sometimes be more effective even if it does seem interventionist.

I guess it comes right back to why some of us feel there is " no time to waste" for new people, and others advocate a more softly, softly approach. In the end hopefully the balance of postings that people see should be enough to give those wishing to act fast enough info. to do it safely and those who are more nervous a chance to absorb information more slowly and not get frightened off.

 

[Grateful]

i see. i was think i was a wimp again. consider yourself lucky the constant toilet visits do get a drag. and the thrush is most interesting. i was quite relieved when i was diagnosed i thought i had some weird illness

I am sorry you went through that, and I know that many people do present with symptoms of the disease, at diagnosis.

I do feel lucky, and sometimes a bit sheepish on this forum given my (relatively) low A1c at diagnosis, and the rapid "reversal" of my T2D within 2.5 months after the doctor prescribed low-carb, no-meds. Indeed, that is why I adopted the user name "Grateful" when I joined this forum, several months after reversing my diabetes.

I had been peeing a lot for about the past five years but ascribed that to "getting old" and indeed, the visits to the toilet have not reduced even though I am now "reversed." So I have decided the frequent urination (maybe eight times a day, far more than when I was a young man) was not caused by T2D. I did have two other, vague symptoms: A headache that started one month before diagnosis and did not go away until several weeks into the low-carb diet; and strange fits of hair-trigger anger a few times in the months preceding the diagnosis.

So when I say "symptom-free" it is because there is no way to be sure that those vague "symptoms" had any connection with diabetes.

Far from being "relieved" I was devasted by the diagnosis, which came out of the blue following a routine medical. By body type, I am a beanpole. I had put on weight in the previous 18 years or so, but my BMI was still firmly in the "normal" category. At the time, I had bought into the stereotype that "only obese people get diabetes" so it was a bolt out of the blue.

Nearly 10 months later, I am wiser, and sadder. And the beanpole of my youth is back, with the ribs showing and the sticking-out, bony hips. That, I now know, is my healthy self!

 

[Grateful]

I guess it comes right back to why some of us feel there is " no time to waste" for new people, and others advocate a more softly, softly approach. In the end hopefully the balance of postings that people see should be enough to give those wishing to act fast enough info. to do it safely and those who are more nervous a chance to absorb information more slowly and not get frightened off.

Gosh that's hard to be "unequivocal" about. But I will come out and say it: While I believe that a Type 2 diabetes diagnosis (or, a progressive worsening of the disease) count as health emergencies, I think in some cases (many cases?) it may not be essential to act immediately if there is an overriding personal reason for (a short) delay.

For instance. I am almost sure that when diagnosed, I had already been T2D for several years. That's because my previous A1c, taken about seven years earlier, was 5.5% and I am assuming it just gradually notched upwards. But who knows? In that context, what difference did it make that I started low-carb in February of this year, compared to (say) a few months later? Answer: Almost "zip."

Thinking about the guy, his wedding, his honeymoon. He has been diet-controlled for some time now. His A1c has worsened to a level that warrants great concern. I assume he was not self-testing (my doctor does not suggest it for diet-controlled T2D patients). I have to assume that the guy had no idea that his BG control had failed recently.

How urgent is it to rectify the situation? In a world of total risk-avoidance, it is absolutely urgent. Indeed, you could argue that he should have put off his wedding until it was sorted out!

I am comfortable with taking calculated risks. That's why I currently don't self-test: too much hassle, and too much anxiety. But that's just me.

What would I have done if I had been the poor guy heading into his wedding? This: "Doctor, I look forward to seeing you after my honeymoon. Meanwhile though, do you think you could give me a prescription for whatever drug you might have in mind? I can fill the prescription and take the pills with me. I won't take them unless things go pear-shaped. What do you think?"

I mean, can you imagine the possible side effects of the Metformin and/or sulfonylreas during a wedding and honeymoon, when you have never taken these drugs before?

Just my own two cents, as they say here in America.

(Edited later to fix typo.)

 

[paulus1]

i was peeing about 48 times a day seriously. it was none stop. nothing wrong with being spotted early it saves you the risk of more damage so dont worry about that. my bloods from 2010 until 2 years back were fixed at 37 hba1c then at test it was 104 so in my case there was no gradual decline. im always difficult.

 

[Grateful]

im always difficult.

Well, this is just another case of "we are all different." I have no idea what happened, in my case, largely because for six years in a row I neglected to have my routine annual medical, even though here in the U.S.A. it is free of charge under my insurance policy. A very stupid thing to neglect.

So it could have been that my A1c drifted upwards for seven years. Or it could have happened recently and suddenly (as it did with you) and I was just fortunate that it was "caught" randomly before it could skyrocket. Nothing any of us can do about these things, post-diagnosis....

(Edited later for clarity.)

 

[Mbaker]

Which is lovely assuming that with an Hba1C at 13% the patient was actually able to stay awake during the days of his honeymoon and was not suffering from erectile disfunction in the evening. Both all too likely with blood sugars at that level. If either were the case the patient may well have enjoyed his honeymoon more had he had a strict week of not eating carbs before the marriage. I would certainly not have been wanting to party at my 10.3% on diagnosis!

Its all too likely that the reason he asked that precise question was actually driven by erectile disfunction. That being one of the prime reasons many men are driven to seek help.

This is why this thread is so important, actually vital, as the options are more or less initial information.

My thoughts are what might a judge say if presented with all of the considered arguments in this thread. Whilst I am completely biased in my view, I would imagine the newbie's health needs would trump mental impact / readiness. Now during the course of input I am wobbling as, if the hypotheical person with Type 2 is mentally shocked by the diagnosis, would they be in a position to implement the advice.

Wobble over, for me on balance the potential harm of providing advice, is not likely to create a suicide scenario at the extreme, but the lack of direct practical advice for the majority adds to or keeps the same level of trauma. So a lack of further advice in my opinion is more regressive.

 

[Mbaker]

I believe Dr Unwin is himself diabetic so his changes are to be expected . It is interesting what true excellent insulin sensitivity can actually look like - I did do a test for one guy, young, ripped, clearly very fit. He binged chocolates and sweets for an hour, later tests showed his blood glucose just remained at 3.6 before, during after.

I do think that once apple etc find way to add blood glucose to fit-bits etc, we will see a big change in people's perception of the problem.

I thought I heard Dr Unwin say he was diabetic in the PHC video he did with his wife, but was not clear if he was talking about a patient. When I did a search yesterday I could not find a direct reference to him being Type 2, in any event his posts on twitter were revealing.

 

[rmz80]

In a way getting advice from this diabetes forum has a big advantage over a forums covering other subjects. The fact that you can get meter readings means after a few days; any good advice should show up as an improved BG reading. In the case of HbA1c readings this should show correct medication and good working advice over a few months. Initially phone help (or even a an email) to diabetes nurse is a useful first step.

 

[wiflib]

I can post again!

I wasn’t ignoring you all, honest

 

[woodywhippet61]

In a way getting advice from this diabetes forum has a big advantage over a forums covering other subjects. The fact that you can get meter readings means after a few days; any good advice should show up as an improved BG reading. In the case of HbA1c readings this should show correct medication and good working advice over a few months. Initially phone help (or even a an email) to diabetes nurse is a useful first step.

This is what I found. I could see for myself that the diet advice I got here worked. I could also see that the diet advice given to me from my DN lead to readings of 17.9

 

[JohnEGreen]

Support may make people feel better. Good advice however on how to change your situation can not only make you feel better but also maybe be better physically.

 

[Boo1979]

Its a very fine line - I think many / most people feel somewhat helpless / hopeless when told they have a chronic health condition, particularly when most of what they are told / find by googling that the condition will shorten their life.
Giving an alternative view by offering tales of personl success with various strategies can be a very helpful antedote to those feelings but what if the results reported in replies to the newbies are not those experienced by the newbie when they try them? i supspect that just then reinforces a sense of hoplessness / failure. Similarly, I for one, certainly find that if I just receive gushing tea and sympathy in response to a problem it somehow conveys a message of weakness in doing anything about my situation
I absolutely think newbies need to have an advice that there are several different ways to approach the diagnosis that they have received and suppourt to experiment in order to find out which approach suits their body and their personality / lifestyle the best. This would, I think, incorporate advice on how to test and how to use the resulting information, as well as links to sources of further information on the various approaches
At the same time I think that detailed advice to follow approach x above all others ( be it LC, LCHF, ND, or whatever) should be reserved until the person has got their head around the basics enough to know what they want to ask and I do not think posts such as “ I did X and got an haba1c reduction of....” are very appropriate, certainly not on the general sections of the forum, maybe on the subfora dedicated to specific approaches

 

[Bluetit1802]

I do not think posts such as “ I did X and got an haba1c reduction of....” are very appropriate, certainly not on the general sections of the forum, maybe on the subfora dedicated to specific approaches

I agree 100%. Posts such as that can come later when the newbie has gained some knowledge. It may lead to expectations that are unrealistic for the newbie, for several reasons.

 

[Grateful]

I agree 100%. Posts such as that can come later when the newbie has gained some knowledge. It may lead to expectations that are unrealistic for the newbie, for several reasons.

On the other hand, when I was first diagnosed with T2D I had absolutely no "peer examples" at all. I am in America and had not found this forum. I did the low-carb diet, with no drugs, on the advice of my doctor, but initially thought he was probably just jollying me along prior to loading me up with drugs later (I even wondered about his competence). All the standard advice I found on the American Diabetes Association website and in other places said almost nothing about low-carb, which was another reason to think my doc must be weird.

Then, about a month later I saw an article in the ADA's magazine telling the story of someone who had actually reversed his diabetes with a low-carb diet; this was the first concrete example I had seen and I began to think that my doctor was onto something.

That did not prevent me from being incredibly shocked when the HbA1c at 2.5 months showed complete reversal. It was actually just as shocking as the initial diagnosis. I think I could have avoided some of those huge emotional swings if I had found this forum at diagnosis, and been able to read the stories of (dozens? hundreds? thousands!) of people who have reversed their T2D with diet alone (or diet + Metformin).

Also, let's imagine that I had either been (1) lacking motivation or (2) lacking information about low-carb foods. This was not my case, but if it had been the case, it is quite likely that, absent being able to consult this forum, my attempt to reverse T2D with a LC diet would have failed!

I've now been reading this forum for nearly three months. When I joined, I had already "reversed" my T2D but at the time, still felt dazed, like it was a big miracle. Well I now know that this is not true. It is the norm for people matching approximately my profile at diagnosis. There is nothing magical about it, in fact it becomes almost boring reading how effective it has been for so many people here.

We need all of those individual stories. They are incredibly motivational for the newly diagnosed, if those newbies are in any way medically suited to a low-drug solution. Those stories are by far the best feature of this forum, in my opinion -- even more important than advice and support. That will only change when effective dietary approaches to Type 2 diabetes become the medical norm and those individual stories become redundant information. (The use of the word "when" in the last sentence reflects my optimism!)

(Edited later to insert the words "Type 2" into the penultimate sentence.)