# Bit of a shock



## ColinUK

Went to see the GP today and as he was filling out a prescription for something he commented that it’d be fine with my diabetes. 
“What diabetes?”
“You’ve been diabetic since 2014.”
“Why hasn’t anyone told me?”
“No comment.”

That was three hours ago. Appointment booked for a couple of weeks to go through the diagnoses etc. 

But thought after that bombshell I’d sign up here for support.


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## Northerner

ColinUK said:


> Went to see the GP today and as he was filling out a prescription for something he commented that it’d be fine with my diabetes.
> “What diabetes?”
> “You’ve been diabetic since 2014.”
> “Why hasn’t anyone told me?”
> “No comment.”
> 
> That was three hours ago. Appointment booked for a couple of weeks to go through the diagnoses etc.
> 
> But thought after that bombshell I’d sign up here for support.


Hi Colin, welcome to the forum  It would have been nice if someone had told you some time in the past 5-6 years!  I imagine it was quite a shock  Did he give you any details or prescribe any medication for it?


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## ColinUK

Northerner said:


> Hi Colin, welcome to the forum  It would have been nice if someone had told you some time in the past 5-6 years!  I imagine it was quite a shock  Did he give you any details or prescribe any medication for it?


I was there for an unrelated issue but he prescribed metformin and I’ve an appointment in a couple of weeks to talk about the diagnoses in more detail. 
Came home and bought an NHS prepay certificate!

Obviously I really feel like eating cake now but am going for a walk along the river instead.


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## Eddy Edson

ColinUK said:


> Went to see the GP today and as he was filling out a prescription for something he commented that it’d be fine with my diabetes.
> “What diabetes?”
> “You’ve been diabetic since 2014.”
> “Why hasn’t anyone told me?”
> “No comment.”
> 
> That was three hours ago. Appointment booked for a couple of weeks to go through the diagnoses etc.
> 
> But thought after that bombshell I’d sign up here for support.



WTF???  I'd say you have cause to be peeved.

Anyway - welcome!


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## Northerner

ColinUK said:


> I was there for an unrelated issue but he prescribed metformin and I’ve an appointment in a couple of weeks to talk about the diagnoses in more detail.
> Came home and bought an NHS prepay certificate!
> 
> Obviously I really feel like eating cake now but am going for a walk along the river instead.


Colin, if you are on medication for diabetes you don't have to pay for ANY of your prescription items!  Can you cancel the payment?


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## Flower

Hello @ColinUK and welcome.

What a way to be diagnosed. One other thing to be aware of if you are prescribed medication for diabetes you qualify for a medical exemption certificate details here https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/free-prescriptions

@Northerner   just beat me to it!  You need to apply for it.


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## ColinUK

Nobody told me that! I just shelled out for a prepay certificate.


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## Northerner

ColinUK said:


> Nobody told me that! I just shelled out for a prepay certificate.


See if you can cancel it  The GP should have told you (nobody told me either, when I was diagnosed)  Seems you're not getting the right information from your healthcare professionals 

Well, since this is all new to you and you're probably wondering what it is all about, I'd suggest setting aside a bit of time and reading Maggie Davey's letter, which will give you a good overview. I'd also recommend getting a copy of  the excellent Type 2 Diabetes: The First Year by Gretchen Becker, which will help to guide you through these early months. With these you should begin to understand what it all entails and how you can tackle it. It's a serious condition, but the good news is that it is manageable and you can lead a full and healthy life with it as long as you stick to some basic principles  Ideally, I'd suggest getting a blood glucose meter so you can monitor the effects of your food choices on your blood sugar levels. You are unlikely to be prescribed one by the nurse or GP as many see them as unnecessary, but in reality they are just looking for short term savings in their budgets - the long term benefits of knowing what you can safely include in your diet and what you may need to reduce or exclude are worth far more to you and the NHS than any short term penny-pinching  Have a read of Test,Review, Adjust by Alan S to understand how it all works  If you do decide to get a meter, then the cheapest option we have come across is the SD Codefree Meter which has test strips at around £8 for 50 (substantially less than the £25-£30 you might pay for most brands on the High St, and perfectly adequate for the job!  ).

Another important thing is to start doing some regular exercise, if you don't already do so  You don't need to go mad and hit the gym - find something you enjoy and can stick with. For some that can be as straightforward as a brisk daily walk - whatever you can do will really help with your blood sugar levels, as well as improving your overall general health and feeling of well-being  Many people find that the adaptations they make to diet and activity levels result in them feeling much happier and healthier than they have for some time - it's a shame you didn't know about your diagnosis earlier because you could have started all this years ago!  Ah well, lok forward, not back 

Let us know if you have any other questions and we will be more than happy to help


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## Northerner

ColinUK said:


> Nobody told me that! I just shelled out for a prepay certificate.


p.s. I just found this so I think you should get a refund:

https://contactcentreservices.nhsbs...-ve-become-exempt-from-nhs-prescription-costs


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## trophywench

I'm sorry, I think you need to take this further.  

GPs are obliged to arrange 15 different checks a year to all people with diabetes which clearly you have not had - you'd absolutely remember the retinal photos if nothing else! - this sound to me that it likely amounts to negligence.  Is it only you the surgery hasn't bothered to tell there's something up - or are there shedloads of other folk too?

I strongly suggest you should ring the Diabetes UK Helpline for advice.


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## Ralph-YK

Welcome to the forum Colin from a fellow T2.


Northerner said:


> The GP should have told you (nobody told me either, when I was diagnosed)  Seems you're not getting the right information from your healthcare professionals


Me too.


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## ColinUK

thanks for the advice 

i only bought the prepay certificate today so there’s plenty of time to lodge the refund request.


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## ColinUK

trophywench said:


> I'm sorry, I think you need to take this further.
> 
> GPs are obliged to arrange 15 different checks a year to all people with diabetes which clearly you have not had - you'd absolutely remember the retinal photos if nothing else! - this sound to me that it likely amounts to negligence.  Is it only you the surgery hasn't bothered to tell there's something up - or are there shedloads of other folk too?
> 
> I strongly suggest you should ring the Diabetes UK Helpline for advice.



I’ll speak to the surgery and see exactly what’s been going on before taking out any further. But it does seem like a huge error on the part of the previous GP.

Today’s appointment was incredibly rushed so there was no time to explore or seek clarification of anything.


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## Jodee

That sounds pretty bad Colin if you've been recorded as diabetic and no one has told you especially as diabetes checks are carried out minimum annually and if glucose levels are high every 3 or 6 months depending how high. HbA1c first and foremost but check with the helpline see what they advise.

Also page here:  https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/15-healthcare-essentials


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## CathyB

Welcome Colin, I am gobsmacked at your experience, thought my diagnosis was bad but yours is just unforgivable!


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## Chris1980

ColinUK said:


> Went to see the GP today and as he was filling out a prescription for something he commented that it’d be fine with my diabetes.
> “What diabetes?”
> “You’ve been diabetic since 2014.”
> “Why hasn’t anyone told me?”
> “No comment.”
> 
> That was three hours ago. Appointment booked for a couple of weeks to go through the diagnoses etc.
> 
> But thought after that bombshell I’d sign up here for support.


I am so sorry to hear that. Can the doctor tell when it started?


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## everydayupsanddowns

Really sorry to hear about your experience @ColinUK

Glad you have found the helpful, friendly and supportive community here. You've already been given some great sources of information, but feel free to ask any question. Nothing will be regarded as too obvious or 'silly'

Good luck with it and hope you get better support from your surgery going forwards!


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## rebrascora

Hi and welcome from me too.
Since your GP practice have omitted to tell you other stuff, can I recommend that you take the Metformin mid meal with a substantial amount of food to reduce the risk of digestive upset. Metformin is renowned for causing flatulence, colic pains and diarrhoea. Forewarned is forearmed! You may be lucky and not suffer any ill effects and/or they can subside after a few weeks, but it definitely helps to sandwich them with food as they travel though your digestive tract.


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## ColinUK

Chris1980 said:


> I am so sorry to hear that. Can the doctor tell when it started?


The doctor said that tests showed when it started. And it was years ago.


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## ColinUK

rebrascora said:


> Hi and welcome from me too.
> Since your GP practice have omitted to tell you other stuff, can I recommend that you take the Metformin mid meal with a substantial amount of food to reduce the risk of digestive upset. Metformin is renowned for causing flatulence, colic pains and diarrhoea. Forewarned is forearmed! You may be lucky and not suffer any ill effects and/or they can subside after a few weeks, but it definitely helps to sandwich them with food as they travel though your digestive tract.


I’ll ask the pharmacist about the slow release version others have mentioned. 

Have to say I’m somewhat reluctant to start meds and would rather make drastic changes to my diet and monitor the impact of that action first. 
If I’ve been T2 for a while but not medicated and asymptotic surely it makes sense to do that rather than do the drug thing.


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## Northerner

ColinUK said:


> The doctor said that tests showed weekend it started. And it was years ago.


I'd certainly want to know why/how it has been overlooked for so long, there must surely be something in your records - perhaps you have been tested since but your levels have been below diabetic range, so they haven't mentioned it? Are you being treated for any other conditions? When you get the opportunity, ask your GP what your HbA1c is now, and what it has been in the past including diagnosis - this is a special blood test that gives a good indication of how well your blood sugar levels have been controlled in the 12 week period prior to the blood being taken for the test, and should be performed at least once a year.


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## ColinUK

I’ve now thrown out all bad sugar produce in the cupboards and freezer. 

I bake so I had tonnes of different types of sugars and they’re all gone. 

I’ve chucked all rice, pasta, couscous, potato produce etc too. If it’s not in the house then I can’t eat it. 

Just knocked up a lovely mushroom omelette for breakfast and dressed it with a chilli spiced yoghurt.


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## Northerner

ColinUK said:


> I’ve now thrown out all bad sugar produce in the cupboards and freezer.
> 
> I bake so I had tonnes of different types of sugars and they’re all gone.
> 
> I’ve chucked all rice, pasta, couscous, potato produce etc too. If it’s not in the house then I can’t eat it.
> 
> Just knocked up a lovely mushroom omelette for breakfast and dressed it with a chilli spiced yoghurt.


Colin, just a word of caution - make sure the changes you make will be sustainable, you don't want to feel massively deprived in three months time. I'm not saying you will!  As I mentioned earlier, if you can get a test meter and start checking your responses to your food choices then you'll be able to retain maximum flexibility in your diet - there's no point in ditching things that actually have a benign effect on you, unless, of course, you feel that this is the only way to tackle things  It is true though, that a diagnosis (even if only learning about it several years after the event!) can prompt us to rethink our food and discover new ways and new things to enjoy


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## rebrascora

Pleased you enjoyed your omelette and it sounds like you have a very positive mental attitude to this. Learning how to eat low carb takes a bit of practice and trial and error but once you get into the swing of it and add in a bit of fat, it becomes much more sustainable than you would expect. I don't feel deprived because I eat a chunk of my favourite cheese whenever I fancy it and fatty meat which has so much more flavour than lean meat and cream in my coffee on a morning, which all makes me feel quite spoiled, decadent even, and it is hard to feel deprived when you have a nice cooked breakfast instead of a bowl of boring cereal or a couple of slices of toast. 

Symptoms often don't occur with diabetes until your levels are really high.... I was over 100 when I got symptoms and the threshold for diabetes is 48 with prediabetes being 42-47, so more than double the baseline diabetic range for me. The concern is that in that in between range there can be small changes taking place in your blood vessels and nerves which are not immediately apparent and cause no obvious symptoms but can cause complications over time. Increasing your activity as well as improving your diet should help to reverse any changes that may have already occured. If your HbA1c is very high like mine was, then they will likely want you to start on medication straight away and I wouldn't argue with that but if it is not too high, perhaps below 70, you might have room to negotiate a 3 month hiatus to enable you to see if you can reduce it with lifestyle changes first. Since you have been untreated for the past 5 years, I think you have reasonable grounds to argue your case for another 3 months drugs free now you are armed with knowledge, not just of your condition but how to tackle it.


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## Felinia

I'm appalled at the way you have been, or rather not been, treated.  Symptoms vary - my HbA1c was 57 on diagnosis, but I was experiencing extreme fatigue and pee'd for England, so was not surprised with the diagnosis.  So you just don't know what, if any, damage has occurred in the past 5+ years.  You seem to have taken on board the right sort of dietary changes, but would agree with Northener and suggest moderation rather than total abstinence.  I have a little low carb bread, or a little mash padded out with with carrots, swede and parsnips.  I experimented with reducing carbs and settled on 75gm +- 15gm which is well under the recommended <130gm from DUK.  But we are all different.  My last HbA1c was 48 so my DSN said I could have the occasional treat, and I do.  So I don't feel deprived.  I do keep an online daily diary with an app which measures every cal, carb, sugar in every item of food or drink, so I know exactly where I am each day.  
I hope you get your refund.  As for exercise, are you able to get out at lunchtime and go for a brisk walk - even just 10 minutes?  Mushroom omelette is one of my "go-to" meals when I go out, the others being a nice salad or a home made soup.  Best wishes


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## Ditto

That is utterly disgusting. A similar thing happened to me. I was back at the docs for something else and he asked me "You are diabetic aren't you?" but I'd gone into denial on diagnosis so neither of us were sure. Crazy.


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## Sharron1

ColinUK said:


> The doctor said that tests showed when it started. And it was years ago.


I am never lost for words but your story has rendered me speechless .


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## ColinUK

Felinia said:


> I'm appalled at the way you have been, or rather not been, treated.  Symptoms vary - my HbA1c was 57 on diagnosis, but I was experiencing extreme fatigue and pee'd for England, so was not surprised with the diagnosis.  So you just don't know what, if any, damage has occurred in the past 5+ years.  You seem to have taken on board the right sort of dietary changes, but would agree with Northener and suggest moderation rather than total abstinence.  I have a little low carb bread, or a little mash padded out with with carrots, swede and parsnips.  I experimented with reducing carbs and settled on 75gm +- 15gm which is well under the recommended <130gm from DUK.  But we are all different.  My last HbA1c was 48 so my DSN said I could have the occasional treat, and I do.  So I don't feel deprived.  I do keep an online daily diary with an app which measures every cal, carb, sugar in every item of food or drink, so I know exactly where I am each day.
> I hope you get your refund.  As for exercise, are you able to get out at lunchtime and go for a brisk walk - even just 10 minutes?  Mushroom omelette is one of my "go-to" meals when I go out, the others being a nice salad or a home made soup.  Best wishes



I’m lucky because I’m within walking distance of my local shops so I’m going to make sure that I don’t overstock the basics. That way I will have to detour via the shops frequently and that will help build a daily walking habit


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## ColinUK

Northerner said:


> See if you can cancel it  The GP should have told you (nobody told me either, when I was diagnosed)  Seems you're not getting the right information from your healthcare professionals
> 
> Well, since this is all new to you and you're probably wondering what it is all about, I'd suggest setting aside a bit of time and reading Maggie Davey's letter, which will give you a good overview. I'd also recommend getting a copy of  the excellent Type 2 Diabetes: The First Year by Gretchen Becker, which will help to guide you through these early months. With these you should begin to understand what it all entails and how you can tackle it. It's a serious condition, but the good news is that it is manageable and you can lead a full and healthy life with it as long as you stick to some basic principles  Ideally, I'd suggest getting a blood glucose meter so you can monitor the effects of your food choices on your blood sugar levels. You are unlikely to be prescribed one by the nurse or GP as many see them as unnecessary, but in reality they are just looking for short term savings in their budgets - the long term benefits of knowing what you can safely include in your diet and what you may need to reduce or exclude are worth far more to you and the NHS than any short term penny-pinching  Have a read of Test,Review, Adjust by Alan S to understand how it all works  If you do decide to get a meter, then the cheapest option we have come across is the SD Codefree Meter which has test strips at around £8 for 50 (substantially less than the £25-£30 you might pay for most brands on the High St, and perfectly adequate for the job!  ).
> 
> Another important thing is to start doing some regular exercise, if you don't already do so  You don't need to go mad and hit the gym - find something you enjoy and can stick with. For some that can be as straightforward as a brisk daily walk - whatever you can do will really help with your blood sugar levels, as well as improving your overall general health and feeling of well-being  Many people find that the adaptations they make to diet and activity levels result in them feeling much happier and healthier than they have for some time - it's a shame you didn't know about your diagnosis earlier because you could have started all this years ago!  Ah well, lok forward, not back
> 
> Let us know if you have any other questions and we will be more than happy to help



Ordered the BG monitor today. It should arrive Wednesday or Thursday. Haven’t ordered additional test strips yet but realised that I’m going to get through them at a heck of a rate initially. Just didn’t feel that getting everything arriving at once would be particularly good for my mental health. 
I was only just commenting the other day that my bathroom cabinet had nothing medical in it apart from ibuprofen, paracetamol and a box of plasters - nose it’s got metformin and will be joined by BG monitor accessories. It’ll look like the cabinet of someone who’s ill.


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## ianf0ster

Hi Colin,  You have been given a terrible shock, but you are already taking huge steps to beat Diabetes. 
I'm one of the many who are taking control of my T2 via a Low Carb Way Of Eating. I agree that it is best to start by making gradual sustainable changes.

Some people hear that losing weight can reverse T2 - then they go on a 'crash diet', lose some weight but also reduce their metabolic rate which makes it difficult to avoid putting that weight back on (plus more) once the 'will power' runs out (as it will). It is the dame sort of thing for changing your 'way of eating' - you can't do it through willpower alone.
Find Low Carb foods and meals that you actually like and eat more of those, unfortunately it isn't just the sugary things that you need to test your reaction to. Starches can actually be worse than sugars for some - we are all different, which is why testing with the Blood Glucose meter is so important.

I was fortunate in that my preferred way of eating before my GP scared me about possible heart problems, was very similar to what I eat now as a recovering Diabetic. I always loved meat, cheese, nuts, olives and even cauliflower. If you do it right your tastes will slowly change so that you are able to cut out enough sugars and starches without feeling deprived, and that is the most important thing because this is for life!


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## trophywench

When my husband and I were about your age Colin, his mom said to us 'Old age don't come on its own you know!' and we LAUGHED.  20 years later we're laughing on the other side of our faces, mate.

Nihil carburundum illegitimae.


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## Brando77

ColinUK said:


> Ordered the BG monitor today. It should arrive Wednesday or Thursday. Haven’t ordered additional test strips yet but realised that I’m going to get through them at a heck of a rate initially. Just didn’t feel that getting everything arriving at once would be particularly good for my mental health.
> I was only just commenting the other day that my bathroom cabinet had nothing medical in it apart from ibuprofen, paracetamol and a box of plasters - nose it’s got metformin and will be joined by BG monitor accessories. It’ll look like the cabinet of someone who’s ill.


I heard ibuprofen is a no-no on Metformin and take paracetamol instead. I'm sure I got that info on here, may be wrong. It was when I first got diagnosed and I was soaking up stacks of info.
Could be wrong, dunno


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## ColinUK

Brando77 said:


> I heard ibuprofen is a no-no on Metformin and take paracetamol instead. I'm sure I got that info on here, may be wrong. It was when I first got diagnosed and I was soaking up stacks of info.
> Could be wrong, dunno



Found this... like most drug interaction sites it basically says everything pretty much interacts with everything. But ibuprofen seems OK 

https://www.drugs.com/drug-interactions/metformin.html


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## ColinUK

Lots on the other diabetes organisation forums about ibuprofen causing kidney damage and that being an issue of diabetes has also impacted them. But they’re as confused over there as we seem to be here with half the posts saying that the Dr said it’s OK and the other half saying they were told to stop using it immediately. 

i only take it if I’m in need of an anti-inflammatory and that’s not a frequent occurrence but I’ll speak with the surgery and the pharmacist about what to steer clear of in the form of OTC meds from now on. 
Anything interesting or definitive I’ll feed back here.


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## Ralph-YK

Brando77 said:


> I heard ibuprofen is a no-no on Metformin and take paracetamol instead. I'm sure I got that info on here, may be wrong. It was when I first got diagnosed and I was soaking up stacks of info.
> Could be wrong, dunno


I was advised by heart specialist nurse not to take ibuprofen because of heat medication. Could take paracetamol. Don't know about metformin.


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## NotWorriedAtAll

Just saw this thread of yours Colin.
Blimey!!
My diagnosis was lovely in comparison.
I had blood tests because I'd been feeling decidedly iffy for a while and I also had some 'lady problems'.
Then I got a phone call to come in to see the GP urgently!!
No explanation and when I asked they said they couldn't tell me anything it had to be face to face.

I made an appointment which was a few days (which scared me more because usually it takes weeks to get an appointment) and I worried myself sick there was something awful coming up like something fatal.
Then I got to the GP and he had a sad, sympathetic face and started by saying it was bad news and I nearly had a heart attack on the spot.
Then he started waffling on and beating around the bush so I cut him off and asked him if I was dying and if not could he cut to the chase.
And then he told me it was diabetes type 2 and by then I was so relieved it wasn't cancer or something really ominous I was practically pleased as I knew diabetes could be managed with exercise and diet.

I like cooking so for me this has been a licence to have a huge amount of fun making all my favourite foods - I never liked carby things anyway and was only eating them because I thought I had to have them for a healthy diet.

If you want to find out properly what has been going on with your health to get a proper handle on what you are dealing with as far as your GP etc are concerned you can make a Subject Access Request and then they have to give you copies of all the documents etc that relate to you that have been generated in the practice and they are not allowed to charge you for it either.  Then you will have control over your own data and you will be able to see if there is anything else they haven't told you and also whether the information you have is actually correct - just in case they mixed your information up with someone else with the same name or something. There should be information on your surgery website on how to make this request.
This is the link on the Information Commissioner's Website on your rights regarding your personal information so you have the information you need.
https://ico.org.uk/your-data-matters/your-right-to-get-copies-of-your-data/


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## ColinUK

I’ll be off to the GP in a little while and I’ll hope for some answers. I want to know what figures have been returned from blood tests over the years and when precisely he thinks I became diabetic. 

A SAR shouldn’t be required as you have a right to see all of your medical records already. However I’ll go down that route if necessary. Most importantly I want to know what the treatment plan is, why I’ve apparently fallen through the net, when and what clinical checks are planned and also when the side effects from the metformin will bugger off!!


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## ColinUK

So... the GP gave me a print out of all my figures and I’ll look over them in the morning but he was astonished that I’d bought a BG monitor and was quite dismissive of the steps I’ve taken so far.
“Most type 2’s just take the medication and that’s all”
“I’m not most type 2’s”
“Evidently.”

So putting aside that realisation that my GP is a prat, what else did I learn?

Well it seems my HbAC1 has hovered around the upper limit for a while... one test it’d be 0.1 over and the next it’d be 0.1 under. Last two years it’s been 0.1 over each time. So I haven’t been diabetic since 2014. I’ve been borderline since then and really just into the diagnostic range for the last two years.

“It’s really borderline so that’s why you weren’t probably told.”

He’s changed my metformin to the slow release after my detailing the side effects. Which elicited a response of “Haven’t you gotten used to them by now?”
“No”
“So have you cut the dosage down?”
“No”
“Why not?”
“Because it’s what you prescribed me!”
“And you’ve not become used to the side effects?”
“Yes I’m very used to the side effects. I can set my watch by the side effects. But if they can be stopped I’d like to get used to not having them!”
“I’ll change your medication.”

We spoke about diet a little and I mentioned I’d significantly cut down on carbs, was weaning myself off sugars, eating more fish, olive oil and other healthy fats, veg etc...
“Well I can give you a diet sheet if you’d like. It just says to follow a Mediterranean low carb diet. Do you know what that is?”
“Yes. It’s what I’ve said I’m following! Low carb, natural fats, good quality protein.”
“I won’t print off the diet sheet then.”

During the consultation the printer toner needed changing so the practice manager came in to do that. The GP himself was pacing around the room at one point. It was like a comedy sketch. Especially when he bumped into a shelf and knocked a pot plant flying.

Anyway.... I’m more relaxed. He’s happy with my monitoring everything but thinks it’s unnecessary of course. He’s given me the form for prescription charge exemption. I’m going to see the practice nurse on 10/2 which is a week after a repeat of the blood tests. Immediately after the nurse appointment I’m in with the same GP to get the blood test results.

He’s quite keen to put me on statins and something for high bp. I’m quite keen that he doesn’t have the need to do that so I’ll do everything I can do between now and then to make sure he doesn’t need to.

Also mentioned that I’d looked at the DUK website and joined this forum. He said it’s the gold standard for advice and I agree with him


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## rebrascora

Thanks Colin.I had such a good giggle at that. You describe it so vividly that I can see it in my head.
Doctors so hate not to be in control! of your treatment!
I can't believe he is continuing to prescribe Metformin, even the slow release version, when your levels are so borderline and you have modified your diet and clearly know more than him about what you need to do to control it. I have every confidence that you will have it well into the pre diabetes range and maybe complete remission by your next blood test... although it may be tight time wise for that .... and I would have been inclined to negotiate a hiatus on medication for at least 3 months to give you an opportunity to prove that you can do it through diet and exercise alone, but look forward to you getting a good HbA1c next month and hopefully coming off Metformin in whatever form after that.
You are doing really great, so keep at it!


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## Ralph-YK

ColinUK said:


> Which elicited a response of “Haven’t you gotten used to them by now?”
> “No”
> “So have you cut the dosage down?”
> “No”
> “Why not?”
> “Because it’s what you prescribed me!”
> “And you’ve not become used to the side effects?”
> “Yes I’m very used to the side effects. I can set my watch by the side effects. But if they can be stopped I’d like to get used to not having them!”
> “I’ll change your medication.”





ColinUK said:


> During the consultation the printer toner needed changing so the practice manager came in to do that. The GP himself was pacing around the room at one point. It was like a comedy sketch. Especially when he bumped into a shelf and knocked a pot plant flying.


You've got the start of a very good sketch/scene there


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## ColinUK

rebrascora said:


> Thanks Colin.I had such a good giggle at that. You describe it so vividly that I can see it in my head.
> Doctors so hate not to be in control! of your treatment!
> I can't believe he is continuing to prescribe Metformin, even the slow release version, when your levels are so borderline and you have modified your diet and clearly know more than him about what you need to do to control it. I have every confidence that you will have it well into the pre diabetes range and maybe complete remission by your next blood test... although it may be tight time wise for that .... and I would have been inclined to negotiate a hiatus on medication for at least 3 months to give you an opportunity to prove that you can do it through diet and exercise alone, but look forward to you getting a good HbA1c next month and hopefully coming off Metformin in whatever form after that.
> You are doing really great, so keep at it!


He’s primed to medicate like all doctors are I guess. I’m happy to take the meds and carry on with the lifestyle changes to hopefully get this into remission/reversed maybe by the blood test after next.


----------



## Ralph-YK

ColinUK said:


> Well it seems my HbAC1 has hovered around the upper limit for a while... one test it’d be 0.1 over and the next it’d be 0.1 under. Last two years it’s been 0.1 over each time. So I haven’t been diabetic since 2014. I’ve been borderline since then and really just into the diagnostic range for the last two years.


Are you getting you're results in the old scale? And been around 6.5 (48 in the new scale)?


----------



## Neens

Hi @ColinUK - I was having time away from Forum - but wanted to see how you got on. My D team are a little hesitant about BG monitoring as T2. I think it may have to do with the mental/emotional toll... but had I not tested I would still be eating about 5 bananas a week, whole apples and pears.
It is really difficult to pinpoint when we became diabetic. But I guess as you have had tests before now you can. Happy to hear that you are only just over normal range (unless I have misunderstood) and you have lost over a stone in such a short time that will help with all sorts of health issues or prevent future ones.
Glad you got a print out. When I asked for one they were hesitant about that too. To be fair I don't understand half the jargon.But it is useful to have the HbA1c results.


----------



## ColinUK

Ralph-YK said:


> Are you getting you're results in the old scale? And been around 6.5 (48 in the new scale)?


Possibly. I’ll look at the report in more detail tomorrow and pull our specific figures


----------



## ColinUK

Neens said:


> Hi @ColinUK - I was having time away from Forum - but wanted to see how you got on. My D team are a little hesitant about BG monitoring as T2. I think it may have to do with the mental/emotional toll... but had I not tested I would still be eating about 5 bananas a week, whole apples and pears.
> It is really difficult to pinpoint when we became diabetic. But I guess as you have had tests before now you can. Happy to hear that you are only just over normal range (unless I have misunderstood) and you have lost over a stone in such a short time that will help with all sorts of health issues or prevent future ones.
> Glad you got a print out. When I asked for one they were hesitant about that too. To be fair I don't understand half the jargon.But it is useful to have the HbA1c results.


It’s the testing that’s really helped shape my eating so I’m going to keep it up. 
I don’t understand the majority of stuff on the report but I’ll go through it with the help of Google tomorrow


----------



## Eddy Edson

ColinUK said:


> something for high bp



I reckon: keep losing weight and being active, and watch the salt.  But if that doesn't work, take the frikkn meds - high BP is much more likely to do you damage than BG at yr levels.


----------



## ColinUK

Eddy Edson said:


> I reckon: keep losing weight and being active, and watch the salt.  But if that doesn't work, take the frikkn meds - high BP is much more likely to do you damage than BG at yr levels.


This month so far it’s averaged 135/87 but it’s clearly coming down. Last measurement was 125/80 but was higher in the GP office. If it’s indicated however then of course I’ll take the meds


----------



## Eddy Edson

ColinUK said:


> This month so far it’s averaged 135/87 but it’s clearly coming down. Last measurement was 125/80 but was higher in the GP office. If it’s indicated however then of course I’ll take the meds



Sounds good! Sure you're aware of "white coat syndrome" - ie BP reading higher at surgery vs at home.  I'm typically 135/80-ish at surgery vs 115/65-ish at home. This I believe is because I have a subconscious fear that the doc is suddenly going to tell me I have flesh eating bacteria, ebola, etc etc. 

On statins: Highly recommend ignoring most of what you read on message boards and social media: benefit to 1-in-140 at most, will make yr nose fall off, scam by the dead ghost of Ancel Keyes, LDL protects against corinovirus etc etc. Most of it is at best tendentious, and much of it is garbage.  

How much good they'll do you depends on yr individual risk level, and yr doc shouldn't be prescribing without taking you thru that. If yr doc is such a pratt that he/she is too incapable/unwilling to do that, find another one.

FWIW, I have a very high risk level, because I have atheroscelrosis resulting in a blocked leg artery.  Every credible recommendation I've seen says "Max tolerated statin dose & get LDL cholesterol as low as possible". I had to prod my doc into prescribing that after doing my research on the various expert body reviews and guidelines.  If I'd believed in message boards etc I probably would have refused all statins, and my CV event risk would be hugely increased.


----------



## ColinUK

Eddy Edson said:


> Sounds good! Sure you're aware of "white coat syndrome" - ie BP reading higher at surgery vs at home.  I'm typically 135/80-ish at surgery vs 115/65-ish at home. This I believe is because I have a subconscious fear that the doc is suddenly going to tell me I have flesh eating bacteria, ebola, etc etc.
> 
> On statins: Highly recommend ignoring most of what you read on message boards and social media: benefit to 1-in-140 at most, will make yr nose fall off, scam by the dead ghost of Ancel Keyes, LDL protects against corinovirus etc etc. Most of it is at best tendentious, and much of it is garbage.
> 
> How much good they'll do you depends on yr individual risk level, and yr doc shouldn't be prescribing without taking you thru that. If yr doc is such a pratt that he/she is too incapable/unwilling to do that, find another one.
> 
> FWIW, I have a very high risk level, because I have atheroscelrosis resulting in a blocked leg artery.  Every credible recommendation I've seen says "Max tolerated statin dose & get LDL cholesterol as low as possible". I had to prod my doc into prescribing that after doing my research on the various expert body reviews and guidelines.  If I'd believed in message boards etc I probably would have refused all statins, and my CV event risk would be hugely increased.


But to quote Abraham Lincoln, “Everything you read on the Internet is true”


----------



## NotWorriedAtAll

Crikey!!  I hope he didn't keep talking to you about your personal health care while the practice manager was in the room. That is completely against GDPR and all sorts of confidentiality stuff.

My general ponderings about the medication situation -

I am certainly not a person who is against meds.
That said I am against taking meds unnecessarily.

Because every med has side effects and effects on the body generally that are part and parcel of how they work intentionally.
Meds should only be taken if not taking them will be more harmful than taking them.
They shouldn't be taken if the downsides of them are more harmful than not taking them.

Obviously if a person has definite high blood pressure they need them.  Obviously if a person has atherosclerosis - they need statins.  But I don't think that a person who doesn't have these conditions should take the meds 'just in case.'

Metformin is a great med if someone definitely has diabetes and cannot get their levels (or doesn't want to) down by diet and exercise. But it is completely not needed if they can and do want to take control by those methods.

Moreover taking metformin when carb levels are low is not healthy even if there are no obvious side effects.

All medications put a strain on the liver and kidneys which is why you are supposed to have tests regularly once you are on them to check that no damage is happening. For me personally I prefer not to take meds that could cause me damage if I can achieve the same or better results by simple lifestyle changes. It would be worth the risk of that if I was unable to control my blood sugars and blood pressure by other means but as I can control them by diet and very moderate exercise then I don't see why I would take those risks for no measurable benefit.

Also once someone is on blood pressure meds as a regular thing they are then stuck with having to take them because a missed dose can cause irregular heart beats and even heart attacks (it is in the paper information that comes with them) and if they want to come off blood pressure meds later because they may no longer be needed they have to wean off over a long period of time to make sure they don't get these potentially fatal side effects.

I have white coat BP and before my GP prescribed blood pressure meds for me they gave me a 24 hour monitor to ensure that they were not prescribing them needlessly.  I wore it and then they used that information. At the time it was borderline even with that info but I took them for a year and now I am off them (which took ages to achieve) except for taking a low dose now and then if I am in a stressful situation. I came off metformin and the blood pressure meds because there was no good change in my readings using them - my blood sugar levels were not improved on metformin (in fact they got more likely to have high peaks) and my blood pressure was not better on my bp meds.  When I came off them both readings became more consistently good.

My last BP was 128/80 in the surgery and with me being a bit stressed (without BP meds) and the GP agreed with me that taking meds for that was overkill.

A person should do whatever they personally feel is sensible but they should be working together with their medical professionals to make joint decisions based on being properly informed about the positives and negatives of what the options are and then they can make informed choices and decisions that best suit their specific needs and requirements.


----------



## ColinUK

I made a decision to carry on talking about things whilst the practice manager was in the room and said it was OK to talk in front of her. After all she has access to everything anyway. 
I’ll see what happens over time but this GP was very quick to praise the efficacy of metformin and when I went through the dietary changes I’ve made and the BG monitoring results he put all of them down as a result of the drugs. Which was a touch frustrating as it made my efforts seem worthless. 
I’m expecting better from the nurse.


----------



## NotWorriedAtAll

I hope so too.
I am very lucky with my GP practice - they have a Diabetes expert who saw me about three months into my journey and who was over the moon with my progress and put it down to my handling of the condition. I'm getting my first anniversary blood test results back today and I'm a bit nervous because so far it has all seemed too good to be true. Fingers crossed for both of us.


----------



## Northerner

ColinUK said:


> So... the GP gave me a print out of all my figures and I’ll look over them in the morning but he was astonished that I’d bought a BG monitor and was quite dismissive of the steps I’ve taken so far.
> “Most type 2’s just take the medication and that’s all”
> “I’m not most type 2’s”
> “Evidently.”
> 
> So putting aside that realisation that my GP is a prat, what else did I learn?
> 
> Well it seems my HbAC1 has hovered around the upper limit for a while... one test it’d be 0.1 over and the next it’d be 0.1 under. Last two years it’s been 0.1 over each time. So I haven’t been diabetic since 2014. I’ve been borderline since then and really just into the diagnostic range for the last two years.
> 
> “It’s really borderline so that’s why you weren’t probably told.”
> 
> He’s changed my metformin to the slow release after my detailing the side effects. Which elicited a response of “Haven’t you gotten used to them by now?”
> “No”
> “So have you cut the dosage down?”
> “No”
> “Why not?”
> “Because it’s what you prescribed me!”
> “And you’ve not become used to the side effects?”
> “Yes I’m very used to the side effects. I can set my watch by the side effects. But if they can be stopped I’d like to get used to not having them!”
> “I’ll change your medication.”
> 
> We spoke about diet a little and I mentioned I’d significantly cut down on carbs, was weaning myself off sugars, eating more fish, olive oil and other healthy fats, veg etc...
> “Well I can give you a diet sheet if you’d like. It just says to follow a Mediterranean low carb diet. Do you know what that is?”
> “Yes. It’s what I’ve said I’m following! Low carb, natural fats, good quality protein.”
> “I won’t print off the diet sheet then.”
> 
> During the consultation the printer toner needed changing so the practice manager came in to do that. The GP himself was pacing around the room at one point. It was like a comedy sketch. Especially when he bumped into a shelf and knocked a pot plant flying.
> 
> Anyway.... I’m more relaxed. He’s happy with my monitoring everything but thinks it’s unnecessary of course. He’s given me the form for prescription charge exemption. I’m going to see the practice nurse on 10/2 which is a week after a repeat of the blood tests. Immediately after the nurse appointment I’m in with the same GP to get the blood test results.
> 
> He’s quite keen to put me on statins and something for high bp. I’m quite keen that he doesn’t have the need to do that so I’ll do everything I can do between now and then to make sure he doesn’t need to.
> 
> Also mentioned that I’d looked at the DUK website and joined this forum. He said it’s the gold standard for advice and I agree with him


Great description of your encounter @ColinUK  It sounds to me like he is one of those GPs who doesn't find diabetes 'sexy', so just prescribes and forgets about it - just not interested  It does make you worry about the state some of his other, less pro-active patients if they are getting such minimal response  Apparently, this attitude is widespread - I once attended a meeting of the top diabetes consultants in Southampton (I was there as a 'Patient Representative' because of my work in the forum, and they said that one of the major reasons for the poor levels of many Type 2s in the area was that the GPs tended to (consciously or sub-consciously) blame the patient for their condition, and believed the only path was progression to increased medication, eventually insulin, and almost inevitable serious complications in the years to come  At that time Southampton was one of the worst areas in the country for amputations due to diabetes 

At least there were positive words about you joining the forum - at one time GPs dismissed the value or positively discouraged people from online forums because they did not think the advice was trustworthy, probably without ever actually visiting a forum and reading it 

Anyway! It's great news that you have only been borderline all these years, although a shame that they didn't tell you earlier so you could have made some changes before you actually reached diagnosis levels


----------



## ColinUK

Northerner said:


> Great description of your encounter @ColinUK  It sounds to me like he is one of those GPs who doesn't find diabetes 'sexy', so just prescribes and forgets about it - just not interested  It does make you worry about the state some of his other, less pro-active patients if they are getting such minimal response  Apparently, this attitude is widespread - I once attended a meeting of the top diabetes consultants in Southampton (I was there as a 'Patient Representative' because of my work in the forum, and they said that one of the major reasons for the poor levels of many Type 2s in the area was that the GPs tended to (consciously or sub-consciously) blame the patient for their condition, and believed the only path was progression to increased medication, eventually insulin, and almost inevitable serious complications in the years to come  At that time Southampton was one of the worst areas in the country for amputations due to diabetes
> 
> At least there were positive words about you joining the forum - at one time GPs dismissed the value or positively discouraged people from online forums because they did not think the advice was trustworthy, probably without ever actually visiting a forum and reading it
> 
> Anyway! It's great news that you have only been borderline all these years, although a shame that they didn't tell you earlier so you could have made some changes before you actually reached diagnosis levels


That was my main beef yesterday. But then again I don’t honestly know if I would have made the changes after being told I was pre. I like to think I would but human nature and everything...


----------



## Edgar's Raven

Good grief, @ColinUK - just read through this thread (didn't realise you were a Newbie!) and what it shows is that the care for those with diabetes (I'm focussing on T2 as that's what I have/had) is wildly different, depending on your GP.   No wonder you are upset at the way you were treated, but it seems like you have a handle on the way forward.    Very wise words in other comments here, especially the 'don't go mad' in regard to plunging into very low carb/keto - it can be too much at first for some.    It's a shame your GP wasn't knocked out by the plant pot.....    Mine was so laid-back about it he was horizontal:  "just see what you can do with diet and exercise".   His approach worked for me as I'm a little like that too and he doesn't chuck out meds like sweeties, but it wouldn't work for others.       Make sure you have all the diabetic checks available - bang on desks if necessary!   I had to fund mine or ask for three-month bloods at first - as soon as the hbA1C came down to 'normal' (still prediabetic though) my practice wasn't interested.     With your diagnosed BG levels, what you have now embarked upon re diet and exercise, you'll be on your way down (BG-wise!) very soon.


----------



## Ralph-YK

NotWorriedAtAll said:


> Also once someone is on blood pressure meds as a regular thing they are then stuck with having to take them because a missed dose can cause irregular heart beats and even heart attacks (it is in the paper information that comes with them) and if they want to come off blood pressure meds later because they may no longer be needed they have to wean off over a long period of time to make sure they don't get these potentially fatal side effects.


I've not been weaned off most every meds I've taken, including BP/heart tablets I've taken.
Interestingly high BP tablets are also use for other things. Which is a pain for people like me who have low BP. Ironically, 10 years ago I was put on some because of high BP. Got diagnosed for other things, and kept on the tablets for that. Even though my BP came down.


----------



## NotWorriedAtAll

Ralph-YK said:


> I've not been weaned off most every meds I've taken, including BP/heart tablets I've taken.
> Interestingly high BP tablets are also use for other things. Which is a pain for people like me who have low BP. Ironically, 10 years ago I was put on some because of high BP. Got diagnosed for other things, and kept on the tablets for that. Even though my BP came down.


Just got back from getting my yearly check up results and told them I'd come off my bp meds. They were initially worried about that until I explained I'd weaned off them and not just stopped abruptly. I've come off the prescription now except for the low dose ones for me to take as and when needed for social anxiety. That is only now and then so no need to worry about getting dependent.


----------



## Sharron1

ColinUK said:


> So... the GP gave me a print out of all my figures and I’ll look over them in the morning but he was astonished that I’d bought a BG monitor and was quite dismissive of the steps I’ve taken so far.
> “Most type 2’s just take the medication and that’s all”
> “I’m not most type 2’s”
> “Evidently.”
> 
> So putting aside that realisation that my GP is a prat, what else did I learn?
> 
> Well it seems my HbAC1 has hovered around the upper limit for a while... one test it’d be 0.1 over and the next it’d be 0.1 under. Last two years it’s been 0.1 over each time. So I haven’t been diabetic since 2014. I’ve been borderline since then and really just into the diagnostic range for the last two years.
> 
> “It’s really borderline so that’s why you weren’t probably told.”
> 
> He’s changed my metformin to the slow release after my detailing the side effects. Which elicited a response of “Haven’t you gotten used to them by now?”
> “No”
> “So have you cut the dosage down?”
> “No”
> “Why not?”
> “Because it’s what you prescribed me!”
> “And you’ve not become used to the side effects?”
> “Yes I’m very used to the side effects. I can set my watch by the side effects. But if they can be stopped I’d like to get used to not having them!”
> “I’ll change your medication.”
> 
> We spoke about diet a little and I mentioned I’d significantly cut down on carbs, was weaning myself off sugars, eating more fish, olive oil and other healthy fats, veg etc...
> “Well I can give you a diet sheet if you’d like. It just says to follow a Mediterranean low carb diet. Do you know what that is?”
> “Yes. It’s what I’ve said I’m following! Low carb, natural fats, good quality protein.”
> “I won’t print off the diet sheet then.”
> 
> During the consultation the printer toner needed changing so the practice manager came in to do that. The GP himself was pacing around the room at one point. It was like a comedy sketch. Especially when he bumped into a shelf and knocked a pot plant flying.
> 
> Anyway.... I’m more relaxed. He’s happy with my monitoring everything but thinks it’s unnecessary of course. He’s given me the form for prescription charge exemption. I’m going to see the practice nurse on 10/2 which is a week after a repeat of the blood tests. Immediately after the nurse appointment I’m in with the same GP to get the blood test results.
> 
> He’s quite keen to put me on statins and something for high bp. I’m quite keen that he doesn’t have the need to do that so I’ll do everything I can do between now and then to make sure he doesn’t need to.
> 
> Also mentioned that I’d looked at the DUK website and joined this forum. He said it’s the gold standard for advice and I agree with him


God, what a story. Bet you can't wait to see him again


----------



## Lucylemonpip

Lol! I loved your description of your last GP consultation. I could visualise it all. I am so sorry that you’ve had such a rubbish time of it. I would say though, that if it were me, I’d change my GP or even the practice. You might find a much better one and have a totally different experience. 

My diabetes nurse said there was no need for a BG monitor at this stage, as my HbA1c is 50, so just concentrate on losing weight. However, I had already got one and have now started to monitor what I’m eating low carb-wise and how my meals affect my BG. Besides, it’s actually interesting to monitor what foods do what.


----------



## ColinUK

Sharron1 said:


> God, what a story. Bet you can't wait to see him again


Actually I don’t dread it. I think he’s certainly different from my last GP but I like the practice. I’ve been under their care for 20 years pretty much.


----------



## ColinUK

So talking details from the print out the GP gave me...

*Blood Glucose level*
March 2012 5.2 mmol/L
Feb 2016 5.67
Aug 2017 5.9

*HbA1c*
Nov 2019 8.8

*Cholesterol*
Ratio Nov 2019 4.2

March 2012
Overall 6.3
HDL 1.08
LDL 4.0

Feb 2016
Overall 5.93
HDL 0.99
LDL ??

Aug 2017
Overall 6.1
HDL 1.16
LDL 3.76

May 2019
Overall 6.1
HDL 1.22
LDL 3.76

Nov 2019
Overall 5.9
HDL 1.4
LDL ??

You can see the two attached files (if I’ve done it right) so if anyone can unpick the key data and let me know what to watch out for or what to question with the nurse and/or GP when I see him on the 10th I’d be very grateful. 













46BD7503-2964-4110-9326-81E96CB4AD43



__ ColinUK
__ Jan 30, 2020



						28/01/2020
					
















6607158C-FE17-4E2A-A449-6CB91EF95CAD



__ ColinUK
__ Jan 30, 2020
__ 1



						28/01/2020 2


----------



## ColinUK

BP is inching down and I’m getting more readings in the normal range than I used to. Majority are low end of “high normal” but of expect that to change for the better as I drop weight.


----------



## ColinUK

And meds have been switch from standard metformin @ 2 x 500 mg twice daily to the slow release version but the dosage has been halved. So that’s 2x500mg one daily.


----------



## Felinia

Hi 
I used a blood sugar converter to input your results from 2012 to all be on the same basis of mmols/mol which is the modern measuring system. 

RECOMMENDED HBA1C RANGES The recommended HbA1c range for most with diabetes is to keep the value under 48 mmols/mol (under 6.5% in the old percentage units). 

Mar 2012: 30 
Aug 2017: 50 
May 2019: 50 
Nov 2019: 73 

As you can see, you were very good in 2012, just in the diabetic level in 2017, maintained for 21 months, then shot up in 6 months. At a level of 73 I believe Metformin is usually prescribed straight away. The good news is that with diet and exercise, many people can bring down their levels, but you really need to be re-measured after 3 months to see whether the medication and lifestyle measures are working. 

Like you, mine shot up in just 6 months, but with hindsight, my diet had slipped, and 2 accidents with fractures meant I was not exercising for almost 20 weeks and had gained weight. Once I addressed the diet and exercise issues I reduced from 57 to 48 in 3 months.

I expect you will need to ask to be re-tested within 3 months of starting the medication. If you think back over the period May-Nov, can you identify issues which may have caused the jump - stress being another major factor? If not already suggested you should ask to go on a Training Course. Others may have additional suggestions. 

Your total cholesterol is high but has been fairly consistent. Diabetics are usually advised to get the level below 4. I can't recall if you are on statins - if not you may be recommended to take them. 
Best wishes


----------



## ColinUK

Felinia said:


> Hi
> I used a blood sugar converter to input your results from 2012 to all be on the same basis of mmols/mol which is the modern measuring system.
> 
> RECOMMENDED HBA1C RANGES The recommended HbA1c range for most with diabetes is to keep the value under 48 mmols/mol (under 6.5% in the old percentage units).
> 
> Mar 2012: 30
> Aug 2017: 50
> May 2019: 50
> Nov 2019: 73
> 
> As you can see, you were very good in 2012, just in the diabetic level in 2017, maintained for 21 months, then shot up in 6 months. At a level of 73 I believe Metformin is usually prescribed straight away. The good news is that with diet and exercise, many people can bring down their levels, but you really need to be re-measured after 3 months to see whether the medication and lifestyle measures are working.
> 
> Like you, mine shot up in just 6 months, but with hindsight, my diet had slipped, and 2 accidents with fractures meant I was not exercising for almost 20 weeks and had gained weight. Once I addressed the diet and exercise issues I reduced from 57 to 48 in 3 months.
> 
> I expect you will need to ask to be re-tested within 3 months of starting the medication. If you think back over the period May-Nov, can you identify issues which may have caused the jump - stress being another major factor? If not already suggested you should ask to go on a Training Course. Others may have additional suggestions.
> 
> Your total cholesterol is high but has been fairly consistent. Diabetics are usually advised to get the level below 4. I can't recall if you are on statins - if not you may be recommended to take them.
> Best wishes


Thanks for doing that for me. 
Yes I can pin point something(s) that cause huge amounts of stress. I changed jobs and moved to a role and a company that I just don’t enjoy. Also there were a spate of deaths in very quick succession - family members and also friends. It all became too much and I had a bit of a breakdown.


----------



## Ralph-YK

Well you've got a lot of information there.
The second image shows your HbA1c in both old and new scales. Some people are still using the old scale (including professionals it appears), while others use the new scale (bigger numbers). So having both can be useful.
Can be confusing though. And they've split the old numbers, with a line showing newer between.
So, you're HbA1c was (new scale):
50; 50; 73 (big jump)
HbA1c (old scale):
6.7; 6.7; 8.8

48 (6.5) is the point at which they diagnose you as diabetic. (Even if you go below this, you're still down as diabetic).

I can never remember which one mmol/L is. I'm guessing the "blood glucose level" is from a finger prick test (I suggest you ask). Although the numbers look similar to the old scale HbA1c, it is telling you something different.
HbA1c is an average covering the last 12 weeks. Finger prick is your level at that moment.
Do you remember having your finger pricked, and a drop of blood being put on a machine?


----------



## Ralph-YK

ColinUK said:


> Thanks for doing that for me.
> Yes I can pin point something(s) that cause huge amounts of stress. I changed jobs and moved to a role and a company that I just don’t enjoy. Also there were a spate of deaths in very quick succession - family members and also friends. It all became too much and I had a bit of a breakdown.


Sorry to hear that Colin


----------



## Felinia

ColinUK said:


> Thanks for doing that for me.
> Yes I can pin point something(s) that cause huge amounts of stress. I changed jobs and moved to a role and a company that I just don’t enjoy. Also there were a spate of deaths in very quick succession - family members and also friends. It all became too much and I had a bit of a breakdown.


Sorry to hear of your problems.  Stress really does affect your diabetes, so I hope you can find some resolution with your work issues.  But it's a hard world out there.  My cousin's partner was made redundant at 59 from the company he had worked for since he left school, where he was a manager (Management buy-out).  He found work driving a food delivery van on minimum wage but was much happier.  He made a few suggestions and after a year, they offered him a better job which he also enjoys - that and the staff perks of getting free food samples!!


----------



## Eddy Edson

What a jumble that lab report is - categories mixed together etc. And no reference ranges given for the various metrics. It's not designed for patients and probably a lot of docs would find it less useful than it could be, unless eg the carry the normal reference range for calcium etc etc in their heads.

Anyway, a bunch of the numbers are electrolytes/liver function tests.  This is very useful for digging into things: https://labtestsonline.org.uk/  Unfortunately, the UK version doesn't give standard reference ranges, saying that they can vary between labs.  Here in Oz things seem to be more standardised, and the local version does give reference ranges https://www.labtestsonline.org.au/  Probably broadly applicable to UK results.

I guess one approach for things other than the cholesterol, blood glucose, HbA1c results might be to check yr various numbers against the Oz ranges, and get your doctor to discuss with you anything which looks iffy. Given past performance, I wouldn't be inclined to trust that you would necessarily have been told if anything was out of line.

For cholesterol: as before, nobody here can tell you whether yr numbers are OK or not.  This is the tool which HCP's in the UK are supposed to use for assessing CV risk: https://qrisk.org/2017/  (There's a later version: https://qrisk.org/three/ but last I looked NICE hasn't gotten around to adopting it yet.)  I'd suggest running it on yrself to get a feel for risk levels.  

There isn't, or shouldn't be, a magic risk level which marks a statin/no-statin divide - should come down to clinical judgement by the HCP, informed by the risk calculation, and in discussion with the patient about risks vs benefits and also in the context of potential lifestyle changes.  But generally I think statins would become part of the discussion when the qrisk score is >= 7.5%.

A caveat is if you already have significant atherosclerosis or other CV conditions - in which case statins are usually indicated regardless of the risk score.


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## Tee G

So sorry to hear this news, its shameful how these things can happen....  I had a similar experience after i suffered a kidney stone, where my scan results got lost in the ether and never made it back to my doctor to review, hence i didnt get a follow up/all clear and I thought, stupidly, no news is good news and it was only a co-incidence some months later (when I was taking my late mother to her stone clinic) that her consultant there had a quick look at my scans out of curiosity.  He found i had been left with a 90 degree bend in one of my tubes!!! ...you can imagine my shock (But its all fixed now btw!     Since then, I always ask the receptionist at my GP surgery for a copy of any blood tests, scans etc etc ive had done.  It may be helpful in future that anytime you have bloods done or any other monitoring, get a copy of the results for your own info and peace of mind. It pays to be pro-active in these areas of life.


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## Eddy Edson

Eddy Edson said:


> What a jumble that lab report is - categories mixed together etc. And no reference ranges given for the various metrics. It's not designed for patients and probably a lot of docs would find it less useful than it could be, unless eg the carry the normal reference range for calcium etc etc in their heads.
> 
> Anyway, a bunch of the numbers are electrolytes/liver function tests.  This is very useful for digging into things: https://labtestsonline.org.uk/  Unfortunately, the UK version doesn't give standard reference ranges, saying that they can vary between labs.  Here in Oz things seem to be more standardised, and the local version does give reference ranges https://www.labtestsonline.org.au/  Probably broadly applicable to UK results.
> 
> I guess one approach for things other than the cholesterol, blood glucose, HbA1c results might be to check yr various numbers against the Oz ranges, and get your doctor to discuss with you anything which looks iffy. Given past performance, I wouldn't be inclined to trust that you would necessarily have been told if anything was out of line.
> 
> For cholesterol: as before, nobody here can tell you whether yr numbers are OK or not.  This is the tool which HCP's in the UK are supposed to use for assessing CV risk: https://qrisk.org/2017/  (There's a later version: https://qrisk.org/three/ but last I looked NICE hasn't gotten around to adopting it yet.)  I'd suggest running it on yrself to get a feel for risk levels.
> 
> There isn't, or shouldn't be, a magic risk level which marks a statin/no-statin divide - should come down to clinical judgement by the HCP, informed by the risk calculation, and in discussion with the patient about risks vs benefits and also in the context of potential lifestyle changes.  But generally I think statins would become part of the discussion when the qrisk score is >= 7.5%.
> 
> A caveat is if you already have significant atherosclerosis or other CV conditions - in which case statins are usually indicated regardless of the risk score.



These are the NICE guidelines for cholesterol modification, statins etc: https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations

However, bear in mind that they seem to be overdue for an update. The NICE surveillance committee made a bunch of update/amendment recommendations in January 2018 which have not been acted upon, for some reason.

https://www.nice.org.uk/guidance/cg...73/chapter/Surveillance-decision?tab=evidence

- Replace the QRISK2 tool with QRISK3.

- "NHS Choices" shouldn't be used as an authoritative recommendation source. (That would include the < 30% of calories from fats, which I don't think any credible international expert group recommends any more; rather, no upper limit on fats in general, but restrict saturated fats.)

- No lower limit to LDL cholesterol for CV benefits - the lower, the better.

- Other stuff.

These changes would bring NICE more into line with latest US guidance, which is what I follow - frankly, it's more detailed and nuanced, and supported by a richer evidence base and analyses.

But a lot of this is really secondary detail, with the risk analysis being much more important, along with the discussion of risk reduction potential vs potential harms.

Another important thing to note is that risk calculation tools all have just a yes/no switch for diabetes: nothing about duration, HbA1c, meds etc.  This is pretty clearly inadequate. Diabetes does increase atherosclerosis risk and progression, and it is thought that some of this persists even if the diabetes is excellently controlled. But there will surely be a big risk difference between well-controlled and out-of-control diabetes. And some recent research suggests that if all your markers are in a good range - LDL, BP, BG etc - then in fact a diabetic doesn't necessarily have greater risks.  But it's an active research area at the moment.


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## ianf0ster

Eddy Edson said:


> - No lower limit to LDL cholesterol for CV benefits - the lower, the better.


I agree, but only because no LDL = death, and you can't have a heart attack if you're already dead.
LDL is essential for life !


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## ColinUK

Diagnosis: Jan 2020 73 
Feb 2020: 63

First appointment with the diabetes nurse and she was really pleased. GP said “Your HbA1C is really high” no acknowledgment of the improvement since diagnosis a month ago just criticism - I said it’s come down a long way in a month and he just shrugged. The lifestyle changes I’ve made run counter to his advice too. He again said it was pointless to track my BG levels and that my BP monitor “won’t be accurate because it’s not for doctors”. 

The diabetes nurse thought it great that I was tracking BG, BP and weight. She found the tracked results useful. All of my readings were very close to those she got using her equipment. 

All he wanted was to double my metformin. I won’t be seeing him again but will make sure I see a GP with a better bedside manner.


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## ColinUK

Forgot to say the nurse did the feet test and was happy. She commented on the softness of my skin and asked what moisturiser I used on my feet!

She’s referring my to one of the training courses - not sure which one. And she’s also referred for the eye tests.


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## NotWorriedAtAll

Given the HbA1c is an average over three months and your January one was 73 - that will be still affecting your current HbA1c and skewing the result to show a higher reading than if it showed your real situation at the moment.

Keep going as you are going and in a couple of months you will be getting readings in the 40s and maybe even 30s from the readings you are seeing on your BG monitor.

I think the tricky part for people like us who get a massive motivation as soon as we get our diagnosis to change our lifestyles/dietary habits is that we find a way to move forward that isn't just a response to a bad diagnosis but is actually a change we enjoy and want to keep going with because we prefer it to how we were living before.

My nurses ( I don't see the GP for this any more although mine has been mostly helpful) and I've changed them twice because of staffing changes - were at first worried that my excellent control would slip because they see people who treat it like a slimming club and start off very gung ho and then go back to their old ways.  But I know and I think my nurse now knows it too - that this isn't going to happen with me because my old ways make me shudder and I so much prefer keto food I would be very upset if I had to go back to eating stuff like milk and sugar and rice and potatoes and pastry and such like.  I'm much happier on psyllium husk and cheese and salami and konjac and olives and fatty cuts of meat and green veg etc.

My only 'slips' are introducing crispbread and chocologic chocolate back into my repertoire and I still stay within my 20 - 40g of carb a day limit even on a 'naughty' day.


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## Eddy Edson

ColinUK said:


> Diagnosis: Jan 2020 73
> Feb 2020: 63
> 
> I won’t be seeing him again but will make sure I see a GP with a better bedside manner.



What a twit. That's a big HbA1c improvement in a month; not encouraging you to monitor yr own BP is just dumb and goes against all the guidelines I've seen; and showing no interest in yr preferred brand of moisture is just insensitive 

Ditch him and get a better one.


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## ColinUK

There are three GP’s at the practice and I’m going to avoid him going forward.


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## NotWorriedAtAll

I just did some sums.

Assuming two months at 73 (two months of the previous blood test's 3 months) and one month at 42 (this month since you've been making all the changes)
Thats 73 + 73 + 42 = 188
Divide that by 3 to get a three month average 188/3 = 62.66 which rounds up to 63 !!

So that means it is likely you have got your levels down to 42 as I suspected from the readings you've been sharing here.
And that is an average of 42 over the last month - which means you may be even doing better than that now you've got the hang of how things work.

Doubling the Metformin on those results would be craziness!!


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## ColinUK

NotWorriedAtAll said:


> I just did some sums.
> 
> Assuming two months at 73 (two months of the previous blood test's 3 months) and one month at 42 (this month since you've been making all the changes)
> Thats 73 + 73 + 42 = 188
> Divide that by 3 to get a three month average 188/3 = 62.66 which rounds up to 63 !!
> 
> So that means it is likely you have got your levels down to 42 as I suspected from the readings you've been sharing here.
> And that is an average of 42 over the last month - which means you may be even doing better than that now you've got the hang of how things work.
> 
> Doubling the Metformin on those results would be craziness!!



Pretty much what I said to the doctor, who of course just shrugged. 

Repeat bloods in three months.


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## NotWorriedAtAll

ColinUK said:


> Pretty much what I said to the doctor, who of course just shrugged.
> 
> Repeat bloods in three months.


Yes that will clinch it for you


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## Tee G

Hi @ColinUK  - you carry on doing what you're, im very impressed with your achievements in such a short time frame, and i know you will keep it up, you seems very informed and tenacious.  Good for you.    I have today just returned from the nurse about my blood pressure, as it was on the high last week (It does this occasionally) on my annual asthma review check and she gave me a BP monitor to use twice a day at home for a week.  I told her i already have one and monitor myself regularly and knew it was a little up.    She looked down her nose (which was easy because they sat me on a very low chair!!)  and abruptly said "Well its not calibrated"  I replied whenever i get my BP checked officially i come home use my machine and its pretty much the same reading so its good enough for me to monitor myself with it.    I told her i was pretty sure this spike in my BP reading was just down to a little too much coffee lately ( i get these spike in Blood pressure if i indulge in too much salt or coffee, so its no news to me) .....She ignored me.  Anyhow just got the results back this morning, and as i thought, my BP is absolutely normal for the last 6 1/2 day - since i weakened down my coffee and quit using a giant mug for it   LOL.......  So much for her calibrated machine!


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## ColinUK

NotWorriedAtAll said:


> Yes that will clinch it for you


Hope so!


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## ColinUK

Got my appointment for the eye check through for the end of the month and an invite for a flu jab. 
I’ll pop into the surgery and book that because annoyingly you can’t book nurse appointments via the website.


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## trophywench

What a plonker - which bit of 'BG meters are allowed to have a tolerance of about 10%' is he not aware of?  And does he use a pristine brand new one every time he needs to check a BG?  LOL  Might ask him to tell you when the machines used at the lab had their last QA certification?

Big Grin!


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## Tirnanog

Colin I came across your story I cannot believe you were so neglected I would have been tempted to change Dr. I am nearly 80 and have been on thyroxine since I was 29 and have never paid for prescriptions since then.
You have done great

Tirnanog


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## Tee G

you can get a flu jab at some local chemists too.  I got nabbed in there when i was buying some plasters LOL


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## Mephistophlillie

I'm a bit puzzled as to why they've requested an Hba1c so soon after the previous one? (especially after the hideous neglect you were subjected too) I was diagnosed in mid-December, and I'm due another test beginning March. I'm trying to push it back to the end of the month, to give Christmas a damn good chance to get out of my system  (not that I ate/drank particularly badly) The fact that it's come down, whilst still having the "undiagnosed" months in your system is a mark of hard work.

My average reading is about 6.5 over 200ish tests since December, and if you take the monthly average separately it is dropping  too (5.9 in Feb) - so I hope to see an improvement from my 97 Hba1c in December.


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## Neens

@ColinUK just wondering... you have had 2x HbA1c tests in as many months... what results are they expecting if these are supposed to be 3 months apart? Are they meant to be 3 months apart? That's what I understood - my 2nd one is next month and my 1st was 4th Dec.


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## Neens

Mephistophlillie said:


> I'm a bit puzzled as to why they've requested an Hba1c so soon after the previous one? (especially after the hideous neglect you were subjected too) I was diagnosed in mid-December, and I'm due another test beginning March. I'm trying to push it back to the end of the month, to give Christmas a damn good chance to get out of my system  (not that I ate/drank particularly badly) The fact that it's come down, whilst still having the "undiagnosed" months in your system is a mark of hard work.
> 
> My average reading is about 6.5 over 200ish tests since December, and if you take the monthly average separately it is dropping  too (5.9 in Feb) - so I hope to see an improvement from my 97 Hba1c in December.


Sorry - we posted almost the same question - I was on page 4 of this thread and didn't see your message until after. 
I am with you on having 2nd HbA1c test after Christmas/ NY/ Valentine's... I pushed it back 1 week but only because they need the blood test first!


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## Ralph-YK

Neens said:


> what results are they expecting if these are supposed to be 3 months apart? Are they meant to be 3 months apart?


Generally they're supposed to be at least 3 months apart. It's possible medical people want to check results.


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## ColinUK

Neens said:


> @ColinUK just wondering... you have had 2x HbA1c tests in as many months... what results are they expecting if these are supposed to be 3 months apart? Are they meant to be 3 months apart? That's what I understood - my 2nd one is next month and my 1st was 4th Dec.


Does it matter what they were expecting? I’d rather have the test more often than not as it gives a direction of travel for my BG levels. 
The DN was quite happy with the drop that was showing after a month (73 to 63).


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## Neens

ColinUK said:


> Does it matter what they were expecting? I’d rather have the test more often than not as it gives a direction of travel for my BG levels.
> The DN was quite happy with the drop that was showing after a month (73 to 63).


Colin, I was using it as figure of speech... and referring to an older post here
-------------------------------------------------
Feb 10, 2020

Diagnosis: Jan 2020 73
Feb 2020: 63

First appointment with the diabetes nurse and she was really pleased. GP said “Your HbA1C is really high” no acknowledgment of the improvement since diagnosis a month ago just criticism - I said it’s come down a long way in a month and he just shrugged. The lifestyle changes I’ve made run counter to his advice too. He again said it was pointless to track my BG levels and that my BP monitor “won’t be accurate because it’s not for doctors”.

The diabetes nurse thought it great that I was tracking BG, BP and weight. She found the tracked results useful. All of my readings were very close to those she got using her equipment.

All he wanted was to double my metformin. I won’t be seeing him again but will make sure I see a GP with a better bedside manner.

------------------------------------------------

In reference to the unsympathetic GP - who should had acknowledged the amazing changes/difference you have achieved in such a short time - and if he wasn't happy with -10 mmol/L he should bear in mind that this is just 1 month.... 

Glad the DN is being more supportive they should be proud of what you have achieved. It is amazing and I am sure it will continue to drop. 

We may have got crossed wires. I didn't mean you should consider what they think.


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## ColinUK

Cool


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