You DON'T have to be fat and over 40 to develop diabetes...and I'm proof

[mcdonagh47]

And even though they report that SMBG makes D&E far more effective, they won't support it as a stand alone therapy. Why? 🙂

Of course NICE doesn't support SMBG as a stand alone therapy, who on earth would, how would taking bg reading in itself bring it down !

SMBG can't be a stand alone therapy it has to be part of a strategy.

 

[Northerner]

You're not a new T2, you have had it for 7 years. What did you weigh at diagnosis and, out of interest, what were the changes you made to your diet that even your partner has ahdad to adjust to ?

Is it not the case that 20% are not overweight at diagnosis? Why would they be expected to lose weight? My neighbour has never been overweight - diagnosed a year ago, he wasn't told to lose weight or even to get more exercise as he's already very active. If you're going to be picky about other people's posts the n please don't make sweeping generalisations in your own.

 

[mcdonagh47]

Looks up again and nods, sagely. 🙂

From day one following diagnosis I was put on gliclazide, but after a few weeks was moved on to metformin. But from day one, I also starting walking regularly (even when I felt pretty grotty on the way back with what I assume to be 'false hypos').

Just three months after diagnosis after losing just 1 stone, I was also able to come of the metformin (against the advice of the consultant because they like people to stay on it for its heart protecting properties). I always treated the medication as a kick start helping get my bg's under control again. But I was quite happy not to have to take it either!

Since then (21 months) I've been D&E and up to now have been reasonably well controlled (last HbA1c was best ever at 5.8% - 40mmol/mol).

Andy 🙂

You living proof of the "lose weight, get some exercise " advice given to newbies ! The very advice that is being attacked in this thread !

 

[Northerner]

You living proof of the "lose weight, get some exercise " advice given to newbies ! The very advice that is being attacked in this thread !

I'd contest the view that the advice is being 'attacked' 🙄

 

[cherrypie]

You're not a new T2, you have had it for 7 years. What did you weigh at diagnosis and, out of interest, what were the changes you made to your diet that even your partner has ahdad to adjust to ?

Hi,

I weighed 8stone at diagnosis, am now 7st12lb. My height is 5ft 7in so you can understand the need to keep the weight on. The only changes I made was to use the GI/GL method of eating as recommended by my G.P, cutting out white flour products and some fruits and veggies. I do eat pulses in moderation and if I have say a bean and chicken casserole then the beans replace any other form of carbohydrate. I was diagnosed in 2003 so it is 8yrs. now without medication. I have a GP who understands the need for test strips for newly diagnosed which helped a lot with finding out what I could eat. I still can get them on prescription but only use them occasionally now for when I try a new food, feeling unwell or stress levels.
Hubby eats what he likes as snacks but he eats the same as me at main meals.
I find it difficult to sit still for long periods and am always on the go. I cycle as much as I can, go for walks with hubby, use the car only when absolutely necessary and do voluntary work. I also help out an elderly couple near me with meal preparation and a bit of housework.

I also found this guide on the internet and found it very good.
http://www.ad4dx.com/pdf/free-tiger.pdf

I have always felt that you need test strips as this condition is self managed.

 

[Robster65]

Crikey are you now claiming that your GP hasn't heard of Metformin, Gliclazide , insulin - that's simply impossible to believe !

He's heard of them. But they weren't mentioned. D & E. No analysis of current lifestyle. Just exercise more and try to eat starchy carbs.

We don't live in a utopian idyll where every GP is fully clued up on everything. Some seem to dispense the same advice based on their medical training decades previously (again, I don't have their names).

Rob

 

[mcdonagh47]

Is it not the case that 20% are not overweight at diagnosis? Why would they be expected to lose weight? generalisations in your own.

90% of new T2s are above ideal weight at diagnosis, 80% are overweight or obese. So the advice to lose weight is relevant to 90% of new t2s and important for 80% of them.
I think research shows that even new T2s at "normal weight" ( only 10%) would benefit in IR reduction and bg reductions from losing weight a couple of pounds. I'll have to check out the refs again.

 

[everydayupsanddowns]

Of course NICE doesn't support SMBG as a stand alone therapy, who on earth would, how would taking bg reading in itself bring it down !

SMBG can't be a stand alone therapy it has to be part of a strategy.

Are you being deliberately obtuse? Don't shoot the messenger...

The findings of the ROSSO study44 and the data from the large Kaiser Permanente cohorts43 added considerable confidence to the view that SMBG was an integral part of effective patient education packages and enabled the effective use of many other therapies and lifestyle interventions. The view in the previous guideline that self-monitoring of plasma glucose is not a stand-alone intervention was endorsed.(NICE T2 guidelines 8.1.2)

As I read it: Hey look at this! SMBG really helps people control their T2d with D&E. But let's not give them strips anyway.

 

[mcdonagh47]

Are you being deliberately obtuse? Don't shoot the messenger...
.[/I]

I repeat nobody on God's Earth is going to advocate smbg as a "stand alone therapy" for T2 diabetics because simply taking bgs readings ijn itself is going to do jack squat for them.

 

[everydayupsanddowns]

So you are being deliberately obtuse... Or are you just relishing in a little pedantry?

OK how about: SMBG-as-a-therapy-that-involves-prescriptions-but-does-not-necessarily-involve-the-use-of-oral-agents

Better?

 

[mcdonagh47]

Hi,

I weighed 8stone at diagnosis, am now 7st12lb. My height is 5ft 7in so you can understand the need to keep the weight on. The only changes I made was to use the GI/GL method of eating as recommended by my G.P, cutting out white flour products and some fruits and veggies. I do eat pulses in moderation and if I have say a bean and chicken casserole then the beans replace any other form of carbohydrate. I was diagnosed in 2003 so it is 8yrs. now without medication. I have a GP who understands the need for test strips for newly diagnosed which helped a lot with finding out what I could eat. I still can get them on prescription but only use them occasionally now for when I try a new food, feeling unwell or stress levels.
Hubby eats what he likes as snacks but he eats the same as me at main meals.
I find it difficult to sit still for long periods and am always on the go. I cycle as much as I can, go for walks with hubby, use the car only when absolutely necessary and do voluntary work. I also help out an elderly couple near me with meal preparation and a bit of housework.

I also found this guide on the internet and found it very good.
http://www.ad4dx.com/pdf/free-tiger.pdf

I have always felt that you need test strips as this condition is self managed.

Hi CherryP,

thanks for the info. a fascinating success story ( apart from the underweight bit) that has lessons for us all. And of course another vindication of the D&E advice given out to new T2s

 

[Mark T]

It?s nice to see that we can have a good discussion here

Ultimately what the thread starts out with is that the media has its own image of Type 2 diabetes (and type 1). Pretty much that image is wrong, but hey, it sells.

The advice offered by the NHS is pretty much a one size fits all, which suits many Type 2?s but not *all*. In a group of people of a big enough size there will always be exceptions to the rule ? if only because life likes to throw a curveball occasionally and we (as the human race) don?t know everything.

Some of the humour in this post was quite funny - maybe we ought to get back to that?

 

[mcdonagh47]

So you are being deliberately obtuse... Or are you just relishing in a little pedantry?

OK how about: SMBG-as-a-therapy-that-involves-prescriptions-but-does-not-necessarily-involve-the-use-of-oral-agents

Better?

sighs ... the phrase "stand alone therapy" as used in this passage of Nice guidelines means you can't just tell people to test and that will do on its own. Its a good job NICE doesn't support SMBG as a "stand alone therapy" for T2s , just imaghine the number of wasted test strips if that was the case !

 

[Northerner]

sighs ... the phrase "stand alone therapy" as used in this passage of Nice guidelines means you can't just tell people to test and that will do on its own.

I think you are deliberately misinterpreting this. No HCP would hand over any form of therapy without instructions in it's use. You wouldn't be given pills and not told 'take two in the morning, avoid grapefruit', for example. Diabetes is 99% self-managed, because it's with you every day and there may be only a few occasions throughout the year when someone with any medical qualification is around to tell you what to do next. Therefore you need a tool that will tell you that you are doing things correctly.

 

[Robster65]

But surely any stand-alone therapy would need guidance.

Imagine if you gave people metformin and told them to take them as they wished ? [sigh] 🙄

The assumption that patients would be given instruction on best use can be taken as read, or it wouldn't be therapy. It would be a handout.

So prescribed test strips along with guidance on how and when to test and how to interpret the results, would form a stand-alone therapy.

Rob

 

[Northerner]

...Some of the humour in this post was quite funny - maybe we ought to get back to that?

Laughter is often the best therapy 😉

 

[Robster65]

Laughter is often the best therapy 😉

As long as it comes with instruction (or it may be distorted for personal satisfaction)

Rob

 

[mcdonagh47]

I think you are deliberately misinterpreting this. No HCP would hand over any form of therapy without instructions in it's use. things correctly.

I'm not misinterpreting anything. NICE guidelines on this are not capable of being misinterpreted, its absolutely clear - smbg cannot be used as a "stand alone therapy" - i.e. HCPs cannot dish out strips as just another crutch for T2s to lean on.
It isn't going to do anything for them in and of itself. It has to be part of a package/strategy/education.
NICE are perfectly correct in taking that stance.

 

[Northerner]

As long as it comes with instruction (or it may be distorted for personal satisfaction)

Rob

Yes, I think all the humour has been sucked out of this thread, so it will be closed...