Why the Patient and Doctor Have Different Interests

[Bluetit1802]

Good luck with the CPN and also the blood tests - don't forget to ask for a print out. Your GP isn't likely to explain anything it may or may not reveal. We can help if you don't understand it all. It isn't just blood glucose stuff that is important, it is all the other things too.

 

[dbr10]

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.

I very rapidly became quite alarmed that the diet advice might make my condition worse; but also that the treatment I was offered seemed to be completely inadequate. IMO treatment should involve doing everything possible through diet, medication and exercise to help diabetic patients to achieve and maintain normal non-diabetic glucose levels. How can it be that the people responsible for treating your condition don't think they should offer that kind of help?

 

[ally1]

Good luck with the CPN and also the blood tests - don't forget to ask for a print out. Your GP isn't likely to explain anything it may or may not reveal. We can help if you don't understand it all. It isn't just blood glucose stuff that is important, it is all the other things too.

Thank you
I am hoping that the cpn can help.
I know that the blood test on Tuesday will show a rise. I certainly need some help to get me back on track x

 

[ickihun]

You are doing brilliantly @ally1 . All credit to you.
Keep going as your definately making a difference.

You are one strong cookie.

If your hba1c has increased they will help. That's for sure.
I wonder if insulin would help you more?
Let's see what they discover and advise.

Whatever happens it will help.

 

[Daibell]

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.

Yes, money is probably the main problem but my two diabetes GPs have shown a level of ignorance that neither have shown when I have raised other health issues with them i.e. they are good GPs except when it comes to diabetes. From posts on this and other forums over many years there is evidence of a lack of up-to-date and comprehensive training for GPs with regard to diabetes and DUK ('org') doesn't help. BTW my private c-peptide test showed I had quite low insulin which confirmed that my diabetes GP should not have refused me insulin and then offered it to me a year later. GPs are what it says on the tin 'Generalists'.

 

[CherryAA]

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.

I spoke to Sam Feldman the director of the Public Health Collaboration in the UK on this very subject last week, because I think there should be a campaign to get fasting insulin included on the standard lipid profile worldwide. its certainly way more meaningful than cholesterol.

He tells me it not currently supplied on the NHS but agreed pretty much with the overall theories about insulin and how it works.
At present if you do want to get one done you will probably need to pay for it separately. Whether you can persuade the NHS to give you the vial you need at the same time they do your other tests, is anyone's guess.

@bulkbiker did the whole thing privately -including popping into a local private hospital to get the vial, and then sending off for the result, I beleive @BrianTheElder did too.
I use a private doctor for it, which I doubt is the cheapest option. it might be useful if either '@BrianTheElder or @bulbiker set up a thread setting out the mechanics they did so others can explore it it they want to ?

I've had two done so far. One 6 months into an LHCF diet 20, and the other 6 months later at 8.3 ,
I only even found out it existed because of the Tim Noakes study.

I have uploaded a chart showing fasting insulin levels for a bunch of LCHF controlled diabetic patients tracked against time on LCHF in a study I took part in.at 6 months I have added in the data for me at 12 months later and @bulkbiker at two years.

I have also uploaded a chart showing levels of insulin growing in obese patients ( divide the numbers by 14.4 to get to the same measures. on the other chart. ) I have re-added the three data elements I know for me and @bulkbiker, we are about the same age and long term obese. I have no idea how high it got at 40 years because NO_ONE tests it which is criminal.

Currently this is couched in terms of - when you get fat - you cause the levels of your fasting insulin to rise.
I think its the other way round - when you eat refined foods cooked in omega 6 vegetable oils if causes your insulin to go up because they cause glucose spikes, so when your insulin is high, it is a fat storing hormone so its the insulin that make you fat.
Ergo getting rid of it will also help you slim.

The fastest way to bring down fasting insulin is to fast. The fastest way to increase metabolism is to feast.

That is the entire basis of my "low insulin diet" . ie one meal per day , feasting to get all required nutrients the remaining 23 hours to fast to bring down insulin.

I won't know if it works until I get another insulin test done. Currently I'm down 7kg in 10 days on this method eating a LOT more than before after a six month stall so it looks like its working.
I've no idea what the implications are for diabetes as whole.

This chart completes that picture - why some people with diabetes need insulin and many others don't.
The former becuase they no longer have much, the latter because they have too much. Currently differentiation as to which one someone is at the point of diagnosis seems to be a lottery .

 

[Bluetit1802]

I spoke to Sam Feldman the director of the Public Health Collaboration in the UK on this very subject last week, because I think there should be a campaign to get fasting insulin included on the standard lipid profile worldwide. its certainly way more meaningful than cholesterol.

He tells me it not currently supplied on the NHS but agreed pretty much with the overall theories about insulin and how it works.
At present if you do want to get one done you will probably need to pay for it separately. Whether you can persuade the NHS to give you the vial you need at the same time they do your other tests, is anyone's guess.

Yes, I do know this. I should have explained properly that I am thinking of doing the same as @bulkbiker but need to know if I can have the bloods taken at my surgery. I seem to recall Bulkbiker said you can ask the testing company to supply the correct vial and take this along to the surgery, then send it off. But if my surgery can't or won't do this, I am stuck. I am only still thinking about it at this stage!

 

[CherryAA]

Yes, I do know this. I should have explained properly that I am thinking of doing the same as @bulkbiker but need to know if I can have the bloods taken at my surgery. I seem to recall Bulkbiker said you can ask the testing company to supply the correct vial and take this along to the surgery, then send it off. But if my surgery can't or won't do this, I am stuck. I am only still thinking about it at this stage!

thanks, I mentioned it because it looks like others are interested , I know you personally are pretty much upto speed on all this I think @bulkbiker asked a local private hospital to give him the vial of blood reasonably cheaply .

 

[bulkbiker]

Yes, I do know this. I should have explained properly that I am thinking of doing the same as @bulkbiker but need to know if I can have the bloods taken at my surgery. I seem to recall Bulkbiker said you can ask the testing company to supply the correct vial and take this along to the surgery, then send it off. But if my surgery can't or won't do this, I am stuck. I am only still thinking about it at this stage!

I can let you know after 18th Oct when I'm due my next HbA1c and Full lipid panel. I'm going to ask the NHS phlebotomist to do an extra vial for medichecks. If she won't then I'll have to do what I did last time and get the blood draw privately which cost £24 from the local private hospital. Thats on top of the £39 for the medichecks fasting insulin test.

 

[bulkbiker]

Yes, I do know this. I should have explained properly that I am thinking of doing the same as @bulkbiker but need to know if I can have the bloods taken at my surgery. I seem to recall Bulkbiker said you can ask the testing company to supply the correct vial and take this along to the surgery, then send it off. But if my surgery can't or won't do this, I am stuck. I am only still thinking about it at this stage!

If you want to get it done privately then give medichecks a call and they will tell you the nearest place they can do the blood draw. I tried to do the finger prick sample but it seriously would have taken a week for me to get enough blood out. If you want I had an offer that I think can get you some discount.. I'll have to go back and check the e-mail they sent.

 

[Ymdawd]

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

This sounds eerily familiar

 

[Guzzler]

It occurs to me is that we are almost daily told that 'Diabesity' is sky rocketing and that it is costing our NHS billions in treatment. Some accountant/manager somewhere, surely, has worked out that the current system is not cost effective or sustainable which begs the question why the number crunchers havn't put their two penn'orth in?
Let's say that ND is a roaring success (it is looking promising) it still takes years, perhaps decades to train HCPs and change public perceptions. Many more people are trying to address their Diabetes on the advice of their HCPs than are going it alone with personal research and this seems like being short changed. My opinion of HCPs has plummeted since I was diagnosed and I now have trust issues, too. After all, if my GP and/or DN are unaware of the current research or unwilling to change their approach so as to benefit patients then why on earth should I take their advice on other health issues. It is a slippery slope.

 

[BrianTheElder]

Yes, I do know this. I should have explained properly that I am thinking of doing the same as @bulkbiker but need to know if I can have the bloods taken at my surgery. I seem to recall Bulkbiker said you can ask the testing company to supply the correct vial and take this along to the surgery, then send it off. But if my surgery can't or won't do this, I am stuck. I am only still thinking about it at this stage!

I agree with @bulkbiker I took his advice and went to the local private hospital with the vial Medichecks sent. The nurse there said there was no way you could fill the vial from finger pricks. Overall a very straightforward and quick process, just a shame it's not on the NHS as it should be.

 

[kokhongw]

Unfortunately these views has likely carried over from children to adulthood...

International Committee Advises: Don’t Measure Fasting Insulin in Children
September 28th, 2009
http://www.diabetesincontrol.com/in...ses-dont-measure-fasting-insulin-in-children/

“Fasting insulin is not an optimal tool for the individual assessment of peripheral insulin sensitivity…. The current level of evidence does not support the development of a definition of insulin resistance by fasting insulin,” said Dr. Levy-Marchal, of Robert Debre Hospital, Paris.

Measuring insulin levels is an unnecessary health care expenditure, added Dr. Arslanian, the Richard L. Day Endowed Professor of Pediatrics at the University of Pittsburgh. “We’re already talking about how expensive health care costs are in the United States. Why do that when your eyes can tell you — or the body mass index can tell you. If you’re obese, the insulin level will be higher. You treat the obesity and the insulin comes down. You don’t treat the insulin.”

For all their medical training and insights, they fail to see the insulin connection...is it any wonder that the world faces an obesity/diabetes crisis?

 

[ickihun]

In me my insulin resistance level feels like it is very variable.
I guess brackets of levels may be more useful a measurement in fasting insulin results?
I am heavily awaiting a time where my bgs and weight is stable. I'm still losing and bgs are out of control a little again. Working on it thou.
Any insulin test I would have wouldnt be accurate for very long. They probably wouldnt waste their money on one for me.

I think a meter would be more useful. Bg and insulin level with ketones if over 20mml/l.
Technology needs to keep up more than nhs, on this one.

 

[ickihun]

Unfortunately these views are carried over from children to adulthood...

International Committee Advises: Don’t Measure Fasting Insulin in Children
September 28th, 2009
http://www.diabetesincontrol.com/in...ses-dont-measure-fasting-insulin-in-children/




For all their medical training and insights, they fail to see the insulin connection...is it any wonder that the world faces an obesity/diabetes crisis?

Take diabetes away. Obesity causes other problems which are costing the nhs. Many bariatric patients aren't diabetic in my group.

 

[Seacrow]

Wow. It really is a postcode lottery. I was dx as type 1 due to ketoacidosis, then type 2 because I didn't need insulin, then type 1 because I did need insulin. At this point my GP, a very sensible person, said it was beyond her, and referred me to a consultant. I had the full range of tests, including GAD and c-pep. I had a poorly functioning pancreas and mild insulin resistance.

Since then the pancreas has totally stopped producing insulin, and I'm now severely insulin resistant. Confirmed by more GAD and c-pep tests - done because I asked for them. My consultant has also been happy to do a thyroid set of tests and a bone density set, at MY REQUEST. He wouldn't have done them as standard, but stuck them on with the HbA1c no probs. Ended up with a diagnosis of hyperparathyroidism, which no one would have looked for otherwise.

My point is, if you get access to someone who knows what they're talking about, and you make a logical and reasoned argument, they are supposed to do as you ask. Maybe I've just been really lucky.

 

[DavidGrahamJones]

BTW my private c-peptide test showed I had quite low insulin

Out of interest, do you make sure that your GP gets a copy of any private blood tests.

Also, I seemed to remember that Warwick University were providers of Diabetic courses for medics, certificate to MSc level. I see they still offer courses, they used to be something of a gold standard in the old days, perhaps we should insist our GPs have received adequate training.

 

[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.

Hi mod, so sorry for using the wrong word. Thank you for editing that word x

 

[CherryAA]

Unfortunately these views has likely carried over from children to adulthood...

International Committee Advises: Don’t Measure Fasting Insulin in Children
September 28th, 2009
http://www.diabetesincontrol.com/in...ses-dont-measure-fasting-insulin-in-children/

For all their medical training and insights, they fail to see the insulin connection...is it any wonder that the world faces an obesity/diabetes crisis?

@kokhongw
I replied to this on my own diet thread below, so as not to derail this one