Questions for my GP?

[DJC3]

Hi all. I was diagnosed T2 a year ago at the same time as I was diagnosed with cancer. It’s been a tough old year but my last scan was clear so I feel up for the battle against diabetes now.
I was given no information whatsoever by my GP, just told to take Metformin twice daily. I’ve been back a few times over the last few months asking for a diabetic review and saying I’d like to get it under control by lifestyle changes, but all they ever do is give me a form for another blood test - they never tell me the results of the last one so Ive no idea how I’m doing. ( Ive recently requested online patient access so I’ll be able to look for myself)

Since finding this forum I’ve learned so much and feel so much more confident. Many of my questions have been answered just by browsing the threads - there are so many knowlegable and kindhearted people here.

I bought a blood sugar monitor from Amazon and now test before and after each meal as well as following a proper low carb diet ( I thought originally this just meant cutting out cakes and biscuits). One postive aspect of cancer was that I lost a lot of weight so now am in a healthy weight band. I’m not getting spikes after meals but levels dont seem to be dropping much below 6.7. How long before permanent effects are seen?

I have another GP appt on Friday and I’m determined to get somewhere this time. Ive read here that NICE guidelines say I should have been offered a diabetes management course (X pert or similar) so I will insist on that but what other questions do you think I should be asking? How often is it useful to have HbA1c tested? Any advice on how to tackle this appointment would be very much appreciated.

Thank you in anticipation, sorry if Ive rambled too much

D

 

[LouWilk059]

Bump.

Congratulations on the cancer remission! I'm type 2 but no meds and from Canada so will leave it to locals to assist with your questions. Welcome to the forum.

 

[rmz80]

I could spend all day this but here is a few ideas to go on.

First of all gp’s use 10 min time slots you may need 2 time slots for this!

1) Take a list and dosage of medications you are on and ask what they do.

2) Ask if blood test results are in your notes particularly HbA1c.

3) Ask about kidney function and LDL cholesterol levels

4) Ask about a blood pressure target.

5) Ask if you need to test for ketones

6) Ask about flu shots, foot test and eye test and when these are due.

7) Ask about any courses and diabetes management classes you can do.

8) Write a list of about 5 other issues you’ve come across

That should keep them busy for a least 20min

 

[eggs11]

If there's one thing I've learned in the last 2 months, it's make sure you get a print-out of your blood test results, so you really can see what's going on - don't rely on the gp/receptionist to tell you all the details. I would ask for a print-out of all recent results while you wait for your online access.

 

[NicoleC1971]

Hi. Really glad to hear that you are doing so well and have the motivation to get the most out of the GP! I do not know what kind of cancer you had but some cancers may well have a metabolic element hence taking care of your diabetic health may benefit your all round health too.
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/15-healthcare-essentials - the link to what you should expect btw.
In addition to the other useful stuff already mentioned, I have found the X PERT health guide really useful:
https://www.xperthealth.org.uk/shop (the general handbook one with orange cover) since it covers all aspects of medications and other aspects of diabetes care ( I am type 1 but work with type 2s). You can also check if its offered in your area.
Your GP does not seem to have much of an interest and may even be a bit shocked to have a clued up patient! Take a look at Dr David Unwin on YouTube as his approach is to offer patients the option to go low carb. I am just mentioning this so that you know its not some slightly weird or faddy thing to do even if your GP cannot offer much beyond the blood tests and referral to Desmond or xPert.

 

[bamba]

Tagging @daisy1 for standard advice

 

[suvvern]

It may be worth contacting a Diabetes Specialist Nurse to talk through your test results. They usually ( well in this area at least) have half hour long appointments so you can get really detailed help. Ask your gp reception how to get in touch, or ring your local hospital and ask to be put through to the diabetes department to make the appointment. You may have to go to hospital to see the DSN.

 

[ixi1429]

Hi,
To add to @rmz80

Ask how oftetn thhye want to see the Diabetic nuse/maanger (DN). Msot of us either see the DN on demand or every 3 to 6 months in line with our testing.
Online access is good as you should be able to view all the testing - Chloresterol etc).
As A UK diabetic you should receive the flu shot for nothing. I do and I am gainfully employed
They should put you on a course - mine was X Pert for 6 weeks (afternoons) whcih prove really useful to me.

 

[DJC3]

Thank you so much for all these useful replies: I am scribbling all the suggestions down so I don’t forget to ask, and don’t let myself get fobbed off again. I think you’re right rmz80 - I may need a longer appointment!

 

[derry60]

Bless you, what a brave lady...Well done for getting the all clear. All the above advice is good advice. You will find that many people on here will help you, you have come to the right place welcome

 

[daisy1]

@DJC3

Hello DJC3 and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you like and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

 

[DJC3]

Hello again, thought I’d let you know how the GP appointment went:

Have to say I came away feeling really disappointed. I managed to make it a double appt as I had so many questions, but he still seemed keen to hurry me out. He said his special interest was diabetes which was encouraging but then proceeded to dismiss most of my questions ( ‘how does Metformin work?’ ‘Oh we’ll get to that later’ and he never did explain).

My HbA1c has come down from 66 in Sept 17 to 48 at the beginning of Feb. He said that was good and I didn’t need to worry about it anymore. I said I thought it should be under 42 he said ‘well, ideally, yes but 48 is fine’. My next blood test apparently wont be til Sep 2018! Once a year is all he considers necessary. He dismissed my questions about lipid profile - this was last done in Sept and wont be repeated til next Sept. There is no specialist diabetic nurse, dietitian or clinic attatched to the surgery so any further questions I had would have to be in an appointment with him. I told him about being on LCHF diet and he didn’t seem that interested.

The only positive thing that came out of it is that he hs put me down for the DESMOND course but I think that was only because I mentioned it!

He spent most of the time looking at his screen and seemed a bit bored if I’m honest. Don’t feel there was much support there at all so I’m doubly glad to have found this forum where I can actually learn about this disease and how to tackle it.

Thank you all for just being here!

 

[eggs11]

Hello again, thought I’d let you know how the GP appointment went:

Have to say I came away feeling really disappointed. I managed to make it a double appt as I had so many questions, but he still seemed keen to hurry me out. He said his special interest was diabetes which was encouraging but then proceeded to dismiss most of my questions ( ‘how does Metformin work?’ ‘Oh we’ll get to that later’ and he never did explain).

My HbA1c has come down from 66 in Sept 17 to 48 at the beginning of Feb. He said that was good and I didn’t need to worry about it anymore. I said I thought it should be under 42 he said ‘well, ideally, yes but 48 is fine’. My next blood test apparently wont be til Sep 2018! Once a year is all he considers necessary. He dismissed my questions about lipid profile - this was last done in Sept and wont be repeated til next Sept. There is no specialist diabetic nurse, dietitian or clinic attatched to the surgery so any further questions I had would have to be in an appointment with him. I told him about being on LCHF diet and he didn’t seem that interested.

The only positive thing that came out of it is that he hs put me down for the DESMOND course but I think that was only because I mentioned it!

He spent most of the time looking at his screen and seemed a bit bored if I’m honest. Don’t feel there was much support there at all so I’m doubly glad to have found this forum where I can actually learn about this disease and how to tackle it.

Thank you all for just being here!

Sounds frustrating to say the least! You could maybe suss out other gps in your area and change to one that has a specialist diabetes nurse/team - having said that, from what I've read on here they can vary too, I've been very lucky to have a good nurse. Or go over the 15 health care essentials list that @NicoleC1971 gave the link for and see where your gp has not kept to the guidelines and go back to him with the pdf. Good luck - and as you say in the meantime the support and advice on here will help you no end.

 

[bulkbiker]

‘how does Metformin work?’ ‘Oh we’ll get to that later’ and he never did explain

He probably doesn't know...

 

[britishpub]

I wouldn’t use the word “probably”

 

[DJC3]

Yes the 15 Healthcare essentials that @NicoleC1971 posted is a good starting point and I will go through them today and tick them off ( or not) and take the list in with me next time, or perhaps send to the practice manager.

Looking forward to being inspired by the Desmond course though - has anyone here done it? Any good?

 

[Rachox]

So sorry to hear of your GP’s indifference to your questions. He really has sold you short, I expect he’s not used to a patient so interested in understanding everything about their condition. I’m very lucky with my GP, we always have a thorough, knowledgeable discussion when I visit. He agrees with me doing low carb so I am fortunate there. Is it worth seeing a different GP in the practice next time?

 

[ixi1429]

48 is good going - well done. Obviously more to do but this is REALY good progress.
I have not done DESMOND. I did one of the other - X PERT. It was really informative, more than my local GP and form the sounds of it, my GP is better than yours.
I had to ask (positively and not pushy) to get a blood test 3 months after I started the LCHF. I told them that I had started this and wanted to see what impact it was having so I could decide if it was worthwhile continuing on LCHF.

Did he take your weight?, check your feet? book you an appointment? Is there another doctor or Diabetic nurse at the surgery you can see?

 

[TheBigNewt]

An A1C of 48 is excellent, you should be happy. And if the doctor seemed a bit indifferent remember he's probably seeing multiple patients a day with A1C's that are 2-3 times what yours is. I don't live there but I would imagine a NHS GP is overworked and underpaid, writes a ton of prescriptions, reviews tons of lab results. You're taking good care of your diabetes and he's prescribing the meds. Here some people use a "consierge" physician service that allows them to communicate with the doctor via email or txt or phone way more often. They pay for it of course.

 

[Alexandra100]

I strongly recommend you get hold of and read Jenny Ruhl's book "Your Diabetes Questions Answered" https://www.amazon.co.uk/Your-Diabe...d-Practical/dp/0964711672/ref=asap_bc?ie=UTF8
She is not a doctor but she has survived many years of T2 diabetes without significant complications and has spent years keeping up with all the research studies ever published. She is clear and compassionate. When I first found I had elevated blood glucose I took out all the books about diabetes in the library system where I live - about 10 in all. I quickly took back 9 of them, but Jenny's I still have on extended loan, and I quite often consult it or re-read chapters. Diabetes is a complicated subject - you can't grasp it all in in one go. The other author who is head and shoulders above the rest is Dr Bernstein, to whom we more or less owe the whole idea of low carb diets and home testing. However he is T1, although much in his book is valuable for T2s, and his book is very thick and rather expensive. He also has very high expectations of his fellow diabetics, which can be a bit daunting, especially at first. So IMO a great classic to buy eventually, but I'd go for JR first. You might like to read the biographical account of how Dr B turned his diabetes around after many years developing terrible complications: http://www.diabetes-book.com
Both JR and Dr B would say that if you can manage to get your A1c lower than 48, preferably even below the pre-diabetic level of 42, that would be much the best. But everyone has to find their own compromise between sacrificing carbs and bg levels. At least if you read JR's book you will be able to make an informed choice.