NHS Direct doctor says... NO testing when taking Metformin

[Lamont D]

Just to be clear; as a Type 2 you will have impaired ability to metabolise carbohydrates.

Some will be able to handle more carbohydrates than others (all carbohydrate turns to sugars things like 'GI' are only measures of the time it takes).

The primary elevator of blood sugars is the carbohydrate we consume.

You cannot know how well your pancreas is working by guessing and you cannot identify which foods spike you by looking at your HbA1c.

You need to be able to assess your own tolerance for carbohydrates and reduce them as necessary; that can only be done by checking your blood sugars before and after eating.

The primary reason for not giving Type 2's blood testing equipment is cost. It has nothing to do with assisting you in managing your diabetes. If you can get your GP to prescribe them great, if not you need to buy them for yourself at least until you get a handle on what you can and cannot eat.

In general the NHS thinks that fats and protein are 'bad' and carbohydrates are 'good'. They are wrong. Almost completely wrong when you are dealing with people like us who cannot metabolise sugars. This advice will change; see - http://drmalcolmkendrick.org/2015/05/20/sorry-seems-to-be-the-hardest-word/

You cannot afford to wait for the orthodoxy to change; you need to sort out what you eat right now. Diabetic medicine for Type 2's is pretty ineffective. Reducing your carbohydrate is not; it is brilliantly effective and can stop your diabetes in its tracks.

You don't need to eat breakfast if you are not hungry, you should avoid porridge unless you know that it does not spike you blood sugars (it spikes mine incredibly quickly and then drops them down quickly too).

As diabetics we are in a the bizarre situation where virtually all the advice we are given is wrong. You don't need carbohydrates, you don't need to avoid fats, you don't need to limit protein to protect your kidneys. Type 2 diabetes is not progressive (if handled properly). Metformin is fine but has trivial implications for your blood sugars.

We're out here on our own without maps; we need to think for ourselves.

Read this forum if you don't believe me.

Best

Dillinger

Great post @Dillinger

If like me, you got the dreaded recommended eat well plate diet, I was ill for more years than I like to remember.
It is as Dillinger has said the carbs that is causing your blood glucose levels to be high.
I can't have carbs in my diet, they make me ill.
The need for this forum is the reason why the recommended diets given by most doctors is so wrong.
The success stories on this forum should persuade you of that!
I am living proof, that you don't need carbs, I am fitter, healthier, and so full of energy, it is beyond most dieticians comprehension!

 

[catherinecherub]

http://www.nursinginpractice.com/article/self-monitoring-blood-glucose-levels

This ongoing controversy led the prestigious journal Diabetes Care to issue an invitation to two authors with opposing views on the usefulness of SMBG in non-insulin taking type 2 patients to publish their arguments for and against. (12,13) Malanda the author of the most recent systematic review argued that there was no substantial evidence demonstrating that SMBG had a positive effect on reducing blood glucose levels in people with type 2 diabetes. Polonsky and Fisher provided an alternative explanation stating that implementing SMBG in unstructured ways was indeed a waste of resources but as part of structured educational package their evidence has demonstrated that those with suboptimal blood glucose control SMBG can be used in partnership with health care professionals to significantly improve blood glucose control.

So this suggests that not only is SMBG useful for all those with type 1 diabetes and insulin requiring type 2 diabetes patients but also for individuals with type 2 diabetes who would like to use it as a way of monitoring their condition. Indeed Polonsky et al found that offering structured training not only to patients performing SMBG but also to their clinicians to help them understand how to support patients, may have enabled the very significant improvements reported. (8) The importance of providing meaningful education to people with type 2 diabetes not on insulin but who want to use SMBG is acknowledged in the NICE Guidance on type 2 diabetes. (14)

 

[Corrodine Healer.]

Sorry for the length of this, it is all relevent...

I felt paticularly unwell the other day, and having gone without food for over 12 hours I tested my blood. My mmol/L was 12.0, which is high (for me).

I was preparing my lunch at the time and wondered if I should still eat my main meal with this high reading, or not? My thinking being - if my reading is already high then eating could raise it even more.

So, before cooking, I thought I'd ring "111" and ask their opinion (as it was a Bank Holiday and my options were limited).
I talked with a very nice lady on the phone. She checked with her superior and came back to me to say it was OK to still eat it. She said a doctor would call me back within the next couple of hours, but if I felt worse to ring 111 again.

Sometime later, after having cooked and eaten, I got a call from another lady saying the doctor was busy but would still call me back at some point. No problem I thought.

When the doctor eventually did call me he asked some routine questions but then launched into a lecture on blood testing!
He insisted I SHOULD NOT BE TESTING at all, as I was on Metformin. According to him, nobody on Metformin should be testing as it interferes with doing so (?!).
I tried to explain I have always tested once a day, originally on my G.P.s instruction (and whilst taking Metformin). I told him the doctor stopped issuing test strips about a year ago (£££), however I have been buying them to continue testing myself (normally only once a day).
I also pointed out to him if I didn't test my blood HOW was I supposed to know whether my diabetes was "under control" or not?
I had only tested twice on this occasion as I felt so unwell. Without testing I wouldn't have known my blood sugar level was the (probable) cause of me feeling ill.

The doctor grew increasingly stroppy saying I was making up my readings, as what I had told him wasn't possible!
WHY would I do such a thing? I even agreed with him that, the longer I went without food, I would have expected my reading to get lower, not higher.

For information my reading(s) that day were:

On waking (my normal testing time) my reading was 7.4
I don't eat breakfast, as a rule.
At 1215 (before eating) and after 12 hours + without food it was 12.0
(Lunch was eaten about 1300)
At 1410 it had reduced to 8.1
At 1515 it was 5.8
I ate again at teatime.
But at 2355 it was back up at 10.4 and I was feeling quite ill again. This time I didn't phone 111, as my previous dealings with their doctor had scared me off doing so!
I live alone, and I went to bed wondering if it would go higher in my sleep and (perhaps) never wake up.

Anyway, if you are still awake after reading all this...
Has ANYONE else been told NOT to take blood glucose readings whilst using Metformin? It's the first time since being diagnosed Type 2, in 2008, that I've ever heard of it.

How the hell is a sufferer supposed to take control of their diabetes WITHOUT knowing what their blood glucose is?

Puzzled.

Not testing in T2 is a cost thing, my nurse told me not to bother as eating right and taking mess wil rule out the need.... Mm mm. Could it be that your body released sugar because you had gone so long without food?

 

[Corrodine Healer.]

My daughter is also on Metformin and has to buy her own test strips, because I am on Insulin, I get mine free. Everyone who is diabetic should be able to monitor their own glucose levels, to be in control. It is a travesty but true most clinics and surgeries have a limited budget and the decision to cut down on issuiing testing kits is purely financial. This monetary consideration, takes precedent over the health of the population. This is not only applicable to diabetics.

 

[Arab Horse]

When I told the nurse I test, she told me that they don't advise that. Only type 1s need to test.
Then in the next breath
She told me to come back immediately if my BG ever rose above 12 mmol/l.

Absurd.

Edited to correct from T2 to T1

And how will you know if it has if you don't teat; bonkers. I was diagnosed with a blood glucose of 18.6 at a routine free NHS health check. I didn't feel ill, had no symptoms so no reason to be tested but was told that my levels were of BS and HbA1c were at the levels where I was in danger of a stroke or heart attack. I can only tell if my glucose is high by testing, it doesn't make me feel unwell, thirsty or any of the other symptoms we are supposed to get.

You would think that it would be cheaper to give people test strips than treat the consequences of long long term poor diabetes control. Worth a letter to the health minister while they are looking to restructure the NHS!

 

[dawnmc]

I agree testing should be compulsory. However this must go hand in hand with proper training/education, and that would mean admitting that carbs are at fault. It would also cost more money if strips were doled out like statins and no follow up, there are so many diabetics these days that time/staff etc aren't available. Many diabetics I imagine think that taking the pills will sort them out and we all know that's not how it works. People just expect the NHS to pick up the pieces and then DLA to fund them when they have their legs chopped off or they go blind etc. It means taking responsibility for our own health, and while we on this forum are keeping ourselves well informed there are many that don't.

 

[Dillinger]

You would think that it would be cheaper to give people test strips than treat the consequences of long long term poor diabetes control. Worth a letter to the health minister while they are looking to restructure the NHS!

It is much much cheaper. Also consider the implications of having an amputation or going blind or being on dialysis for the patient; they go from being a productive member of society paying taxes to being a recipient of state aid.

The trouble is the cost centres are different so no one makes that equation; test strips come out of GP's budgets, hospital admissions/procedures are under a different budget and tax/welfare are completely separate.

It's the wonderful world of healthcare!

Best

Dillinger

 

[Ali H]

Exactly Dillinger, it is a false economy isn't it but they don't seem to learn.

Ali

 

[MikeZ]

It is much much cheaper. Also consider the implications of having an amputation or going blind or being on dialysis for the patient; they go from being a productive member of society paying taxes to being a recipient of state aid.

The trouble is the cost centres are different so no one makes that equation; test strips come out of GP's budgets, hospital admissions/procedures are under a different budget and tax/welfare are completely separate.

It's the wonderful world of healthcare!

Best

Dillinger

Possibly the wrong forum for this but here goes nothing...

As a conservative Yankee, I'll offer my perspective on the entire government controlled, or directed, or however you want to call it....health care notion.

Health care costs are totally out of control and I certainly see the need for revision. I just can't wrap my arms around the idea that the government, (yours or ours), is going to make things better. However, let's assume for this argument that there is no other choice and there really is no going back.

IMHO, this creates a mindset, (among some), that the government's role is right and proper and dare I say EXPECTED??? The real downside, in my mind, is that so many folks give up on taking control and responsibility and just rely on the drugs handed out. This creates a perpetuity that is bad for the individual and society.

It would be wonderful if we could have these things handled for us without any collateral damage. But you can't get someone hooked on a system without it spilling into the way that they view the world.

JMO.

In case you hadn't noticed, I offered no solution. I should be a politician.

 

[zbd]

I was diagnosed in the early 1990's.I was prescribed Metformin initially and over the years progressed to the max dosage, not only of metformin but gliclizide and sitaglyptin, until the doctor told me at the end of last year that he could do no more and referred me to the hospital for suitability of insulin.
In the early days with my GP I was given a meter and a diary, I followed the regime given me to the letter, put the results into a computer spreadsheet to work out averages (all in single figures) and proudly presented these to the Doc who in return showed me my Hba1c results which bore absolutely no relationship or comparison to the diary I had spent the previous 6 months compiling.
I attended the practice's clinic every 6 months for the next couple of years with the same results until I got fed up and binned the meter, and just kept taking the tablets until my Hba1c passed the point of redemption and the hospital recommended insulin.
To my disappointment I then found I had to continue with the metformin and all its anti-social side effects.
The only thing regular testing did for me was to give me something more to worry about and the resulting high blood pressure

 

[Brunneria]

I was diagnosed in the early 1990's.I was prescribed Metformin initially and over the years progressed to the max dosage, not only of metformin but gliclizide and sitaglyptin, until the doctor told me at the end of last year that he could do no more and referred me to the hospital for suitability of insulin.
In the early days with my GP I was given a meter and a diary, I followed the regime given me to the letter, put the results into a computer spreadsheet to work out averages (all in single figures) and proudly presented these to the Doc who in return showed me my Hba1c results which bore absolutely no relationship or comparison to the diary I had spent the previous 6 months compiling.
I attended the practice's clinic every 6 months for the next couple of years with the same results until I got fed up and binned the meter, and just kept taking the tablets until my Hba1c passed the point of redemption and the hospital recommended insulin.
To my disappointment I then found I had to continue with the metformin and all its anti-social side effects.
The only thing regular testing did for me was to give me something more to worry about and the resulting high blood pressure

I use every single test as a guide and monitor for my diet choices.

If something I've eaten sends my blood glucose higher than I want, I eat less next time, or avoid that food completely.

It took a couple of months of intensive testing, but I'm confident now about everything I eat, and its impact.
Basically I eat to my meter. Which has resulted in a low carb diet and steady, non diabetic readings - although if I eat a slice of bread and a piece of cake, I would shot up to the mid teens.
Best thing this forum has ever taught me.

Edited for an irritating apostrophe.

 

[hilte]

Nice guidelines state that diet controlled or Metformin only don't need to test.

Sorry for the length of this, it is all relevent...

I felt paticularly unwell the other day, and having gone without food for over 12 hours I tested my blood. My mmol/L was 12.0, which is high (for me).

I was preparing my lunch at the time and wondered if I should still eat my main meal with this high reading, or not? My thinking being - if my reading is already high then eating could raise it even more.

So, before cooking, I thought I'd ring "111" and ask their opinion (as it was a Bank Holiday and my options were limited).
I talked with a very nice lady on the phone. She checked with her superior and came back to me to say it was OK to still eat it. She said a doctor would call me back within the next couple of hours, but if I felt worse to ring 111 again.

Sometime later, after having cooked and eaten, I got a call from another lady saying the doctor was busy but would still call me back at some point. No problem I thought.

When the doctor eventually did call me he asked some routine questions but then launched into a lecture on blood testing!
He insisted I SHOULD NOT BE TESTING at all, as I was on Metformin. According to him, nobody on Metformin should be testing as it interferes with doing so (?!).
I tried to explain I have always tested once a day, originally on my G.P.s instruction (and whilst taking Metformin). I told him the doctor stopped issuing test strips about a year ago (£££), however I have been buying them to continue testing myself (normally only once a day).
I also pointed out to him if I didn't test my blood HOW was I supposed to know whether my diabetes was "under control" or not?
I had only tested twice on this occasion as I felt so unwell. Without testing I wouldn't have known my blood sugar level was the (probable) cause of me feeling ill.

The doctor grew increasingly stroppy saying I was making up my readings, as what I had told him wasn't possible!
WHY would I do such a thing? I even agreed with him that, the longer I went without food, I would have expected my reading to get lower, not higher.

For information my reading(s) that day were:

On waking (my normal testing time) my reading was 7.4
I don't eat breakfast, as a rule.
At 1215 (before eating) and after 12 hours + without food it was 12.0
(Lunch was eaten about 1300)
At 1410 it had reduced to 8.1
At 1515 it was 5.8
I ate again at teatime.
But at 2355 it was back up at 10.4 and I was feeling quite ill again. This time I didn't phone 111, as my previous dealings with their doctor had scared me off doing so!
I live alone, and I went to bed wondering if it would go higher in my sleep and (perhaps) never wake up.

Anyway, if you are still awake after reading all this...
Has ANYONE else been told NOT to take blood glucose readings whilst using Metformin? It's the first time since being diagnosed Type 2, in 2008, that I've ever heard of it.

How the hell is a sufferer supposed to take control of their diabetes WITHOUT knowing what their blood glucose is?

Puzzled.

Are you taking Metformin in the morning and not having breakfast? Because thats not good.

 

[hilte]

Hi , I hope my thoughts applicable to me are helpful to you :T2 and metformin
a) when newly diagnosed after major non related surgery , my gp practice was great and provided a meter and test strips .
b) after about two years I have recently got a letter - out come ....no test strips or needles can be provided by prescription .

- The evening I got that I was deeply upset since it impacted on the deep trust I had previously experienced in the NHS care provided previously .
Observations - when newly diagnosed I had to contact the needle supplier via their helpline and ( though obviously keen to sell their products ) were very concerned that the needle stick was faulty .

Further conversation with their care line ,if I recall correctly was excellent :

a) newly diagnosed - why not try testing every couple of hours at first and write down food/glucose levels and feelings
b) they thought tit that UK testing was so limited ....why not before , after meals and track a trend with different foodstuffs ( excellent advice) - it was alleged in germany it is common to test often . Then you get to know what foods /when and how to manage them .
c) stick to one type of meter and do check it for inaccuracies .

Personally
,

a) I cannot imagine how a newly diagnosed t2 metformin user can understand the impact of foodstuffs and control their levels without a meter .
b) ALSO I HAVE NOTICED A LONGER TIME SPAN BETWEEN NHS ANNUAL EYE TESTS and 8 weeks on I have to chase for results .
c) PLUS I AM GOING TO CHECK it is doing all the NHS checks that the private eye care provider has to do re NHS eye testing .

d) Similarly , deeply saddened by the GP letter I have now gone out and had to purchase the items myself .
e) I find reading the balance magazine helpful
f) My sugar levels go up with anything with diet in ie sweetners . So you may want to check that out .with your meter
g) for me I can take fizzy water and then add lemon to it -I steer clear of fizzy diet drinks
h) and finally ........my personal opinion is that the short term drops in prescription budget is a precursor to hugh financiail and physicla costs as NHS patients cant help themselves to control their disease .

My pharmacist suggested that I went back to the GP and said it was essential to my care .

 

[LucySW]

This forum represents a tiny minority of people with Diabetes. The vast majority of people I talk to with it are clueless and what's more, don't want to know or change. I have a friend on insulin who is always in the mid to late teens. She was told to eat a banana and porridge for breakfast by the Dr. She told me until a Dr tells her otherwise, she won't change........ despite talking to her about low carbing!

Ali

Unfortunately, in my experience this is true.

 

[LucySW]

I was diagnosed 2yrs ago now and I've never self tested, I was told by my diabetic nurse that it wasn't necessary for me to do it. And yes I too am on metformin. I have only had 2 checks since being put on the tablets exactly 2yrs to the day! Is this how it should be?

Kate, sorry to reply to this late, you probably know all this by now.

But anyway. No it isn't, not really, not if you want to be well and to be better. I think Jenny Ruhl at http://mobile.dudamobile.com/site/phlaunt1?url=http://www.phlaunt.com/diabetes/#2897 is a very good guide, and absolutely reliable. Read around her site. Also another book called
http://www.amazon.co.uk/gp/aw/d/184...hen+becker&dpPl=1&dpID=41Z0WzpCiSL&ref=plSrch

But as to why/how you should test, read here:

http://mobile.dudamobile.com/site/phlaunt1?url=http://www.phlaunt.com/diabetes/#2831

 

[LucySW]

Just to be clear; as a Type 2 you will have impaired ability to metabolise carbohydrates.

Some will be able to handle more carbohydrates than others (all carbohydrate turns to sugars things like 'GI' are only measures of the time it takes).

The primary elevator of blood sugars is the carbohydrate we consume.

You cannot know how well your pancreas is working by guessing and you cannot identify which foods spike you by looking at your HbA1c.

You need to be able to assess your own tolerance for carbohydrates and reduce them as necessary; that can only be done by checking your blood sugars before and after eating.

The primary reason for not giving Type 2's blood testing equipment is cost. It has nothing to do with assisting you in managing your diabetes. If you can get your GP to prescribe them great, if not you need to buy them for yourself at least until you get a handle on what you can and cannot eat.

In general the NHS thinks that fats and protein are 'bad' and carbohydrates are 'good'. They are wrong. Almost completely wrong when you are dealing with people like us who cannot metabolise sugars. This advice will change; see - http://drmalcolmkendrick.org/2015/05/20/sorry-seems-to-be-the-hardest-word/

You cannot afford to wait for the orthodoxy to change; you need to sort out what you eat right now. Diabetic medicine for Type 2's is pretty ineffective. Reducing your carbohydrate is not; it is brilliantly effective and can stop your diabetes in its tracks.

You don't need to eat breakfast if you are not hungry, you should avoid porridge unless you know that it does not spike you blood sugars (it spikes mine incredibly quickly and then drops them down quickly too).

As diabetics we are in a the bizarre situation where virtually all the advice we are given is wrong. You don't need carbohydrates, you don't need to avoid fats, you don't need to limit protein to protect your kidneys. Type 2 diabetes is not progressive (if handled properly). Metformin is fine but has trivial implications for your blood sugars.

We're out here on our own without maps; we need to think for ourselves.

Read this forum if you don't believe me.

Best

Dillinger

Bravo @Dillinger !! Bravo.

Cor you're wonderful.

Lucy

 

[graj0]

It's the wonderful world of healthcare!

Dillinger

It's what happens when bean counters rule the roost.

 

[Jennyjustfeet]

I was told a few years ago that testing wS an expensive commodity if only on meteor min. From then on I felt I was too expensive for the NHS to bother with me. Result - my bolide sugars went haywire and became worse when I be cane wheat intolerant. Result- high abh1c, result- now on gliclezide a low carb diet. Got test strips back begrudgingly and often have hypos!
If the test strips hD not been taken away my sugars would not have got out of control I believe. False economy by NHS

 

[MarkE]

[snipped]
However, let's assume for this argument that there is no other choice and there really is no going back.

IMHO, this creates a mindset, (among some), that the government's role is right and proper and dare I say EXPECTED??? The real downside, in my mind, is that so many folks give up on taking control and responsibility and just rely on the drugs handed out. This creates a perpetuity that is bad for the individual and society.

[snipped]

Wrong end of the stick a tad, my dear chap: the test strips are to enable us to take responsibility/ control for our own condition- the reason they keep giving for their refusal, is that "they" know best and we should not bother our foolish wee heads over the nitty gritty of our own condition. Now THAT smacks more of the attitude you are against, surely?

 

[MikeZ]

Wrong end of the stick a tad, my dear chap: the test strips are to enable us to take responsibility/ control for our own condition- the reason they keep giving for their refusal, is that "they" know best and we should not bother our foolish wee heads over the nitty gritty of our own condition. Now THAT smacks more of the attitude you are against, surely?

I wasn't replying to that particular end of the stick, but rather to the "big picture" stick. Which is this: Because there are so many that willingly and happily latch onto the government teat, it creates problems for legitimate needs and concerns. It creates a divide. And it gives ammo to those that would deny, (test strips in this case), needed supplies or services.

That is "collateral damage" that I spoke of. There can be a tendency to "assume" that people are out to milk the system because so many are.