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whelk

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I've been type 2 for about 8 years and slowly declining. Metformin, then Metformin and Avandia, now Metformin and Gliclazide. Also on Ramipril, a Statin, and Aspirin. Diabetic nurse says "Insulin," when my HbA1C hit 8.5. Not for me, so I become more radical with my diet and started at the gym. Within a week I started getting hypoglycaemic so have abandoned the Gliclazide and left off the Statin too. I've lost 35kg, my BP has declined and is now around 110/60. I test my BG at my own expense. It is rarely over 7. Tonight, about three hours after dinner it was 3.8 which seems very low. The nurse said "no," to radical diet and insisted that there is no alternative to insulin. I have another HbA1c fairly soon which I can't avoid because I need a repeat prescription. What to do next?
 

When you say 'slowly declining' do you mean that your BS hasn't been low enough or you've had further symptoms. And during these 8 years what kind of diet have you been eating? Have you been eating too many carbs is that why you're not improving? Or have you been eating LCHF and still not improving?
 
I'd stuck to the diet recommended by the surgery which suggested more cereal and other carbohydrates than I'd normally eat. Just ate to live, no sugar or anything like that.The decline is reflected in the way the medication has been increased in response to my HbA1c. The Gliclazide seems to have had a negative effect.
 

By following the NHS line I'm not surprised you're getting worse. Carbohydrates enter our blood and turn to glucose, so you have been avoiding sugar, while the NHS diet has filled you up with the stuff. Of all the food groups carbs is the one you need to watch most. Read some of the posts here, and you will see what I mean. Carbs and sugar need to be reduced/avoided.
 
Until recently I just took the pills, followed advice and got on with life. I just needed to act in response to the insulin threat and the letter which said something like, "you're going blind, but don't panic, we'll test you again next year."
 
whelk said:
Until recently I just took the pills, followed advice and got on with life. I just needed to act in response to the insulin threat and the letter which said something like, "you're going blind, but don't panic, we'll test you again next year."
Click to expand...

Typical NHS I'm afraid. Read up here on the forum, you MUST reduce your carbs, bread, potato's, pasta, rice, and things made with flour. It sounds a terrible prospect, but I promise once you get into the swing of it, and see those figures coming down as well as any excess weight, you will be so proud of yourself. Ask questions, and keep asking, you will get there.
 
Like I said, I've lost 35kg by changing diet and exercise and my BP and BG numbers are very low having ditched the Gliclazide. I've managed to steer clear of the surgery but they get you in the end when a prescription runs out and a review is flagged.

It was never an obsession, the decline being fairly slow.
 

The question is; do you want the decline to carry on, or do you want to beat it? That is a very personal question, and I'm not asking you to answer it here, just to think bout it.
 
whelk,

I guess I have similar questions as Grace. You say that you had a radical rethink of your diet and also state that you are self testing. My question is, how long and accurate are your tests? Have you tracked and recorded your foods against your your meter readings. I would suspect that after having gone down this road with your health care people for so long, you will run into considerable resistance by rebelling now unless you can show them in black and white just what you have found that triggers a sugar response and what you are removing from your diet that is harming your levels. I track dates and times of tests, all foods, Blood pressure 3x a day and record anything else that might be relevant to my condition... I.E. exercise, stressful situations, sleep... If you can make a logical case for your efforts and are making improvements by your actions, I would think it would be difficult to tell you that you are wrong.

Kenny

P.S. Defren makes a good point. If I knew that I was on the right track and it was my desire to do the best I could for myself a doctor would be hard pressed to make me change my diet particularly if I had played their came for so long with only bad results to show for it..... They would have to prove to me that my way was wrong and that they would find tough to do for a diet that dropped all of the foods that harmed your BS while finding other foods that more than make up for the nutritive slack.... Make no mistake, you are in a race against time for the quality of YOUR future..
 


Try this - you won't be hungry and you'll feel lots better without the carbs you've been told to eat by the NHS. I'm not a doctor but neither are most of the people on this forum, but we ARE diabetics who have found great benefit from this method of eating ... Good luck!

http://www.dietdoctor.com/lchf
 
The doc may prescribe you insulin but he/she can't force you to take it - ultimately the decision is yours. If you can use low carb (plus metformin) to get good control your results will end up speaking for themselves.
 
If you have stopped the gliciazide and are still achieving low readings hen you have improved your condition considerably.

Just show them the evidence. The weigh loss speaks for itself and will have reduced your insulin resistance.

Your hBA1C should confoirm that you are doinfg well so you shouldn't be afraid of it.As the others have said you need your facts and figures. You have not adoped a radical diet - merely reduced your starchy carbs . That and ditching the glic will account for the
weight loss.

If the weight loss and new low readings haven't kicked in for sufficient time to count you must remeber that noone can force you to take insulin if you are not ready to do so. Tell them that you want o carry on with your present regime for a further three months o see if the improvement can be permanent. It is not your condition which is geing worse it is just the effect of the medication.
You would quite probably gain some weight with insulin which would reverse all your good work.

Four years ago my DSN was pestering me to go on insiulin. amy ophalmologist arranged for me to see a diabetes consultant who put me on Januvia as my own bg tests showed that my levels spiked in the evening. he said I could gradually ditch the glimepiride if necessary. It became necessary within an incredibly short time and nooone has mentioned insulin since.

Your 3.8 is a bit low especially at night as it might eresult in higher fasting readings because of liver dump if it goes oo low overnight. Its best to try to keep it even by balancing out diet and exercise and medication,

Just show hem that you are able and ready to ake control If spikes are affecing you , you might benefoit from Januvia too.

My readings used to be 4s and 5s but would spike to 18 sometimes even after a low carb ,meal with very small portions. I just knew
within myself that I was not ready for insulin .
 
Thanks folks. My fasting BG was 5.0 this morning, so I'm happy with that for now. Saw the Doc this morning about an unrelated issue and have a HbA1c booked for next week. Dieting is not a problem. I eat what I like (things I enjoy as opposed to ad lib) and have never had a sweet tooth, so ditching bread and cereal suits me just fine. Unlike the nurse, the Doc is not fixated on the 'list' and was open to options which we will discuss when the HbA1c results come back.

How does the metered BG test relate to HbA1c? Can you guesstimate one from the other in any reliable way?
 
This is the current way of getting the conversion done, but if you are looking to convert your readings to an estimated HbA1c you need to take an average of all of your daily readings ( the more you take, the more accurate your estimate.... some places I have read suggest a minimum of 6 up to 10 readings a day) and use the formula in the link... :thumbup:

http://www.diabetes.org.uk/Professional ... 1c-values/

Good to hear that you have the ability to talk with your doctor..... at the end of the day... they sign the prescription not the nurse.

Kenny
 
Good to hear that you have the ability to talk with your doctor..... at the end of the day... they sign the prescription not the nurse.

Kenny[/quote]

I used that argument with a couple of the Gps in my practice to explain why I had consulted them rather than the nurse about my diabetes when the issue concerned meedication. It was quite apparent that ,leaving it all o the nurse had led to them feeling that they were out of touch with developments in he reatment of T2 and lacked the confidence to treat a diabetic wihout referring to her. But , as you say, they are still signing the prescripions.

After some trial and error I found one GP who obviously had some reservaions about the situation and is willing to challenge the nurse. As I don't like to put her ina diffficult position I try o do this as little as possible. I wonder if it was ever realluy ennvisaged hat the Nurses would take over all treatment odf diabetics to the extent to which some GOP's have done?
It seems illogical for such a serious disease.
 
Hi, My GP never sees me, I only ever see my DN. She has been very supportive but I feel like the GP is so detached from me that he feels he can just prescribe meds willy nilly which the DN dispenses. There is no connection, no relationship between me and the GP. I get on well with the DN but she prob speaks to the GP for 30 seconds about me and then onto the other 40 or 50 patients she is taking care of on his behalf.

The fact that he doesn't know that I am low carbing and want to reduce my meds is frustrating - I am sure he never bothers to read my notes, just gives me more pills.
 
I was in hat situation for 3 years when I changed to my present practice. You just knew one of the en GPs was just rubber samping whatever he Nurse suggesed. I found this quite wiorrying when I found he Nurse had a limited knowledhge of T2
and once ried to prescribe somehing which migh have blinded me.Although a GP conducted the annual review it was just a wquestion of following the ick sheet. Questions wwere sidelined or I wasradvised to consult the nurse !

Things changed a couple of years ago when I happened to get an annual revuiew when some medical students were present.
I made good use of their presence to ge some answers and followed it up wih an appoinment with the same GP -on the grounds that she knew the backgrond.
Since then , I have tried to ensure my annual review is done nby the same GP also with students present. After finding that the nurse has ignored some of her recommendaions she is becoming as exasperated as I am and if necessary I can get her to give me a hearing. If you approach one of the others re diabees hey tell you hat the Nurse atends more courses than hey do!
So there is no other difference between doctor and nurse? By sheer perseverance I have manged to sort out some long term issus.

I have never understood the justification for Drs to be able to ignore this disease but I sometimes have suspected it could be because many of them do not agree with the guidelines issued for treatment . The nurses on the other hand for the most part don't seem to question anything.
Those of us who rarely if ever see a GP are really at he mercy of the Nurses who are under a great deal of pressure regarding targets etc. I am sure here must be a better way.
 

The only way forward is for doctors and nurses to remember what they came into the profession for in the first place because I think the technological revolution that has very much taken over the NHS, has left a lot of them with amnesia. The past 2 decades has been about MACHINES and INSTALLING them and TRAINING people how to use them. Somewhere along that very enthusiastic and euphoric line - the patient and what it's all for, has been forgotten.
 

Not sure what the problem is as it sounds like you're doing all the right things . If your meter keeps a history of readings tell him you think your new lifestyle is working fine and is sustainable and here are the BG readings to prove it. Tell him you have got those readings and have come off the Glicazide. In a worse case remember the final decision is yours not the docs and certainly not the nurses. You have every right to refuse any suggested treatment without any comeback. You must give your consent. The doctor is allowed to explain to you why he / she thinks you are wrong but that's about it.
 
I agree whelk does not appear o have a problem with his diabetes- he seems to be doing very well. The problem is that he obviously feels disengaged from the HCPs treating him - he doesn't feel that he is part of the process. He feels that things will be imposed upon hm without consultation.

That is why others including myself have had to reminfd him that he can't be forced to do something he doesn't want to do.
So many face this problem . Its so unnecessary .
 
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