type 2 diabetes treatment from practice nurse only

[antonov124]

I've been type 2 diabetic for 3 years

am on metformin 2*500mg 2twice daily and have recently stopped taking linagliptin as it wasn't helping and my hba1c was still rising, (is currently 7.6)

i see the nurse at my local doctors clininc who seems to just say "take this and diet", oh if it was that easy.
I have a sedentary lifestyle due to working 9-5 and know i need to get out there, but with depression etc it always seems to be 'I'll do it tomorrow'

Should i only be seen by my practice nurse for my diabetes, or should i be seen elsewhere in the NHS.

Have seen other posts re testing strips and i have no trouble obtaining them . my bloods average 18.6 and the nurse doesn't seem phased by this but i find it worrying

other meds

simvastatin 80mg
anti-deperessants
ramapril (was on adalat but taken off as my kidneys were flushing ketones)

Am not sure what i should really be doing as I feel i'm being paid lip service and its all my own fault


Darren

unhappy 40 year old diabetic

 

[Squire Fulwood]

Being put in the care of a nurse is what happens to most of us. While with the GP on one occasion I mentioned some blood sugar readings and she just said, "Tell the nurse".

I am not complaining since I have an absolutely great nurse but she would have put me on stronger medication if I was getting numbers of the size that you are. I had a lower Hba1c than you and I was put on Glimipiride.

Your average blood sugar readings are also higher than I have ever experienced and I would also worry if mine were that high. I can't understand why your nurse is treating it so casually.

 

[Paul_c]

other meds

simvastatin 80mg
anti-deperessants
ramapril (was on adalat but taken off as my kidneys were flushing ketones)

I am extremely surprised that you are on an 80 mg dose of Simvastatin especially as there are clear warnings about that dosage in the literature available for doctors.

http://www.rxlist.com/zocor-drug/warnin ... utions.htm

The risk of myopathy, including rhabdomyolysis, is greater in patients on simvastatin 80 mg compared with other statin therapies with similar or greater LDL-C-lowering efficacy and compared with lower doses of simvastatin. Therefore, the 80-mg dose of ZOCOR should be used only in patients who have been taking simvastatin 80 mg chronically (e.g., for 12 months or more) without evidence of muscle toxicity [see DOSAGE AND ADMINISTRATION, Restricted Dosing for 80 mg]. If, however, a patient who is currently tolerating the 80-mg dose of ZOCOR needs to be initiated on an interacting drug that is contraindicated or is associated with a dose cap for simvastatin, that patient should be switched to an alternative statin with less potential for the drug-drug interaction. Patients should be advised of the increased risk of myopathy, including rhabdomyolysis, and to report promptly any unexplained muscle pain, tenderness or weakness. If symptoms occur, treatment should be discontinued immediately.

and in view of this warning:

Drug Interactions

The risk of myopathy and rhabdomyolysis is increased by high levels of statin activity in plasma. Simvastatin is metabolized by the cytochrome P450 isoform 3A4. Certain drugs which inhibit this metabolic pathway can raise the plasma levels of simvastatin and may increase the risk of myopathy. These include itraconazole, ketoconazole, and posaconazole, the macrolide antibiotics erythromycin and clarithromycin, and the ketolide antibiotic telithromycin, HIV protease inhibitors, boceprevir, telaprevir, the antidepressant nefazodone, or large quantities of grapefruit juice ( > 1 quart daily). Combination of these drugs with simvastatin is contraindicated.

(My bolding and underlining above)

You would want to know what anti-depressants you've been put on.

 

[Daibell]

Hi. I agree that 80mg of Simvastatin is higher than many patients would want to go with. I would suggest you ask the GP to reduce it. I also agree that the GP/nurse should try prescribing one of the sulphonylureas such as Gliclazide or Glimepride to see if that helps. A average blood levels of 18 is too high. You don't say what your BMI is? Also what sort of diet are you on? In my experience surgery nurses can be better than diabetes GPs assuming they have some specialism in diabetes.

 

[antonov124]

hi

thanks for all your responses,

stats 6ft
19.5 st
bmi 36.2
anti-depressants citalopram 20mg,
diet, am currently attending choose to change, so am going through CBT at present, have reduced all fatty foods, and the naughties (sweets, chocolate and crisps)
have a very large caffeine and milk intake and can drink upwards of 20-30 cups per day :sick:

Have been on simvastatin 80mg for at least 2.5 years now, and take it religiously at night.

my nurse is always mentioning different types of mediction but doesn't issue any as she says that most will increase my weight which will not help my weight loss, I have shed a few pounds lately (14lbs over 14 weeks)


Have had my medicine review recently and was kept to the same dose of medication so i just pop them as directed.


Darren

 

[Daibell]

Hi. Yes, losing weight is obviously the priority but note that any carb is 'naughty', not just sugary ones, if you take too many or the portion size is too large. Keeping fat down will help reduce calories, but note that reducing the carbs is more important than the fats as reducing carbs will help get the sugars down as well; reducing fats won't.

 

[EllisB]

Darren,

Getting more physical activity will be key for you because the benefits are threefold, helping with weight loss, insulin sensitivity and depression.

I also sit in front of a computer all day, but I have finally found a fitness class that works for me (http://www.britmilfit.com). Whatever you do it takes a few weeks but if you keep it up for a couple of months it becomes addictive. I never could find the motivation to go to the gym enough to reach the addictive stage.

I would strongly recommend a group class because I find that the group dynamic helps with motivation.

HTH

Ellis

 

[Dr Zordas]

...Am not sure what i should really be doing as I feel i'm being paid lip service and its all my own fault

Ditto! :clap:

Exactly the same feeling. She can't seem to grasp the fact that I've worked night-shifts, 12 to 16.5hrs per night, for almost 30yrs and that I should be 'taking more excercise'. When, exactly. :?

She reminds me of an over-bearing Hattie Jacques (if that's possible) and I feel like I'm thirteen again getting a bollocking... :eh:

 

[mpe]

Should i only be seen by my practice nurse for my diabetes, or should i be seen elsewhere in the NHS.

No eye or foot screening?

Have seen other posts re testing strips and i have no trouble obtaining them . my bloods average 18.6 and the nurse doesn't seem phased by this but i find it worrying.

If it was 8.6 that would be "worrying", 18.6 would be better described as "highly alarming". (Even as a maximum.)

 

[mpe]

Hi. Yes, losing weight is obviously the priority but note that any carb is 'naughty', not just sugary ones,

Actually the non "sugary" ones may well be the worst. Because of a quirk of the chemistry involved disaccharides equate to 106% sugar and polysaccharides equate to 111% sugar.

if you take too many or the portion size is too large. Keeping fat down will help reduce calories, but note that reducing the carbs is more important than the fats as reducing carbs will help get the sugars down as well; reducing fats won't.

If you are going to eat a high carbohydrate diet, from the point of view of blood glucose control, sucrose or lactose @53% glucose are a much better option than amylose or amylopectin @111% glucose. Most possible high carbohydrate diets would also be high in glucose diets. Even those which didn't have a specific class (of 1/3) for foods high in glucose polysaccharides.
The biggest irony is that humans don't need to eat any glucose, fructose or galactose. Any which the body cannot use in fairly short order get converted (saturated) fats anyway.
Many people also find it trivially easy to overeat on a high carbohydrate diet, but much harder on any diet where carbohydrates do not dominate.

 

[Thommothebear]

Re simvastatin - i was on that for several years with ever increasing cholesterol and ever increasing doses. Last oct my total cholesterol was approaching 8 and my doctor and I agreed that changing from 40mg simvastatin to 80mg was not going to be in my best interests due to the side effects I was already suffering. Instead she changed me to to 40mg atorvastatin.

Within a month all side effects had ceased. Blood test after three months I was down to 4.6 total cholesterol, further three months it s gone down a little more but the ldl/hd lratios had improved a lot and my triglycerides are normal. My next set of results are due next week

 

[hanadr]

I'd be worried by those blood glucose levels too. Normal blood/non-diabeic glucose is about 5 and normal HbA1c is about 4.5% anything much higher is dangerous.
You do have control over what you eat, so I'd recommend you read up about low carb diets and try it for yourself
Hana

 

[mcdonagh47]

Its common for T2s to dumped off on Practice Nurses, you just have to go along with them to gain access to all the other services and tests. An Endocrinologist should be managing your condition but of course there is a world-wide shortage of Endos !
The few of them in Britain are prioritised to Type 1s so we T2s are stuck with Practice Nurses and rarely even get to see a kosher Diabetic Specialist Nurse (DSN).

And of course we are told to start on "Diet and Exercise" but the silly thing is - there is no specific programme of Diet or Exercise set out for new T2s, its just a vacuous phrase.

You should ask to go on a course, preferably X-Pert Diabetes Type 2 or failing that, Desmond.

In the meantime here are a few online things to look at ....

A good place to start is by reading Jennifer's Advice ....
http://www.phlaunt.com/diabetes/14045524.php

and Maggie Davey's Open letter ...
http://www.sequin.pwp.blueyonder.co.uk/ ... penlet.pdf

Test,Review, Adjust by Alan S ....
http://loraldiabetes.blogspot.co.uk/200 ... djust.html

They are just some things to start on and remember the two mantra of good control ...

"Test,test, test" and "Eat to your meter".