Why the Patient and Doctor Have Different Interests

[Grateful]

As a relatively recently diagnosed T2, I have been puzzled by the apparent disconnect (in some cases) between the patient's and the doctor's approach.

In summary, the doctors may be over-emphasizing the drug approach and under-emphasizing the dietary/exercise/lifestyle approach even though it can help a lot of T2s and even allow some of us to do without any meds at all.

So what may be going on? Bear with me for a minute:

(1) Uncontrolled diabetes is a serious disease with nasty complications. For a doctor to fail to do everything necessary to treat diabetes patients, and thus allow complications to develop, would be hard to understand -- even if that was just a handful of patients out of several hundred. If that means drugs could be over-prescribed in some cases, it is still to the "overall good" of the patient cohort viewed as a whole.

(2) The non-drug approaches to diabetes are entirely reliant on "self treatment." It's all very well for a doctor to give dietary/exercise/lifestyle advice but how many people will follow it? Also, how many will be totally truthful with their doctor when reporting what they have been doing? Plus, once again, it only takes a small percentage of failure to show the doctor in a pretty bad light.

(3) I am quite surprised at how vague the state of diagnostic knowledge seems to be. We all know the broad outline. When looking at T2, the issue can involve insulin resistance and eventually the exhaustion of the pancreas, such that it doesn't produce enough insulin. There are all sorts of tests for glucose tolerance or whatever, but almost no detailed "individual diagnosis." So for instance, I know that I am a Type 2 but have no precise knowledge of the state of health of my pancreas. I know that it must be working reasonably well because the diet/exercise regimen is working great. I have no *precise* idea how strong the insulin resistance is, nor (precisely) how healthy the pancreas is. These are obvious limits to modern medicine: and they are a powerful incentive for doctors to lump all diabetics into one basket when making treatment decisions.

I have no professional medical knowledge and I may be completely off-base in my analysis above. It's just my "two cents" as they say here in America.

 

[DavidGrahamJones]

So what may be going on?

A lot of type II diabetics are not able to change their diet sufficiently to help control their BG. It is much easier to prescribe drugs and get everyone to eat what doctors think is a proper sensible diet. In my case I was told that I should not reduce my intake of carbs, no explanation, just don't. When I did cut my carbs, the expected happened, my BG dropped, I was having regular hypos because I was over medicated and I was able to ditch the drugs.

My present doctor has told me that she cannot "trust" all of her diabetic patients to follow a low carb regime as has been shown when they have their regular HbA1c test, so she has to prescribe drugs like Gliclazide.

have no precise knowledge of the state of health of my pancreas.

A c-peptide test will give you an indication of the state of your pancreas and it's ability to produce insulin. There is also a blood test available for measuring insulin resistance. Here in the UK I paid for my own tests, just re-assuring to know what point I'm at.

 

[Rachox]

I agree. I’m fairly new to this too, I’ve adopted a low carb lifestyle and have got my HbA1c down to non diabetic levels. I’m also on Metformin which I tolerate well and am happy to remain on it for it other health benefits. I do wonder how well I’m preserving my pancreatic function by not repeatedly challenging it with high amounts of carbohydrates. As there doesn’t appear to be much in the way of long term studies we have to live in hope. It annoys me that the NHS risk assessments for heart disease automatically score heavily against you as soon as you click diabetic. There’s no accounting for how well you manage it. That’s my two penny worth as we say in the UK

 

[ally1]

My gp had given me no info, my DN, in my opinion, is worse then rubbish.
I have learnt so much here

Edited by mod for language.

 

[Guzzler]

Some doctors give a patient three months to make a difference in diet/excercise/weight loss. Others do not. Some look at results and deign that drugs are imperative to bring dangerously high bg levels down without a period of grace. I suppose just as all patients are different the same goes for doctors.
What point I think you may have missed is that some doctors are diagnosing a patient before they have even sat down based on appearance alone yet miss others who to all intents and purposes look healthy but can be T2 or T1 for that matter. Doctors really must accept that blind faith is not enough any more, we are far more savvy these days what with the wealth of information available at our fingertips. I personally respect a doctorwho actually listens and discusses options rather than one who turns to his screen whilst you are mid sentence. And finally, the next doctor who ticks a box in front of me will get the length of my tongue. I am not a statistic.

 

[Bluetit1802]

@Grateful

I can add to your list.
There is a readily available and cheap test to discover the amount of insulin we have floating about. It is a fasting insulin test.

Most T2s over produce insulin, but it can't be used effectively because of the insulin resistance, so even more insulin is produced to try again to clear the glucose. Doesn't work, so even more is produced. And so IR increases. What on earth is the point in doctors prescribing drugs such as Gliclazide, which forces the pancreas to produce even more insulin, when we already have more than enough but it doesn't work properly. ?

A fasting insulin test would be of great benefit BEFORE prescribing Gliclazide etc.

Current theory suggests too much insulin floating about is as bad as, or worse, than too much glucose.

As for doctors, most of them devolve all the lifestyle/dietary education to the nurses. They simply don't have the time to learn about it. It isn't just diabetics on their books. The nurses have the power to decrease/increase medications the doctor has previously prescribed. (If they are prescribing nurses, which they ought to be - mine is)

My HbA1c on diagnosis was 53. Metformin was never mentioned. Nor were any other meds.

 

[Grateful]

A c-peptide test will give you an indication of the state of your pancreas and it's ability to produce insulin. There is also a blood test available for measuring insulin resistance. Here in the UK I paid for my own tests, just re-assuring to know what point I'm at.

I didn't know that and it is very interesting. Presumably the results can affect the "treatment decision tree" and given that it is a chronic illness with years of treatment ahead, it seems a shame that the initial testing is not more thorough than it is. This would probably not just improve outcomes, but also save time and money!

 

[Guzzler]

Oooh! Please Sir, can I swap my Cholesterol test for a Fasting Insulin Test? Want to talk about over prescribing? The NHS spends in excess of £2 billion per year on statins. Statins which are sometimes prescribed to otherwise healthy individuals just because the clock has turned over and they have reached a certain age. Never mind the 'guidelines' a little common sense wouldn't go amiss.

Sorry, rant over.

 

[Bluetit1802]

When I have my review in December I am going to ask my nurse for a fasting insulin test. I am half wondering if she has ever heard of this, but no harm in trying. I would rather have that than an HbA1c, which in my case is a total waste of time and money.

 

[bulkbiker]

When I have my review in December I am going to ask my nurse for a fasting insulin test. I am half wondering if she has ever heard of this, but no harm in trying. I would rather have that than an HbA1c, which in my case is a total waste of time and money.

Well you know my story about that.. 2 phlebotomists and various doctors have all claimed to know nothing of such a thing but privately it's available...I wonder what the NHS is trying to do to us..

 

[hankjam]

and from the bigger picture.
As someone mentioned earlier not all are able to change to diet and exercise, so the drugs to have an important role to play.
Those of us who found this forum and have been able to gain an improvement from LCHF must be a relatively low proportion of diabetics. Have the important big studies been done to show that the effects are good and long lasting. Without those it's hardly surprising medicine has not flipped from drugs to LCHF.
It might not be right but it is the way it might be.
Given the way they seem to be wedded to statins I'm not going to be holding my breath.....

 

[Grateful]

Yes, it seems our situation is "Patient, heal thyself".

On the one hand, that is a challenge. On the other hand, it does put a lot of tools in our own hands.

(Edited to remove a comment I made that looks, in retrospect, a bit insensitive.)

 

[DavidGrahamJones]

It annoys me that the NHS risk assessments for heart disease automatically score heavily against you as soon as you click diabetic.

Personally I don't panic too much about the assessments because it is so easy to pick holes in the factors used and probably the factors they don't use like a decent diet. A lot of doctors would not call my low carb, no processed food diet decent anyway.

 

[woodywhippet61]

I got the 3 months to see what happens thing. Actually I got 3 weeks and the difference was noticeable in that short time so got the thumbs up for 3 months. I really don't want to go on meds, the longer I can delay it the better. My gp surgery 2-3 years ago was going to give me an OGTT (I was pre diabetic) but didn't have it, at the time I had other health issues. I wish that I'd thought to explore pre diabetes and fatty liver more and found this forum then. But that time has been and gone.

Personally I like the idea that I can help myself I needed to take back control after I was diagnosed.

 

[Daibell]

Hi. I'm afraid the degree of in-depth testing we are given for diabetes is mainly limited by cost to the NHS and ignorance by some GPs of the existence of these tests. You can have some of these done privately as I did for c-peptide and GAD. There is a tendency to lump us into one of two categories i.e. T1 or T2 often by guesswork and you may need to follow up yourself with private tests.

 

[DavidGrahamJones]

the degree of in-depth testing we are given for diabetes is mainly limited by cost to the NHS and ignorance by some GPs of the existence of these tests.

I'm more generous to our beloved GPs and would suggest that it's probably all down to money. Only an opinion. I paid about £90 for a c-peptide test and I see that Spire Healthcare are charging £160. Useful but not always essential. I also had an insulin resistance test.

 

[Jo_the_boat]

My gp had given me no info, my DN, in my opinion, is worse then ****.
I have learnt so much here

I really think you should be more forthright with your opinions. This wishy-washy beating about the bush doesn't help anyone!

 

[ally1]

I really think you should be more forthright with your opinions. This wishy-washy beating about the bush doesn't help anyone!

I agree but when they won,t help me, then what do I do

 

[ickihun]

My gp had given me no info, my DN, in my opinion, is worse then rubbish.
I have learnt so much here

I've learnt more here but my gp and diabetes team have been very active in my medical care.
It really annoys me that yours isn't.
Who controls your meds? I think your gp is out of his depth so follows your specials, when he reads their letters, humf!!
Maybe he didn't take enough notice when he studied mental health. Many gps just get a fine line of info about everything. Like lawyers, they learn more on the job!
Yours needs retraining in mental health, for sure.
Mine is great with mr ickihun. I couldnt ask for more support.
Ps. I got my podaritist referral on friday. Even thou my gps computers were being enhanced.
My gp knows me so it is a benefit.
Please please please @ally1 get a gp who you can talk to and who will in turn support you. Dump your rubbish gp!

 

[ally1]

I've learnt more here but my gp and diabetes team have been very active in my medical care.
It really annoys me that yours isn't.
Who controls your meds? I think your gp is out of his depth so follows your specials, when he reads their letters, humf!!
Maybe he didn't take enough notice when he studied mental health. Many gps just get a fine line of info about everything. Like lawyers, they learn more on the job!
Yours needs retraining in mental health, for sure.
Mine is great with mr ickihun. I couldnt ask for more support.
Ps. I got my podaritist referral on friday. Even thou my gps computers were being enhanced.
My gp knows me so it is a benefit.
Please please please @ally1 get a gp who you can talk to and who will in turn support you. Dump your rubbish gp!

I've learnt more here but my gp and diabetes team have been very active in my medical care.
It really annoys me that yours isn't.
Who controls your meds? I think your gp is out of his depth so follows your specials, when he reads their letters, humf!!
Maybe he didn't take enough notice when he studied mental health. Many gps just get a fine line of info about everything. Like lawyers, they learn more on the job!
Yours needs retraining in mental health, for sure.
Mine is great with mr ickihun. I couldnt ask for more support.
Ps. I got my podaritist referral on friday. Even thou my gps computers were being enhanced.
My gp knows me so it is a benefit.
Please please please @ally1 get a gp who you can talk to and who will in turn support you. Dump your rubbish gp!

Thank you for replying.
My psych has organised for a cpn to visit me tomorrow afternoon.
He knows I am struggling with my diabetes and bipolar. She apparently is aware of me struggling with bother. I do think some of it is my meds interacting with each other.
The thing I am most concerned with at the moment is how quickly the neuropathy has crept up my left leg. The physio I saw a couple of weeks ago, said physio won,t help but was given a walking stick which is a great help.
My psych has been great and he is aware that my anti psycotic med can cause higher bs levels which he is keeping me on a low level. That is why he wrote to my gp about having ideally 3 month blood test so that I Don, t get more diabetic related things.
I do understand that all gp surgeries are very busy and Don, t have the time to spend more then 10 minutes with each patient. I do admit, when I was first diagnosed as type2, my gp did help alot but that's tailed off over the past two years.
Also at the moment, I am on a big downer, bipolar wise so I do admit that things are getting on top off me.
I do feel that my psych and gp should correspond more with each other regarding the meds I am on.
Funnily enough, yesterday I received a letter from my surgery for a blood test on Tuesday and presume it's for my diabetes.
I will see what the cpn has to say regarding if she can help, just hope she can. Psych was concerned enough last time I saw him, to Warrant extra support at the moment.