Is it really this simple?

[happydog]

A friend has been diagnosed with T2 diabetes. Her doctor says that it is really simple to look after the condition. All that is needed is to take 2 x Metformin daily and keep BG between 4-7 before meals and less than 8.5 after meals. She has been given a meter and a pot of strips and been told to do 30 mins exercise 5 times a week cut down on sugar and carbs and make sure she is in the ranges quoted, bingo job done, come back in a year. Is it really that simple?

 

[Ljc]

Said like that it sounds simple, but we here know the reality is very different don't we, perhaps the doc was trying to encourage her by saying how easy it would be with a little effort.
One good thing she has been given a meter and a pot of test strips, most don't get them.
However I think a year is far too long to wait for tests and a review to see how well she is doing.

 

[Bubbsie]

A friend has been diagnosed with T2 diabetes. Her doctor says that it is really simple to look after the condition. All that is needed is to take 2 x Metformin daily and keep BG between 4-7 before meals and less than 8.5 after meals. She has been given a meter and a pot of strips and been told to do 30 mins exercise 5 times a week cut down on sugar and carbs and make sure she is in the ranges quoted, bingo job done, come back in a year. Is it really that simple?

No...I don't believe it is that simple happydog...in theory the advice is correct...keep the BGs in range (yes)...exercise (yes)...take the medication (yes)...forward thinking doctor...given testing strips & a meter...rare nowadays...but...has the GP given any advice on how to keep those blood sugars in range...any sign of an education course...any reference to the right reading materials...what carbs to reduce...support in the initial stages is crucial...just an annual review for someone newly diagnosed...don't believe that's sufficient...I've been diagnosed just over a year...have a review coming up in October...that will be my fourth in the past twelve months...we need those be frequent...particularly in the beginning..all very well to say test...come back in a year...the home testing will only give us a spot check...when we test...not equivalent to the HbA1c test...the real indicator of how we are managing our diabetes...any sign of her being referred for a foot check...eye screening...an appointment with a DSN...diabetes is not simple (as we know)...to hear a doctor say take the pills...test...come back in a year...without any recourse to further support/advice is disappointing...frustrating...there is every possibility some of us can reduce our BG levels to non-diabetic range...reduce/stop taking medication...avoid complications/progression...to be told our aim should be solely to remain in the recommended diabetic range...keep taking the medication...come back in twelve months is frankly dismissive...indicates in my opinion her GP does not know a great deal what we should be aiming to achieve (or diabetes)...I sincerely hope you refer your friend to the forum...so she can seek the right advice...discuss any difficulties she may encounter...get the right support so badly lacking among our health care professionals...there is nothing simple about it.

 

[happydog]

I also think that a year is far too long. No there has not been any other information etc. Doctor says that provided she sticks to what he has told her it really is very simple. She said to me that she does not understand why I think that it is hard when clearly it is not and that I have the wrong mindset about it. I have told her about the forum and she was vaguely interested but says that she is not "depressed" so she can do it on her own. She described the forum as being for "needy" people. I hope she succeeds, but I still find it hard every day so I am not going to change my mindset. 🙂. I could not have done it without the help that I got and still get from the lovely people on here, thank you to everyone for your encouragement. 🙂.

 

[Robin]

If the definition of a 'needy person' is one that uses the forum, then count me in! I need all the tips and tricks on here to fine tune my results. I suspect all will be well until your friend hits a bump in the road, like illness, or stress, and the wheels will come off because she doesn't have enough background resources to know how to deal with it.

 

[HOBIE]

If you read from a text book yes it is BUT life is not like that. Keep moving around & eating less carbs really helps but its not a perfect answer. Some Drs & Nurses have there opinions

 

[Ralph-YK]

Well, the basic idea is that simple. Big issues for me is knowing what to do. Having support, advice and encouragement, being dismissed by health care professionals, being discouraged, dealing with health care professionals, eating apples pie and custard and refusing to exercise.

She described the forum as being for "needy" people.

Ugh. Why, that ... [where's the zipped mouth emoji]

 

[Bill Stewardson]

That really is quite typical of the approach to type 2 Ds today.

Nice uplifting chat, then go away and come back in a year. Sadly it is becoming more and more evident that T2s are being more devalued with every passing day. You do not have to be at all clued in to imagine the potential for other things to develop during those 365 days.

T2s are being seen as some sort of minor irritant, people who bring with them nothing in particular who rank alongside hay fever sufferers.

All the advice given by the Dr in this case is good and the provision of testing equipment is positive. The complete lack of any ongoing supervision or educational support is far from acceptable.

The NHS has deteriorating funding, Ds have deteriorating health, realistically the worsening of one is necessary to prevent the worsening of the other.

 

[Copepod]

Being positive, the GP's advice covered the essentials - increase exercise (sensible target amount stated), decrease carbohydrate in diet (not just sugar), test blood glucose levels (sensible range stated) and take medication. The thing that worries me is that there will be a 12 month wait until next planned check. I'd be happier with a recall in 3 or 6 months. However, presumably friend will return to GP if their levels are regularly out of range?
If she doesn't want to join the forum, that's fine, but we're here if she changes her mind.

 

[Amigo]

Sounds like my doctor except for the advice on ranges! It's lifted straight from NICE guidelines and is the bald, academic approach which works if you never steer off the path of righteousness. Depending on the actual state of somebody's pancreas and co-morbidities impacting generally (like severe arthritis that make exercise difficult), it's not the worst advice I've ever heard. He's also given the means to test which is a plus for a type 2.

In honesty, after 2 years and with the means to self test (that's the biggie), I think most people should have a good idea what they can eat. Motivation and adherence is the bigger problem.

I only have a Hba1c test once a year. Nobody at my surgery mentions diabetes in the interim and they clearly trust me to take the DIY route but it wouldn't suit everyone. In truth however, if I followed this GP's advice, I'd be fine. Except I don't take the metformin. I believe regular home testing is the real indicator of control evidenced by the people on here who have had spectacular and worrying morning highs every day but still managed Hba1c's out of diabetic range. I'm not reassured by the Hba1c because to me it's what happens every day that's more important.

 

[pav]

A friend has been diagnosed with T2 diabetes. Her doctor says that it is really simple to look after the condition. All that is needed is to take 2 x Metformin daily and keep BG between 4-7 before meals and less than 8.5 after meals. She has been given a meter and a pot of strips and been told to do 30 mins exercise 5 times a week cut down on sugar and carbs and make sure she is in the ranges quoted, bingo job done, come back in a year. Is it really that simple?

I wish it was that simple, if it was I would be very happy. Its good that she has been given a meter so at least she ca see what food is doing to her in the way it reacts. 12 months is far to long to wait for a follow up, I would say a max of 3 months between checkups and would say her next appointment be 1 month to see if any changes are working or the docs need to review whats happening in case a meds change is required.

 

[Bill Stewardson]

I also think that a year is far too long. No there has not been any other information etc. Doctor says that provided she sticks to what he has told her it really is very simple. She said to me that she does not understand why I think that it is hard when clearly it is not and that I have the wrong mindset about it. I have told her about the forum and she was vaguely interested but says that she is not "depressed" so she can do it on her own. She described the forum as being for "needy" people. I hope she succeeds, but I still find it hard every day so I am not going to change my mindset. 🙂. I could not have done it without the help that I got and still get from the lovely people on here, thank you to everyone for your encouragement. 🙂.

There do seem to be a few opinions about this forum, my DN told me on the first appt with her that "its for those on insulin". Whether it is or not is for you to decide, however, it is becoming clearly evident that the entire NHS, support services, and even public opinion IS being being subtlety guided away from T2s, which is cash driven.

 

[Bubbsie]

Said like that it sounds simple, but we here know the reality is very different don't we, perhaps the doc was trying to encourage her by saying how easy it would be with a little effort.
One good thing she has been given a meter and a pot of test strips, most don't get them.
However I think a year is far too long to wa

I also think that a year is far too long. No there has not been any other information etc. Doctor says that provided she sticks to what he has told her it really is very simple. She said to me that she does not understand why I think that it is hard when clearly it is not and that I have the wrong mindset about it. I have told her about the forum and she was vaguely interested but says that she is not "depressed" so she can do it on her own. She described the forum as being for "needy" people. I hope she succeeds, but I still find it hard every day so I am not going to change my mindset. 🙂. I could not have done it without the help that I got and still get from the lovely people on here, thank you to everyone for your encouragement. 🙂.

If the definition of a 'needy person' is one that uses the forum, then count me in! I need all the tips and tricks on here to fine tune my results. I suspect all will be well until your friend hits a bump in the road, like illness, or stress, and the wheels will come off because she doesn't have enough background resources to know how to deal with it.

Absolutely spot on @Robin...in those circumstances I also consider myself 'needy' ...how frustrating @happydog your friend has been given that view...based on the advice of her GP who doesn't understand the complexities of diabetes...even the most well managed of us can hit a 'bump in the road' (excuse the blatant plagiarism here) occasionally...without rhyme or reason...I hope your friend will be persuaded to change her point of view on this...come & have a look at the forum...before she takes the advice she has been given too literally .

 

[Bubbsie]

Sounds like my doctor except for the advice on ranges! It's lifted straight from NICE guidelines and is the bald, academic approach which works if you never steer off the path of righteousness. Depending on the actual state of somebody's pancreas and co-morbidities impacting generally (like severe arthritis that make exercise difficult), it's not the worst advice I've ever heard. He's also given the means to test which is a plus for a type 2.

In honesty, after 2 years and with the means to self test (that's the biggie), I think most people should have a good idea what they can eat. Motivation and adherence is the bigger problem.

I only have a Hba1c test once a year. Nobody at my surgery mentions diabetes in the interim and they clearly trust me to take the DIY route but it wouldn't suit everyone. In truth however, if I followed this GP's advice, I'd be fine. Except I don't take the metformin. I believe regular home testing is the real indicator of control evidenced by the people on here who have had spectacular and worrying morning highs every day but still managed Hba1c's out of diabetic range. I'm not reassured by the Hba1c because to me it's what happens every day that's more important.

Agree to a large extent Amigo...however...she is new to this...sent off with a meter & medication...see you in a years time...and why would her health care team want to limit her to the recommended ranges...it is possible for some of us here to reduce our BG levels to non-diabetic range...reduce...stop the medication...rely on diet & exercise only...it works at keeping you in the diabetic range...why should we/she have to stop there?.

 

[Bubbsie]

Being positive, the GP's advice covered the essentials - increase exercise (sensible target amount stated), decrease carbohydrate in diet (not just sugar), test blood glucose levels (sensible range stated) and take medication. The thing that worries me is that there will be a 12 month wait until next planned check. I'd be happier with a recall in 3 or 6 months. However, presumably friend will return to GP if their levels are regularly out of range?
If she doesn't want to join the forum, that's fine, but we're here if she changes her mind.

What do you consider the essentials to be Copepod...being positive...really?...no referral to a DSN...no foot checks...no eye screening...no education course...happydog has said that's (as far as she knows) the total of her diabetes 'care package'...with a further review in 12 months...that is woefully inadequate...sub-standard...there is nothing simple about managing diabetes...be that type 1 or 2...we cannot presume 'the friend' will return to the GP if her levels are out of range...after all she seems to have been persuaded managing her diabetes is simple.

 

[Amigo]

Agree to a large extent Amigo...however...she is new to this...sent off with a meter & medication...see you in a years time...and why would her health care team want to limit her to the recommended ranges...it is possible for some of us here to reduce our BG levels to non-diabetic range...reduce...stop the medication...rely on diet & exercise only...it works at keeping you in the diabetic range...why should we/she have to stop there?.

In fairness Bubbsie this is a third hand account of the conversation with her doctor and setting initial realistic goals set by NICE as levels that help to avoid diabetic complications isn't a bad one. I'd have been more concerned if he'd suggested she should aim for much lower levels to start with because we don't know her initial Hba1c. Telling her to aim for control doesn't preclude the hope that she'd be able to exceed expectations.
I don't agree with suggesting he'd see her in a year particularly as he'd started her on meds and should be reviewing them but my GP did leave it to me to make follow up appointments and drive my own treatment regime. I actually think that this GP was being positive in his advice because he encouraged control and management rather than the depressing...'of course you'll deteriorate in time' which some medics seem to believe. I wouldn't have been unhappy with his advice but I'm a lone player and prefer to then go off and teach myself. Not everyone is or can. I found invaluable advice from this forum and certainly not in a needy way.

It's too easy to beat up GP's but in reality they are very hard pressed and type 2 diabetes must be one of the few conditions where they know patients can be their own masters and healers. Of course they should aid the means to achieve that but compared to most medical conditions they see, this is one that has the potential to be 'tamed'. Trouble is they find themselves dictated to in terms of what they can prescribe for self management and the truth is many are out of date in terms of diabetic knowledge. In reality many patients simply refuse to comply anyway and they can't prevent patients from gorging or refusing to exercise if they're able.

I'd like to see an information pack given to all patients at diagnosis with nutrition advice, offer of an Education Course, testing advice, contact numbers including this site and the usual health warnings around non compliance. Along with this would be a testing meter, instructions on how to use it and a diary of what then to expect in terms of eye and foot checks.

However I didn't even receive any of that when I received a cancer diagnosis! 😳

 

[Greyhound Gal]

As a T1, supposedly I get seen every 3 months by my consultant, but I haven't seen him since last September. In fact the only medical apt I have had re D since then was my yearly review just over a week ago with the GP nurse.
My consultant will sign me off whenever I next see him as HbA1c is under 48, so my only care will be from the nurse at my GP who knows less than I do.
Luckily, with the help of this forum, I have my D under control.
Supposedly T1's get more care, but this is not always the case. Very much a postcode lottery I think like all healthcare.

 

[Bubbsie]

In fairness Bubbsie this is a third hand account of the conversation with her doctor and setting initial realistic goals set by NICE as levels that help to avoid diabetic complications isn't a bad one. I'd have been more concerned if he'd suggested she should aim for much lower levels to start with because we don't know her initial Hba1c. Telling her to aim for control doesn't preclude the hope that she'd be able to exceed expectations.
I don't agree with suggesting he'd see her in a year particularly as he'd started her on meds and should be reviewing them but my GP did leave it to me to make follow up appointments and drive my own treatment regime. I actually think that this GP was being positive in his advice because he encouraged control and management rather than the depressing...'of course you'll deteriorate in time' which some medics seem to believe. I wouldn't have been unhappy with his advice but I'm a lone player and prefer to then go off and teach myself. Not everyone is or can. I found invaluable advice from this forum and certainly not in a needy way.

It's too easy to beat up GP's but in reality they are very hard pressed and type 2 diabetes must be one of the few conditions where they know patients can be their own masters and healers. Of course they should aid the means to achieve that but compared to most medical conditions they see, this is one that has the potential to be 'tamed'. Trouble is they find themselves dictated to in terms of what they can prescribe for self management and the truth is many are out of date in terms of diabetic knowledge. In reality many patients simply refuse to comply anyway and they can't prevent patients from gorging or refusing to exercise if they're able.

I'd like to see an information pack given to all patients at diagnosis with nutrition advice, offer of an Education Course, testing advice, contact numbers including this site and the usual health warnings around non compliance. Along with this would be a testing meter, instructions on how to use it and a diary of what then to expect in terms of eye and foot checks.

However I didn't even receive any of that when I received a cancer diagnosis! 😳

Again agree with many of your points...but...not all...we are all hard pressed nowadays Amigo...that is no excuse...we can be our own masters if given the right support...this may be a third hand account...however...given my own experience...almost identical...it does happen...is still happening...totally support the stance you give in the penultimate paragraph...disappointing it isn't supported by DUK...or others...possibly because they take the same view...it is a simple matter to manage diabetes...who knows?

 

[Bill Stewardson]

Looking through the contents of this post it seems that being seen in a year after diagnosis in not something to be alarmed about ( for T2s)Well, it certainly alarms me. Also I'm not sure that citing other illnesses and how they may/may not get the same treatment in any way makes it right. To me it just highlights the overall deterioration of health care.
As Ds we are all well aware that we are more susceptible to infections, and that stress has direct effect on BG levels. Turfing a newby D out into the world on the back of a 12 month wait is scarily unacceptable. What about all this stuff that is surfacing regarding Ds not being able to get insurance ??

On the one hand they are not ill enough to be seen within a year, on the other they can't get life insurance , whats that about ??

Putting forward that using this forum can plug the gap left by the medical profession is, again seriously scary. I cannot understand why DUK are not screaming this from every available rooftop. There may well be lots of very good advice given in here, is it really acceptable that it's function is in any way to be regarded as taking the place of a GP ??
Are we going to see GP receptionists putting forward the DUK forum because the Dr is busy for the next year ??

I'm struggling to come up with an illness where a patient would be told to take the tablets and come back in a year,, maybe somebody could enlighten me ?

 

[Maz2]

I thought it was hba1c every three months for diabetics. I believe this is what my friend has. I was sent on a diabetes prevention programme for a year as pre-diabetic - due to end in October. By then I will have had four hba1c including the final October one. My GP had originally said he would do another test in a year which I think is the guidelines for pre-diabetics but I thought it was more often than that for diabetics.

Not sure how often my neighbour is seen and she is diabetic.

I know with pre-diabetes it seems to depend where you live. A friend of mine was told she was pre-diabetic and sent on a prevention course but she said they are not taking any hba1cs but she will have one with her GP after a year. A colleague where I used to work was told she was pre-diabetic and was not offered a course at all.