New NICE guidelines.

Oldvatr said:

Unfortunately, in a monopoly market, and a sadly increasing but captive audience, then market share will still increase regardless of price. The only way that could change is to assist other manufacturers to bring generics to market.

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UH! - Have you ever seen the generic market? I used to be an inventory manager for one of (if not the biggest) UK Pharmaceutical wholesaler - drugs are kept on license for 'x' amount of years to enable developing companies to recoup their costs which at least in part go towards developing new drugs, they then have to try and compete with generic makers who can throw these meds out for a fraction of the price - but if we didn't have this licensing of new drugs - we not see some of the life-saving meds that have come onto the market in recent times.

The generic, grey market and parallel import markets are HUGE; unfortunately some generics don't work as efficiently as the brands, or use ingredients that can cause further problems for patients.

I've just fallen into this myself with something as common as effervescent co-codamol as my pharmacy's wholesaler has changed to brand containing Aspartame (to which I have a severe allergy - and only thought to check after a weekend of being frighteningly ill)

I know exactly how they are able to source other brands - but not really my place to say - I still take two branded meds because of severe reactions with generics. It's an even bigger problem in Wales because our stupid assembly don't charge or scripts - so there is a massive effort to drive costs down even further - certainly not for the benefit of customers and potentially resulting in a longer higher term cost for care-givers.

Oldvatr said:

You raise a very good point here. I too was surprised to see the Glitazones still being recommended as a general issue drug,. I was on Actos for some time, but got taken off after my heart attack. I had previously been on Avandia, but in that case it got banned before I had my heart attack. The NICE recommendation is for Actos only , which is pioglitazone.

We must take into account that NICE is a comittee that meets infrequently. and in common with comittees eveywhere it takes time to formulate policies and then takes even longer to agree the wording. I am not surprised it is behind the times in regard to dietary matters since there have been major changes just in the last year (LCHF for instance). There is still a querty over high fat diets and T1D which seems to be being ignored at the moment. It may change things yet again. So, NiCE tends to be a dinosaur that takes a while to react to someone biting its tail. You suggest <<having carbs with every meal>> is a bad thing, but i would suggest that all meals will have carbs in them, its just a question of how many. else we die !

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Aha. Some would say you don't need any carbs because you can get enough (glucose) from proteins and fats. You do need fibre though so at least some carbs makes sense.

CollieBoy said:

Might I suggest Price! Why bother to save patient sufering, if you can save a penny!

Some cannot cope with Metformin, but deal with Gliclazide relatively easily!

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True but Gliclazide has a completely different function from Metformin. The former stimulates the pancreas to produce more insulin whereas Metformin reduces insulin resistance in the muscles and slightly reduces the liver's glycogen output. Many T2s would be expected to already have excess insulin?

silky1 said:

I can't say I've read it all, nor have I read every response, however (and I appreciate this may go against the grain for some of you) - but since diagnosis, I've lived on a diet of fruit (Lots of people say fruit, noooooo), fruit juice with more ice than juice, no added fat omelettes (I bought one of these true non-stick pans) and gluten free pasta or rice - with a lean meat of gluten free breaded chicken - I know some people including my D nurse would have horrors at the amount of fruit I eat - yet my HbA1C has dropped from 106 to 44 in 3 months with 75% of my self readings being below 7.

As a newbie to Type II Diabetes I'm sure I've got loads to learn and will have many questions, but I'd far sooner learn it from my own ups and downs (I'm sure there will be times when I get it wrong) and the experience of others and how they manage their conditions rather than reading a book full of guidelines from an organisation with probably limited (if any) experience of TII Diabetes between them

Just my opinion

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Well done getting your levels down. It is your score, so your D nurse should support what you are doing. I would only ask that you check the Vitamin B side of your diet, since there is one that you may need to consider supplementing (B6 I think). I understand you not wanting to know every nuance of the NICE guidelines, but it is the official basis for our treatments, and the medical profession is required to follow them quite strictly. at the moment it is likely that I now know more than my DCN or GP since they probably have not had a chance to read or digest its contents, and i may have to use my knowledge of it if we need to discuss changes to my care plan at my next months review. I too have had a similar success in dropping my HbA1c in the last 3 months, so I expect I will want to edit my prescription to save the NHS some more pennies.

Daibell said:

Aha. Some would say you don't need any carbs because you can get enough (glucose) from proteins and fats. You do need fibre though so at least some carbs makes sense.

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I had a discussionwith my buddy about the LCHF diet. He is T1D and on a pump. He explained that there is a question mark over the HF part of this diet, since there is new research that seems to show that T1D suffer a specific form of Insulin Resistance that is triggered by high fat content, and that this is something that he has personal experience of. The attitude to HF has only recently changed, and follows publication of one report. Although I am doing LCHF myself, I am aware that there may still be question marks about the fat content. Your observation on fibre is quite valid, and I would add that there are micronutrients that would also be missing and may need supplementing. Personally i would find lower than 20 gms a day impossible to live with.

Daibell said:

True but Gliclazide has a completely different function from Metformin. The former stimulates the pancreas to produce more insulin whereas Metformin reduces insulin resistance in the muscles and slightly reduces the liver's glycogen output. Many T2s would be expected to already have excess insulin?

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It is an urban myth that us T2D's are awash with unused insulin. Sometimes Insulin resistance acts to restrict the production of insulin in the Pancreas, or acts as an autoimmune disease to kill off beta cells. Looking at the Krebs Cycle, there are at least three different mechanisms that control the passage of glucose in the bloodstream at the cellular level, and any one of these mechanisms can go wrong. This Cycle explains Metabolic Syndrome, heightened cholesterol levels, and many other aspects of T2 life and death. As a T2 on Metformin, I was placed on Gliclazide as second line when my bgl continued to rise above the NiCE guidelines, and I benefited from both medecines, thank you. i would point out that Metformin has a primary mechanism of restricting the production of glucose in the bloodstream, and the other mechanism you quote, namely reduction of insulin resistance in muscles, is largely unsubstantiated, although I did read an ADA journal where they did note a slight effect in some peripheral muscles in a small subset of test subjects.

Oldvatr said:

Well done getting your levels down. It is your score, so your D nurse should support what you are doing. I would only ask that you check the Vitamin B side of your diet, since there is one that you may need to consider supplementing (B6 I think). I understand you not wanting to know every nuance of the NICE guidelines, but it is the official basis for our treatments, and the medical profession is required to follow them quite strictly. at the moment it is likely that I now know more than my DCN or GP since they probably have not had a chance to read or digest its contents, and i may have to use my knowledge of it if we need to discuss changes to my care plan at my next months review. I too have had a similar success in dropping my HbA1c in the last 3 months, so I expect I will want to edit my prescription to save the NHS some more pennies.

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Thank you - one of the few times I wish i could put my care firmly in the hands of my GP and family (and believe me, that isn't something I say lightly) - between my sister, daughter and mother, they have more experience (and qualifications in) diabetes than I could shake a stick to.

When I have a question, it's usually my sister, daughter or GP I speak to - rightly or wrongly I don't feel comfortable with the practice nurse who because I'm severely disabled as well, talks and treats me as if I'm a deaf inbecile rather than someone with a degree, MBA and teaching qualification - that's not boasting - but I loathe stereotyping particularly when in over 99% of cases - they get it wrong.

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It's B12 and Folate I think you're referring to - I have coeliac disease so get quarterly B12 jabs - Folate I cannot tolerate in any shape or form - but thanks to self checking and regular blood tests for anything you can shake a stick at - I am monitored very carefully as I have an inherited issue with iron stores which I can't seem to hold.

PS - I'd been telling the medical profession for a LONG time I was convinced I was diabetic or at least insulin resistant and no-one would listen - show me how many others don't but can drink `12+ cans of coke or lucozade every day - with the number steadily increasing and now I know more - running up to my diagnosis, I was borderline going into a Hyper coma = no-one had been able to wake me or keep me awake for about 2/3 weeks (by this time, I was way past the numbers mentioned above - really scary now

silky1 said:

I can't say I've read it all, nor have I read every response, however (and I appreciate this may go against the grain for some of you) - but since diagnosis, I've lived on a diet of fruit (Lots of people say fruit, noooooo), fruit juice with more ice than juice, no added fat omelettes (I bought one of these true non-stick pans) and gluten free pasta or rice - with a lean meat of gluten free breaded chicken - I know some people including my D nurse would have horrors at the amount of fruit I eat - yet my HbA1C has dropped from 106 to 44 in 3 months with 75% of my self readings being below 7.

As a newbie to Type II Diabetes I'm sure I've got loads to learn and will have many questions, but I'd far sooner learn it from my own ups and downs (I'm sure there will be times when I get it wrong) and the experience of others and how they manage their conditions rather than reading a book full of guidelines from an organisation with probably limited (if any) experience of TII Diabetes between them

Just my opinion

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Please read the following article from Time. I cannot vouch for its veracity or tell if it is biassed, but it ties in with other articles I have read about fructose. The link is:-
http://content.time.com/time/health/article/0,8599,1892841,00.html

silky1 said:

Thank you - one of the few times I wish i could put my care firmly in the hands of my GP and family (and believe me, that isn't something I say lightly) - between my sister, daughter and mother, they have more experience (and qualifications in) diabetes than I could shake a stick to.

When I have a question, it's usually my sister, daughter or GP I speak to - rightly or wrongly I don't feel comfortable with the practice nurse who because I'm severely disabled as well, talks and treats me as if I'm a deaf inbecile rather than someone with a degree, MBA and teaching qualification - that's not boasting - but I loathe stereotyping particularly when in over 99% of cases - they get it wrong.

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It's B12 and Folate I think you're referring to - I have coeliac disease so get quarterly B12 jabs - Folate I cannot tolerate in any shape or form - but thanks to self checking and regular blood tests for anything you can shake a stick at - I am monitored very carefully as I have an inherited issue with iron stores which I can't seem to hold.

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I am sorry to hear of your other tribulations. i am glad you are being well cared for. I lost my mother to diabetes, ao mine is inherited. I have to rely on my GP, who has at least taken the steps to listen to and check my research and is moving towards becoming a good ally in my journey. I have just messaged you again about something I have found on the web that may be of interest to you, I was actually researching it for a friend of mine who is T1D and has also gone on a fruit diet in the belief that (a) the body does not metabolise fructose and (b) fruit is low carb, so must be good for diabetics, right? Good luck, and once again well done in your HBa1c. There is another thread section where you can pat youself on the back as it were, and share your successes with the community.

Oldvatr said:

I am sorry to hear of your other tribulations. i am glad you are being well cared for. I lost my mother to diabetes, ao mine is inherited. I have to rely on my GP, who has at least taken the steps to listen to and check my research and is moving towards becoming a good ally in my journey. I have just messaged you again about something I have found on the web that may be of interest to you, I was actually researching it for a friend of mine who is T1D and has also gone on a fruit diet in the belief that (a) the body does not metabolise fructose and (b) fruit is low carb, so must be good for diabetics, right? Good luck, and once again well done in your HBa1c. There is another thread section where you can pat youself on the back as it were, and share your successes with the community.

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How much is environmental and how much in the genes is anyone's guess - my grandmother, dad's sister, my dad and my sister - the first two were full T2 diabetics - my late dad and sister both had gall bladder and pancreatic issues - my father passed away from acute pancreatitis which turned chronic - my sister is battling secondary breast cancer so has this to cope with as well, and I've had two acute attacks of pancreatitis since my dad passed away - yet - no there appears to be no genetic marker to say this familial (same with the breast cancer!!)

I'm most certainly not patting myself on the back - give three or four more HbA1C's at similar levels - then I might be patting myself on he back - I was chuffed to hear how much it has dropped - but I have a long way to go yet - the biggest irony re: the pancreatitis is that neither me or dad drunk / drink alcohol and it apparently it is all down to pure chance

Wow. Reading all that I am somewhat concerned that the experts that will be treating me may not be that expert. My first visit is on Friday. I really have no idea what to expect.

MikePea said:

Wow. Reading all that I am somewhat concerned that the experts that will be treating me may not be that expert. My first visit is on Friday. I really have no idea what to expect.

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Hi Mike.There is masses or information and experience in this forum, and elewhere in cyberspace. Remember that the doctor is a practioner of many skills, but Master of none. These new guidelines will take a while to be absorbed by our medical team who probably had their diabetes training some time ago. If you do some research into the condition, then you will find that quite quickly you will become the expert in how things affect you and what you need, I find that i can now have a sensible dialogue with my GP and I find I am leading him by the hand rather than him dictate. It helps to read the NICE guidelines so that I understand the constraints that are laid down on him and the Practice, and we work out a care plan with this in mind. So far we are succeeding, and I am in a better place than I was 6 months ago. the real experts can be found on this site since we live with it from day to day

Oldvatr said:

Hi Mike.There is masses or information and experience in this forum, and elewhere in cyberspace. Remember that the doctor is a practioner of many skills, but Master of none. These new guidelines will take a while to be absorbed by our medical team who probably had their diabetes training some time ago. If you do some research into the condition, then you will find that quite quickly you will become the expert in how things affect you and what you need, I find that i can now have a sensible dialogue with my GP and I find I am leading him by the hand rather than him dictate. It helps to read the NICE guidelines so that I understand the constraints that are laid down on him and the Practice, and we work out a care plan with this in mind. So far we are succeeding, and I am in a better place than I was 6 months ago. the real experts can be found on this site since we live with it from day to day

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I suspect most GPs even the diabetes experts don't have enough time to keep up with all the latest guidelines across their subjects. My current diabetes GP did the Warwick course for diabetes but is still a GP and has to cover everything which is quite impossible. We can in many ways become experts in our own ailments as we have the time and focus. Over the years I've found the NICE diabetes guidelines to be quite sensible overall.

Daibell said:

I suspect most GPs even the diabetes experts don't have enough time to keep up with all the latest guidelines across their subjects. My current diabetes GP did the Warwick course for diabetes but is still a GP and has to cover everything which is quite impossible. We can in many ways become experts in our own ailments as we have the time and focus. Over the years I've found the NICE diabetes guidelines to be quite sensible overall.

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I would go so far as to say that they seem to be more patient friendly this year.There are some things that I don;t fully agree with, but they do seem to be listening to us a bit more.

I have a question on the NICE guidelines. Does it mention blood sugar levels before and after meals? I can't see it but have I just missed it?

From what I see, there are no specific guidelines on how often to test, when to test, or what ranges to aim for, but I have seen this advice somewhere on the Forum. i see that there is another section on Self Monitoring added (para 2.5) where the jury is out on any recommendations about self test regime guidelines.

On a personal note, and indirectly associated with T2 and NICE, I see they have changed their guidelines for Clopidogrel, which is a medication I am currently prescribed. i had 2 strokes and a heart attack to boot, so think I still need it. Will need to talk to the Boss about this one.

Oldvatr said:

From what I see, there are no specific guidelines on how often to test, when to test, or what ranges to aim for, but I have seen this advice somewhere on the Forum. i see that there is another section on Self Monitoring added (para 2.5) where the jury is out on any recommendations about self test regime guidelines.

On a personal note, and indirectly associated with T2 and NICE, I see they have changed their guidelines for Clopidogrel, which is a medication I am currently prescribed. i had 2 strokes and a heart attack to boot, so think I still need it. Will need to talk to the Boss about this one.

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Thanks I couldn't see any numbers quoted on this but I assume (don't know) that they had been in previous guidelines as this website quotes them. I don't think I have looked at the NICE guidelines before and wondered what the previous guidelines said regarding self testing.

Hiitsme said:

Thanks I couldn't see any numbers quoted on this but I assume (don't know) that they had been in previous guidelines as this website quotes them. I don't think I have looked at the NICE guidelines before and wondered what the previous guidelines said regarding self testing.

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Printout of PDF of Cliical Guideline 87 (Mar 2010)

CollieBoy said:

Printout of PDF of Cliical Guideline 87 (Mar 2010)
View attachment 16666

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Thank you @CollieBoy
So it seems now that there are no NICE guidelines on Blood Sugar targets for self testing for Type 2. Soon after diagnosis (earlier this year) I found on this site
Type 2 diabetes

4 to 7 mmol/L - before meals

under 8.5 mmol/L - 2 hours after meals

I noticed these had changed slightly - I found these 23 September 2015 - again on this site

4 to 7 mmol/L - before meals

under 8.5 mmol/L - at least 90 minutes after meals

These I have used for me and gave me really helpful targets which are still my aims. Aiming at this my HbA1c dropped from 95 to 50 and last one of 33. So as I understand it now there are no helpful targets. It all seems so woolly. I would love to encourage others to aim for the old targets but assume now we shouldn't even be encouraging self testing. I am totally convinced that for me without testing on a regular basis I would not have had anything like the reduction in HbA1c that I have had. I would accept for me now that I no longer need to test as often (I don't test anything like as much as I did) but I still want to keep good control. .Even 6 months between HbA1c tests I think is too long without self testing.