What happens next? Need a bit of guidance

[Simon592]

Hi. So I've never had any real illnesses or been in the healthcare system so apologies if my questions are naive or impatient.
These are questions I wished I asked at the time but also feeling like I don't want to keep bothering the GP surgery.

5 weeks ago a clinician diagnosed me with Type 2 after 2x blood tests.
I was given a one-off prescription of 84x metformin tablets and instructed to take according to the starting schedule.
Will there be an assessment of metformin's effect on me? Or do I just request more when I run out and keep taking them?

The clinician said someone will contact me for an annual review, eye test and diabetes program.
No one called for 3 weeks so I called the GP surgery. They said it was my responsibility to book the annual review but someone will contact me regarding the others....

At the annual review, the nurse gave me advice, tested my feet, and had me do a urine test. My blood is to be tested in 3 months.
She also referred me to the diabetes program at the hospital (which I thought was already done by the clinician?) and an exercise program at a gym. Again, was told someone will contact me for these programs and also the eye test.

It's been a further 2 weeks now and no contact. Is there anything else I need to do?
(I discovered the NHS medical exemption card myself. Confused why no one told me about it!)

Thanks in advance for any responses!

 

[KennyA]

Hi and welcome. You seem to have had the "information is dangerous" introduction to Type 2. It happens, probably too frequently.

So a series of questions and some answers - clinical-related information from Bilous and Donnelly's Handbook of Diabetes , which is not advice to people with diabetes, but advice and information for clinical staff:

Did they tell you what the results of the two blood tests was? These will have been HbA1c tests and that test is currently how Type 2 is diagnosed. Automatic diagnosis happens at 48mmol/mol and above. I'd guess you were close to that as they've done a confirmatory second test.

They almost certainly won't assess the impact of the metformin. Starting someone on metformin is just the clinical protocol set by the NICE guidelines. The NICE guidelines (now over 20 years old) assume that T2 is a progressive disease that will need to be increasingly managed for the rest of your life by more and different drugs. The NICE guidelines do not consider that it is easily possible to reduce blood glucose levels by limiting carbohydrate in the diet.

In any case, metformin does not affect glucose in or produced by the food you eat. What it does do is interfere with the ability of your liver to adjust your blood glucose (mainly upwards).

I can't be much help about the eye and foot checks and the diabetes course. Each local area will arrange these to suit, and there's no set national pattern. I did a course in 2020, which was equally good and bad in parts. I've had one eye check in three (?) years but had a foot check last month. The eye checks used to happen in the next town over, which I could only get to by driving, and they won't let you have the eye check if you need to drive home.

I still get the same checks as someone with elevated blood glucose, even though my BG has been normal for five years. This is because the NHS as a system doesn't accept that anything can happen except for the condition getting worse.

You will be contacted for the tests etc, in due course and in the fullness of time when the wheels of the bureaucracy turn, because GPs have a list of activites that they have to complete around Type 2, and are paid for levels of completion. You might find that nothing happens for weeks and then you get four separate appointments within a couple of days.

Back when I was diagnosed, I found this forum to be consistently the best source or advice and support. It beats the official line easily. There's a wealth of experience on here, and the thing you may find interesting is the variation in experience of those of us who have on the surface got "the same disease" but in practice have very widely different conditions to manage. The trick is to find what works for you, rather than what works for me or somebody else, and be really wary of anyone trying to tell you there's only one way to do it.

best of luck!

 

[coby]

Hi. So I've never had any real illnesses or been in the healthcare system so apologies if my questions are naive or impatient.
These are questions I wished I asked at the time but also feeling like I don't want to keep bothering the GP surgery.

5 weeks ago a clinician diagnosed me with Type 2 after 2x blood tests.
I was given a one-off prescription of 84x metformin tablets and instructed to take according to the starting schedule.
Will there be an assessment of metformin's effect on me? Or do I just request more when I run out and keep taking them?

The clinician said someone will contact me for an annual review, eye test and diabetes program.
No one called for 3 weeks so I called the GP surgery. They said it was my responsibility to book the annual review but someone will contact me regarding the others....

At the annual review, the nurse gave me advice, tested my feet, and had me do a urine test. My blood is to be tested in 3 months.
She also referred me to the diabetes program at the hospital (which I thought was already done by the clinician?) and an exercise program at a gym. Again, was told someone will contact me for these programs and also the eye test.

It's been a further 2 weeks now and no contact. Is there anything else I need to do?
(I discovered the NHS medical exemption card myself. Confused why no one told me about it!)

Thanks in advance for any responses!

Hi @Simon592

You must be feeling abandoned and confused!
Some health centres are so bad at explaining what's what despite knowing that this is an alien diagnosis for you.
To my mind this is certainly not putting the patient first.

I was lucky in that my GP went out of her way to explain everything to me and to reassure me that I'd be well looked after and that changes in my diet could alter the outcome for me.
Even so it was a massive big deal to me and very confusing until I found this forum by chance.

Please feel free to ask ANY questions .. no matter if you think they sound silly because I promise you they don't.
I struggled for a couple of years through not asking enough questions on here but when eventually it all clicked I soon found my way and have been in non-diabetic numbers for four years now, as well as off medication.

I am so glad you found this site

 

[RN25]

I found the initial info from the Drs /nurse very poor too. You have my sympathies. I was also someone who had rarely been ill and never even had a repeat prescription so again all quite overwhelming. My situation was different to yours in that I was diagnosed prediabetic first (again with very little info from the Drs). A friend suggested looking into the blood sugar diet (michael mosley) and I would recommend that to try to reverse type 2 (and generally get healthier). I did that with the help of the online programme. I lost weight but unfortunately my prediabetes progressed quickly to diabetes and after being quite insistent with the Dr to be tested for type 1 that was confirmed. Again little help from the GP but I am now under the hospital. They also seem to be drip feeding info, I think to avoid overwhelm and due to short appointments, but I feel they hopefully are on it now. I had my eye screening last week and am told will be called each year for that.
I would also consider the free trial of the libre cgm to see which foods spike you and understand your daily patterns. Google freestyle libre. Unfortunately a type 2 won't get one on the nhs and they are over £100 a month to pay yourself. It was from the info I got from that and then metformin having no effect (after paying for another cgm after being diagnosed diabetic) that I pushed for the type 1 test. NHS would have waited 3 months for the follow up Hba1c test.
Don't be afraid to be politely assertive to the GP surgery. My experience is you need to be. Even when the receptionists speak to you like you are a crazy person for asking very reasonable questions! Good luck