T2 Medication

[Unbeliever]

I wonder if anyone has any experience of adusting medication to circumstances as it is possible to do with insulin?

I saw a consultant at the hospital a couple of tmes after being referred o them bu the opthalmic consultant.. I was given anuvia and told I could come off glimepirides if i reduced my HBA1C o under 7.
Last one was 6.5
When I reduced carbs and sarted to exercise more I foungd I was having hypos every day sometimes2 or 3 times a day. So I gradually stopped taking the glimepiride .
None f the GPs in my practice seems o know anything abou diabetes,. In fact hey seem terrified of being asked abou it. I have no faith in the DsN who wanted o put me onto pioglitazone although she was well aware I have macular oedema. I have been discharged by the consultant from he hospital diabetes clinic as he couldn't ustify my being there with my levels.

In the course of reducing the glimepiride and befoere my last HBA1C I suggested o the GP that I should take the glimepiride nly on the days I would nt be able to take long walks etc. She agreed relucantly and this seemed to work very well.

Now I have stopped aking thenm altogether I find that I have no more hypos but that my levels have risen a little. I really think I have reached the limit of what I can do with diet and exercise..

I ust wondered if it would be better to tolerate slightly higher but more even leveld {beter for the retinopathy} or to suggest another "arrangement2 to the Dr . I think that there is a img dose which migh be he answer. Unfortunately , I feel that I have to do all the work . It would be useless ust to go and ask heir advice wihou having some suggesion to offfer.

The DSN wanted me to go onto insulin while taking 6mg of amaryl. As my bgs were mostly 5s but wih spikes I feel sure i wold have spent most of my time in hospital.

I am sure that most medication is not meant to be used in this way but taking amaryl only when needed did seem to work for me.

Any experience f this or any houghts please?

 

[catherinecherub]

Hi Unbeliever,
Whilst it is normal to ask questions with regard to medication when you see your GP, I would be worried if I had a Dr. like yours. Usually if you make suggestions the GP would be more active in answering them and not leaving the choices to you. Role reversal? The DSN doesn't seem to be taking your concerns onboard either. Why would you need insulin with your levels, is there something she isn't telling you?

I would ask for a Consultant appointment again as you need a medication review a.s.a.p. IMHO especially as you have been referred by an Opthalmic Consultant previously.

 

[Unbeliever]

Hi Catherine, Thanks for your reply.

Since I first had to change to this practice I have found that the Gp's are very reluctant to "interfere" with what they consider to be the DSN/s area of responsibility.
The DSN tries to put everyone on to Insulin. She tried to put me onto it over the phone before we had even met and before she had my records- she persisted in this even though i told her that my previous gp had said that insulin had health implications for me. This was after all the nurses and other people in the PCT area had beeen sent on courses about initiating insulin at local level.

It seems that they were told that it was better to put patients onto insulin sooner rather than later and patients always benefied with no problems! She old me hat there was no downside to insulin .

I have recently had a medication review at my annnual diabetic review. This was conducted by the most senior female GP in the presence of students. I had o produce a copy of the consultant's letter because as my HBA1C was Ok noone had looked further into my case.
This GP and he one who reluctantly agreed o le me vary the amaryl are the most helpful and cooperative. in the practice. Won;t even try to telll you abou the others. One young docor stands in he middle of the floor quoting DuK newsletters at me - even when I have not consulted him about my diabees.

I ust feel that everyone concerned is waiting for my levels o rise so they can get me onto insulin.
I think he consultant sensed or was familiar to some of my concerns wihout my voicing them as he suggested that I should be referred back o the hospital if insulin was required.

The macular oedema occurred as a result of my blood sugar falling rapidly. It is not responding to treatment . My eye consultant is very concerned and this is why he became involved. It seems o me that the important thing is to keep my levels even - maybe this is even more important than keeping them very low.
I doubt very much that I can ge another consultan appointment. Everythig is on track isn' it? I am doing well!
When my euyes deteriorate and I haemoerrhage it is always when some level is reduced. My bs in the first place - they are not sure whether i was coming off rosiglitazone or starting amaryl. then my BS when the medication was increased and recently the ereducion in BS again.
I think I have suffered because of argets. Mad rush to reduce my bg initially , GP too scared to accept I suffer from white caot syndrome so overmedicated for Bp and also even my eye consultant
worrying overmuch about the magic HBA1C level of &. To be fair he was very upset about hat and I did appreciate his reasons.
I am of course , pleased that I have managed o reduce my levels abnd will do all I can to maintain them but i live in absolute dresd of any changes to my medication. That is the reason I am so reluctant o go onto insulin.
I can't help feeling I would be bettter left alone. I think the DSN has now come to the same conclusion as I have heard nothing from her for months.
I have HBA!Cs every 3 months. and I am sure noone will care about the resul unless i is over the 7.5 target for the paracice.

Last year it rose t. That was because I was almost blind nd couldn't go out alone and my husband had an accident which left him unable to walk for four months. This meant that I had no exercise and much less than usual conrol over my diet ,. Of course everyone now points to this figure as a comparison but it was a real anomaly.

I hope this explains why I feel I need to see the GP armed with some solutin . I am probably worrying unnecessarily as my levels haven't risen too much . i think it migh also explain my username..

 

[catherinecherub]

Might be worth ringing the Consultant's secretary voicing your concerns to see if she will forward them on to him. You don't have to demonise your lack of care, just explain the quandry you are in without naming names. Your eyes are more precious than a difference of opinion about treatment that you receive at your surgery.
I know that in America many Type 2's are put on insulin straight after diagnosis. The rationale behind this seems to be that your poor old pancreas has a rest and as your numbers come down they discontinue the insulin and start prescribing oral meds.
I fully understand your username now.

 

[Daibell]

It's amazing how confused the medical profession are when it comes to diabetes. With your BS levels I'm very surprised you were offered insulin by your DSN. Diet and tablets would be normal advice for your levels. I was above 7.5 at my last GP appointment and I actually asked for insulin as I was already taking max dose tablets and my GP effectively refused saying insulin was a 'last resort' (for Type 2s) and prescribed Januvia to try to avoid insulin. I guess the reasons to avoid insulin until really needed is the inconvenience and weight gain but some professionals do advise taking it early on. I sympathise with your problems with GPs and DSN but I suspect you really do need to seek alternative advice. You could try to discuss NICE diabetes treatment guidelines (downloadable from the NHS website) with your DSN as they don't suggest taking insulin early on

 

[Unbeliever]

I was not newly diagnosed but merely new to the practice. Every time i saw the DSN she was only interested in discussing insulin.

She told me that the only alternative to the glimepiride which she didn't hink was working was pioglitazone. I wasn't happy with this as my previous GP had old me that there were three or four alernatives.

My opthalmic consultant suggested hat he would ask the diabetic consultant o see me when we discussed my conrol and I told him that I was experiencing "spikes" and noone in my practice wanted to know about it. The clinic put me n anuvia which has worked well for me..because it is obviously essential to me o keep my levels even for the sake of my sight. I I am convinced that even is mre imprtant than low in my case.

It is very upseting when HCP's don't seem to get he point that all my problems have been caused by a too sudden reduction in blood sugar and blood pressure, They say they understand but if they think there is the smalles change they still veer towards the view hat my levels must be reduced asap.
I think he DSN has now washed her hands of me as i have rejected all her blandishments re insulin.

The macular oedema has terrified them alll withut this resulting in any improvement o my reatment.
Consequently I feel I have nowhere to go with my concerns.

The consultant told me that I could contac the nurses in the diabetic clinic if necessary bu i don't think my present concern is one for them.

I am probably worrying unnecessarily because my bs has not risen dramatically but as two hospital consultants have been involved and as i have to have HBA1Cs every 3 months I ust fear that commonsense will go out of the window and that any rise in my bg level [even taking into account that I have come offf 6 mg of glimepiride} will result in overreaction and Sister Insulin on my back again.
No wonder my BP rises when I even think of requesing a repeat prescripion. :shock:

Thanks for your replies guys . I sometimes wonder if its ust me !

I am back to the eye clinic soon. The folk there especially the consultant are very good to me {don't blame hem for the reatment not working!]They may be able to suggest a way of geting my problem answered without a lot of fuss..

I am sure that better communication and cooperation between Gp and hospital and different depts would help in many cases and in many different conditions.
I am sure there are reasons why this doesn't always happen .. I have noticed the same sort of thing wih friends treated for cancer.

I feel that I have offended various people by not going through the "proper channels" although said channels had done little to help. and i wasn't my idea o see the consultant!
Because I can still find the surgery door handle without assistance- the fact I am losuing my sight is of minr importance. apparently. IMy sight was at the legally blind level for most of last year but het were unaware of it this and ust kept showing me insulin pens etc. I am not needle phobic .

All that nonsense stopped after the blood pressure medicatin incident which does not however, appear to have been noed anywhere,
It seems fairly obvious to me that where there are diabetic complications then there has o be some sort of connecion or cooperation between those reating the diabetes and those reating the complications,
I daresay it is all down to money - most things are. sorry for the ran!