Follow up bloods from diagnosis

[RFS]

My blood work is back from initial diagnosis in June/July

My hbA1C is down from 111 at diagnosis to 59 - Room for improvement obviously... but a hell of a lot better than it was!

Fasting BG is agonisingly close to normal... dammit!!! Next time! 18.5 > 6.1
The one that makes me the happiest though - Cholesterol down to normal - he had mentioned statins and wanted to get me on those at the next appointment - so with any luck that will be the end of THAT discussion!

He was sceptical of what use a Freestyle Libre monitor was for my lifestyle (working away, no idea when I will be able to cram in lunch and dinner etc)... hopefully we can now have a sensible discussion about my management and not an offhand "just take tablets, tablets and more tablets"!

 

[Sprogladite]

Well done, that is a huge improvement and a testament to all the hard work you've been doing! Keep up the good work 🙂

 

[Ljc]

That’s a fantastic improvement

 

[Bubbsie]

My blood work is back from initial diagnosis in June/July

My hbA1C is down from 111 at diagnosis to 59 - Room for improvement obviously... but a hell of a lot better than it was!

Fasting BG is agonisingly close to normal... dammit!!! Next time! 18.5 > 6.1
The one that makes me the happiest though - Cholesterol down to normal - he had mentioned statins and wanted to get me on those at the next appointment - so with any luck that will be the end of THAT discussion!

He was sceptical of what use a Freestyle Libre monitor was for my lifestyle (working away, no idea when I will be able to cram in lunch and dinner etc)... hopefully we can now have a sensible discussion about my management and not an offhand "just take tablets, tablets and more tablets"!

Great results RFS...almost halved your HbA1c result from diagnosis...obviously you want to reduce your levels further...while accepting there is room for improvement you need to take some credit for such impressive work...as for the Statins question...why on earth would you want them...need them with your cholesterol in normal range...think its protocol to 'ply' diabetes with statins...whether the results warrant it or not...my total cholesterol is still high...but...two of my ratios are in the good range...one is optimum...I'll be refusing Statins at my next review (tomorrow)...be interested to hear if he does still try to offer you them...would love to witness that discussion...while GPs often criticise the use of self testing for type 2s on anti-diabetic medication or diet & exercise only...oddly enough they more than are happy to accept the results...possibly the credit...well done.

 

[RFS]

Great results RFS...almost halved your HbA1c result from diagnosis...obviously you want to reduce your levels further...while accepting there is room for improvement you need to take some credit for such impressive work...as for the Statins question...why on earth would you want them...need them with your cholesterol in normal range...think its protocol to 'ply' diabetes with statins...whether the results warrant it or not...my total cholesterol is still high...but...two of my ratios are in the good range...one is optimum...I'll be refusing Statins at my next review (tomorrow)...be interested to hear if he does still try to offer you them...would love to witness that discussion...while GPs often criticise the use of self testing for type 2s on anti-diabetic medication or diet & exercise only...oddly enough they more than are happy to accept the results...possibly the credit...well done.

Bit-in-Bold - hahah yes how very true that would be both amusing and galling in the same respect!!! I'll update and let you know what he says! And in the mean time I ought to perfect my 'smile sweetly and nod' manoeuvre

 

[the blue wildebeest]

Well done RFS! And about Statins... According to the latest encounter with a GP "all diabetics should be taking them for life". As a statement of bias it could not be more perfect. (When I suggested that a review was overdue after nine years, apparently, he looked at my latest result. "3.5" But "it could go up if you stop taking them..." I am prepared to take that risk.)

 

[Bubbsie]

Bit-in-Bold - hahah yes how very true that would be both amusing and galling in the same respect!!! I'll update and let you know what he says! And in the mean time I ought to perfect my 'smile sweetly and nod' manoeuvre

On three occasions I was advised not to test...during my first and only appointment with the DSN (I refuse to see her now) she said I was obsessive when she knew I was home testing between 4-6 times daily...had to advise her I would continue to test as my GP had said my control was excellent...didn't quite make the non-diabetic range this review...a nasty infection defeated me...will do it for the next one...see you there then RFS...41mmols or under...be interested to hear what he has to say...definitely.

 

[RFS]

I have only just had my retinopathy appointment through which is after I get back from Singapore, and I am pretty suree he told me if 'you can't control your sugars we will refer you to a DSN' - that will be fun.
DSN: So you need to eat at the same time every day blah blah
Me: Fine mostly when I am at home - goes to pieces when I am covering tournaments - then you don't know when you are going to eat lunch and dinner (breakfast is the only thing you can guarantee) and you have no idea what you can eat. Some tournaments provide excellent food (Stuttgart), some provide nothing (Madrid, Rome), some give you sandwiches only (Birmingham)... some have nothing but c**p (Indian Wells)... and depending on press conferences and matches, you grab your food as and when you can in a 12-14 hour day! I can see this conversation being a real treat!

 

[Mark Parrott]

You've done brilliantly, RFS. I'm really lucky that my DSN doesn't push statins on me as my breakdown is very good despite LDL being on the high side. My GP thinks different, but she is the poison dwarf. There has been so much research, mainly in America, about cholesterol & it is now in doubt that a high cholesterol is related to health problems. In a case study, it was shown that the majority of patients who died of heart problems or strokes had a 'normal' cholesterol level. These companies that make cholesterol lowering products make billions & have a big influence in the medical industry. Of course, i'm not promoting this idea, just saying that the info is out there to look at & people can make their own minds up on what to believe.

 

[Bubbsie]

I have only just had my retinopathy appointment through which is after I get back from Singapore, and I am pretty suree he told me if 'you can't control your sugars we will refer you to a DSN' - that will be fun.
DSN: So you need to eat at the same time every day blah blah
Me: Fine mostly when I am at home - goes to pieces when I am covering tournaments - then you don't know when you are going to eat lunch and dinner (breakfast is the only thing you can guarantee) and you have no idea what you can eat. Some tournaments provide excellent food (Stuttgart), some provide nothing (Madrid, Rome), some give you sandwiches only (Birmingham)... some have nothing but c**p (Indian Wells)... and depending on press conferences and matches, you grab your food as and when you can in a 12-14 hour day! I can see this conversation being a real treat!

Similar here...often have work that necessitates lengthy interviews...running over 5/6 days or more...a long way from home...nothing as exotic as Singapore!) usually way up north...have to eat on the run...if I remember I pack some protein bars in my bag...the only meal I am guaranteed is breakfast...not impressed by the DSNs I've met...entrenched attitudes...archaic outdated advice...not prepared to listen/discuss...compromise...so some good news for you...I presume since you are managing to control your blood sugars...you can avoid the DSN...only the poison dwarf left to deal with!

 

[Bubbsie]

You've done brilliantly, RFS. I'm really lucky that my DSN doesn't push statins on me as my breakdown is very good despite LDL being on the high side. My GP thinks different, but she is the poison dwarf. There has been so much research, mainly in America, about cholesterol & it is now in doubt that a high cholesterol is related to health problems. In a case study, it was shown that the majority of patients who died of heart problems or strokes had a 'normal' cholesterol level. These companies that make cholesterol lowering products make billions & have a big influence in the medical industry. Of course, i'm not promoting this idea, just saying that the info is out there to look at & people can make their own minds up on what to believe.

Mark...it's only after reading your previous posts I started to read up on cholesterol...never thought I'd get to grips with the mechanics of it...I was wrong...it was fascinating... I understood it...was so well prepared on the subject matter at my last review...discussed it...declined it...GP said he understood why...no statins thus far... like you my LDL could be better...however...when I checked the breakdown...looked at the ratios...all well within normal range...some of them considered optimum...prepared my homework...ready for the Statin discussion if it raises it's ugly head tomorrow.

 

[Grogg1]

I have only just had my retinopathy appointment through which is after I get back from Singapore, and I am pretty suree he told me if 'you can't control your sugars we will refer you to a DSN' - that will be fun.
DSN: So you need to eat at the same time every day blah blah
Me: Fine mostly when I am at home - goes to pieces when I am covering tournaments - then you don't know when you are going to eat lunch and dinner (breakfast is the only thing you can guarantee) and you have no idea what you can eat. Some tournaments provide excellent food (Stuttgart), some provide nothing (Madrid, Rome), some give you sandwiches only (Birmingham)... some have nothing but c**p (Indian Wells)... and depending on press conferences and matches, you grab your food as and when you can in a 12-14 hour day! I can see this conversation being a real treat!

You are clearly doing well and coping with erratic eating patterns/offerings. I haven't been told to eat regularly and was a similar levels to you at diagnosis (see my signature). I rarely eat breakfast as I don't wake up hungry and sometimes miss lunch and sometimes I pig out!!

My DN is talking about taking me off Metformin at next review in 6 months but told me I need to reduce my cholesterol but I think I need to read up a bit on what my levels really mean.

You say you use Libre for testing, does your GP provide this? My GP has given me a monitor and 50 strips a month so I supplement with the Codefree meter and monitor which I self fund. I see on the Libre site it says from Nov NHS funding but not sure how I could get my GP to prescribe as I'm T2. My DN is supportive of me testing as she says it's clearly useful as my results show.

 

[RFS]

You are clearly doing well and coping with erratic eating patterns/offerings. I haven't been told to eat regularly and was a similar levels to you at diagnosis (see my signature). I rarely eat breakfast as I don't wake up hungry and sometimes miss lunch and sometimes I pig out!!

My DN is talking about taking me off Metformin at next review in 6 months but told me I need to reduce my cholesterol but I think I need to read up a bit on what my levels really mean.

You say you use Libre for testing, does your GP provide this? My GP has given me a monitor and 50 strips a month so I supplement with the Codefree meter and monitor which I self fund. I see on the Libre site it says from Nov NHS funding but not sure how I could get my GP to prescribe as I'm T2. My DN is supportive of me testing as she says it's clearly useful as my results show.

Hi there @Grogg1 - alas my GP thinks I have wasted my money and told me he NEVER recommends to any of his T2 patients to test, finishing up with a 'well... if you feel happy with it then go ahead, but you are on tablets now so you don't need it,' before cheerfully telling me he would be putting me on a gazillion more tablets before my days on earth were done!

So I would imagine that unless I can't remain stable or better still reduce my numbers still further, he will NEVER fund it. I would imagine T1's, T2s on insulin would get priority, and a T2 (who might have been borderline T1.5) who has demonstrated they can already self-fund will drop right to the bottom of the list, despite being self-employed etc.

My appt with the GP is next Thursday so it will be interesting to see what he says. The numbers are still obviously quite high, so I can honestly seeing him argue I have not demonstrated good control but in three months I think that is some drop. I almost reduced it by half, in three months, so I am going to argue my case to be given another 3 months to try and get it at least under 48. THEN if I can't he can up the dosage. And that includes another two tournaments and the run up to Christmas so there's a test right there.

My pharmacist thinks I really ought to push for him to fund it, given the job and how it has obviously really helped me understand what affects me! I'll keep you posted!

 

[Bubbsie]

Hi there @Grogg1 - alas my GP thinks I have wasted my money and told me he NEVER recommends to any of his T2 patients to test, finishing up with a 'well... if you feel happy with it then go ahead, but you are on tablets now so you don't need it,' before cheerfully telling me he would be putting me on a gazillion more tablets before my days on earth were done!

So I would imagine that unless I can't remain stable or better still reduce my numbers still further, he will NEVER fund it. I would imagine T1's, T2s on insulin would get priority, and a T2 (who might have been borderline T1.5) who has demonstrated they can already self-fund will drop right to the bottom of the list, despite being self-employed etc.

My appt with the GP is next Thursday so it will be interesting to see what he says. The numbers are still obviously quite high, so I can honestly seeing him argue I have not demonstrated good control but in three months I think that is some drop. I almost reduced it by half, in three months, so I am going to argue my case to be given another 3 months to try and get it at least under 48. THEN if I can't he can up the dosage. And that includes another two tournaments and the run up to Christmas so there's a test right there.

My pharmacist thinks I really ought to push for him to fund it, given the job and how it has obviously really helped me understand what affects me! I'll keep you posted!

RFS they refuse to fund testing strips for T2s non dependant on hypo causing medications to save money...that's the only reason...type 2s are an easy target...GPS/DSNs are advised by the local Clinical Commissioning Groups (CCGs) who set their spending budgets...the CCGs base this on their interpretation of the NICE guidelines which say testing strips should not be routinely prescribed...the CCGs interpretation is wrong...the guidelines leave room for discretion...they say 'do not routinely prescribe'...as opposed to 'do not prescribe routinely'...my GP was willing to prescribe testing strips...he warned me the CCG would intervene...stop him from doing so...he asked me to challenge them...I did...successfully...I now have my meter/strips on a repeat prescription...you can challenge a refusal to supply strips...justify your need for home testing...any decision to increase/decrease your medication...any change to how you manage/control your diabetes should only be made after a full discussion between a patient & their health care team...I would never advise anyone to disregard medical advice...however...since you have managed to halve your HbA1c results for your first review...I see no reason why any responsible health care professional would not agree to a further three month period on the same dosage...early days for you yet RFS...the 'politics' of NHS funding...CCGs...Nice guidelines are an absolute minefield...every justification for testing regularly...every justification for your practice to supply testing strips & a meter...the testing strips issue for type 2s in our circumstances always provokes quite a debate on the forum...it's one issue I feel passionate about...if you run into any difficulty securing testing strips from your GP...I can advise you how I approached it...keep us updated...good luck.

 

[everydayupsanddowns]

My pharmacist thinks I really ought to push for him to fund it, given the job and how it has obviously really helped me understand what affects me! I'll keep you posted!

I'm with your pharmacist - as @Bubbsie says, the refusal of strips can be challenged - demonstrate how you use the information each result gives you, how they help you make adjustments to your diet and exercise plan, learn which foods to avoid for you as an *individual*. How they improve your quality of life and inform your self-management.

 

[Bubbsie]

RFS...justifying your need for testing strips requires the right approach...particularly since you have intermittent working hours...no set routine...very similar to my own circumstances...you have to have a good understanding of the NICE guidelines...the CCGs meetings where they have discussed this issue...once you have 'armed' yourself with the right information...the chances of securing your testing strips on prescription will be better...if you need any assistance...I'd be happy to help...send me a PM (private message)...I can pass you the details if you need them.

 

[RFS]

RFS...justifying your need for testing strips requires the right approach...particularly since you have intermittent working hours...no set routine...very similar to my own circumstances...you have to have a good understanding of the NICE guidelines...the CCGs meetings where they have discussed this issue...once you have 'armed' yourself with the right information...the chances of securing your testing strips on prescription will be better...if you need any assistance...I'd be happy to help...send me a PM (private message)...I can pass you the details if you need them.

The reason I use the Libre scanner is so that I don't have to use strips to be honest. So for me it still is unlikely to deliver the right outcome. I spend all day writing, so I can't imagine multiple finger pricks is going to make a 10 day tournament a barrel of laughs. My management has been via a flash glucose monitor only.

 

[Bubbsie]

The reason I use the Libre scanner is so that I don't have to use strips to be honest. So for me it still is unlikely to deliver the right outcome. I spend all day writing, so I can't imagine multiple finger pricks is going to make a 10 day tournament a barrel of laughs. My management has been via a flash glucose monitor only.

That's a different argument entirely...since they have just become available on the NHS for selected groups...you be more likely to win the lottery than have that supplied by your surgery.

 

[RFS]

That's a different argument entirely...since they have just become available on the NHS for selected groups...you be more likely to win the lottery than have that supplied by your surgery.

Exactamundo...although winning the lottery would ALSO be rather nice! I am intrigued to see what my friend says this evening. She was genuinely surprised that I had self-funded anything to monitor... well... anything. But obvs it is more than that. Exercise has played a small part (although this week I all but abandoned it to avoid my accountants sending someone round to remove my fingernails for not getting my receipts in for my year end accounts!)

But you guys do raise an interesting point... I might see if he WOULD at least fund strips (which would also help calibrate with the Libre as I think the general concencus is it can be 2mmol out from blood as it measures interstitial fluid)...Anyway - thanks for the advice peeps and will let you know how Thursday goes.

 

[trophywench]

A large part of the argument you are able to use with your GP, is to show him from the scanner memory that you are spending less time at higher numbers which is borne out by your HbA1c.

This is exactly what happens with anyone using an insulin pump properly. Doesn't 'automatically' stop us spiking or plummeting if we get it wrong - but the amount of every day we spend at 'normal' levels cannot be anything but far better for us - whatever 'Type' label we happen to have etched onto our foreheads!