No benefit of self-testing for type 2

[HpprKM]

What a selfless thought - our children and grandchildren matter

 

[Sid Bonkers]

Re: No benefit of self-testing for type 2 and my own fears

I am really mystified why doctors seem adamant not to self test, my own GP - a very reasonable and helpful lady - really does not want me to self test - I am not asking for strips to be paid for (though not sure why we should be entitled to this, as diabetes is a potentially a life threatening disease), so I do find it difficult to understand where she is coming from :?

Next time you see your GP why not ask her, she may have a convincing answer but I somehow doubt it.

The latest 2010 NICE guidelines for Bg levels for T2's are as follows:
Fasting (waking and before meals).......between 4 - 7 mmol/l
2 hrs after meals........................no more than 8.5 mmol/l

Print or write down these guidelines and without being aggressive ask you doctor how you can achieve the postprandial (after meal) figures without testing your blood glucose, if she says something like "oh we can tell everything we need from your HbA1c" ask why the NICE bother to work out these figures. Im pretty sure she will not have an answer

In point of fact it is entirely possible to have an HbA1c in the 6's or even the 5's and still have large postprandial spikes, the only way is to test.

Good luck for your retirement by the way

 

[Daibell]

I just had my 6 monthly GP visit and during our 'discussion' I was told I should not be self-monitoring despite having a high'ish HbA1c. I explained that I did this to find out what foods affected by BS. I also found on an overseas holiday that the time shift completely messed-up my BS causing it to rocket (morning glucose dumping?) for few weeks. I found this by self-monitoring and cut back my carb intake further. I was told I shouldn't have cut back and to have a normal healthy diabetic diet. You can imagine my comments. I've just read my NHS County Diabetes Guidelines which are excellent and indicate that if you are on sulfonylureas you should self-test to avoid hypos. Well, I'm on sulfonylureas.....

 

[HpprKM]

I read this post with interest, then have to confess ignorance - what are 'sulfonylureas...'?

 

[HpprKM]

To Sid Bonkers re:

Next time you see your GP why not ask her, she may have a convincing answer but I somehow doubt it.

- this sounds like good advice, I think I will this and get back to you with the answer!

 

[sugarless sue]

I read this post with interest, then have to confess ignorance - what are 'sulfonylureas...'?

Drugs such as Gliclazide.

 

[cugila]

what are 'sulfonylureas...'?

If you want all the technical stuff..........

Sulfonylureas
The sulfonylureas act mainly by augmenting insulin secretion and consequently are effective only when some residual pancreatic beta-cell activity is present; during long-term administration they also have an extrapancreatic action. All may cause hypoglycaemia but this is uncommon and usually indicates excessive dosage. Sulfonylurea-induced hypoglycaemia may persist for many hours and must always be treated in hospital.

Sulfonylureas are considered for patients who are not overweight, or in whom metformin is contra-indicated or not tolerated. Several sulfonylureas are available and choice is determined by side-effects and the duration of action as well as the patient’s age and renal function. Glibenclamide, a long-acting sulfonylurea, is associated with a greater risk of hypoglycaemia; for this reason it should be avoided in the elderly, and shorter-acting alternatives, such as gliclazide or tolbutamide, should be used instead.

Source : BNF 61

 

[HpprKM]

Thx Cugila, just wondered if they were contained in Metformin, but assumedly not! Also somewhat intrigued by the comment that they can be prescribed to T2s who are not overweight, as I have been writing on the concern of my weight loss since being on Metformin and not in the overweight category :?

 

[cugila]

These are just one of a group of anti-Diabetic drugs.

Metformin is a Biguanide, a stand alone drug :

Metformin, the only available biguanide, has a different mode of action from the sulfonylureas, and is not interchangeable with them. It exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation of glucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells.

Metformin is the drug of first choice in overweight patients in whom strict dieting has failed to control diabetes, if appropriate it may also be considered as an option in patients who are not overweight. It is also used when diabetes is inadequately controlled with sulfonylurea treatment. When the combination of strict diet and metformin treatment fails, other options include:

Sulphonylureas as above. Gliclazide in particular will encourage weight gain so diet has to be watched when using it.

Then there are other AD drugs as here.......

Acarbose, an inhibitor of intestinal alpha glucosidases, delays the digestion and absorption of starch and sucrose; it has a small but significant effect in lowering blood glucose. Use of acarbose is usually reserved for when other oral hypoglycaemics are not tolerated or are contra-indicated. Postprandial hyperglycaemia in type 1 diabetes can be reduced by acarbose, but it has been little used for this purpose. Flatulence deters some from using acarbose although this side-effect tends to decrease with time.

Nateglinide and repaglinide stimulate insulin release. Both drugs have a rapid onset of action and short duration of activity, and should be administered shortly before each main meal. Repaglinide may be given as monotherapy for patients who are not overweight or for those in whom metformin is contra-indicated or not tolerated, or it may be given in combination with metformin. Nateglinide is licensed only for use with metformin.

The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration. Pioglitazone can be used alone or in combination with metformin or with a sulfonylurea (if metformin inappropriate), or with both; the combination of pioglitazone plus metformin is preferred to pioglitazone plus sulfonylurea, particularly for obese patients. Inadequate response to a combination of metformin and sulfonylurea may indicate failing insulin release; the introduction of pioglitazone has a limited role in these circumstances and the initiation of insulin is often more appropriate. Pioglitazone is also licensed in combination with insulin, in patients who have not achieved adequate glycaemic control with insulin alone, when metformin is inappropriate. Blood-glucose control may deteriorate temporarily when pioglitazone is substituted for an oral antidiabetic drug that is being used in combination with another. Long-term benefits of pioglitazone have not yet been demonstrated.

Source : BNF 61

 

[HpprKM]

Cugila, thanks again for so much information. At the bottom line I am wondering, if as a non-overweight T2 on Metformin if it is the most suitable drug for me - I realise that you cannot answer that question, but I am wondering if I should discuss this with my GP - as my sugar levels seem to be remaining in control and, other than weight loss, am not aware of any other side effects, or whether to leave well alone? I know you will refer me to discuss with my GP and I will do so, but as we all know, we cannot always rely on the so called 'experts' theories completely.

 

[cugila]

I have previously been on max doses of Metformin and Gliclazide for a while, then stopped the Glic and eventually came off the Met too. I now take 1g Met in the morning as an adjunct to my Byetta and haven't found it has made any detrimental difference to weight. It also has other CV benefits so am happy to continue with it. The ideal would be none at all, but I don't think TBH that will happen any time soon. My anti-Cancer treatment knocked my immune system about and I still have problems now after 12 months or more so I need the extra help.

Metformin dosn't always promote weight loss.......I don't think it did in me. It was Byetta and diet changes that did that for me. You can always try it for the benefit it could give you and as I say to others, if weight loss DOES become a factor.......up the calories a little.

It isn't all about just carbs/protein and fats........some tweaking in other areas can also help.....

 

[HpprKM]

I have previously been on max doses of Metformin and Gliclazide for a while, then stopped the Glic and eventually came off the Met too. I now take 1g Met in the morning as an adjunct to my Byetta and haven't found it has made any detrimental difference to weight.

Really good to hear you are doing so well, and wondering what your average blood sugar readings are now - and what they were pretreatment :?:

 

[catherinecherub]

According to this article, Type2's in Canada are having the same problem. Seems this journalist knows best!!!!
http://www.timescolonist.com/opinion/Di ... story.html

 

[Sid Bonkers]

It occurred to me the other day that the urban speed limit in this country is 30 miles an hour, how lucky are we that our cars have speedometers that tell us when we are going over that speed, without them we wouldnt know what speed we were doing which could be dangerous and cause serious accidents that would cost the NHS squillions of £'s.

 

[sugarless sue]

This article, while freshly dated, is either a re-hash or the same article he published about two years ago !

While recycling is good this particular one is best put in the compost heap !

It is on the Forum somewhere already.

 

[HpprKM]

Re: Canadian Article - As a dual Canadian Citizen I just want to say that Canada are forerunners in medical advances (after all we all know where Banting came from)! Born in Alliston, Ontario his house is now on show in London, Ontario. I have visited that house some years ago, never dreaming that one day I would be diagnosed with diabetes..... Of no relevance at all really, but one of the universities he went to was UWO, and I am proud to say my son also went to that university juhttp://en.wikipedia.org/wiki/Frederick_Banting Yes, I know he was a long time ago, but certainly cannot be forgotten in the world of diabetes advances. I have no idea what the writer of that article was thinking, but would not mind betting they are not diabetic.

I just want to quote from the Canadian Diabetic Care Advice on managing diabetes:

Monitoring blood glucose
A speedometer on your car helps you control your speed... monitoring helps you control your blood glucose.

Blood glucose readings:

Let you know what your blood glucose level is at the moment you take it.
Help you understand the relationship between the food you eat, physical activity, medications and your glucose level.

Just to put the record straight, diabetes is a huge problem in Canada as in the States and, sadly,I know many Canadians who are diabetic, and I feel sure they are doing their best to combat it :wink: