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Why the Patient and Doctor Have Different Interests

Did you have to see a specialist in order to pay for your own tests?
 
I find the full gambit of medical support around T2 pitiful. They don't tell you about the side effects of the drugs they put you on and the fact that you could end up having injections for the rest of your life because of medication. My wife is type 2 as am I and has been taking antacids, Nsaids, and other prescribed medication such as metaformin for a number of years. It transpired that after having a blood test for extreme fatigue, vertigo and peripheral neuropathy that her B12 had hit the floor.

The upshot of this was that she was given 4 large intramuscular injections of B12 serum over a period of two weeks together with an injection of Folic Acid and when she asked if her injection in three months time was her last she was told "oh no your having these for the rest of your life" . Needless to say she was a little shocked, I wasn't, I had already researched the subject and found out not only the above, but that increasing age is detrimental as well for B12 uptake.

There is evidence to show that 20% of the UK population could be undiagnosed for this condition which is shameful. My serum B12 was 179ng/L and the lower threshold here in this part of the UK medical wilderness is 147ng/L, as a subsequence I was regarded as underserving of B12 supplement. However after reading a case study from the Haematology Dept at Imperial College regarding a young man who was found collapsed in his flat and was taken to hospital, I am not happy. He had no history of illness, no history of drug abuse. His serum B12 levels were 238ng/L and all other parameters seemed normal. He was only diagnosed with B12 deficiency on discovery that he was a strict vegan (regularly regarded as priority candidates for B12 deficiency).

There is only one way to describe the NHS treatment of type 2 diabetes patients who's symptoms are similar to B12 deficiency and that is shoddy.
 
i moved surgeries after my diagnosis of type 2 when the diabetic doctors brushed me off with i dont wont to go into specifics when i started asking questions
my new surgery is much better i have done the X- pert program and whilst it was informative, i have found this forum the most helpful.
i have never heard of some of the tests mentioned on this post so i will look into this
it may seem harsh but it feels like but monitoring and drugs and then you are on your own is not an uncommon experience
 
Beefeater said:
My serum B12 was 179ng/L and the lower threshold here in this part of the UK medical wilderness is 147ng/L, as a subsequence I was regarded as underserving of B12 supplement.
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The lowest threshold of the standard range on my lab reports is 160ng/L. Happily mine were 577ng/L
 
Hi @Bluetit1802, I just booked a phlebotomy appt with my surgery and took the vial and paperwork with me. I told the phlebotomist it was a private test and and all she seemed concerned about was that the details on the vial matched the paperwork.
 
CoastGirl said:
Hi @Bluetit1802, I just booked a phlebotomy appt with my surgery and took the vial and paperwork with me. I told the phlebotomist it was a private test and and all she seemed concerned about was that the details on the vial matched the paperwork.
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Useful info.. I'll let you guys know what happens next week when I try the same thing.
 
bulkbiker said:
Useful info.. I'll let you guys know what happens next week when I try the same thing.
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@bulkbiker, Good luck but don't think you'll have a problem if you're having other NHS bloods taken as it's just a matter of connecting an extra vial. I was slightly concerned when I went in as I was only having the private test done but, as I said, the phlebotomist didn't question it.
 
Oh yes I'll be stuck a few times no doubt.. last time only 2 attempts before she gave up and booked me an appointment with her colleague...
 

You might as well ask why General Custer led his troops to their massacre at Little Bighorn that day. It seemed like a good idea at the time, I guess.

I think it's pretty clear that T2D is a killer and that most docs are badly mistreating it today.

Here are some reasons I think continuing to do what they're doing seems like a good enough idea for now.
- it's established practice. T2D is considered to be a chronic disease. So there.
- It's comfortable. MD's are herd animals. They generally don't want to be the first one to try a new procedure or the last one. Middle of the pack is the safe place to be.
- to an MD a prescription pad is reliable and a diet is uncontrollable and unreliable. Most weight loss diets fail so why fool around? Low carb is different but most MD's don't get that. Which brings me to my next point.
- insulin resistance and low carb are a double disconnect for most MD's. They were raised on blood sugar as the problem and high carb as the diet of choice. They have little training in nutrition and much of what they have is flawed. So when they hear 'low carb' they think 'another ridiculous diet fad'.
- they get away with it. T2D's in remission don't cause trouble, they just go away. HMO's and health administrations keep paying the bills. New T2D's keep showing up.

My opinion is that we are nearing a long overdue tipping point on this, however. Treat to reverse will become the default and treat to maintain with drugs a last choice. We're seeing it with the Low Carb Program, Virta Health, an overwhelming body of research. And many others.

This dam is ready to burst. Can't come soon enough for me.
 
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Most type 2 diabetics are overweight or obese. The problem is that there is too much glucose in the blood and fatty liver means that excess glucose can't be removed even if blood insulin levels are high. In such cases using insulin or drugs like gliclazide to stimulate more insulin production in the pancreas may be making things worse. The solution is to reduce the supply of glucose to the blood through a low carb diet and burn off the excess fat in the liver and pancreas by ketogenic diet and intermittent fasting. Fasting is a lot cheaper and much more effective than many drugs to treat type 2 diabetes, but GPs seem to be totally unaware of this.

Diabetes is associated with an increased risk of heart disease, but it turns out that most people who have heart attacks have frequent blood glucose spikes (see the Japanese Glucose Spike documentary) whether they have diabetes of not. High cholesterol can be a response to inflammation caused by glucose spikes, so is a symptom not a cause of calcification of the arteries. The solution is to reduce the risk of inflation by reducing glucose spikes. You can reduce glucose spikes using a low carb diet and also changing the order you eat your food with the higher carb items like rice eaten at the end of your meal with vegetables eaten first. Doctors seem to be pushing Statins on patients, when they should be advising patients to reduce risk of heart disease, cancer and alzheimers by eating a low carb and low glucose spike diet.
 
Following a period of a year or so working freelance within my career via an agency without any specific base at any one time, and only approaching GP's for my monthly Repeat Prescription renewals as a Temporary Patient, my experience has been that a number of GP's actually don't have a clue. Up to the end of last year, I had everything under control but after a period of ill health including Mental Health issues, and returning home to recuperate, getting back on track has been difficult to say the least.

My experience has been that in general, the Surgery Nurse has more idea of what he/she is doing and can be relied upon to come up with answers plus how to move forward and achieve results. But now I'm back in regular full time work and settled down in a new job since late May, and in turn signed on to a permanent GP Surgery in my area, there is a lack of joined up thinking, that is, both the GP's and Nursing personnel are at odds with each other and contradict each other in terms of treatment and how to get to grips with my T2 Diabetes. My latest Review was this week, with less than favourable results with the result that I'm now on increased medication as well as following more "diet advice" etc.

But that end result only came about when faced with the Doctor's advice differing from that of the surgery Nurse, I had to really put my foot down and ended up asking that they put their heads together to come up with a mutually agreeable solution. Sounds harsh, but it had to be done.

Yet around 5 weeks ago, I was taken ill and admitted to hospital, ending up being in for a couple of days; the Diabetic team there stated my Diabetes was under control and nothing to worry about. So, within a month or so, I have conflicting information; who is right?
 


I applaud you on your comments within your blog. You hit it right on the head.

I am a person who is not taking medication, and am doing dietary, keto eating plan, along with walking min 8 klm a day approx. 9,000 steps, or min 5 klm a day 7,000 steps, plus other general exercise on top. Carbs 20/50 a day and not had potatotes, bread, pasta or rice for 12 months! and I am in total control WITHOUT MEDICATION and lost 18 kilos in between. Feeling great energized and never felt better in my entire life aged 68 and still surfing every day!

The bewilderment to this, I have not received any support from my Doctor, I changed him for this after 30 years care he has provided me, to a new doctor, who to my wonderment even more, did not support the efforts I explained, to a degree he did not even look at my two A1C the latter which I reduced by 23% in four months NO MEDICATION.

As you state, NOT EVERYONE will follow this routine, it takes self motivation to the highest degree, and determination to prove to the Medical Industry and Diabetes world they are wrong in chronic irreversible disease, and personally not a doctor but feel, they are going down the wrong avenue in treating the symptom SUGARS, instead of focusing targeting CAUSE INSULIN RESISTENCE. Sugars are a symptom of the CAUSE. This is a concerning factor no one seems to want to admit, take on board and even consider, this is the case, and reviews on how to treat in different way should be considered.

Not knowing how "precise" the general situation of ones condition is as you say, plus with added frightening concern, the cut off numbers our situation is based upon ultimately, are all ARBITRARY CUT OFFS, there is no medical evidence or clinical support to back up this decided number, even the so called Experts USA and other, state, and acknowledge they are just that
Arbitrary at whim and random, in good faith as presumed, to capture the disease earlier, but in do so, its not so black and white, as ONE NUMBER DOES NOT FIT ALL SIZES. Diabetes should be viewed with pragmatic approach BASED ON INDIVIDUAL circumstances, situation, and will power and flex the so called arbitrary cut off numbers as to be given label diabetes is life changing and effects one mentally and daily life from travel insurance, dentist, employment, and other.

How Precise is the cut offs that's the question, they are lowered at whim, from 140mg/dl then to 110mg/dl then finally 100mg/dl On all changes, what happened, thousands of normal people, overnight, suddenly became pre diabetic, not an official diagnosis by the way to my understanding?, or diabetic, finally resulting in big business of sales of medications for these people who were not taking medications before, monitors, strips it goes on that a person who is labelled as pre or diabetic become the best customer of Diabetes world for ever. that's concerning!

The world shares this disease, yet its admitted again, all have different cut offs they may be small, but they differ, here in Spain as A1C cut off is 6.6% I am on this border cut off number, yet in New Zealand as their cut off A1C without classic symptoms my case, is 6.7%. Its a case where you are diagnosed at the time is good luck or bad luck. I am in spain, labelled as diabetic, if I jump on plane back to Australia or New Zealand, I am PRE DIABETIC, caution only situation, exercise, and diet change,reviewed in 12 months approach, how pragmatic is that, its how it should be until the world comes up with a 100% full proof medical and clinical cut off number, that the entire world strictly follows this criteria number and follow the same format of diagnosing.

Obviously, I don't view myself as Diabetic I respect spain they are not wrong, but that does not mean they are right either, New Zealand criterias cut off A1C is not wrong either, but if I have a choice I put myself a label of Pre Diabetes, as I cannot do more than I am doing now, I have reduced high normal sugars down to normal 88mg/dl fasting, 92mg/dl 2 hr after eat 97mg/dl random, and only check my fingers every three months, and they are consistently stable, with only a difference of 1 or two numbers higher or lower either side. Yet the diabetic world say A1C is the gold and the best, not finger testing.

A1C have flows in precise situations lab errors, lab differences of testing, 0.5% or more one way or the other, and the format they check as I understand, is candy sugar sticking to red blood cells over 3 months, again, not everyones blood cells are the same, a diabetic I believe cells live 81 days, a non diabetic 141 days, if I am not mistaken? if this proves the case, the sugar will have stayed LONGER on the non diabetic, but that does not mean they have more sugar, yet the test result no doubt will show a High, so its a false situation that A1C assume that everyones red blood cells live the same lifespan that the format of testing is based upon Once upon a time, the Who stated on their website, they felt A1C were not recommended as a reliable marker for diagnosing, they have not changed this and allow same, Australia, do not have A1C covered as the main form to diagnose, it is viewed, as a help tool along with finger testing.

There are some serious situations areas surrounding Diabetes overall that I feel clearly need adjusting, and reviewing and especially as you state, IN MY OPINION, THERE HAS TO BE CUT OFF LEVELS OF COURSE, AS GUIDES, but it also has to have pragmatic approach by the system, the doctors, to view the persons INDIVIDUAL situation, and not one size or number fits all is the serious problem here.

if one is sitting on a cut off number and diagnosed diabetic even though they have reduced their numbers, exercising, no carbs, and continued control of sugars, such circumstances have to be taken on board that the cut offs are arbitrary, first of all and the person could be below this number as well. and this is not taking place this has to change, as over medicating can take place wrongful diagnosis spain Diabetic, another country Pre Diabetic, is appalling, and also affects the mental state, of any other good health of the person, that may deteriorate re anxiety and worry unnecessarily.

The Doctors, have to be more supportive to the person as individual and I feel is incumbent on them to be pragmatic, use common sense, and show flexibility within reason when numbers to not greatly exceeed the border cut off arbitrary

I again applaud your comments viewing, a great blog.

Mallorca
 

Hello,

I can relate to your situation 100% I have both conflicting and contradictory situation within the Diabetic System itself, which is appalling and disturbing, I am given label of diabetic here in Spain based on their cut off A1C numbers for diagnosing, 6.7% yet if I jump on a plane back home to New Zealand, their cut off 6.7% no classis symptoms my case!, I fall under Pre Diabetic, caution, diet exercise, review 12 months and no medication. Now that is crazy don't you think and frightening.

The world shares this disease, yet the cut offs are arbitrary admitted by the experts at whim random, and change as and when, it finally depends where you are in the world residing time of diagnosis another frightening thing, spain is not wrong, nor is New Zealand, they are after all following the criterias of their respective countries, but the poor person in between is given label diabetic one country rules, and pre diabetic another.

So we have to take the diagnosis or I have personally with a big pinch of salt!!!! if one is hovering on a border line number and they are doing everything right, lost 18 kilos, walking min 5 and up to 9 klm a day, surfing daily, no carbs, by that no potatoes, rice, pasta, bread your in control and doing the best possible. No medications taken either.

the diabetic world has to wake up change its tactics from business to more care control of the people, set a strict cut off medically backed and the world to follow that so contradctions and conflicting situations do not exist as they do now, in your case as explained, and my own personal experience.

Its appalling situation to be in existence for us all.

Don't give up, your right to have been foreceful in approach, as its the only way to be, its your body, and the best medication is yourself, to ensure, 100 questions are asked, and 100 answers in turn are given, and that's not an easy task, as everyone passes the buck, there is no strict criterias, why, all numbers are at whim random, finger testing, and A1C and personally I don't have condidence of trust in the cut off numbers, as they are not in the best interests as made out for instead for the pharmas and business and ultimately its my personal viewing, its not the doctors medical world that finally diagnose one its the pharmas and system! and that's even more concerning.

Mallorca
 
I agree. I am new to all of this diabetes lifestyle. I was diagnosed from a A1c test that was followed up by another 2-3 weeks later with the same result. My fasting BG's for the 1st one was 10.3 for the 2nd one was 6.6 . But the change in fb's was not of any consequence to the DN it was ONLY the A1c that counted.

Of course the difference was that I'd stopped eating sugars and carbs (as much as possible), quit alcohol, quit junk food, and was beginning to walk. But the nurse wasn't interested in that. I was there to be told to go on meds because without them I wouldn't be able to manage my bgl's on and to eat those nice carbs. Anyway that's history and I think/hope that we've both moved on from there.

My biggest problem with the diabetes lifestyle is that whatever I use to test my bgl's with is inaccurate to some degree. I understand that we are all different. But surely somewhere there is something that I can use as a marker to say this is a true reflection of my blood glucose level. I was really hoping that the A1c test would do this but it doesn't does it.
 

I don't see it as a problem. Our meters, the HbA1c and if we can afford it, a Libre sensor are all we have. There are, of course, other tests the doctor can order, such as an OGTT and a Fructosamine test to determine both diagnosis and subsequent control. Or you can do a home OGGT for around £5 for a bottle of Rapidose if that is of interest. Or you could pay for a fasting insulin level test if you wish. (they don't routinely do these on the NHS)

What we t2s on diet only or Metformin are looking for are trends over a period of time. Keeping records of all meter readings and averaging the FBG, pre and post meal and bedtime readings over, say a week or a month, every week/month, will show if we are going up or down. This is what I do on a spreadsheet. If these averages are trending downwards, then I am content. As I am well controlled, I am also happy if they are stable. I only worry if the trends are upwards. I absolutely know I am a "high glycator", meaning my HbA1c is always higher than any other measurements indicate, most likely because my red blood cells are long lived or because my haematocrit levels are teetering at the top of the range. So basically, I take as little notice of it as I can, but I do take notice of my meter readings, and my Libre sensor readings when I wear one.
 

Yes I know that you don't understand what I'm saying because you keep telling me. I was going to try to explain to you BUT it would just be wasting my time and yours wouldn't it. Your posts are brilliant and informative and I enjoy reading them.
 
woodywhippet61 said:
Yes I know that you don't understand what I'm saying because you keep telling me. I was going to try to explain to you BUT it would just be wasting my time and yours wouldn't it. Your posts are brilliant and informative and I enjoy reading them.
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Thank you for saying you enjoy reading my posts. I do understand what you are saying (I think). You want to know a way of discovering your true glucose reading? My only answer to that is, in my humble opinion, there is no way because it is impossible. One finger prick full or one vial full won't find it. If anyone finds a way they might win a Nobel Prize. Of course, I could be quite wrong.
 

Since I heard the comment that doctors treat symptoms, not causes of illness I have thought a lot about my interaction with them. Obviously individual patients and doctors vary, and there are time and cost constraints at play too. In my experience some doctors react badly and some well to a patient that is interested in their condition and asks questions and has done some research for themselves. I am fortunate in that my diabetic specialist GP has seen that I did what I told her I would do and my results are good enough to show that, her reaction has been positive. Despite the advice in the NICE guidelines she is interested in what I have done, indeed she was the one who gave me the pointer to this site! But for every one she sees like me, who has genuinely changed their lifestyle to improve their situation, how many does she see who plainly do nothing and don't care? That may explain the attitude of some medical staff who are more intent on simply dictating the standard line than getting more adventurous in their approach. This site has proved to be a wonderful resource of ideas and experiences, which has served me well. The only proviso I would apply is to check if you are going to add a supplement or change a diet while on any medication, by researching online and/or running it by your doctor to make sure you are not going to create unwanted interactions.
 
Alexandra100 said:
Did you have to see a specialist in order to pay for your own tests?
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Hi, apologies for slow reply, been away for 3 weeks and weened myself off the PC ruling my life as much as it seems to. LOL

I actually consult a Nutritional Therapist who persuaded me that GPs of years ago were wrong in recommending not to cut carbs. My present GP is happy although initially skeptical, she even trusted me to try the Newcastle approach which did exactly as suggested, not reversal so much but huge improvement in BG levels which had gone berserk despite low carb (40gms daily).

In answer to your question, my NT deals with organisations which do all sort of tests. I'll have to look some names up, I'm supposed to be unpacking and stuffing stuff in the washing machine. I've paid for several tests over the last 4 years and they have all shown things about what my body is doing, and I'm happy with paying. Our NHS isn't or doesn't appear to be geared up for some of the more sophisticated aspects of our health.
 
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