Lamont D
Oracle
- Messages
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- Type of diabetes
- Reactive hypoglycemia
- Treatment type
- I do not have diabetes
2 years! that's not so long! Try over a decade! And a couple of misdiagnosis!
Mind you I'm weird!
2 years! that's not so long! Try over a decade! And a couple of misdiagnosis!T2 seems to et a rougher deal than t1 in advice. However saying that it took over 2 years of nagging from me to get a diagnosis to the gps
Again, I am not saying it is ok for doctors to ignore informed consent or to "treat adults as if they are incapable of making decisions". I don't know why you think I am saying that.Apologies for taking some time to respond, but I have been somewhat busy today. Again, I’ll deal with each point in order.
“….I've been diagnosed for 3 years, but I'm not sure why you think that's relevant….”
Thank you for the information. I wondered how long you had taken to develop your options, and also to gauge how close you might be to 40, and therefore your predicted need for insulin. hank you for the information. Whilst of course, the discussion isn’t about you, but it is about your beliefs and statements you make, so context can be helpful.
“….The worst aspects of the NHS approach, eg over-reliance on drugs and telling people to eat carbs at every meal, are terrible…”
No challenge on this one. But these are their official guidelines, and you talk about the implications of deviation further into your post. I sympathise with their plight on this. I believe GPs have a hard time keeping up with all the chronic epidemics they face every day; hypertension ,back ache, stress, non-diabetic obesity, arthritis to name just a few, and have frequently acknowledged it on these boards..
Not every patient these doctors see is willing to do what it takes to lose a large amount of weight and restrict their food choices long term…. But if you are a doctor faced with someone you have known for years, and you have reason to believe they are not likely to see it through with long term changes, then that doctor will probably try to protect them from harm using things they as the doctor can control…”.
That a doctor predicts or assumes an outcome from a range of options, based on his experience of the most of his patients does not mean he can ignore his responsibilities. In UK, we have a concept of informed consent, which means, his patient must understand what I am being recommended, or prescribed, and that I must also understand the alternatives and implications. Where a patient’s cognitive abilities are impaired, the person giving consent should have all of that information and be making those choices.
In their circles, saying "but the patient wanted to manage their condition with diet only, so I didn't mention medication" wouldn't cut it.
Absolutely not, but it would be utterly acceptable if the patient was informed of the option to medicate, but declined it. Adults need to be accountable for their actions. To treat adults as if they are incapable of making decisions is, to my way of thinking, offensive.
Whilst I no longer practise, I am a former clinician, dealing with and accountable for my patients wellbeing on a daily basis. I would never, ever have written a prescription or performed a procedure without explaining without my patient understanding what and why I was prescribing.
“….Also, a lot of people with T2 diabetes who are overweight and over, say, 45, are likely to already be on some form of medication. Some will be on a lot. For those people, the prospect of taking one more is not daunting, like it is for someone on no medication….”
Of course they might be, but equally plausibly, they could hate being a slave to the pharmacy, or even feel that your “just one more” is the straw breaking the camel’s back.
I’m sure your view is informed partly from your own experience of taking medication, and from your description of other medical conditions, perhaps you already fit the description you paint above, but I value my freedom from regular medication.
“….Maybe it's a personal thing but I am much more comfortable and contented accepting what I think is likely to happen, than I would be wishing and hoping for something, only to be disappointed or worse when it changes…”
I am genuinely happy for you, that you have found a good place in dealing with your condition. I am also in a good place with my own. Where we differ is our current picture of the future. I remain committed to remaining med-free where I possibly can, but I am open minded enough to accept that were I no longer able to deal with a condition without pharmaceutical support, and the implications of not medicating were serious, I would submit.
“….I have been through a lot already and if I have to use insulin in my old age it wouldn't seem so bad compared to stuff I've already been through.”
Please don’t assume that because I am currently extremely fit and well, that this has always been the case. I was a sickly child, and lost a certain amount of school time, early in my education. And in my 20s I was also very ill. And I mean very ill. It’s quite a sobering experience when your parents fly, from another country, to say goodbye to you; such are the expectations of ones’ survival. Nothing will ever erase the look on my either of my parents’ face. There is so much about that period of my life that I do not remember for one reason or another, but I will never forget those expressions.
To answer your question bluntly it is down to laziness.
Now let me elaborate. Most patients are too lazy to make the changes needed to wrestle back the control they need or even do the reading they need to. The doctors do not have the time/energy (apathy) to drive these patients into change. Most people have been raised on the believe that western medicine can cure anything (almost) so when a doctor gives you a pill then that will fix it won't it!
GPs are too general to keep up with all the research (again they are out of date) and it is easy to just follow the hierarchies direction and "government is like a super tanker" it will turn but only after another generation are screwed over by the current guidelines.
There is a belief still in the medical profession that T2 is forever and it cannot be reversed despite the evidence in front of them
It all comes down to apathy in most patients and an over-worked medical profession
I agree, let's avoid unnecessary meds. I work to get my cocktail of meds down to the absolute minimum. But that's not because I don't want to "submit" to being a "slave", it's because the standard medical approach is to aim for the "minimum effective dose" of any medication. I interpret that as also meaning don't take unnecessary meds.Very interesting post CatLady. I can see this from both sides of the coin (how boring is that? lol), in that there is a section of those who are diagnosed, with "lifestyle issues", who will quite happily take the recommended medication which is usually offered and carry on eating the same and acting the same. But it's in that "offer" that the grey area lies I believe - I think it is rarely an offer, more an instruction. I question do they actually get the support to make changes immediately after diagnosis (offer of meter and strips for a trial period for example), regardless of the background? I feel that the magic bean is offered, then all talk of diet (which usually comes down to losing weight) will mostly be ignored because of the faulty belief that Met will keep everything under control - I say Met because I believe it's the usual DOC for T2. How many people that are given Met actually know it's basic action I wonder - that it reduces the levels by such a small amount? I know quite a few that think it's like paracetamol for a headache, eat the food, take a tablet and the any impact from the food eaten will stop. I know there have been many arrive on this forum thinking that this is the mechanism of action, obviously worrying. Bottom line is that we know diabetes does damage but it doesn't happen overnight so surely giving a window of opportunity at time of diagnosis, and before dishing out medication, couldn't hurt? And at the same time, maybe explaining how said medication actually works, that it's not a quick fix solution.
On a personal level, I have had quite serious ill health since I was a toddler, asthma which has had me on life support and for which I have had to take a shed load of medication. I have also always had psychological issues regarding food. I loathe taking medication, really resent it and avoid it if I think I can do without and have had that with me all my life. When I was diagnosed back in 2011 (I think), it came as no surprise. I was very overweight due to the stress I was under caring for a disabled daughter with severe behavioural issues who could be very aggressive, the nature of her syndrome meant our home was on lockdown so there was no escape - and I ate. The doc that I saw, although lovely, commenced with "and we will start you on Metformin and statins"..and that was enough for me - that there was no discussion, just an assumption. I refused the lot, he looked shell-shocked and that was that.
I was 47 then, had found this forum already (my daughter is on insulin, all a bit complicated) and muddled my way around until I found the balance with my diet. I've lost 6 stone, bloods when I (rarely) test are ok and the DN at my new practice has questioned my original diagnosis because my A1c levels have been in normal range for a few years - apparently I'm cured!
I have taken Met on a couple of occasions but the mental stress of taking something that I don't think is needed was too much - if levels were rising I think I could cope with taking it. I take certain meds now, no choice otherwise I wouldn't be able to function, fallout from cancer treatment. The thought of having to take a med if I can avoid it is anathema to me, I'll fight it to the last (into old age I suspect lol) - but I do know I'm a bit extreme with this opinion
I agree, I read about a med before taking it for the first time, if I have internet access. In emergency situations I haven't always been able to do that, but I remedy that as soon as I can. I make do by asking the doctor what are the most common side effect and risks, and I ask if they have checked it against all my other meds for interactions. They are required to do this anyway, but it doesn't hurt to gently remind them, so they know we are watching. Often I've had to remind them of one or another interactions that I'm aware of, so I think that keeps them on their toes.Wow this has been such an interesting topic. As ladybird says I can see both sides.
Doctors mainly not all but most become doctors to help people so their aim is to cute or manage. I guess in light of day their training is all broke fix and medication is what they know. However there are a lot of doctors developing to more free way of thinking and organic like therapies. It's really down to the individual doctor. I would also says it's about management doctrinal are under various pressures to meet various medical and financial outcomes. I feel doctors have a really tough balance and they all tend to come from a place of helping. Some are not. Its very hard when you know someone isn't looking after themselves to sit back when they know a solution. However I feel this is where the other side of the argument comes in. What is it that prevents people from either taking a pill? Or finding an organic way diet e t c to help themselves. A guy called bernes said it is all to do with gimmick which means deep meanings we have about something written into our psychie as children we must be a good patient we must do what they say or we must rebel against it. I guess this is where discovering your own take on it is essential.
I personally when reading the posts thought you all had good insightful views and give a real deep view of all sides of the coin.
I am a great believer in knowledge is power so whatever way it is for you organic or not all that matters is is it right for you? And is it truly what you want? Or are you feeling you need to comply? Which isn't bad because it can change for the future.
I guess what I am saying is it's about you and your feelings. I personally even in hospital do not allow medication unless I know what it is had time to research it. Reason because I have been given medication in the past that caused me issues and for me doctors are human and are definitely allowed to make mistakes but it's up to me to have power in knowing what I am having and taking responsibility for that. /sorry a little rant but I do see both sides and value all your options as they make sense and are true
To answer your question bluntly it is down to laziness.
Now let me elaborate. Most patients are too lazy to make the changes needed to wrestle back the control they need or even do the reading they need to. The doctors do not have the time/energy (apathy) to drive these patients into change. Most people have been raised on the believe that western medicine can cure anything (almost) so when a doctor gives you a pill then that will fix it won't it!
GPs are too general to keep up with all the research (again they are out of date) and it is easy to just follow the hierarchies direction and "government is like a super tanker" it will turn but only after another generation are screwed over by the current guidelines.
There is a belief still in the medical profession that T2 is forever and it cannot be reversed despite the evidence in front of them
It all comes down to apathy in most patients and an over-worked medical profession
GPs used to be considered as Gods years ago. That isn't the case anymore.
However, I believe it is important for GPs to actually ask "would you consider eating less (carbs)? Would you be willing to adjust your diet or are you just wanting medication?"
Trouble is there is a conflict of interests.. They get paid by results... They have targets for their pay under DES and QOF and more!! And limited time per patient. So the easiest option is drugs...
Similar issues in NZ. But, none of this supports the idea that they prescribe medications inappropriately because of their targets. Targets are not usually set in that way.Des and Qof targets are all linked to getting better results for hba1c, % of patients doing a wee test once a year etc...
Our GPs get paid in strange ways... They are a business.
Currently PMS Practices are being targeted by NHS England and CCG's. Our Practice stand to lose £67,000 in revenue.... And losing services like T2's going on to insulin by the Practice- instead it will be done elsewhere.. Where! We don't know....
There are horrendous pressures behind the scenes for Practice Managers. GP partners, as well as seeing patients.
The patients and patient groups should be informed of proposals according to NHS England guidelines for PMS reviews in 2014... So far all they have done is try and impose 3 options on GPs and giving them stupid deadines to meet with their choice of options.
Sorry for veering off at a tangent... But this is important for patients to realise what is happening to certain GP's and implications that may follow.
I think you are agreeing with me. Many T2 are too lazy to change and find out. Most GPs do not keep up with current knowledge and just spout out the rubbish fed to them by governing bodies - is that not laziness? I suppose you could put it in the bracket of covering ones backside! When I was diagnosed I was given the standard DUK booklets and a prescription for met and told to book myself on a course. So actually the lack of direction could well have been the best thing for me but that is because "I have to know" drive.I respectfully disagree somewhat. Patients that are not lazy and apathetic, but trust and follow the advice regarding diet that doctors, diabetes nurses and dietitians provide along with the advice not to self test blood glucose levels, will most likely see their type 2 get progressively worse. In fact, these HCPs tell type 2 patients that their condition will get progressively worse. It is not a moral failure on the part of patients that their blood sugar control deteriorates. GPs may or not be lazy, but they are generally following the official protocols put out by diabetes organizations. I was very lucky in that I had such a useless doctor that he refused to refer me to diabetes specialists and told me to get another doctor when I started asking questions. That's when I got on the internet and learned all I could about type 2, as well as joining this forum. When I got a new doctor, she tried to put me on more meds in addition to metformin (a statin and hypertension lowering drug). By then I knew enough to question this and never took them. The point that I am making is that the system is broken and it's difficult to blame the patients or the HCPs for the sad state of things. I wish I knew how to fix the system since billions of dollars/pounds could be saved along with countless lives, but I don't know. I am hoping I can convince my diabetes nurse that the protocols for type 2 are terrible, but even that may not be possible as it will be very difficult for her to disregard her training, despite seeing my results.
Yes, and I think those who do veer off piste are to be commended. I imagine there is a way to do it that minimises risk of scrutiny. For those patients whose HbA1c triggers the Metformin part of the guidelines, the GP could note down that it was discussed and the patient didn't want it. It's hard to see how the authorities could criticise a doctor for a decision that was out of their control. Browbeating a patient into accepting a drug they don't want is pretty bad form, IMO.The reason the most GPs continue to work to government guidelines, however good or bad they are, is predominantly down to liability. If you veer off piste, as a practice you run the risk of censure. The result ? The practice undergoes sever scrutiny and potentially you are struck off and law suits ensue. That's the main reason for sticking to official guidelines. When the low carb studies are complete and a part of the NICE guidelines for treating T2, it will be recommended.
So is Financial Conduct Authority Guidance, but I've yet to see a financial institution turn around to the FCA and say "Well it's only a guideline". As NICE is a legislatively created body that feeds into the department of Health, regardless of whether they produce "Guidelines" or "Legislation" it will be seen as the DoH point of view and followed accordingly by many.NICE are guidelines.. Or so Our top chap (GP) of our CCG states
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