NHS - Unreal comments

[Ali H]

I have recently had a bariatric consultation that involved seeing an endo and a dietician. I have today received a written report and I have had to read it twice just to be sure I understand the comments surrounding blood checking. I will type it word for word below (the specific bit about testing that is) -

We did discuss that she is over testing her blood sugar levels and that we advise people to test only before meals and at bedtime to get a true picture of what is happening with their levels. As she tests after eating, she notices the normal fluctuations in blood glucose that occur, and is concerned that any dietary changes would cause mealtime spikes in her blood glucose levels, for example she has noticed that after consuming certain fruits she sees a rise in her blood sugar levels which is normal and would not affect her overall control.

Blah blah we discussed some dietary changes and that this may well be at the expense of very stable blood glucose levels throughout the day but not impact on her HBA1C.

I am astounded at the above, having been complimented elsewhere in the letter on my good control and current HBA1C result, I am being accused of over testing (erm I have had this last box of strips for at least 4 months and it is still less than half gone.....) and testing at the wrong times because all that is doing is revealing the normal spikes you see after food!

How on earth do they think I have reduced my HBA1C from 12.6 at diagnosis to 6.4 at the time of this consultation? By following NHS advice, not seeing what spikes my levels and not adjusting my diet accordingly? How on earth can ignoring post prandial spikes and eating fruit in my diet as prescribed not have an affect on my overall HBA1C? That is just not possible because if my levels are raised more often, this will affect the average surely?

Maybe I am reading this all wrong, thoughts anybody?

Ali

 

[Hobs]

I do not think they have got this right! To test before a meal will make sure you are starting at the right level before it will rise form the anticipated meal. To NOT test 2hrs after a meal will totally negate the before meal test as you will not know by how much the food has raised your level. Managing diabetes is all about keeping levels within set parameters and the only way to do this at home is by self testing before and then 2hrs after eating. If its not, then I have been doing it all wrong for the last 12 years.

 

[mo1905]

Not sure what's wrong or right butI was told the most important readings are prior to earing. Not sure why though !


Sent from the Diabetes Forum App

 

[Ali H]

Exactly Hobs, in the early days that is what I did to see the rises caused by various meals. How else do you know the effect it has? How can more spikes not lead to a higher HBA1C too?

Right now, I seriously feel like saying stuff the lot of it, totally hacked off.

Ali

 

[Daibell]

Hi. I'm not surprised. The NHS seems to be more about slavishly following process and not thinking laterally enough along the way. From my own experience and from other posts on the forum HCPs don't seem to realise that food affects the direction of diabetes. They will talk about having carbs at every meal to ensure the brain keeps going but not thinking that it affects the diabetes itself. Being an engineer by profession I was trained to measure as part of a process of management and I have seen the best engineers always doing this. How HCPs can assume that guessing is better than measurement seems quite bizarre to me. All we can do is take control as most of us do in an intelligent way and hope that the NHS learns from some of the practices in other areas of science and engineering. Having just watched the TV program about brain surgery I can see that there are areas within the NHS of great excellence and where measurement and analysis are very much the order of the day; perhaps it's all about money....

 

[coco4]

Hi yes I was told only to test before meals, before bed and when I woke in the morning. Diagnosed type 1 May 2011, so still quite new to it all. Mind you this was from a Doctor who "specializes" in diabetes who also told me he never knew how to remember which was which when referring to HYPOglycemia and HYPERglycemia!!!!!! My husband replied at the time, "it's easy just think of the O in hypo as a zero (low) and the E in hyper as elevated (high)." Doctor said he would try. I thought I've got no hope relying on you, thank goodness for this forum

 

[AMBrennan]

Being an engineer by profession I was trained to measure as part of a process of management and I have seen the best engineers always doing this.

I really hope that that's an unfortunate misleading oversimplification as observations are useless if you can't take any action to change things.

How HCPs can assume that guessing is better than measurement seems quite bizarre to me.

That's because they are saying no such thing - they are saying that the post-meal observations cannot be used to improve your control. Whether that's true is debatable, but it is not a blatant strawman.

hope that the NHS learns from some of the practices in other areas of science and engineering

Be careful what you wish for - people on this site are more fond of common sense/theory based medicine ("How can more spikes not lead to a higher HBA1C too?") and scientific approach is what current NICE guidelines are based on.

 

[Daibell]

Hi AMBrennan. Any management process involves setting objectives, measuring and taking action to ensure the objectives are met. By measuring 2 hours after a meal you can change your diet, take more exercise, discuss changed meds etc with the GP and so on. Without this information you are moving into guesswork or taking no action or the wrong action. It's not debatable that a 2 hour measurement helps many people; if you know the effect of food on you then you can take action to improve control as many posters on this forum can testify to. I agree with you that the current NICE guidelines are based on good science and the latest Oct 2012 update talks quite clearly about diabetics having a meter and measuring; sadly some HCPs won't follow these guidelines.

 

[Ali H]

Exactly Daibell, if you don't know how you respond to food you cannot moderate to keep your HBA1C down. A Pre prandial reading only tells you if you have come back to an acceptable level some hours after food, it doesn't tell you just how much that food affected you.

Ali

 

[oweri02]

Ali, that's awful - sometimes you wonder where the health-worker's empathy is.

DAPHNE and InSight courses you HAVE to pre and 2 hour post-test to work out what your insulin requirements are, e.g. number of grams of CARBS= X number of units of Insulin, and if your pre-test you are above your chosen value then how many extra units of insulin to bring that back into check also.

My only guess is that the "over testing her blood sugar levels" comment may have thought you were testing within the post-2 hour window, which would likely be unhelpful. Trying to believe positive intent...

Though, there's nothing stopping you asking the author of the report to clarify??

 

[Ali H]

No, she knows I was testing 2 hours after and that I know what I am doing. My use of strips is frugal to say the least, I do not abuse their provision. Oh well, lets ulcerate our limbs, get gangrene and all the other complications because the NHS recommends pre meal and beddy byes testing only. No wonder my ancient parents are clueless about their diabetes.

Ali

 

[mickthered]

still awaiting my first hospital diabetes clinic or whatever its called but have been advised by the docs to test about 3 -4 times a day at various times so that when I do go the more info I have the easier it will be for them

At the moment have only been testing mostly once a day around 2 hours after my main meal

 

[Ali H]

Your Doc sounds enlightened, good luck, see if you can start a food diary and then you can show them your readings in relation to what you have eaten.

Ali

 

[de130770]

i gave up with the hospitals a few years back now.
it is my gp that sends me for the bloodtests.
the hospital would not consider me for a pump even when moorefields hospital could not contrall my blood suger swings.
it was a case of feeding me all day to get the blood sugers in the 20's for them to drop to 1.1 by 11pm with out the evening insulin.
if a decent hospital has truble how do i stand doing it at home?

 

[Superchip]

IMHO if anybody blindly follows the nhs guidlines on diet or some of the quack advice on testing that has been quoted on here then more education from these forums is called for.

I feel so sorry for newly diagnosed diabetics that have no other choice than to listen to their gp's and hcp's who, lets face it either don't know, don't want to know, or have to toe the 'official line' ,there are of course some intelligent ones, but few and far between. I've met all types over the years, there are more opinions out there than stars in the galaxy.

I'm totally with Daibell and others, especially regarding management, measuring and taking appropriate action, makes sense. of course if some are happy to play the guessing game ? so be it.

I spent 30 years as an engineer, so testing as often as you want is the way to go ! Without a doubt !

GLA Superchip

 

[Endoftheline]

I agree with Superchip as I am on a pump and need to test before and 2 hours after every meal or would not be able to put the correct blouse in or check my basal. After all the diabetes changes day to day according to health and stress and what the day brings.

 

[izzzi]

Hi, Ali

Thank goodness your a few steps ahead of the so called game and they don't like it.

The only way to win is by constant practice and testing. In our world success is control.

My doctor told me "whatever your doing, it is working, keep to it"

Must say that this Forum is not a medical or diet expert, nevertheless has made me a more healthy person.

Good luck,

Roy,

 

[Ali H]

It is sad and distressing to read about the poor advice being given, the scathing criticisms of those of us who want to understand things more and test regularly.

Luckily my day to day GP is much better, like you, Roy, he said I don't know what you are doing but keep on doing it. That was when I dropped 5.6 points off of my A1C three months after diagnosis. I want to get this right but I don't need or want patronising and inaccurate treatment along the way.

Ali

 

[hanadr]

The majority of Healthcare professionals truly believe in their own advice. I realised that a while ago. In addition they coukld never amit to being wrong.
They probably believe it was their advice that got the HbA1c down.
If you believe their advice is Rubbish, which I'd concur with, ignore it and keep doing what works for you. I started out that way and now the diabetes team at my Health Centre have come round to my way of thinking. It's only taken about 6 years!
Hana

 

[lukkymik]

Having read the above its "nice" but scary to know that its not just me that has to deal with lunatic medics who so believe there own hype. OK so i'm an oddment re carbs inas much as I cant work without them therefore if I cut them back I close down so to speak.. However after 10 years my HBa1C has come down from 16 to about 8 and if it drops much below that I really struggle. I was advised by a specialist to cut out all carbs for 3 months "to see how it affected my BSugar levels" I asked him what would I be left to eat then? He didnt understand my concern. I then informed this specialist that carbs occur in nearly every foodstuff in some shape or form so would he be paying for my funeral due to death by starvation. He told me not to be stupid so I said if he could provide me with a carb free diet sheet that I could follow I would do as he asked. 8 years on i'm still waiting!!! Sorry but the only Dr i've ever trusted re diabetes was Dr who was a Diabetic. Unfortunately she emmigrated to New Zealand!!!!!