XPERT Course

[Martin.A]

Just got back from session number one (of six) of the XPERT course for T2s. DN running the course dismissed finger prick testing as a waste of time. Hba1c is all the matters, he says. I challenged him on the basis that you don't want a nasty surprise at your next Hba1c test because you had no idea your levels were on the rise but he was having none of it.

I've been doing a waking test every day for 6 months now and recording my results on a spreadsheet. I started off getting 8s and 7s, which turned into 7s and 6s, which in turn became 6s and 5s, and are now 5s and 4s. I did Statistics at college but you don't need to be a statistician to see that there's a downward trend.

Post-prandial results also show a downward trend.

Should be an interesting few weeks...!

Martin

 

[Andy HB]

Sad to say that I think the DN is wrong. It's like driving a car blindfold only taking the blindfold off occasionally to see how much progress has been made. Fine, if the road is nice and straight (maybe), but definitely a problem if there are curves in the road!

Also, the HbA1c only shows a weighted average of blood glucose levels over the previous 12 weeks. It could show a perfectly decent figure, but the BG levels could have been fluctuating wildly during that period.

Nope, the DN's position is utterly unscientific and is unsupportable.

By the way, when I went on the Xpert course (nearly ten years ago now .... coming up to my ten year diaversary!), I was given a completely different message. I was also actually given a meter by my DSN. I used it to good effect and have been medication free for nearly all that time because of the information I obtained.

So, just to emphasise, the DN is just plain wrong. 🙂

 

[Bronco Billy]

I think you were right to challenge him. Did he explain why he thinks finger pricking is a waste of time?

 

[Docb]

It's the patronising in this sort of thing that irks me. The value in monitoring varies from individual to individual, their circumstances and their ability to cope and react to what they see. Whoever has told your DN what to say has taken the view that, because monitoring might not a good idea for a few, it will not be recommended for anybody. It's the simple way out and requires no judgement to be made about individuals and it ensures is that the odd person for whom it is inappropriate will not get one. That will keep them safe from criticism.

One thing I am pretty sure of is that if your DN was diabetic, he would have a meter and be monitoring regularly and adjusting his lifestyle to get his HBA1c down.

 

[SB2015]

When I had a discussion with someone who runs these courses they were also of the mind don’t test. My cynical mind thought it was just that they did not want people to be asking for test strips at GPs as they will generally not fund them. However her concern was that :

People will not be able to do anything about a high level
!!!!!! Apart from changing their diet, portion size, level of activity, ...
Perhaps that could be part of the course

They may become ‘obsessive about their levels.
I find that description very annoying. We need to do the work to sort things out day by day. That is not obsession, it is being responsible and from what I read on here those that do this find that their levels drop

I get the feeling that they are required to help people to manage their condition as best they can without test strips because of the cost. However it is a pity that they do not encourage those that choose to self fund.

 

[everydayupsanddowns]

Ugh! So sorry you’ve had to deal with that attitude Martin

I completely understand that self monitoring isn’t for everyone - but to dismiss it as a waste of time to someone who is actively (and very successfully) making dietary changes based on the results of their own monitoring is patronising and just plain silly. 🙄

An HbA1c might be great for giving. General picture (though with CGM it’s limitations even there are apparent) but it really can’t help with specifics - how does this, that or the other meal / activity affect you as an individual.

 

[grovesy]

I suspect the attitude also stems from some of the research that also does not support testing for Type 2.

 

[Drummer]

I'd arrive early and stand outside handing out leaflets with information about low carb on one side and about my success and the availability of online help the other.
Only because I finally worked out how to print on both sides the same way up of course.

 

[Veenorthants]

Hiya, I had a similar experience, our area does a 3 session course for newly diagnosed. 1 afternoon a month. So the 1st session was mainly a broad overview of D and the different types, the 2nd session was mainly discussing food and the do's and don'ts. I told them I had invested in a metre and got told it was not necessary. I also told them what foods I had discovered eg potatoes, baked beans so now I avoid and they told me I shouldn't avoid. They also said a low carb diet was ok but isn't sustainable for long term. So that threw me even more. The 3rd session was mainly about complications and to see if we had listened at previous sessions and achieved to lower our HbA1C and loose any weight.
Thank god I discovered this forum, I have learnt so much more from being on here, everyone has been so helpful

 

[Eddy Edson]

I suspect the attitude also stems from some of the research that also does not support testing for Type 2.

I know one of the doctors here in Oz who is on the local college of GP's committee which came out against general SMBG for T2's. This was their reason: there is no high-quality research showing meaningful outcome benefits, there is research showing lack of benefits at the population level, the money can be better used for other things.

If new research showed positive SMBG outcomes at least for some clinically identifiable groups this guy would probably change his mind

 

[everydayupsanddowns]

I know one of the doctors here in Oz who is on the local college of GP's committee which came out against general SMBG for T2's. This was their reason: there is no high-quality research showing meaningful outcome benefits, there is research showing lack of benefits at the population level, the money can be better used for other things.

If new research showed positive SMBG outcomes at least for some clinically identifiable groups this guy would probably change his mind

I know that this is the reasoning behind many HCPs dismissal of self monitoring, and I also can see that there are a lot of T2s who won’t want to bother with it, or who might find it distressing to see a never-ending succession of our of range numbers, but some of the major studies have this approach:

... I also told them what foods I had discovered eg potatoes, baked beans so now I avoid and they told me I shouldn't avoid. They also said a low carb diet was ok but isn't sustainable for long term. So that threw me even more...

The studies were designed to look at people to self monitoring, but they were not allowed to change anything on the basis of the results, but to ‘adhere’ (yuk!) to the proscribed diet. And that people won’t want to, or be able to sustain a changed way of eating long term.

But even these dismissive studies suggest that there is a population of T2s who get significant benefit.

It’s very frustrating for motivated, proactive T2s here who can see the benefits of self monitoring for them, but get refused strips and have to self fund.

 

[Eddy Edson]

I know that this is the reasoning behind many HCPs dismissal of self monitoring, and I also can see that there are a lot of T2s who won’t want to bother with it, or who might find it distressing to see a never-ending succession of our of range numbers, but some of the major studies have this approach:



The studies were designed to look at people to self monitoring, but they were not allowed to change anything on the basis of the results, but to ‘adhere’ (yuk!) to the proscribed diet. And that people won’t want to, or be able to sustain a changed way of eating long term.

But even these dismissive studies suggest that there is a population of T2s who get significant benefit.

It’s very frustrating for motivated, proactive T2s here who can see the benefits of self monitoring for them, but get refused strips and have to self fund.

Yup. But one of the issues is the lack of good studies. It’s not like these people are anti-SMBG just to be difficult - I hope 🙂

 

[Veenorthants]

@Anitram have you any helpful tips as I would love my BG to get below 6 but it feels like its a long way off at the mo but at a loss as to what else I can change.

@everydayupsanddowns I'm fortunate that I can self fund. I haven't actually asked the Dr or Dn for a tester as I figured after what was said on the course they would say no its not necessary.
You feel like you have a handle on it and then for bizarre unknown reasons they are consistently high

 

[Veenorthants]

Thank you Martin, it sounds a very similar diet to mine already although I am a smoker and have been known to have the odd glass of wine in the evenings😉 apart from those two things there's not a lot of difference. Brekkie I eat a seeded granola with berries and greek yoghurt, lunch and tea is either meat and fish with salad or veg. If I have bread its the Hovis 7 seed lo carb, which I wouldn't even get through a loaf in the week. I guess I just need to be patient as I'm only in month 4, definitely think I will look up both books though could be interesting reading.

Thank you 🙂

 

[karloc]

I do find it shocking really, I can understand if there is not enough evidence that it wont be funded but to dismiss out of hand is just plain wrong (even more so in front of @Anitram saying it worked for me).
Fine to give a warning that just stabbing your finger and looking at a good or bad number without considering the context of what it means. Equally it would be possible to be one of those people (that I could possibly be) that would just delay the 3 monthly test a few weeks thinking I got a couple of weeks of free carbs as it wont show up on test so I am fine.

The best thing I did shortly after I was given the news thanks to people on here talking about it was to get a BG tester. Am I obsessed about my BG readings? - too bloody right I am, I have decided I want to undo what I have done to myself and the first part is to understand what my body is doing. (I do understand we are all different and BG readings might cause stress and it might not help some people)
When I first got my tester I was recording 8 - 9.5 (after making some drastic changes to diet for few days), now mostly in the 4's with max of 6.1 after having tester for a few days and understanding what is happening to my body.

Saw my doctor yesterday and he is very happy with my BG levels, wanted to keep a copy of my spread sheet of numbers. He was happy with my weight loss of almost a stone in 2 weeks. I even raised the fact the I know I was being extreme but he was not concerned but obviously mentioned long term sustainability. My DN also knows I self stab and was happy with the figures and made no comment about self stabbing and was happy that I was making changes.
I guess I am lucky in that my doctors appear to just be keen on me sorting my issues rather than trying to force me down a specific route. Yay a win in the postcode lottery 🙂

I've been doing a waking test every day for 6 months now and recording my results on a spreadsheet. I started off getting 8s and 7s, which turned into 7s and 6s, which in turn became 6s and 5s, and are now 5s and 4s. I did Statistics at college but you don't need to be a statistician to see that there's a downward trend.

I did not do Statistics at college I did real Maths but I also see a downward trend 😉

One this I understand in one part but completely disagree with in a way is the notion of long term sustainability. I needs to loose weight (probably another 3-5 stone) and sort out my BG. Any plan / action can't possibly be long term else I would end up under weight and have other issues. I need a 2 part plan, sort stuff out only then have a long term sustainable plan that will not put me back here again.

 

[Eddy Edson]

do find it shocking really, I can understand if there is not enough evidence that it wont be funded but to dismiss out of hand is just plain wrong (even more so in front of @Anitram saying it worked for me).

Absolutely.

Sustainability: For me it seems to have worked just to grind off half a kilo or so per week until I reached skinniness and then - so far! - sustain without much trouble (actually, main thing so far has to keep from going lower). Kind of a gentle two-stage plan. Personally, I'd just have worries about dropping a lot of weight very quickly and then sustaining, without giving my bod time to get used to things & be content with fewer calories. But as always, I'm sure it's different for different folks.

 

[karloc]

Absolutely.

Sustainability: For me it seems to have worked just to grind off half a kilo or so per week until I reached skinniness and then - so far! - sustain without much trouble (actually, main thing so far has to keep from going lower). Kind of a gentle two-stage plan. Personally, I'd just have worries about dropping a lot of weight very quickly and then sustaining, without giving my bod time to get used to things & be content with fewer calories. But as always, I'm sure it's different for different folks.

I do believe as we are all different that need to find an solution that we truly believe in. If you tell me to do A and I half heartily do A (because I don't really believe it and don't do it properly) then it would not work and I then have "proof" that A was rubbish.

Its horses for courses (or lasagne if your findus) 😉

I am starting to understand the roll of blood glucose in our bodies (I think/hope) and how it (or perhaps the insulin levels to be more accurate) has such an impact on stuff (technical term) and that calories are some what meaningless (nothing is ever quite that simple thou). So I don't believe our bodies need time to adjust to lower calories But our brains (not physically) might so as always there is no one size fits all which is a shame else I could produce the best diet in the world and become crazy rich.

As a side note, loosing weight fast especially through diet only can have side effects that need to be dealt with and not just trousers no longer staying up 😳

 

[Eddy Edson]

not just trousers no longer staying up

Though that is definitely an issue, as I've discovered!

Not a good look, apparently 🙂

Again, it's just me, but being skinny is *fun*. That's pretty good motivation.