What advice about diabetes would you give the medics of the future?

What a lovely idea.

My immediate thought to pass on to medics of the future is to remember that Type 1 diabetes is not a childhood disease and can be diagnosed at any age to people of any size, shape, colour and ethnicity. Too many people are still being dangerously misdiagnosed as type 2 because too many medics do not understand this.

Can I come back if I think of more?

ert said:

I had my yearly interview with the 1st year medical students from an Oxford College who get to try to diagnose me with type 1 diabetes presented with my initial symptoms. They also ask lots of questions about what is it like living with diabetes.

At the end of the interview, the GP's came back (onto the Zoom) and asked if I had I piece of advice about diabetes for the medics of the future, what would that advice be?

I would love to know what you would have said...

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I would ask them if they drive & then enquire as to whether they had a brand new first car or a little hungrier with a cheap runabout for a few hundred quid..?

I feel they all should cut their teeth owning an "old banger." Gives a little flavour of what to expect with the running repairs on the journey & occaisional non-starter prior to a shift...

If the tests done prove its not type one, then I would consider finding the insulin levels of possible type two. This is an overlooked test, but because of insulin resistance, hyperinsulinaemia and hyperglycaemia may be the cause of the symptoms.

Stay safe

I would say to NEVER jump to conclusions based merely on appearance.

I once had a DSN who said of the Diabetes consultants at the clinic "I think sometimes they forget you're human" not me personally but the patients in general and went on to say about how it's all very well saying that for good control you need to do x, y and z but we have our own thoughts and feelings and sometimes we want to eat a whole box of chocolates and sometimes we might forget our insulin or whatever else. And actually when she said those things it was really nice, so I would say is we're not just a robot with an hba1c.

To tell the medics to remember there are different flavours and presentations of diabetes, not just 1 and 2 but others too

I would remind them no two diabetics are the same. What works for one will not necessarily work for another. Don't make assumptions about patients - we are not saints but we do keep to the "rules" most of the time. Due to junior doctors treating their own stereotype of a diabetic, rather than me "dancer ", I lost all trust for them, as they obviously thought I was a liar and a cheat. (One actually accused me of cheating in my diet.)

Knowledge is power and far from being costly to the NHS the prescribing of meters and strips for those T2s who want them will save money in the long run as the patient becomes aware of what effects food has and what they need to avoid to keep their BS at non medicated or normal levels. Caveated to say that there will always be exceptions to the rule and some T2s have no option but to be treated with insulin etc.

As another poster has said, T1 is not just a disease of childhood and is not just caused by antibodies (it can be caused by a virus). Always carry out a C-Peptide test if there is any doubt.

1. Don’t make assumptions about what your patients will and won’t comply with. Dont make the choices for them (unless they ask you to or it’s life and death). Tell them all the available options. And that includes low carb for type 2 even if you personally think it’s hard work/impossible to stick to.

2. Do the test, don’t guess. In this particular topic that would be test the insulin/cpeptide/antibodies before assuming type and best treatment. Too many LADA get missed and too many t2 end up on insulin when they need to reduce insulin not increase it.

Forget everything you have been taught and read "The Diabetes Code" by Dr Jason Fung for T2 and maybe Dr Bernstein for T1?

Listen to diabetics especially those who’ve had it a good length of time , don’t try and “ sheep dip “ all diabetics as a one fits all scenario ,

@ert what a great thing to do. Very interesting. Good ideas already.
I would add, keep up to date with the latest technology. I had a consultation with a Gp a year ago who didn’t know what a Libre was or what it did. Worryingly he wasn’t interested either. As I had gone with skin irritation caused by said Libre, not good!

becca59 said:

@ert what a great thing to do. Very interesting. Good ideas already.
I would add, keep up to date with the latest technology. I had a consultation with a Gp a year ago who didn’t know what a Libre was or what it did. Worryingly he wasn’t interested either. As I had gone with skin irritation caused by said Libre, not good!

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A good point on type 1,.sadly such attitude equally applies type 2.

My advice would be
"When the usual advice means a worsening of condition yet some present with improvements, ASK how they did it "
Simple, but we're not robots, so enquire when results go against the grain.

Many go docs with unexpected reductions.
After ignoring eatwell & die, and going LCHF

Sure mine was, and yet no one seems interested or asks about what clearly works for so many and me in particular
As we buck the trend of simply deteriorating as per normal.

Do agree, scary even, that docs treating diabetics not aware of CGM's..

As some here know, one of my daughters is a 5th year medical student, about to graduate having also worked on the front lines supporting clinicians during the darkest days of Covid. Still bright eyed and bushy tailed though.

I asked her the question posed here to get her perspective and her answers were very illuminating. I hope you'll find this interesting...

She said a huge number of DSNs seem forced into tick boxing without thinking and the strain of diabetes on the NHS resourcing model had been known for many years; they've done little to prepare for what is known to be a tsunami in the making.

In terms of endocrinologists - not impressed with some she's seen, as they're more data scientists rather than human physicians.

Diabetes affects everyone inflicted with the condition differently and treatment needs tuned individually. Believes low carb is the way forward for many but not to the point of being a zealot as that can also cause lasting damage.

Last thing she said - Drs need to listen and discuss with every patient ensuring they're involved and bought into their own care, starting with that 1st appointment.

I'm obviously very biased, but I'd say she's talking a lot of sense and echoes my wishes as to how a clinician should deal with all of us with diabetes.

She talks as much as me (but she listens and very well too).