Review Left Me Feeling Depressed!

[salsa81]

Hi,
After years of not having a face to face appointment at my GP, I FINALLY got a face to face appointment with a so called diabetic nurse yesterday.
I went in all positive and came out feeling like I had been given a terminal diagnosis and didn't have long left to live.
I'm 44, diagnosed when I was 27 and over the last 18 months have not looked after myself as have had a lot of things going on in both my personal and work life.
However I am on a year of looking after 'me' and started to eat more healthily and exercise more.
I'm currently on Metformin, Gliclazide and Trulicity, all full doses of what can be prescribed. I was basically told that unless I went on a very, very low carb diet that I would become insulin dependent and die an early death from organ failure.
This was a nurse I'd never seen before and hadn't bothered to read any of my notes.
I'd said that the nurse I normally see has only just increased my dose of trulicity - to which I got the response, your body is probably used to it so I doubt it will do much to help.
I had been given a libre 2 plus by the other nurse to see what my bloods were doing during the day (and got a free one from the company) and it's been really helpful, wish I could afford the subscription but I just can't.
Anyway, nurse looked at my projected HBA1C from the monitoring and it's gone from 9.6 to 7.7 in less than a month and that's with having a few sweet treats here and there. Didn't even say, keep up what you're doing or that's really good. Nothing.
I'd kept a food diary, she didn't even bother to look at that.
Then tried to force me onto other medication.
Got told that exercise spikes blood sugar and that after 7 years there is no way it can be reversed.
I've already complained to the surgery BUT can anyone give me any hope or positives?
I've been trying to follow some of the Glucose Goddess 'hacks' which I think are helping but is there anyone out there that can give me a bit of hope?
Had a very sleepless night last night being incredibly scared and worried about what is happening to my body.

 

[Woodywoodpecker]

Hi,
After years of not having a face to face appointment at my GP, I FINALLY got a face to face appointment with a so called diabetic nurse yesterday.
I went in all positive and came out feeling like I had been given a terminal diagnosis and didn't have long left to live.
I'm 44, diagnosed when I was 27 and over the last 18 months have not looked after myself as have had a lot of things going on in both my personal and work life.
However I am on a year of looking after 'me' and started to eat more healthily and exercise more.
I'm currently on Metformin, Gliclazide and Trulicity, all full doses of what can be prescribed. I was basically told that unless I went on a very, very low carb diet that I would become insulin dependent and die an early death from organ failure.
This was a nurse I'd never seen before and hadn't bothered to read any of my notes.
I'd said that the nurse I normally see has only just increased my dose of trulicity - to which I got the response, your body is probably used to it so I doubt it will do much to help.
I had been given a libre 2 plus by the other nurse to see what my bloods were doing during the day (and got a free one from the company) and it's been really helpful, wish I could afford the subscription but I just can't.
Anyway, nurse looked at my projected HBA1C from the monitoring and it's gone from 9.6 to 7.7 in less than a month and that's with having a few sweet treats here and there. Didn't even say, keep up what you're doing or that's really good. Nothing.
I'd kept a food diary, she didn't even bother to look at that.
Then tried to force me onto other medication.
Got told that exercise spikes blood sugar and that after 7 years there is no way it can be reversed.
I've already complained to the surgery BUT can anyone give me any hope or positives?
I've been trying to follow some of the Glucose Goddess 'hacks' which I think are helping but is there anyone out there that can give me a bit of hope?
Had a very sleepless night last night being incredibly scared and worried about what is happening to my body.

I’m type 1 so can’t really advise, I just can’t believe that nurse. You seem like uve made good changes, don’t let one nurse get into your head. Keep up the good work

 

[Docb]

Hi @salsa81 and welcome to the forum. Your story is a bit at the extreme end of GP/DN experience but we have heard such things on the forum in the past and no doubt will hear more in the future. Most of our members have excellent relationships with the professionals and hopefully you can draw on them to help you get a better perspective on your diabetes and more importantly help you work out a way forward.

What I suggest is you stop and take stock.

First your HbA1c. I take it the numbers you quote are in the "old" style percentages. If you have got those from your GP then that is telling, they have not caught up yet with the current standard of giving HbA1c results in mmol/mol. If that is so, then your previous result (9.6%) would now be quoted as 80 mmol/mol and your current result (7.7%) would now be quoted as 60 mmol/mol. That is in any book a significant drop and you should be congratulated on it. You now need to work out how to take the next step and get it down to the diagnosis limit.

Second, your weight. Do you need to loose some weight? A blunt question I know but when it comes to planning a way forward it is important. All the evidence suggests that if you are over weight and can loose the excess then the chances are that it will have a big effect on your blood glucose levels and your HbA1c.

Third, your diet. Great you have done a food diary - a good idea in my opinion. A major source of blood glucose is your digestive system processing carbohydrate, it is the way they body turns food into energy that the body can use to function. Look at your diary and work out how much carb you consume in a typical day. Don't worry about what to do with the numbers yet - it would be useful to know.

Can I set you a goal? It is that you get determined to go back to your next review with an HbA1c at or around the diagnosis level of 48 mmol/mol with a view to cutting back on your medication. It is quite possible and we can help you work out a plan to get there. There are no magic bullets and no internet gurus with perfect solutions. You need a plan which fits you and your circumstances and the dogged determination to carry it out.

Hope that helps you to move onto the next stage of getting your blood glucose under better control and show your DN that her approach and advice was poor.

 

[Martin.A]

Sorry to hear that you've had such an awful experience from someone who's supposed to be there to help you but don't let it get you down - it sounds like you're doing really well and things are improving. My advice would be to put it behind you and move on.

I can't fathom their comment about exercise as a diet & exercise regime is a tried and trusted way of managing T2 with or without meds and that's exactly how I manage mine.

 

[JimG]

It sounds like a horrible experience. I've not had that issue with a diabetes nurse, or even any nurse at the GP surgery. All I can say is that you shouldn't let the one bad experience with a nurse upset you. I had something similar when I was in hospital recovering from a liver section to remove a cancerous tumour. Are you able to have another meeting with the GP to express your concerns and perhaps have a second opinion?

 

[JimmyBlue]

Hi @salsa81, sounds like your nurse is one of those who has had the empathy bypass operation. It might help people to formulate their advice if you provide a little more information around you HbA1c levels. What they were previously and what it is now, but only share if you are comforable
From the sound of the medications that you are on I am presuming that your latest HbA1c is quite high. If this is the case then your best option is likely to be keep working on bringing it down. Dependent on how low you can get it will determine whether you can come off some of the other medications. You may want to think about what would be a good target for your HbA1c and use that to determine what you can do in a sustainable way. Telling you to go on a very very low carb diet is not the best advice in the world. It may be worth trying to get an appointment with the surgery nutritionist if it has one, or the health and well being coach (this an NHS service but it is not necessarily offered in all areas and you may need to search on line to see if your health trust provides it who can help you with target setting and guidance on your diet. The LearningZone link at the top of the page offers lots of good advice on these issues.
While the Glucose Goddess has some good hacks, she is not necessarily targetting her suggestions at diabetics.
I am on a sustainable low carb diet for me and while I went low quickly, I believe there are risks if you go to low too fast so I would recommend starting slowly. Key changes to diet to consider are to start slowly, start to reduce the number of carbs you eat (pasta, rice, potatoes, and bread). You don't have to give them up all together but reduce portion sizes, I am not sure how beneficial it is but eating your proteins first is a suggestion. A CGM or blood testing kit to monitor the BG impact of the meals helps if you check your BG level before and after the meal so you know whether to reduce portion sizes further.
Additional exercise also helps. A walk before a meal will often bring your BG levels down so when you eat, a 2-3 mmol/l rise doesn't necessarily result in a post-prandial spike. A walk after a meal also helps with BG absorption. Not sure where your nurse got the idea that exercise "spikes" BG. As some one who runs 14 miles over the course of a week and does resistance exercises 2-3 times, I always find my BG is lower after exercise rather than higher. If you can find a way to do some resistance exercises, you may also find that your insulin sensitivity increases.
In terms of other dietary advice, try the Freshwell Low Carb Project website or download their app. It contains lots of information on low carb diet approaches as well as recipes for meals and snacks. In addition, if you like the sweeter things in life, try SugarFreeLondoner, the site has lots of low carb recipes including deserts, biscuits, cookies, etc.
I am sure that others on here will correct any bad ideas I have proposed but they will also give some good advice and support.
You are already working hard to better manage your diabetes and you should be proud of that. Improving your management and taking steps to bring down your HbA1c levels will continue to help your situation and perhaps using your anger at the non-empathetic nurse with a desire to provide her wrong may provide you with the incentive to show her that you can manage your diabetes effectively.
Finally, you don't need to take out a subscription for the CGM. I buy 1 or 2 a year which I use to track my BG for 15 days just to see where I am and how my next set of bloods might look. They are expensive so buying occasionally is a good way to go.

 

[salsa81]

Hi @salsa81 and welcome to the forum. Your story is a bit at the extreme end of GP/DN experience but we have heard such things on the forum in the past and no doubt will hear more in the future. Most of our members have excellent relationships with the professionals and hopefully you can draw on them to help you get a better perspective on your diabetes and more importantly help you work out a way forward.

What I suggest is you stop and take stock.

First your HbA1c. I take it the numbers you quote are in the "old" style percentages. If you have got those from your GP then that is telling, they have not caught up yet with the current standard of giving HbA1c results in mmol/mol. If that is so, then your previous result (9.6%) would now be quoted as 80 mmol/mol and your current result (7.7%) would now be quoted as 60 mmol/mol. That is in any book a significant drop and you should be congratulated on it. You now need to work out how to take the next step and get it down to the diagnosis limit.

Second, your weight. Do you need to loose some weight? A blunt question I know but when it comes to planning a way forward it is important. All the evidence suggests that if you are over weight and can loose the excess then the chances are that it will have a big effect on your blood glucose levels and your HbA1c.

Third, your diet. Great you have done a food diary - a good idea in my opinion. A major source of blood glucose is your digestive system processing carbohydrate, it is the way they body turns food into energy that the body can use to function. Look at your diary and work out how much carb you consume in a typical day. Don't worry about what to do with the numbers yet - it would be useful to know.

Can I set you a goal? It is that you get determined to go back to your next review with an HbA1c at or around the diagnosis level of 48 mmol/mol with a view to cutting back on your medication. It is quite possible and we can help you work out a plan to get there. There are no magic bullets and no internet gurus with perfect solutions. You need a plan which fits you and your circumstances and the dogged determination to carry it out.

Hope that helps you to move onto the next stage of getting your blood glucose under better control and show your DN that her approach and advice was poor.

Hi,

I'm old fashioned in numbers, I don't understand the new numbers, hence me stating 9.6 down to 7.7. They report it in the new figures but I always ask them to translate back so I can understand where I'm at.
Yes I do have a bit to lose but that depends on whether you agree with what your weight should be to be a healthy BMI.
I'm currently 14st 4 . When I was originally diagnosed I was 18stone. I'd like to lose about a stone and a half to get down to around 13 stone but it's something I've always struggled with. Even with trying it's about 1pound a month which can get me down.
I was put on Mounjaro last year but was never put on the second dose up, put on half a stone and was constantly hungry. It's taken me nearly a year to get that 6 pound off
Th other nurse I've spoken to before was great. She left me the monitor so we could have a look and come up with a plan of what to do and what to target.
I do want to cut back my meds and I know that changing what I eat will help but I'm struggling with what to have for dinner (lunch, I'm a northerner!). Salads don't really fill me up.
I'm having eggs for breakfast in an omelette with some cheddar but apparently my cholesterol is high so I'm worried about their effects on that.
Weekends are really hard and is when I really struggle to keep on track.
I want to prove this nurse wrong and given my age I'd like to stick a virtual 2 fingers up to her .
Open to suggestions and what I should do

 

[salsa81]

It sounds like a horrible experience. I've not had that issue with a diabetes nurse, or even any nurse at the GP surgery. All I can say is that you shouldn't let the one bad experience with a nurse upset you. I had something similar when I was in hospital recovering from a liver section to remove a cancerous tumour. Are you able to have another meeting with the GP to express your concerns and perhaps have a second opinion?

I'm hoping the surgery will get back in contact with me. I want to see another nurse but I also want to see a dietician as well.

 

[Inka]

Do complain about the nurse @salsa81 Whether she was making any valid points or not, her manner sounds like it left a lot to be desired.

Recommended BMI is 18.5 to 24.9. What’s your BMI? You’ve lost weight since diagnosis, so that’s great. If, as is likely, you have insulin resistance, that often makes weight loss harder. That’s a bit ironic because, as you probably know, losing weight can improve insulin resistance. So, do keep going with whatever diet you choose. There are various ones, so pick one that you think you’ll stick to. Some people like a structured plan whereas others like something with a little more flexibility. The recipes on Diabetes U.K. all have the carbs listed, if that’s helpful.

You could also list an average day’s food for you here, and get some suggestions of how to improve it.

 

[Chelseagirl]

Sounds like my DN. was diagnosed as T2 after 3 gestational diabetes diagnoses. In those days, it was the NHS “ Healthy Plate” advice which was hardly helpful to a diabetic and I was put on permanent insulin. (Been prescribed during last 2 pregnancies). Trundled along for 35 years, average Hb results, no one particularly worried. Prescribed Dapagliflozin 12 months ago as I had a heart attack 12 years ago. Now lost 8 kilos and got latest Hb down to 40. Her comment? I don’t like you being so low. I’d had a feeling that it would have dropped (lucky to be able to afford a Dexcom) and had looked up NICE guidelines in advance in which it says “If a patient is this level and not experiencing any hypos, which I wasn’t, they should be encouraged to maintain their regime”. None of that from her, just told to increase carb intake. She doesn’t like me adjusting my insulin either, despite me having done a DAFNE course. She’s so much help it’s unbelievable.

 

[Leadinglights]

Don't be too disheartened as you have made some progress and her suggestion of very low carb would not be sensible with the medication you are taking. Her attitude stinks, maybe she was having a bad day to be charitable.
Following a low carb of around 130g per day should be OK and many have found that an approach which id very doable and doesn't leave people feeling hungry so the link for the Freshwell Program should give you some ideas for meals. https://lowcarbfreshwell.com/
Reducing carbs can often improve cholesterol numbers even though people are eating more healthy fats.
There are options for lunch which should be filling, even salads don't need to be boring with the addition of avocado, olives, feta, cooked meats, coleslaw, cheese. Check out the carbs of some crackers as they are not too bad, ryvita, Mr Kargs high protein or some of the thins.
Home made soups are good and can be filling.

 

[Docb]

I want to prove this nurse wrong and given my age I'd like to stick a virtual 2 fingers up to her .
Open to suggestions and what I should do

That seems an appropriate place to start!

I would think about how you can get rid of that extra weight and if you can do that in conjunction with reducing your carb intake then you have got to be heading in the right direction.

Lets start with dinner, or snappin or if you must be posh, lunch. I would also start with trying to bypass the notion of being "filled up". Better to think about a lunch which you have enjoyed and left you satisfied from its flavours and variety and not from its quantity.

Here's my solution..... I have the same lunch every day but each day it is different. It is the same in that it is always soup and a plate of what I call bits and pieces.

The soup, usually vegetable is always home made. I make a batch every few days with a batch lasting a few lunches. Every batch is different - depends on what veg I have about - and I can add some extra flavour to each portion to ring the changes.

The plate has some salad, some protein - ham or cheese or chicken - some coleslaw (I make my own), maybe some beetroot usually some pickle, some kimchi if I have a batch on the go and maybe some raw veg from the garden if there are any. Carbohydrate comes from a few savoury biscuits (I don't make those) or more often than not a couple of home made samosas - more accurately flat breads filled with something or other. Every batch of kimchi, coleslaw, flatbread is different so as I say, every lunch is different but the only carbs I have to think about are those in the biscuits/flatbreads. I like to finish with a tangerine or something similar or a small piece of very high cocoa chocolate.

That's the way I get to a lowish carb lunch that is interesting and satisfying. All I really have done is to find a way of having a soup and sandwich lunch without the high carb, high calorie, item -the bread.

You are allowed to be sneaky if it helps.

 

[everydayupsanddowns]

Sorry you’ve such a rough time at your appointment. Many of us have had a few howlers over the years - which can be especially disheartening when you were thinking you might get some sort of positive feedback and a helpful discussion about what to do next. Appointments like that can really knock the wind out of your sails

Hope you are able to bounce back with the encouragement of the forum. We ‘get it’.

You’ve had some pointers and thoughts from folks here, but at the end of the day it’s you that has to find a way through the maze of options and build a sustainable and practical way of doing things for you.

 

[salsa81]

Don't be too disheartened as you have made some progress and her suggestion of very low carb would not be sensible with the medication you are taking. Her attitude stinks, maybe she was having a bad day to be charitable.
Following a low carb of around 130g per day should be OK and many have found that an approach which id very doable and doesn't leave people feeling hungry so the link for the Freshwell Program should give you some ideas for meals. https://lowcarbfreshwell.com/
Reducing carbs can often improve cholesterol numbers even though people are eating more healthy fats.
There are options for lunch which should be filling, even salads don't need to be boring with the addition of avocado, olives, feta, cooked meats, coleslaw, cheese. Check out the carbs of some crackers as they are not too bad, ryvita, Mr Kargs high protein or some of the thins.
Home made soups are good and can be filling.

Unfortunately I don't like avocados and I can't stand olives!
I do have a soup maker so in winter I have homemade soups for dinner but don't like having something hot in summer - yes I'm odd!
I'll take a look at the diet link though, thank you

 

[salsa81]

That seems an appropriate place to start!

I would think about how you can get rid of that extra weight and if you can do that in conjunction with reducing your carb intake then you have got to be heading in the right direction.

Lets start with dinner, or snappin or if you must be posh, lunch. I would also start with trying to bypass the notion of being "filled up". Better to think about a lunch which you have enjoyed and left you satisfied from its flavours and variety and not from its quantity.

Here's my solution..... I have the same lunch every day but each day it is different. It is the same in that it is always soup and a plate of what I call bits and pieces.

The soup, usually vegetable is always home made. I make a batch every few days with a batch lasting a few lunches. Every batch is different - depends on what veg I have about - and I can add some extra flavour to each portion to ring the changes.

The plate has some salad, some protein - ham or cheese or chicken - some coleslaw (I make my own), maybe some beetroot usually some pickle, some kimchi if I have a batch on the go and maybe some raw veg from the garden if there are any. Carbohydrate comes from a few savoury biscuits (I don't make those) or more often than not a couple of home made samosas - more accurately flat breads filled with something or other. Every batch of kimchi, coleslaw, flatbread is different so as I say, every lunch is different but the only carbs I have to think about are those in the biscuits/flatbreads. I like to finish with a tangerine or something similar or a small piece of very high cocoa chocolate.

That's the way I get to a lowish carb lunch that is interesting and satisfying. All I really have done is to find a way of having a soup and sandwich lunch without the high carb, high calorie, item -the bread.

You are allowed to be sneaky if it helps.

Thanks for the advice.
I have a soup maker and make homemade soups for winter but I don't like having something hot in summer - yes it may sound strange but if I'm warm, I don't want something that will be hot!
The other 'bits' sound ok but I would have to alter as beetroot is on my list of "don't like" foods I'm not picky but there are somethings I just can't stand!
My current dinner is a sandwich with protein - usually wholemeal or seeded bread - cherry tomatoes, cucumber, a bit of pepper and half a carrot and then a bit of watermelon and kiwi. Plus usually a small pack of crips, something like squares or hula hoops puft.
In winter, homemade soup + 1 slice of bread made using our breadmaker.

 

[salsa81]

Do complain about the nurse @salsa81 Whether she was making any valid points or not, her manner sounds like it left a lot to be desired.

Recommended BMI is 18.5 to 24.9. What’s your BMI? You’ve lost weight since diagnosis, so that’s great. If, as is likely, you have insulin resistance, that often makes weight loss harder. That’s a bit ironic because, as you probably know, losing weight can improve insulin resistance. So, do keep going with whatever diet you choose. There are various ones, so pick one that you think you’ll stick to. Some people like a structured plan whereas others like something with a little more flexibility. The recipes on Diabetes U.K. all have the carbs listed, if that’s helpful.

You could also list an average day’s food for you here, and get some suggestions of how to improve it.

I have already submitted a complaint to the surgery and will be calling them if I haven't heard after the "72 hours" they state they will get back to me.
With regards to BMI, I've just checked and it's 31.2. However, I do think BMI can be a bit mis-leading BECAUSE you can be a healthy but muscley person but have a BMI that is over what you should be. If I got down to what the NHS thinks is a healthy weight for me, I would look positively ill.

However, average days food for me now:
Breakfast - 3 egg omlette with a bit of cheddar
Dinner - sandwich (wholemeal or seeded bread) with protein (no butter), cherry tomatoes, cucumber, a bit of pepper, half a carrot, small bag of sqaures or hula hooops puft
Tea - this can be anything from fish fingers, frozen chips and peas, to pie with veg, ham, peas and new potatoes.

Weekends are harder for me are where I really struggle. We generally have a takeaway or a fakeaway on a Saturday night, blueberries in a bit of sugar syrup, buttermilk pancakes for breakfast on a Sunday and Sunday tea is so varying as it depends on what we have been doing.

 

[Inka]

Well, there’s good news in your diet @salsa81 in that there are plenty of places where you can make improvements and reduce carbs. However - and very importantly - as you’re on Gliclazide and other meds, any reductions should be very gradual as your dose might need adjusting with less carbs. This might be something you want to speak to a (nicer) nurse about for advice. Both your lunch and evening meal have places where you can cut carbs, eg less bread in your lunch, no/less chips or a less carby substitute, etc. But, again, be wary of making drastic changes.

BMI is a bit of a blunt tool, yes, but it works for the vast majority of people, unless you’re something like a rugby player or weight-builder.

 

[salsa81]

BMI is a bit of a blunt tool, yes, but it works for the vast majority of people, unless you’re something like a rugby player or weight-builder.

However if I was at the suggested weight for my height I would look very ill

Also, the frozen chips are probably once a week with Fish Fingers - hubby's favourite meal - and I've just started adding loads of extra veg in with this meal.

 

[Leadinglights]

However if I was at the suggested weight for my height I would look very ill

Also, the frozen chips are probably once a week with Fish Fingers - hubby's favourite meal - and I've just started adding loads of extra veg in with this meal.

Fish fingers are quite high carbs as they have a lot of crumb for the amount of fish so a piece of fish without crumbs or you can get 'lightly dusted' fish fillets which are much lower carb.
I make the point of having only one higher carb food in any one meal so if on the rare occasion I had pie I wouldn't have potatoes or peas but a green veg.
There are quite a few tweaks you can make to bring your carb intake down to nearer 130g per day. Obviously portion size is important.

 

[Inka]

However if I was at the suggested weight for my height I would look very ill

Also, the frozen chips are probably once a week with Fish Fingers - hubby's favourite meal - and I've just started adding loads of extra veg in with this meal.

Extra veg is great 😎 You’re also having a nice selection of veg with your lunch, so you’re on the right track. Could you substitute the fishfingers for a cod portion in that meal? That and a small portion of chips might work. Oven chips are good in that you can check the carbs per weight on the bag and adjust your portion size by weighing the cooked chips.

You must be around 5ft 7? Perhaps your best weight is near the top of the given range. I doubt you’d look ill 🙂