Not just my GP who tells new T2s don't bother testing!

[Grateful]

It's a bit hard to generalize. I was diagnosed with T2 seven months ago, A1C 8.3% (67). Managed to control it entirely with a low-carb diet and exercise: two months after diagnosis A1C 5.5% (37), five months after diagnosis 4.9% (30). No self-testing at all, just those three A1C tests taken at the doctor's surgery. Soon, the testing interval is likely to be increased to six months.

I have no specialized medical knowledge but this regimen seems to make sense for me. I did lose 10KG in the few weeks after going on the diet and have kept all of that weight off (current BMI is 19). My only regular "self-monitoring" is to weigh myself every few days. I hope this will be a good "proxy" for how well I am managing my T2. If the weight starts creeping up again, I can adjust the diet. (It is already very low-carb, but I can always reduce the portions.)

I'm grateful that the testing is so occasional and non-intrusive, and full of admiration and empathy for those of you who have to do it a lot more often.

 

[JTL]

WOW! an awe inspiring amount of info!
When I told a Locum GP that I intended to use acupuncture treatment, I was applauded for my ingenuity! But then told on the next breath... I won't be able to get such treatment via the NHS. When I pointed out that it would be cheaper to go to a monthly complimentary therapy than continuous repeat prescriptions for the rest of my natural life... it was agreed to in principal, but still he had to go by guidelines.... my illnesses are not life threatening (immediately!)
BP was slightly raised after that chat... but within safe guideline parameters!!
and yes, I go regularly (weekly at mo) to acupuncture, and I believe it is helping me, to a point where I hope soon to wean myself off certain meds I was trained as a Holistic Therapist back in the 1990's and firmly believe that complimentary therapies are just that... they help to work along side of the NHS treatments It's a criminal shame that our NHS is suffering under the NICE guidelines but ever hopeful for new ideas to come to light!

I was having none of that hocus pocus hoodoo voodoo chew leaves instead of deeply researched scientific medicine nonsense Butterfly.
Not my scene at all.
But then I started to research vaccines and other meds.
Western medicine is as good as totally toxic.
The medicines we get are to relieve not cure.
Many of them seriously suspect and many of them dangerous.
We're led to believe that western medicine is the best.
I no longer think like that.
Food as medicine has become part of my life and the way I approach my T2 and I'm having far better results than anyone else at my surgery who take the toxic route.
Honey garlic ginger herbs spices and so on are filled with very powerful substances.
I've come to the conclusion that the west has gone very very wrong in so many ways.
We are destroying our health by destroying peoples knowledge and contact with and of the natural world.
The natural world is you and me and everything else.
But our faulty education and information systems have now led the majority to see the natural world as being something over there. Something seperate from ourselves.
Something we encounter now and then.
Something we should save.
We see science as not the great destroyer but only as the great saviour.
One day our science will cure all ills comfort all needs entertain every desire.
It won't.
For all the wondrous things our science has achieved we still can't feed the world. There's more than enough food and money and we know what it is that needs to be done.
But will we do it?
No.
Stubbornly no.
Many put some kind of freedom argument forward that prevents us.
If we know a simple way to solve such a distressing and deadly problem but refuse to do it then our entire political religious scientific economic grandness is never ever going to fulfill it's potential.
The west has become a fully functioning materialistic dead end.
The west have abandoned the spirit of life for shiny things and comfort and to hell with the important things.
My advice?
Go hug a tree.
There'll be a nice one somewhere nearby.
Make the hug a long one.
Ask the tree a question.
Wait a while and see what starts to fill your mind.
That will tell you an awful lot.
Okay rant over.

 

[Ajax]

In the early days ..my random meter-readings ranged between 6.2 → 23.8 mmol/L ..which justified all the aggro I had doing the home-tests.

Even if this was just a one-dimensional metric ..it was a ✻rain-check✻ ..and since I was using my own cash to buy the kit, and because this was about what was happening inside my own body ..it seemed an appropriate action to take at that time.

As my HbA1c has a reached a ✻steady-state✻ ..I have stopped using the glucometer for the time being.

 

[RFSMarch]

Hi
No, I'm not an old timer in the sense that I was diagnosed type2 in March this year!
But I too am baffled by the attitude of the NHS in general to type 2 diabetics
Luckily for me, my DN at our local surgery has been diabetic 20+ years and gave me a lot of (unofficial) advice;
1.... test BG regularly everyday (but can't issue a meter as I'm 'only' type2)
2.... eat low carbs (try max 100g per day)
3... join the forum (gave me link)

all of the above advice given freely, but she could not express these views as a nurse, but as a fellow suffer of diabetes
I'm grateful to her for the support she's shown me cos I understand that others have been less fortunate
Also, we only have locum GPs at our surgery as our GP retired 2 years ago
so my diagnosis was part of a general health check as I have other medical problems, via a Locum GP
The locum prescribed Metformin 500mg 3x per day, but knowing I had IBS said to come back immediately if there were any problems. Of course there were, so next offered SR version, but also advised to come back again if still problems!
That Locum finished his temp stay, and next visit a new Locum, who'd read my notes!!! and was prepared to offer me Gliclazide 40mg as a trial..... praise be! A drug that works!! I'm now on 80mg x2 per day, prescribed by same locum who will be at surgery til New Year . I fund out that her husband is training to specialise in diabetes! Amazingly fortuitous!
But still no offer of a BG testing kit on NHS! But advised to test if poss. I bought an SD codefree kit off Amazon, and regularly check/monitor by BG 3/4 x daily esp if I eat something different...

I was trained as an Holistic therapist back in the 1990's.... but gave it up in favour of regular work, as I only had a small client base that I continued to treat til 2005. I wanted to try the complimentary therapies, alas not available via NHS!, as part of my recovery of other illness'. I recently started a course of Acupuncture, and a complete change of my diet, all of which I believe is starting to help me on the road to better health

Sleeping thru the night is a bug bear for me at mo.... I got approx. 6 hours of interrupted sleep last night.... and of course we all need plenty of rest/sleep for our bodies to have best chance to 'fix' itself!!

That was a bit more long winded than I intended! but cathartic too! Thank you!

Sorry I am a bit late to replying to this @Butterfly1960 ... This is useful stuff to take on board when I see my mate this weekend. I am going to ask the surgery for a printout of my results anyway, ahead of a review with the GP (and I think I will casually say I am happy to see any GP just to get a second opinion from someone at the surgery) and will take them over to show them how it has helped.

I have been quite interested in seeing how my carbs have gone down and if I do have a carby meal (last night I had my favourite Japanese Pancakes using 60g of spelt flour) and I hardly spiked and stayed nice, level and more important IN TARGET. So finally something is working, but I also try and have something immediately less carby the next day.

I am suffering a little though even on 2xMetformin SR - It jams me solid at least once a week... which can be... irritating, to say the least!

 

[Kentoldlady1]

It's a bit hard to generalize. I was diagnosed with T2 seven months ago, A1C 8.3% (67). Managed to control it entirely with a low-carb diet and exercise: two months after diagnosis A1C 5.5% (37), five months after diagnosis 4.9% (30). No self-testing at all, just those three A1C tests taken at the doctor's surgery. Soon, the testing interval is likely to be increased to six months.

I have no specialized medical knowledge but this regimen seems to make sense for me. I did lose 10KG in the few weeks after going on the diet and have kept all of that weight off (current BMI is 19). My only regular "self-monitoring" is to weigh myself every few days. I hope this will be a good "proxy" for how well I am managing my T2. If the weight starts creeping up again, I can adjust the diet. (It is already very low-carb, but I can always reduce the portions.)

I'm grateful that the testing is so occasional and non-intrusive, and full of admiration and empathy for those of you who have to do it a lot more often.

I m really glad that it has worked out well.for.you, but I think I have to disagree about the testing. Like you I have lost weight and now have a non diabetic hba1c. But to be honest for me this has always been about avoiding the complications of d. I really really dont want to.go blind. Not only is a continually raised hba1c an indication of continuing t2d, but so are spikes. I would have no way of knowing if some foods spike my bgl if I dont test.
I have no idea if having a relatively low hba1c can be achieved if you are having spikes as well. I suspect that it could be, if you keep your overall carb intake low, with just a few high spikes during the week. Does anyone know?

In any event, I have decided not to risk it. I might change my mind if there is evidence that occasional spikes make no difference to retinopathy. I dont think anyone really enjoys poking holes in thier fingers!

 

[Biggles2]

...besides close monitoring is rather expensive if financed by the health services...

@kokhongw you have a valid point here. The NHS metrics are for the most part process metrics not outcome metrics. As individuals with this disease, we are interested in the best possible outcomes for ourselves as individuals, not the population level process metrics - e.g. "percentage of T2DM patients with HbA1c below 7.0%" - for which GP's are rewarded if they meet their QOF targets. Also, while GP's are very aware of the long term effects of poorly controlled diabetes, they work within a short-term budgetary cycle. They have to provide services for all patients during that time with their set budget at the same time meet their QOF quality metrics. The diabetes complications issue gets punted down the road because it is not here and now, staring the GP in the face, and for many with T2DM lifestyle changes and improvements take too long, and relapse may be frequent. GP's are penalized for poor process metrics, many of which are measured and reported quarterly. That is why the DM treatment is intensified at such frequent intervals if HbA1c targets are not being met. Take a look at the NICE treatment algorithm: https://www.nice.org.uk/guidance/ng...apy-in-adults-with-type-2-diabetes-2185604173

By incentivizing and rewarding process measures instead of outcome measures the end result is that an unfortunate concept is normalized within the medical profession and the general public, viz that Type 2 DM is a progressive disease, and that treatment escalation is normal and inevitable.

Those of us who actively manage our disease through self funding of our glucose monitoring strips and careful control are "co-producing" our health, and in doing so, we are increasing the capacity of the NHS by actively doing our part, and ensuring better long-term outcomes for ourselves (and the NHS budget). It is unfortunate that many individuals with Type2DM are not. There is hope however, with this wonderful website, and the burgeoning research into control and remission via dietary and lifestyle changes.

 

[Grateful]

I m really glad that it has worked out well.for.you, but I think I have to disagree about the testing. Like you I have lost weight and now have a non diabetic hba1c. But to be honest for me this has always been about avoiding the complications of d. [snip] In any event, I have decided not to risk it. I might change my mind if there is evidence that occasional spikes make no difference to retinopathy. I dont think anyone really enjoys poking holes in thier fingers!

Interesting. My doctor said that the whole point of the HbA1C test is that it reports the level over a period of (about) three months, as opposed to a momentary glucose spike that might have coincided with the time of testing. I did see the eye doctor, and the foot doctor, and had a general medical-checkup, and there were no signs of diabetes complications at the time of diagnosis.

Is there any medical evidence that diabetes complications are possible even if HbA1C is below (say) 5.7% when tested every three months?

Kentoldlady1, well done for getting it under control!

 

[kokhongw]

Is there any medical evidence that diabetes complications are possible even if HbA1C is below (say) 5.7% when tested every three months?

Jenny Ruhl has collected a series of glucose related organ damage in this slightly dated, but still relevant blog
http://www.phlaunt.com/diabetes/14045678.php

The studies you will read below, some of which are not cited in the AACE guidelines, make a cogent case that post-meal blood sugars of 140 mg/dl (7.8 mmol/L) and higher and fasting blood sugars over 100 mg/dl (5.6 mmol/L) when found in association with those higher than normal post-meal blood sugars, cause both permanent organ damage and the worsening of diabetes. Some of this data also suggests that maintaining an A1c of 5.7% to 6% is much safer for people with diabetes who wish to avoid developng diabetic complications.

 

[Biggles2]

My doctor said that the whole point of the HbA1C test is that it reports the level over a period of (about) three months, as opposed to a momentary glucose spike that might have coincided with the time of testing.

@Grateful, the same could be said of the HbA1c - it measures the average glucose level over the past 2-3 months. So you have an average number, not a clear picture of the actual levels (both high and low) that got you that average. The following quote and link is to an article which describes this well. I found their graphs very useful:

'As Drs. Aaron Kowalski and Sanjoy Dutta described in 2013: “A mean speed of 55 mph over the past three months of commuting will never reflect times when a vehicle is racing at 100 mph and far in excess of the speed limit or is slowed to 10 mph in traffic congestion. Similarly, the clinician only receives the most basic of information from the HbA1c measurement and masks the occurrence and frequency of dangerous highs and lows.”' https://diatribe.org/BeyondA1c
​

The article makes the point that the HbA1c is a good process metric to measure how well a given GP or GP practice is doing in terms of how well their patients with diabetes are controlled. However, as individuals, we need more granular information so that we can achieve the best we can in terms of control. The HbA1c does not give us this level of detail, our meters do!

 

[Grateful]

The article makes the point that the HbA1c is a good process metric to measure how well a given GP or GP practice is doing in terms of how well their patients with diabetes are controlled. However, as individuals, we need more granular information so that we can achieve the best we can in terms of control. The HbA1c does not give us this level of detail, our meters do!;)

I thought the modern definition of T2 diabetes hinged on regular HbA1C tests. That particular test was only standardized quite recently (2009?). Is it not the case that people's daily/hourly glucose levels can go all over the place even if they are not diabetic?

Anyway, to each his/her own approach. I am lucky that the periodic A1C tests show that my T2 is under control. My doctor defines that as A1C below 7.0%; my actual figure has settled between 4.9% and 5.5% over time. In my case I do not see the benefit of self-testing. Until and unless the three-monthly figures worsen, the current regimen seems fine for me.

I am on a low-carb diet (below 30g/day), walking between 3 and 6 miles a day, and doing additional physiotherapy at home.

I do completely understand why some of us need daily monitoring but am not persuaded that it makes sense for me.

 

[Biggles2]

I thought the modern definition of T2 diabetes hinged on regular HbA1C tests. That particular test was only standardized quite recently (2009?). Is it not the case that people's daily/hourly glucose levels can go all over the place even if they are not diabetic?

Anyway, to each his/her own approach. I am lucky that the periodic A1C tests show that my T2 is under control. My doctor defines that as A1C below 7.0%; my actual figure has settled between 4.9% and 5.5% over time. In my case I do not see the benefit of self-testing. Until and unless the three-monthly figures worsen, the current regimen seems fine for me.

I am on a low-carb diet (below 30g/day), walking between 3 and 6 miles a day, and doing additional physiotherapy at home.

I do completely understand why some of us need daily monitoring but am not persuaded that it makes sense for me.

@Grateful,
Your results are stellar! Keep doing what you are doing; your hard work and dedication is clearly working really well for you!

 

[Grateful]

@Grateful,
Your results are stellar! Keep doing what you are doing; your hard work and dedication is clearly working really well for you!

Thank you. I do feel relatively fortunate. The T2 is, for the time being, not much more than a "major inconvenience" especially as concerns my loved ones who have to live around the strict diet. Our current compromise is that my wife and I eat completely different meals at breakfast and lunch, but have the same supper (which is close to zero carb). As a result she has been slowly losing weight, which is something that she wanted to do anyway.

I am lucky that I don't seem to miss the starchy foods much. About the only time I "lapsed" was a couple of months ago when I tried my sister-in-law's famously scrumptious apple crumble. But strangely enough it tasted awful (unbelievably rich, in fact almost nauseatingly so).

I am one of those "thin T2s." I am 6'4" and the BMI is currently 19 (it was 22 at time of diagnosis at the start of this year). I am 60 years old. The challenge of course is to stay with the low-carb, moderate exercise routine for the rest of my life -- and to be prepared for a possible worsening of the T2, *if* the docs are correct about it usually being a progressive disease. When I first researched the complications of T2 I was horrified, but now I am much more relaxed: as long as I get regular checkups for the main suspects (eyes, feet, heart, etc.).

Perhaps my biggest motivation is to put off, for as long as possible, the stage when one starts taking lots of medicines (our elderly parents seem to be taking dozens of pills per day). So far, I am taking no medicines at all.

Bizarrely, the T2 diagnosis actually had a silver lining, because the things I have been doing to cope with it are very good things in their own right -- diet, exercise, making sure I get enough sleep, moderating the alcohol intake down to one glass of wine per day (edited to add: pre-diagnosis, it was 3 pints of beer and several glasses of wine). I'm a lazy SOB and frankly it was only because of the shock of the T2 diagnosis that I changed my ways -- I would never have done it otherwise.

I really appreciate the support from this forum, and also seeing how much support is being extended to hundreds of others with T2. Great stuff.