Type 2 friend not getting help she needs

kellyrae · Jul 4, 2012

Hi, I am a type 1, and have a friend who has type 2, I personally have a great diabetic team and receive great care.
However I,m quite worried about my type 2 friend. She has tablets to controll her diabetes, but for two years she is sick every morning and is recently having blood sugars of upto 17 2 hours after eating which only come back down to 13, she has never been refered to a dietician to be advised on what foods she should be eating to help her control her blood sugars, she only sees her GP for guidence as to what medication she should be on and the amount, the last blood tests were taken were last october so she has no idea of her averages!!!
She constantly feels poorly which is understandable considering her blood test highs after her meals.
What I find disturbing too is that she has never been told what ketones are!!!

Surely this is not the type of treatment that is acceptable at any doctors surgery?

She has been to her the GP's tonight and basically had to kick up a fuss to get refered to a diabetic team at her local hospital.

I don't know much about type 2 medication and how it works, but I do know that with her blood sugars being constantly high there is a good chance she has ketones, I have advised her to go to the hospital if it carries on before she gets an appointment.

Any advice would be greatful

Grazer · Jul 4, 2012

Hi kellyrae! Nice you're looking after your friend like this. Sadly, type 2's don't get much in the way of good advice in general. Best you can do to help her is get her to look at this forum, and perhaps pass this on which has worked for me. It's an approach I took which helped me get to near non-diabetic levels mainly through diet, and is a message I've passed on to new type 2's who seem to have found it helpful. Can you copy and pass it on?
"In general terms you will need to reduce the total number of carbohydrates you eat per day. All carbohydrates turn to sugar when we eat them, and no type 2 diabetic on diet only, or on diet and metformin only, can control their blood sugars (BGs) without controlling their carb intake. Even those on strong medication normally choose to control their carb intake to keep the level of medication they take down. The total number of carbs per day you can eat depends on how advanced your diabetes is. It’s perhaps worth starting at about 50% of normal levels for a non-diabetic then adjusting up or down according to how you get on. So that means eating 150 grams of carbs per day for a man, 125 for a woman. You can read the total carb content of food under “nutritional info” on the packet or wrapping, or look it up on the internet for loose food. Just google “carb content..”
You also need to stop or reduce the bad carbs; that is the starchy ones that make your BG go up quickly.
So obviously no sugar or glucose! But also no white bread, white rice, pasta, flour products like pastry, cake and batter. You can eat a little basmati rice, wholewheat pasta or the tri-color pasta fusilli ones in small quantities. Boiled new potatos (again not too many) are OK but not old pots mashed, boiled or in their jackets. (Roast is not so bad, the fat slows their absorption and conversion to glucose in the blood) Amongst other veg, parsnips are about the worst for BG, and carrots not great but ok in smaller amounts.
Multi grain bread (not wholemeal) is not SO bad, but lots of us eat Burgen soya and linseed bread from tescos and sainsburys, although all bread should be in limited amounts.
All fruit has carbohydrates, and needs to be included in the amounts of carbs you eat in a day. For most people, bananas are about the worst for pushing our BG up and berries (like strawberries, raspberries etc) are the least bad.
No sweeties!
Exercise is important. I tend to exercise about an hour after eating when I know my BG will be peaking. This helps to bring it down quicker and further. I do ten minutes hard work on an exercise machine, but you could run up and down stairs for ten minutes or go for a brisk walk.
Returning to types of food and quantities of carbs - you can only find out how many you can eat by testing. Most type 2’s are not given access to testing equipment, so you should get your own – although try arguing with your Doc that you want to manage to NICE guideline blood sugar levels, and can’t do that without testing! If you have to buy a meter, they are cheap and most manufacturers will give them away for free. They make their money on the strips you have to use! So go for the meter with the cheapest testing strips. The SD Codefree available on the internet is about the cheapest at the moment. Some people test before and after eating, on waking (fasting test) and before bed. But if you have limited strips because of cost, the key to me is testing 2 hours after eating. If your BG is above, say, 7.8 at that stage, you need to cut down on the carb content the next time you have that meal. Test after various different meals and you soon get to see a pattern of what you can and can’t eat, and in what quantities. Keep careful records of what you ate and when, together with the result, so you can refer back at a later date. You can then reduce your testing. I said “below, say, 7.8” because NICE guidelines are below 8.5 but most of us think that’s a little high. 7.8 is the max. level at 2 hours after eating that a non-diabetic normally gets to so is perhaps a better target. Some then set progressively lower targets.
Do ask lots of questions; there is normally an answer on here. The more you get to learn about your diabetes, the better it will be.
Good luck!"

hope she finds it helpful

Daibell · Jul 4, 2012

Hi. With HBa1c levels that high your friend should be having quarterly HBA1c blood tests; she needs to insist on that but hopefully a referal to the diabetes clinic will produce the right response. It would appear that your friend's GP is not providing anywhere near the service that the NICE guidelines suggest. At that level assuming the diet is sensibly low-carb your friend should probably be on a 3 level tablet regime like myself or even insulin if the levels can't be brought down. As a matter of interest how old is your friend?

kellyrae · Jul 4, 2012

She's in her 50's I know she has been taking 3000g a day of what medication she takes, I don't even think she knows about having a low carb diet to be honest, so I think with the proper guidence and knowledge she should be able to get her bg's down.

kellyrae · Jul 4, 2012

Thankyou, this is very helpful I will be sure to pass it on .

Grazer said:
Hi kellyrae! Nice you're looking after your friend like this. Sadly, type 2's don't get much in the way of good advice in general. Best you can do to help her is get her to look at this forum, and perhaps pass this on which has worked for me. It's an approach I took which helped me get to near non-diabetic levels mainly through diet, and is a message I've passed on to new type 2's who seem to have found it helpful. Can you copy and pass it on?
"In general terms you will need to reduce the total number of carbohydrates you eat per day. All carbohydrates turn to sugar when we eat them, and no type 2 diabetic on diet only, or on diet and metformin only, can control their blood sugars (BGs) without controlling their carb intake. Even those on strong medication normally choose to control their carb intake to keep the level of medication they take down. The total number of carbs per day you can eat depends on how advanced your diabetes is. It’s perhaps worth starting at about 50% of normal levels for a non-diabetic then adjusting up or down according to how you get on. So that means eating 150 grams of carbs per day for a man, 125 for a woman. You can read the total carb content of food under “nutritional info” on the packet or wrapping, or look it up on the internet for loose food. Just google “carb content..”
You also need to stop or reduce the bad carbs; that is the starchy ones that make your BG go up quickly.
So obviously no sugar or glucose! But also no white bread, white rice, pasta, flour products like pastry, cake and batter. You can eat a little basmati rice, wholewheat pasta or the tri-color pasta fusilli ones in small quantities. Boiled new potatos (again not too many) are OK but not old pots mashed, boiled or in their jackets. (Roast is not so bad, the fat slows their absorption and conversion to glucose in the blood) Amongst other veg, parsnips are about the worst for BG, and carrots not great but ok in smaller amounts.
Multi grain bread (not wholemeal) is not SO bad, but lots of us eat Burgen soya and linseed bread from tescos and sainsburys, although all bread should be in limited amounts.
All fruit has carbohydrates, and needs to be included in the amounts of carbs you eat in a day. For most people, bananas are about the worst for pushing our BG up and berries (like strawberries, raspberries etc) are the least bad.
No sweeties!
Exercise is important. I tend to exercise about an hour after eating when I know my BG will be peaking. This helps to bring it down quicker and further. I do ten minutes hard work on an exercise machine, but you could run up and down stairs for ten minutes or go for a brisk walk.
Returning to types of food and quantities of carbs - you can only find out how many you can eat by testing. Most type 2’s are not given access to testing equipment, so you should get your own – although try arguing with your Doc that you want to manage to NICE guideline blood sugar levels, and can’t do that without testing! If you have to buy a meter, they are cheap and most manufacturers will give them away for free. They make their money on the strips you have to use! So go for the meter with the cheapest testing strips. The SD Codefree available on the internet is about the cheapest at the moment. Some people test before and after eating, on waking (fasting test) and before bed. But if you have limited strips because of cost, the key to me is testing 2 hours after eating. If your BG is above, say, 7.8 at that stage, you need to cut down on the carb content the next time you have that meal. Test after various different meals and you soon get to see a pattern of what you can and can’t eat, and in what quantities. Keep careful records of what you ate and when, together with the result, so you can refer back at a later date. You can then reduce your testing. I said “below, say, 7.8” because NICE guidelines are below 8.5 but most of us think that’s a little high. 7.8 is the max. level at 2 hours after eating that a non-diabetic normally gets to so is perhaps a better target. Some then set progressively lower targets.
Do ask lots of questions; there is normally an answer on here. The more you get to learn about your diabetes, the better it will be.
Good luck!"

hope she finds it helpful

Daibell · Jul 5, 2012

Hi. 3000mg tablets sounds like Metformin which is a good tablet start point. Follow Grazer's dietary advice and hopefully with good clinical advice things will improve. Further meds can be added if needed but diet is the first step.

hanadr · Jul 5, 2012

If you are in Britain
the Advocacy team at Diabetes UK is usually helpful in problems with healthcare professionals; somehow, by being "official" they get listened to.
Hana

kellyrae · Jul 5, 2012

I havespoken to her today and she received a phone call from the diabetes team that she has been referred to, she has an appointment for an all day assesment next tuesday.....even the diabetes nurse were shocked to hear that she has never had any advice in the whole 14 years of having type 2.

Hopefully it will get sorted very soon

Thankyou

daisy1 · Jul 6, 2012

Hi Kelly and welcome to the forum
Here is some more information which might be helpful to your friend, in particular in improving her levels. I hope all goes well on Tuesday. Ask any questions you like as 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 30,000 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

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes ... rains.html

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

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.
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Please sign our e-petition for free testing for all type 2's; here's the link:
http://www.diabetes.co.uk/petition/

Do get your friends and colleagues to sign as well.

Type 2 friend not getting help she needs

kellyrae

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kellyrae

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Type 2 friend not getting help she needs

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