Straight to being drugged up

[Deleted member 28150]

Hello
Is this the normal care I can expect?

I phoned doc 10 days ago with a slight burning inn my feet. Straight for blood test. 1st was 75 2nd was 76. After brief conversation with a nurse prescribed metformin 2 x 500 mg daily. I'm. 6foot 3inch and 16 stone 12. 58 years old. Played rugby until 3 years ago trained 2 times a week. Retired and live between uk and house in france. Very active in france building, cutting wood etc less in the uk.
Have trimmed over 2 stone off since stopping rugby.
Tried to explain to nurse that I did not really want to take drugs would prefer to keep dieting and increase excercise. No discussion but said maybe if my levels drop them I could possibly stop. I then queried how would they know which had worked the diet or the drugs. No answer just a "take the drugs". Since taking the metformin absolutely terrible stomach and bowel problems. Seriously considering doing my own thing and just keeping with my regime my long term partner is a very low level T2 for the last 4 months hers is age related. We've always eaten resonably healthily and have tweeked our diet more.
Not impressed with the health service so far, I realise things are far from normal but feel the lack of explanation is terrible and does not allow me to make an infomed choice.
Sorry to post such a long 1st post but have tried to be open and honest

Big

 

[rebrascora]

Hi Big and welcome

What the NHS lacks in dietary advice to diabetics, we can more than make up for here. There are many members here who have managed to push their diabetes into remission through following a low carb diet and some of those were able to come off the medication after seeing significant improvement whilst others were able to negotiate a hiatus of medication with their Health Care Professional for 3 months to see if lifestyle (dietary and exercise) changes alone would be enough.
I think in the current climate where high Blood Glucose levels puts you at greater risk of C19 complications should you contract the virus, they are probably playing it safe and insisting on medication particularly when HbA1c readings are pretty high like yours.

The problem is that people's metabolic response to carbohydrates can be very individual as well as individual tastes and levels of will power, so it can be tricky to advise people on what they can and can't eat to control such an important vital statistic as BG. One person might be fine eating brown bread and wholemeal pasta, whilst another cannot manage bread or pasta in any form without their BG rocketing. Here on the forum many of us consider a BG meter an invaluable tool in working out our own individual tolerances to carbohydrates and using the results from it to tailor our diet to keep our BG levels within range.

What many people don't realise when they are first diagnosed with diabetes is that it is not just sugar and things made from it but also fruit and starchy foods like bread, pasta, couscous, rice, potatoes, pastry and particularly breakfast cereals even otherwise healthy porridge which are high in carbohydrate and which the body can very quickly break down into glucose.... some people's digestive system doesn't even note any significant difference between low and high GI foods and is able to break them all down quite rapidly, whilst others can manage fine on low GI carbs.... A BG meter is the only way to find out how your body responds. Unfortunately it is significantly cheaper to give people Metformin than to give them a BG meter and test strips on prescription, so most type 2 diabetics need to self fund. That said, a basic BG meter will cost you about £15 and a pot of 50 test strips for it can be as little as £8 if you buy either the SD Gluco Navii or the Spirit Healthcare Tee2 meters. Test strips for other meters can be as much as £25 for a pot of 50 and you go through quite a few in the first few months of testing until you build up a database of foods and readings, so well worth buying a meter with the cheapest strips.
The idea is that you test before a meal and then 2 hours after and you are looking for a rise of no more than 3mmols but ideally just 2 or less. If your BG spikes more than 3 then you ate too many carbs and you need to reduce the portion size of the carbs in that meal. Keeping a food diary along with your readings is key to figuring it out long term.

Breakfast time is the easiest meal to start with because most of us have the same thing every morning. We are also usually more insulin resistant in the morning so whatever carbs we eat are likely to have a greater impact on our BG after breakfast. Therefore swapping to a low carb breakfast instead of toast or breakfast cereal can have a huge impact on your average daily reading. Eggs are usually a good low carb choice (I like an omelette), or a full English minus bread, beans or hash browns, or full fat natural Greek yoghurt with a few berries, seeds and chopped nuts.

Anyway, I have rambled on more than enough but hope it gives you some idea about how to go on. As regards the Metformin, there is a Slow Release version which is kinder on the digestive system and it helps to take the tablets mid meal to reduce the digestive upset but it is up to you ultimately whether you take them or not. If you are able to argue that you can monitor and control your diabetes via a BG meter then a GP might be open to giving you a 3 month opportunity to reduce your levels without medication, but ultimately it is your decision. Many of us believe through our own experience that diet is a much more powerful tool than most medication for managing diabetes but you have to know what foods affect you so that you can reduce or avoid it and a BG meter gives you that information.

Good luck with your diabetes journey. Many of us have found that it has given us the impetus to improve our health and lifestyle, so there are positives to come out of our diagnosis.

 

[trophywench]

Hi from me too, BB. Barbara's given you great advice so the only thing I'm going to do is send you a link, which I urge you to read very soon because I'm certain it will resonate with you judging by your first post. It explains excellently how to use a blood glucose meter (Glucometer but usually referred to amongst 'us' as a BG meter) to best advantage - https://loraldiabetes.blogspot.com/2006/10/test-review-adjust.html

Good luck!

 

[Pine Marten]

Hi [Deleted member 28150], welcome to the forum.

I've not anything to add to the excellent advice except to say please ask any questions you may have, someone here will have an answer! We have all been where you are now, and can help with info and support. I will only add that I managed to give up Metformin after taking it for some time, by a low carb diet and some exercise.

Keep positive and let us know how you get on 🙂

 

[SB2015]

@rebrascora has covered most that I could think of to suggest.

I know I was surprised when I started to count carbohydrates that we were eating. There were so many hidden away, and the news is just full of references to ‘sugar’ rather than carbs. A good start point is simply to start by working out how many you are eating at each meal. There is info on packets for dried goods and on cans, which is not always easy to use but worth getting to grips with. Once you know how many you are eating at a meal you can then make decisions about reducing these, by making swaps or reducing portion sizes.

If you then start testing your glucose levels you can build up a picture of your own reactions to carbs in different foods. I was surprised at how I reacted to some apparently ‘healthy’ foods. You will need to find out what works for you as we are all so individual.

Plenty of help available on here, and you could look at the Diabetes UK Learning Zone. In the current circumstances, the HCPs are working to very different plans. As others have said with your levels as high as they were they are probably erring on the side of caution to protect you.

I hope that you can get to grips with what we have suggested but do come back with questions.

 

[Deleted member 28150]

Many thanks for taking the time to reply, most interesting especially the cost element.
As a non medical doctor I understand the physiological mechanism of diabetes my concern is the large hammer approach to treatment. It seems to be initally a one treatment fits all especially with 3 month tests. I'll try to discuss my concerns with my GP but will look to stop the drugs forthwith

 

[rebrascora]

I wouldn't consider Metformin a "large hammer" medication wise, it is more the "cheap and cheerful" first line of attack.... going straight to insulin would be the "big guns" approach and it does happen very occasionally for Type 2s.

I would think there are probably quite a number of people who are happy to go away with medication and think that, as long as they keep taking the tablets, they don't have to worry too much about changing their diet and lifestyle.... not true of course, but people believe what suits them. Those people might even feel short changed if their GP told them to change their diet and do some exercise but didn't give them tablets.... lots of people want the easy fix option, which is why "snake oil" products are still peddled. Also, many doctors and nurses are unaware of how powerful a low carb diet can be in managing diabetes or frown upon it as unsustainable. This is because most of our calories usually come from carbohydrates, so by eating a very low carb diet we need to get calories from some other source and the best candidate is fat, but for the past 70 years the powers that be have been bombarding us with information that fat is bad and causes cardiovascular disease and makes you fat. Sadly it is now suspected that the current diabetes epidemic is in part due to the low fat advice that we have been subjected to all our lives and the diabetes makes us susceptible to Cardiovascular disease. To make matters worse the population is becoming increasingly obese so the opposite effect has occurred to that which a low fat diet was supposed to achieve.

For me it seems much more natural to eat fatty meat and fish and full fat dairy and lots of eggs and nuts and very few products made from grains. I no longer feel hungry like I used to or crave foods and I eat much less than I did before. The fat in my food makes me feel satisfied because it takes longer to digest and releases energy much more slowly and it tastes really good so I don't feel deprived, which means that it is easy to refuse that cake or chocolate bar if I have a nice chunk of my favourite cheese or cream in my coffee.... this is a total revelation as I was a sugar addict and chocoholic.

Afraid I have waffled on again... sorry! Best advice I can give is to get a meter and test before and 2 hours after each meal to tailor your diet to your body's response to foods. That way you will find what works for you.

 

[Ralph-YK]

Welcome to the forum Big Bear, from a fellow T2.

I phoned doc 10 days ago with a slight burning inn my feet. Straight for blood test. 1st was 75 2nd was 76.

Are you newly diagnosed then? Were the 75 and 76 results from a HbA1c test?

Tried to explain to nurse that I did not really want to take drugs would prefer to keep dieting and increase excercise. No discussion but said maybe if my levels drop them I could possibly stop. I then queried how would they know which had worked the diet or the drugs. No answer just a "take the drugs".

From what I've experienced and heared, yes that's normal.

Since taking the metformin absolutely terrible stomach and bowel problems.

I've heard there's different versions of Metformin, and that one is better than the other in this situation.

 

[Drummer]

I know very well that I shouldn't have done it, but my tablets went in the bin just before Christmas 2016 after the worst month of my life - I was so ill.
I was sticking to low carb eating and kept to 50 gm of carbs maximum daily. Just the thought of there being any need to take the tablets again was enough to remove all temptation, and 80 days after diagnosis I was no longer diabetic. At six months I was normal.
When taking the tablets, just one metformin, one Atorvastatin, I could not go out of the house after swallowing them. The nurse was highly indignant, but the effects were terrible, and I was becoming suicidal it was that bad. She shut up abruptly when she saw my results.

 

[Eddy Edson]

Hello
Is this the normal care I can expect?

I phoned doc 10 days ago with a slight burning inn my feet. Straight for blood test. 1st was 75 2nd was 76. After brief conversation with a nurse prescribed metformin 2 x 500 mg daily. I'm. 6foot 3inch and 16 stone 12. 58 years old. Played rugby until 3 years ago trained 2 times a week. Retired and live between uk and house in france. Very active in france building, cutting wood etc less in the uk.
Have trimmed over 2 stone off since stopping rugby.
Tried to explain to nurse that I did not really want to take drugs would prefer to keep dieting and increase excercise. No discussion but said maybe if my levels drop them I could possibly stop. I then queried how would they know which had worked the diet or the drugs. No answer just a "take the drugs". Since taking the metformin absolutely terrible stomach and bowel problems. Seriously considering doing my own thing and just keeping with my regime my long term partner is a very low level T2 for the last 4 months hers is age related. We've always eaten resonably healthily and have tweeked our diet more.
Not impressed with the health service so far, I realise things are far from normal but feel the lack of explanation is terrible and does not allow me to make an infomed choice.
Sorry to post such a long 1st post but have tried to be open and honest

Big

It's usually straight to Metformin to start with. From what I gather, it's driven in part by research which shows early medication => better long term results. Plus no doubt it ticks a box for the HCP.

But really, diabetes is very much a self-manage proposition and with a bit of focus before long you'll have a far better idea of what works & doesn't work for you tahn anybody else. Everybody's different!

I'd really recommend looking at weight loss as a strategy. No, it doesn't matter whether or not you're officially "overweight" to start with; everybody has their own individual threshhold. Ref Prof Roy Taylor's stuff for details: https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

Anyway, worked brilliantly for me. YMMV, as always.

 

[Toucan]

Hello [Deleted member 28150], welcome to the forum.
As @Ralph-YK people can react differently to the various types of metformin. The slow release versions can sometimes have fewer side effects. I have taken Sukkarto SR for a long time without side effects.

It is a very individual thing though, as is the overall management of diabetes, there is no 'one size fits all'.
You have been given much excellent advice, and you will need to find out what solution works best for you. Be patient, it takes time but will be very worthwhile.

For me the solution is the balance of a low-carb diet, increased exercise and metformin. If I stray from any of the 3 my blood sugars go up.
Best wishes on the journey to find your solution, and there are many of us here to help,

 

[SB2015]

It seems to be initally a one treatment fits all especially with 3 month tests.

The HbA1c test is not done at less that three months intervals, as it is a measure of the average glucose levels over the past three months, skewed to the more recent values. It is only useful to monitor overall progress and does not inform decisions on a day to day basis.

For day to day decision that is where the testing before and after meals comes in alongside a food diary, including quantities. It is this that prompted me to eliminate Pizza. I just haven’t sorted out any system that works with all those carbs as well as loads of fat content which slows the release of glucose. I decided that it just wasn’t worth the effort. However a curry every now and then ....

 

[Deleted member 28150]

Again thanks for the advice, let me clarify my big guns comment, I am a retired bio chemist working within acute toxicity for pharmaceuticals and therefore I am well aware of drug benefits.My concern is the fact of being told to take a drug regime no ifs no buts by what was obviously a very inexperianced young nurse with no explanations as to diet apart from don't eat toast have porridge and use low sugar and salt beans. She didn't weigh me or even take my blood pressure both of which are medical fudimentals and means my GP practice has no idea of anything to do with my heath apart from the blood test. To me a big gun or if preferred a shotgun approach is the dispensing of drugs without a full medical background being undertaken unless serious complications are imminnent and not to discuss what are all the available options.
As has been posted here correct self management of both diet, exercise and most importantly glucose levels is a far superior method of managing or negating T2 rather than a guesstimate take 2 tablets daily and we'll take another blood test in 3 months and increase them as necessary.
If I had used that approach especially in trials without a full medical history. at the very least I could have expected would have been dismissal and prosecution.

 

[Docb]

Seems to me that what you are seeing is one end of the wide range in the way the GP system deals with patients presenting with diabetes. Reading around the forum you will find everything from your experience - sometimes worse - to exemplary. It is inconsistent.

What you might do is to check out the NICE guidelines for treatment of type 2 diabetes. These define the protocol that your GP should be working to. If they are not working to it then it gives you something to go back to them about without appearing to be an internet educated know all telling them how to do their job.

By way of background I spent most of my working life as a research scientist and like you, I was a bit bemused in the early days how much trial and error went into treatment of diabetes. Nobody seemed to want to measure anything that might allow more accurate targetting of pills or diet or anything. Eventually, I worked out that that was the reality and I had to work with it.

I put in some effort into not falling out with the diabetic nurse and GP's because that was the best way of making sure I got what I needed from them. In the meantime I did what seemed to me to be sensible, changing diet (using things I picked up from the members here), taking the pills and monitoring the effects. The diabetes nurse (who finds graphs difficult but is OK with individual numbers) eventually got comfortable with this and when I suggested that the data pointed to cutting medication she happily agreed. More than that, when cutting medication went too far, easily seen in the data I was collecting, a quick visit reinstated them.

My philosophy these days is to work with what exists and use it to best advantage you can and have a quiet internal smile when you get a victory. In the immortal words of, I think, Shirley Conran:

"Life is too short to stuff mushrooms"

 

[Deleted member 28150]

Wise words indeed, I studied medicine for 2 years before moving sideways to do my phd having become disenchanted with the arbitary approach medicine adopted to many illnesses. Unfortunately I suffer from an inability to suffer fools gladly, to my mind any organisation that falls short in their duty of care or ability to deliver what is needed should be infomed so as to enable improvements so we all get the treatments we actually need. Many thanks to all who replied especially for the information regarding the cost element to GP's that seem to be a factor. It has been useful to have visited here

 

[mikeyB]

Hi [Deleted member 28150], welcome to the forum.

I'm a medical doctor, but don't have a doctorate. That's an honorary title designed to annoy folk with real brains.

Can't fault the advice you've been given, or your thinking. Don't take away the thought that prescribing makes money for doctors, it doesn't. What you have encountered is tramlines in thinking, the bane of T2s. You will encounter all sorts of archaic advice from NHS sources on diet. The best advice is to be found on here. Have a good look round the forum, any questions you might have, start a new thread rather than reviving historical ones.

Keep up the exercise, stick to low carb and experiment. Get yourself a glucose testing meter and strips. Then you know how particular foods affect you. The Codefree meter and strips are pretty economical. You'll never get a meter prescribed as a T2.

And stick around, it'll be good to have another fighter in the biochemist corner.🙂

 

[Big Bear]

Sorry managed to get my account deleted, bloody phones however my laptop has returned so no more struggling with little keys and big fingers, MikeyB like your style but need to point out that i was advised not pursue a medical career as I would fail on religious grounds.

I didn't believe I was God

 

[trophywench]

Very first time I needed to query a medic on what they were asking me to do, was the next day after I'd been diagnosed diabetic, in hospital. A day later a chap came sailing down the Ward I was in, case notes in hand with a selection of younger chaps in white coats trailing behind him, reminded me of James Robertson Justice playing Sir Lancelot Spratt, but with a much less imposing voice - and saying loudly in his moderate voice - I'm looking for a young woman with a mind of her own! Would that be yourself? Might be - who wants to know? I replied. Told me I was right, cos what had been said wouldn't help, but explained better what was supposed to have been said and why. Funnily enough for the NHS, even way back then it wasn't massively long before that nurse retired and was replaced by a much more 'with it' one.

That was 49 years ago in July. I still query anything and everything that doesn't make 100% perfect sense to me. They'd get very short shrift from me if they displayed tendencies that the bear says he lacks!

 

[Mandrake]

Hi Big and welcome

What the NHS lacks in dietary advice to diabetics, we can more than make up for here. There are many members here who have managed to push their diabetes into remission through following a low carb diet and some of those were able to come off the medication after seeing significant improvement whilst others were able to negotiate a hiatus of medication with their Health Care Professional for 3 months to see if lifestyle (dietary and exercise) changes alone would be enough.
I think in the current climate where high Blood Glucose levels puts you at greater risk of C19 complications should you contract the virus, they are probably playing it safe and insisting on medication particularly when HbA1c readings are pretty high like yours.

The problem is that people's metabolic response to carbohydrates can be very individual as well as individual tastes and levels of will power, so it can be tricky to advise people on what they can and can't eat to control such an important vital statistic as BG. One person might be fine eating brown bread and wholemeal pasta, whilst another cannot manage bread or pasta in any form without their BG rocketing. Here on the forum many of us consider a BG meter an invaluable tool in working out our own individual tolerances to carbohydrates and using the results from it to tailor our diet to keep our BG levels within range.

What many people don't realise when they are first diagnosed with diabetes is that it is not just sugar and things made from it but also fruit and starchy foods like bread, pasta, couscous, rice, potatoes, pastry and particularly breakfast cereals even otherwise healthy porridge which are high in carbohydrate and which the body can very quickly break down into glucose.... some people's digestive system doesn't even note any significant difference between low and high GI foods and is able to break them all down quite rapidly, whilst others can manage fine on low GI carbs.... A BG meter is the only way to find out how your body responds. Unfortunately it is significantly cheaper to give people Metformin than to give them a BG meter and test strips on prescription, so most type 2 diabetics need to self fund. That said, a basic BG meter will cost you about £15 and a pot of 50 test strips for it can be as little as £8 if you buy either the SD Gluco Navii or the Spirit Healthcare Tee2 meters. Test strips for other meters can be as much as £25 for a pot of 50 and you go through quite a few in the first few months of testing until you build up a database of foods and readings, so well worth buying a meter with the cheapest strips.
The idea is that you test before a meal and then 2 hours after and you are looking for a rise of no more than 3mmols but ideally just 2 or less. If your BG spikes more than 3 then you ate too many carbs and you need to reduce the portion size of the carbs in that meal. Keeping a food diary along with your readings is key to figuring it out long term.

Breakfast time is the easiest meal to start with because most of us have the same thing every morning. We are also usually more insulin resistant in the morning so whatever carbs we eat are likely to have a greater impact on our BG after breakfast. Therefore swapping to a low carb breakfast instead of toast or breakfast cereal can have a huge impact on your average daily reading. Eggs are usually a good low carb choice (I like an omelette), or a full English minus bread, beans or hash browns, or full fat natural Greek yoghurt with a few berries, seeds and chopped nuts.

Anyway, I have rambled on more than enough but hope it gives you some idea about how to go on. As regards the Metformin, there is a Slow Release version which is kinder on the digestive system and it helps to take the tablets mid meal to reduce the digestive upset but it is up to you ultimately whether you take them or not. If you are able to argue that you can monitor and control your diabetes via a BG meter then a GP might be open to giving you a 3 month opportunity to reduce your levels without medication, but ultimately it is your decision. Many of us believe through our own experience that diet is a much more powerful tool than most medication for managing diabetes but you have to know what foods affect you so that you can reduce or avoid it and a BG meter gives you that information.

Good luck with your diabetes journey. Many of us have found that it has given us the impetus to improve our health and lifestyle, so there are positives to come out of our diagnosis.

thank you, this is probably one of the best descriptions of my diagnosis that i have read. thank you