It's that HbA1c time again!

[AJLang]

I hope that the appointment goes really well for you.

 

[cazscot]

Good luck with your review 🙂.

 

[Northerner]

Thanks folks 🙂 And the winners are....newbs and AJLang with their prediction of 5.5%, the same as last time 🙂 Happy with that!

Unfortunately, my usual consultant was away, so I got a different one, who wasn't quite as good. At first he suggested my HbA1c was a bit low, but accepted that it had always been low - I admitted to having hypos, usually when circumstances change, like running more etc. but not really that many that would have a big impact on my levels given that my SD is about 1. We had a discussion about the DVLA and the new rules, although I did tell him that I don't drive and never have, so it seemed a bit pointless talking about it - he did say that the new rules (about 2 assisted hypos losing you your license) had not been publicised by the DVLA and that many of his patients weren't aware of it - perhaps it passed by those without an online presence?

He was also a bit negative about my cholesterol levels - 4.4 down from 4.8 last time - and said that I should be aiming for 2.5 or below! So, we had a little discussion about it, including alternatives to statins, although I have no intention of taking more drugs - he said he wasn't trying to push them on me, just to bear it in mind.

When I told him that I had now stopped taking the lantus, again I thought he was a little negative, basically telling me that I would probably need to start it again at some unspecified point in the future rather than showing any real interest as I believe my usual consultant would have done.

So, not up to the usual standard really - he tended to talk over me when I was trying to say or ask things, although not as bad as some I've had in the past. Overall, my impression was, as I say, a bit negative, and if I hadn't been the kind of person who is confident in my diabetes and general health management then I would have probably come away feeling quite deflated by the experience rather than encouraged.

 

[Dizzydi]

Thanks folks 🙂 And the winners are....newbs and AJLang with their prediction of 5.5%, the same as last time 🙂 Happy with that!

Unfortunately, my usual consultant was away, so I got a different one, who wasn't quite as good. At first he suggested my HbA1c was a bit low, but accepted that it had always been low - I admitted to having hypos, usually when circumstances change, like running more etc. but not really that many that would have a big impact on my levels given that my SD is about 1. We had a discussion about the DVLA and the new rules, although I did tell him that I don't drive and never have, so it seemed a bit pointless talking about it - he did say that the new rules (about 2 assisted hypos losing you your license) had not been publicised by the DVLA and that many of his patients weren't aware of it - perhaps it passed by those without an online presence?

He was also a bit negative about my cholesterol levels - 4.4 down from 4.8 last time - and said that I should be aiming for 2.5 or below! So, we had a little discussion about it, including alternatives to statins, although I have no intention of taking more drugs - he said he wasn't trying to push them on me, just to bear it in mind.

When I told him that I had now stopped taking the lantus, again I thought he was a little negative, basically telling me that I would probably need to start it again at some unspecified point in the future rather than showing any real interest as I believe my usual consultant would have done.

So, not up to the usual standard really - he tended to talk over me when I was trying to say or ask things, although not as bad as some I've had in the past. Overall, my impression was, as I say, a bit negative, and if I hadn't been the kind of person who is confident in my diabetes and general health management then I would have probably come away feeling quite deflated by the experience rather than encouraged.

Oh Northy sorry it all didnt go as planned - suppose it is so hard when you dont see your usual consultant.

I cant believe they said cholesterol levels - you should be aiming for 2.5 or below! Where has he got that from ??

Congrats on the maintain with your HbA1c xxx

 

[Phil65]

Thanks folks 🙂 And the winners are....newbs and AJLang with their prediction of 5.5%, the same as last time 🙂 Happy with that!

Unfortunately, my usual consultant was away, so I got a different one, who wasn't quite as good. At first he suggested my HbA1c was a bit low, but accepted that it had always been low - I admitted to having hypos, usually when circumstances change, like running more etc. but not really that many that would have a big impact on my levels given that my SD is about 1. We had a discussion about the DVLA and the new rules, although I did tell him that I don't drive and never have, so it seemed a bit pointless talking about it - he did say that the new rules (about 2 assisted hypos losing you your license) had not been publicised by the DVLA and that many of his patients weren't aware of it - perhaps it passed by those without an online presence?

He was also a bit negative about my cholesterol levels - 4.4 down from 4.8 last time - and said that I should be aiming for 2.5 or below! So, we had a little discussion about it, including alternatives to statins, although I have no intention of taking more drugs - he said he wasn't trying to push them on me, just to bear it in mind.

When I told him that I had now stopped taking the lantus, again I thought he was a little negative, basically telling me that I would probably need to start it again at some unspecified point in the future rather than showing any real interest as I believe my usual consultant would have done.

So, not up to the usual standard really - he tended to talk over me when I was trying to say or ask things, although not as bad as some I've had in the past. Overall, my impression was, as I say, a bit negative, and if I hadn't been the kind of person who is confident in my diabetes and general health management then I would have probably come away feeling quite deflated by the experience rather than encouraged.

Alan,

Why is it that you can see a consultant in a positive frame of mind and leave feeling deflated! They have no idea sometimes!! It sometimes seems like they have to pick a hole in something or other instead of congratulating you and encouraging you to maintain your excellent control! I'm wondering if your consultant was talking about your LDL levels with regards to your cholesterol?



Total cholesterol
U.S. and some other countries Canada and most of Europe
Below 200 mg/dL Below 5.2 mmol/L Desirable
200-239 mg/dL 5.2-6.2 mmol/L Borderline high
240 mg/dL and above Above 6.2 mmol/L High


LDL cholesterol
U.S. and some other countries Canada and most of Europe
Below 70 mg/dL Below 1.8 mmol/L Ideal for people at very high risk of heart disease
Below 100 mg/dL Below 2.6 mmol/L Ideal for people at risk of heart disease
100-129 mg/dL 2.6-3.3 mmol/L Near ideal
130-159 mg/dL 3.4-4.1 mmol/L Borderline high
160-189 mg/dL 4.1-4.9 mmol/L High
190 mg/dL and above Above 4.9 mmol/L Very high


HDL cholesterol
U.S. and some other countries Canada and most of Europe
Below 40 mg/dL (men)
Below 50 mg/dL (women) Below 1 mmol/L (men)
Below 1.3 mmol/L (women) Poor
50-59 mg/dL 1.3-1.5 mmol/L Better
60 mg/dL and above Above 1.5 mmol/L Best


Triglycerides
U.S. and some other countries Canada and most of Europe
Below 150 mg/dL Below 1.7 mmol/L Desirable
150-199 mg/dL 1.7-2.2 mmol/L Borderline high
200-499 mg/dL 2.3-5.6 mmol/L High
500 mg/dL and above Above 5.6 mmol/L Very high

 

[Northerner]

Hi Phil, no, he meant total cholesterol because I quizzed him on it. I actually asked him if there was no lower limit for total chol and he said no! This doesn't make sense to me as cholesterol is necessary fr every cell in your body 🙄 He said that the 2.5 is based on some Chinese people who live in a hut somewhere who have a chol level of 2.5 and no heart disease. I'd heard that before, of course, when I was researching statins and concluded that, since I wasn't Chinese and living in a hut, to artificially reduce my levels using drugs ignored all the other possible advantages those Chinese people may have, like their genes etc. Really, for me personally, I think the statistical advantage from an artificial reduction in my levels is negligible.

Actually, another thing that always gets me is that I always get a sharp intake of breath when I have my BP taken at these appointments. This morning I was 150/80, yet I measure at home every day and am invariably around 100/70 or lower. Yet, because of the surgery readings I'm on drugs to 'control' it. I take the drugs because I get no side-effects, but I could probably do without them - problem is that it's had to convince the doctors when it's high when I see them!

You're right Phil, even though I know I'm doing OK and don't expect a tickertape parade, where's the harm in giving someone encouragement for doing well, rather than nitpicking little details? 🙄 I know it's probably difficult when you haven't seen someone before so only have notes to go off, so perhaps he thought it was the right approach to point out areas where things might be even better, in case I wasn't aware of them. I've come to the conclusion though that if you were to try and live your life according to some Platonic ideal then you'd probably just end up suffering from stress and depression and would then be at risk from that.

 

[everydayupsanddowns]

Congrats on the A1c Alan - commiserations on the appointment.

Some HCPs seem more cholesterol fixated than others - and you seem to have found one that just looks at one of the numbers in isolation. The more I hear/read about chol the more conflicted and complex the matter seems to be (which levels of what in correlation to which other levels may (or may not) be a possible indication of potential future something or other...)

The fact that he wasn't a good listener is very disappointing. Someone who is doing as well as you and knows your case as intimately as you do deserves more respect - and certainly not to be talked over!

Ah well... there's always next year 🙄

 

[Northerner]

..Ah well... there's always next year 🙄

Cheers Mike - I go every 6 months, so hopefully will get my normal consultant next time 🙂

 

[everydayupsanddowns]

Hi Phil, no, he meant total cholesterol because I quizzed him on it. I actually asked him if there was no lower limit for total chol and he said no! This doesn't make sense to me as cholesterol is necessary fr every cell in your body 🙄 He said that the 2.5 is based on some Chinese people who live in a hut somewhere who have a chol level of 2.5 and no heart disease. I'd heard that before, of course, when I was researching statins and concluded that, since I wasn't Chinese and living in a hut, to artificially reduce my levels using drugs ignored all the other possible advantages those Chinese people may have, like their genes etc. Really, for me personally, I think the statistical advantage from an artificial reduction in my levels is negligible...

A consultant I used to see in the 1990s always cited Japan as the model for cholesterol levels.

This makes me laugh really, because from the 1960s onwards as increasingly Westernised lifestyles meant their cholesterol levels were steadily rising and people expected a sharp rise in CHD levels.

But CHD levels in Japan (already very low) have fallen as average chol has gone up (benefiting from other measures like reduction in smoking). So you are right Northie - it is nothing like as simple as 'get this number low and CHD will disappear'.

http://circ.ahajournals.org/content/118/25/2725.long

 

[DeusXM]

At first he suggested my HbA1c was a bit low, but accepted that it had always been low - I admitted to having hypos, usually when circumstances change, like running more etc. but not really that many that would have a big impact on my levels given that my SD is about 1.

Your A1C is not low. Your A1C is perfectly normal, particularly given your SD. It's doctors like this who lead to the NHS having to deal with complications on a grand scale. As long as doctors persist in believing anything under 7% is only possible with lots of hypos, we will always have substandard diabetes care.

He was also a bit negative about my cholesterol levels - 4.4 down from 4.8 last time - and said that I should be aiming for 2.5 or below! So, we had a little discussion about it, including alternatives to statins, although I have no intention of taking more drugs - he said he wasn't trying to push them on me, just to bear it in mind.

Bluntly, he's an idiot. I can't understand why anyone with a total cholesterol level of 4.4 would even need to consider medication. The ratio of LDL to HDL is far more important, as is your trig level.

Great results all round for you. Shame you got a consultant who's evidently become so jaded they can't believe it when someone actually controls their diabetes.

 

[Northerner]

A consultant I used to see in the 1990s always cited Japan as the model for cholesterol levels.

This makes me laugh really, because from the 1960s onwards as increasingly Westernised lifestyles meant their cholesterol levels were steadily rising and people expected a sharp rise in CHD levels.

But CHD levels in Japan (already very low) have fallen as average chol has gone up (benefiting from other measures like reduction in smoking). So you are right Northie - it is nothing like as simple as 'get this number low and CHD will disappear'.

http://circ.ahajournals.org/content/118/25/2725.long

Cheers Mike, very interesting - perhaps I should forward it to him!🙂 My normal consultant didn't bat an eyelid at my levels, in light of all the other positives in my favour.

 

[lucy123]

Well done you on your hba1c.

I don't have to tell you as you know yourself how well you are doing but I am still going to say - 'well blooming done you' and a big pat on the back from me.


Sound to me like this consultant might have learnt it all from a text book - and talking over you is quite rude!

I would say keep doing what you are doing and hopefully in 6 months you will get to see your normal understanding and listening consultant - are you able to specifically request him at all?

 

[everydayupsanddowns]

Cheers Mike, very interesting - perhaps I should forward it to him!🙂 My normal consultant didn't bat an eyelid at my levels, in light of all the other positives in my favour.

It's not to say that higher chol isn't potentially related to higher CHD risk (even in Japan) it's just that there seems to be a *lot* more to it than simply tab-A into slot-B

 

[Doddy]

congrats on the good figures 🙂
Me personally, I think some consultants just like to hear themselves speak. You know what you are doing, know what your levels should be, and sounds like you have a good relationship with your normal consultant...
I just love how they have this uncanny ability to make you feel deflated, when in actual fact...it's fine!

 

[MargB]

Only just seeing this now - been away on holiday.

Well done on a good maintain and sorry you got a numpty consultant.

 

[Northerner]

Only just seeing this now - been away on holiday.

Well done on a good maintain and sorry you got a numpty consultant.

Thanks Marg. To be fair to him, he wasn't as bad as some I have had, just not what I was expecting and with maybe a few points he could work on 🙂 Perhaps he's used to seeing bad diabetics and he didn't know how to deal with a perfect one 😉

 

[MargB]

That will be it Northey, definitely (lol)

 

[pippin]

Well done Alan 🙂 I was worried as I knew you had the guess post going but didn't see it updated. Excellent result!

Dad was meant to have his review in May but it looks like they haven't remembered although he was there for his INR today. They will wait until he has a blip then call him.....

Really pleased for you 🙂

 

[Newtothis]

Well done on your hard work - you've done brilliantly 🙂

In terms of the cholesterol my DN said those with diabetes should aim for 4 and below so slightly confused myself with the 2.5 but you have done tremendous - you should be very proud of yourself.... xx

 

[Northerner]

Thanks pippin, I'm sure your dad will be fine when he does get his test as you've both done such a great job of managing his diabetes 🙂

Amanda, funnily enough, when I was on statins (put on them at diagnosis) my chol did come down to 2.4 - the DSN said it was the lowest she'd ever seen! I could have got into quite a discussion with him, but since it seemed he wasn't really listening to me it didn't seem worth it. What he did say was that people 'with heart disease' were urged to get it as low as possible. When I was diagnosed they thought I'd had a heart attack, but subsequent investigations showed it was something else and I've had two cardiologists say that they would consider me 'low risk' despite my diabetes, so really I fall into the 'below 4' rather than the '2.5 or below' category 🙂