Referral??

NO personal experience as I am type one, but it doesn't surprise me this is normal in some locations up and down the country......

I would be pushing for a follow up appointment at least so they can review the effects of the oral medications....

Sadly it’s not unusual. Type 2 on less strong medications are not routinely referred to a diabetic hospital clinic. She should be monitored by the Gp or a nurse at the surgery though and 3 monthly tests are recommended by NICE particularly until stable and good control is achieved. It’s important that reaction to the meds are reviewed too.

I’m assuming the medication is metformin as it’s the most common one prescribed on diagnosis but not the only possibility.

I’ll add some links below for information about how to control the blood sugars with diet which is the most urgent thing and which as a welcome by product will usually reduce weight too.

Is she willing to join the forum herself? Or go read the links? If so, her learning and controlling it herself has the best chance of success


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Can I suggest you take a good look at low carb high fat methods of eating (keto is just a version of this). It helps many of us lose significant amounts of weight, if desired, keep our numbers down and for some even eliminate medications and achieve remission and reduce or improve complications. Try clicking these links for more detailed explanations that are well worth readings

https://www.diabetes.co.uk/forum/blog/jokalsbeek.401801/ for info including low carb made simple

And https://www.diabetes.co.uk/forum/category/success-stories-and-testimonials.43/ to show it really works and for motivation

and https://www.diabetes.co.uk/forum/threads/what-have-you-eaten-today.75781/ for food ideas

also https://www.dietdoctor.com/ for more food ideas and general info of carb content of foods. Lots of other websites for recipes out there too. Just use the term low carb or keto with whatever you fancy.


Also it’s very important to be able to check for yourself what’s happening so you can make the necessary adjustments day to day and meal by meal rather than wait 3, 6 or even 12 months and then have no idea what had what effect. Getting a blood glucose meter is the only way to do this (no matter what contradictory advice you may have heard - it’s usually budget based rather than anything more scientific). Please ask if you want any guidance on this.



IMPORTANT FOR ANYONE ON MEDS CONSIDERING LOWERING CARBS: if you lower your carbs then any glucose lowering meds may need to be adjusted accordingly to make sure you aren’t taking more than your new diet requires. It can cause a hypo if you have more gliclazide or insulin etc (this is not relevant for metformin on its own) than your new carb intake requires. Keep a close eye on your numbers and do this with your dr’s knowledge. Please don’t be put off by an ill informed out dated rubbishing of low carb diets or being told you should eat carbs to match meds, it should be the other way around.

Hello and welcome to the forum.

Sadly this is all too common. I had a similar result to your Mum's and I am monitored at my GPs Practice by a Practice Nurse. I have not been referred to a Diabetes clinic or even seen a Diabetes Specialist Nurse.

Please make sure that your Mum gets the standard review with regard to foot checks and an appointment to attend a Retinopathy Screening Test. These are standard and they are very important tests. Good Luck.

Welcome Lstace. What were the tablets given? If the 101 is in mmol/mol and an HbA1c, there isn't an automatic referral for T2 unless:

If there is diagnostic uncertainty and other high-risk areas need to be considered. GP's consider a specialist opinion after a T2 diagnosis if: ⁻ Age > 50 years but BMI <25 OR family history of immune disease ⁻ Age >25 but rapid progression to insulin ⁻ Age < 25 and BMI > 25 with Type 2 diabetes ⁻ Suspected monogenic / atypical / pancreatic diabetes.

The GP should have considered T1 if there were symptoms of ketosis, rapid weight loss, age of onset < 50 years. / BMI <25 kg/m2. ⁻of personal and/or family history of autoimmune disease which would have also sent your mother down the referral route.

Here is the referral pathway quoted above:
https://www.england.nhs.uk/rightcar...40/2018/07/nhs-rightcare-pathway-diabetes.pdf

As said above, the NICE guidelines for newly diagnosed T2 diabetics is to have further blood tests and a nurse/GP review at the surgery in 3 months time. The 3 monthly reviews may change to 6 monthly according to how well the person is managing.

T2 diabetics are normally seen and treated at the GP surgery. The hospital clinics are mainly just for Type 1 diabetics, and very occasionally for a T2 if there are specific problems, but this is unusual.

Maybe a quick phone call to the surgery would be a good idea, just to check that your mother is on the list for a 3 month review with a nurse. (most GPs delegate T2 care to a nurse, although some do this work themselves) I was diagnosed in January 2014 and have not once seen a GP about my diabetes.

In addition to these reviews, your mother should be on the list for a referral for a retinal eye screening test. You could check this is happening in your mum's case. She should also have annual foot checks, usually by the nurse. This is all part of the Diabetes Care Pathway and should be adhered to.

Current official guidance for GPs is that newly diagnosed type 2s should be referred to a specialist eye clinic for a retinal scan, etc, to a podiatry clinic or specialist within the surgery for a foot check, and to the nurse within the surgery who does other diabetic checks. Last year I was seen with 2 weeks by the nurse, then at 1 month three months and six months.
You should also be offered a course such as Desmond or opt out and get an appointment with a dietitian.
https://www.nice.org.uk/guidance/ng28

Lstace said:

Thank you everyone, its nice to hear from people who know what they are talking about! And actually listen!
So, i should have said that she was put on metformin but had an allergic reaction to the full dose, every symptom on the instruction leaflet happened to my mum so she called the surgery and they told her a doctor would call her back as she suffers from anaphylaxis and carries epi pens, but the doctor never called back!!
Yesterday she saw a nurse who told her those tablets are not what she should be on, but would not cause any allergic reactions! She said her sugar levels were so high she should have been put on gliclazide and not to bother using the little blood monitor as it is pointless? She also dismissed my mums 1 stone weightloss and would not tell her the side effects of the gliclazide drugs only that she needs to carry jelly babies as she will probably have a hypo at some point. She also said that she could have liver and kidney damage and they had never bothered to do a liver function test, so tried to take blood and when she was unsuccessful said don't worry we'll do it another time?!
My mum is beside herself as you can imagine but still no follow up checks??
I feel like she needs to see someone who actually knows what they are talking about!
Its so stressful!

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The nurse is just plain wrong! Mum should buy a glucose monitor if she is not prescribed one and @Rachox has some useful info on these.
The liver and kiney function tests should have been done so I think an appointment with the GP asap is in order. Sounds like things are dragging a bit at the Practice. You can see your Mum's test results online if you have signed up for that service, if not you can ask for a print out of all the test results and then you can actually see for yourself which tests were ordered and the results. This is your Mum's right.

Thanks for the tag @Guzzler.
Here’s some info on meters, and to be clear I have no commercial connections with any of the companies mentioned. For a meter with cheap strips go for the Tee2 + found here:

http://spirit-healthcare.co.uk/product/tee2-plus-blood-glucose-meter/ with the strips found here:

http://spirit-healthcare.co.uk/product/tee2-testing-strips/


With more expensive strips is the Caresens Dual which I currently use, this one has the advantage of glucose and ketone testing in one machine, it’s to be found here:

https://shop.spirit-health.co.uk/collections/caresens-dual


And to be totally transparent I used to use the SD Code Free which has the cheapest strips available. However I found itto be becoming less and less reliable. Here it is for anyone wanting to give it a go:

http://homehealth-uk.com/product-category/blood-glucose/blood-glucose-monitor/

and here for the extra strips

http://homehealth-uk.com/all-products/sd-codefree-test-strips-to-be-used-only-with-the-sd-monitor/

There are discount codes if you buy in bulk.

5 packs 264086

10 packs 975833


Don’t forget to check the box that you have diabetes so you can buy VAT free. (for all meters and strips)

Lstace said:

I should also say we have been on a very low carb diet almost keto but a little bit higher and has lost a stone in weight which i think is fantastic! I cook for her and have changed all my recipes to no sugar, low carb!
I read an article that said type 2 can be reversed with diet and lifestyle changes which is what she has focused on since being told in April. Its just a shame that a healthcare person is so dismissive of that fact and hell bent on making her take new drugs?!
She has the contour blood sugar meter that she had to buy as the doctor never mentioned it 6 weeks ago! But like i said, the nurse said it was pointless!!!

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I take it this weight loss happened after she started the low carb diet? Or was it prior to her diagnosis?

Type 2 can be put in remission with the correct diet and lifestyle, although some people do need a bit of help with medication, at least initially. The nurse is completely wrong about not testing. Indeed, if she is put on Gliclazide she may well suffer hypos because this drug forces the pancreas to secrete extra insulin in addition to what it already secretes. This insulin can clear all the glucose from her blood stream making her sugar levels go low. In order to help prevent this happening, she needs to test frequently and take appropriate action if she is going low. This is extremely important if she is eating a very low carb diet whilst on Gliclazide.

Has she been using her meter at all? What sort of levels, and when, does she see on the meter, particularly before a meal and an hour and 2 hours after a meal? (after first bite).

Lstace said:

I should also say we have been on a very low carb diet almost keto but a little bit higher and has lost a stone in weight which i think is fantastic! I cook for her and have changed all my recipes to no sugar, low carb!
I read an article that said type 2 can be reversed with diet and lifestyle changes which is what she has focused on since being told in April. Its just a shame that a healthcare person is so dismissive of that fact and hell bent on making her take new drugs?!
She has the contour blood sugar meter that she had to buy as the doctor never mentioned it 6 weeks ago! But like i said, the nurse said it was pointless!!!

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The nurse is wrong, outdated and lacking in compassion or professionalism.

Does your mum drive? If so the surgery must issue a monitor and test strips to enable her to drive legally as it’s a glucose lowering med. Also how would she know to take a jelly baby for a hypo if she can’t test her levels? Has she started the glicazide yet? It is much stronger in effect than metformin and might well result in hypos if used alongside a low carb diet. Testing is essential to avoid this and reduction of glicazide very likely if low carb diet maintained.

Many professionals do not realise how effectively a meter can be used for type 2 and assessing which foods are safe and which aren’t. Test before and then 2 hrs after eating. You want less than a 2mmol rise, less is even better. If it’s high before a meal consider having fewer carbs in the next meal or waiting til the level has dropped. A 15 min walk around the block or a few climbs of the staircase might speed this up.

Also people in here have started with levels as high or higher and within months seen great improvements without any drugs just a low carb diet. It is feasible to have a 3 month trial of lifestyle change and then retest to see how effective it is. Many doctors and nurses have been very shocked how much can be achieved

She needs those other blood tests and the eye and foot checks and shouldn’t let it slide. Get back in contact and ask who is organising them and when. A gp visit or chat with the practice manager may be required. Point them in the direction of Dr Unwins nhs low carb go training package to support your low carb choices if need be.

Lstace said:

Yes she has lost the weight since starting the diet and has been testing her sugar levels with the monitor. At the beginning the monitor showed that they were always up between 15-20 but now, since the diet, they read between 6-8 before and 2hrs after her meals, but this was just dismissed, so i'm confused because i thought the readings seemed good?!
I worry that they are pushing this drug on her 6 weeks later without even checking the levels again? I know it takes 12 weeks for blood to recycle but surely the meter isnt lying about the results?!

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She has done well to lose that weight, and so have you for taking care of her. Well done.
After starting so high with levels between 15 and 20 before and after meals to reduce these to between 6 and 8 is brilliant. They are excellent levels, and will hopefully continue to reduce. The meter is not lying. The nurse needs re-training. She should not be pushing drugs (strong drugs) without taking account of how she has improved without any drugs. It is clear that her diet is working without medication. Do not worry. It is the nurse that is wrong.

When she has her next HbA1c (hopefully 3 months after the last one) the results should show this nurse how wrong she is. Meanwhile, keep on doing what you are doing. It is working. More carbs will not work!

Please please don’t listen to this nurse. She needs retraining.

As @Bluetit1802 says to push stronger meds whilst ignoring evidence that significant change has occurred (and it has, proven by the fingerprick tests) since the last hb1ac was taken is bordering on negligence in my opinion. At the least a repeat hb1ac should be done to establish the current situation. Yes it will only partially show the great effect of the changes as some of the old glucose battered cells are still present but nevertheless it would show positive change.

Either go and see someone else or keep doing what you’re very successfully already doing til the next check in another 6 weeks would be what I would do in your mums shoes.

Your mum's blood glucose levels seem absolutely fine and on track for getting normal Hba1c in the not too distant future.
I am pretty sure that without a meter to check on the effect, that Gliclazide could be dangerous - it hammers insulin out of the pancreas, and it would be illegal to drive without checking levels. If you are reluctant to take the advice of that nurse the non provision of a meter would be a perfect excuse for not taking the tablets.
I am probably rather anti tablet due to my own experiences after diagnosis.
I know that I am lucky to be able to get Hba1c just at the top of normal simply by eating a low carb diet, but I do feel that it ought to be the first thing to try after diagnosis - it is just a pity that so many drs and nurses seem to wilfully ignore any successes brought about by it.

Lstace said:

Thank you everyone, its nice to hear from people who know what they are talking about! And actually listen!
So, i should have said that she was put on metformin but had an allergic reaction to the full dose, every symptom on the instruction leaflet happened to my mum so she called the surgery and they told her a doctor would call her back as she suffers from anaphylaxis and carries epi pens, but the doctor never called back!!
Yesterday she saw a nurse who told her those tablets are not what she should be on, but would not cause any allergic reactions! She said her sugar levels were so high she should have been put on gliclazide and not to bother using the little blood monitor as it is pointless? She also dismissed my mums 1 stone weightloss and would not tell her the side effects of the gliclazide drugs only that she needs to carry jelly babies as she will probably have a hypo at some point. She also said that she could have liver and kidney damage and they had never bothered to do a liver function test, so tried to take blood and when she was unsuccessful said don't worry we'll do it another time?!
My mum is beside herself as you can imagine but still no follow up checks??
I feel like she needs to see someone who actually knows what they are talking about!
Its so stressful!

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May I ask what country you are in please, as treatment options can vary.