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