Author Topic: reducing gliclazide - bad idea?  (Read 2694 times)

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Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #30 on: 05 November 2016, 01:36:29 PM »
I wonder why the 'diabetes specialist GP' isn't seeing all his diabetic patients..... and how much specialist training goes into the label.

Shocking in terms of their future health that those diabetics didn't at least have the fact of their Hba1c measurement in their arsenal of knowledge.

I have assumed that his/her attention was focused on T1D patients.
eg. My daughter has T1D and has had a fearful struggle with 2 births and various pumps, and I would regard her needs as far greater than mine.

pete

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #31 on: 05 November 2016, 01:37:30 PM »
Just a welcome from me right now since the things I might have posted have been covered.

Appreciated :-)

pete

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #32 on: 05 November 2016, 01:40:09 PM »


It seems to me that you need to reduce your time spent listening to that nurse.
[/quote]

Hi Alan - not sure how to do that. My prescriptions depend on the surgery seeing me on demand :-)

pete

Offline Liam

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Re: reducing gliclazide - bad idea?
« Reply #33 on: 05 November 2016, 03:26:34 PM »
In that case Pete, I'd say listen to what she has to say then decide for yourself if to take heed of it.

I'm not shocked that many didn't know their Hb1Ac. When I was a teen and not interested in my own care I didn't know the numbers but knew it would be high. It was only when I gave myself a kick up the bum and finally decided I had to control this thing that I started to know what my Hb1Ac was. It was amazing how things changing with my nurses and doctors when I went into appointments looking for help and asking the right sort of questions. I'd been kicked out of my hospital clinic for not going. My GPs nurse soon said she wanted me to go back to the clinic as I could now use their help. Soon I had the endo suggesting I should be referred for a pump. Really what I'm trying to put across is that if the patient isn't interested then medical staff likely will not be either.   

Another thing to remember is most GPs / nurses rarely see diabetics getting better results without more medication. Their bad diet advice makes it look like type II just slowly gets worse and worse until everyone is on insulin. One of the big things I've learned about type IIs on this forum is that doesn't need to always be the case.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Venomous

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Re: reducing gliclazide - bad idea?
« Reply #34 on: 05 November 2016, 05:35:10 PM »
I wonder why the 'diabetes specialist GP' isn't seeing all his diabetic patients..... and how much specialist training goes into the label.

Shocking in terms of their future health that those diabetics didn't at least have the fact of their Hba1c measurement in their arsenal of knowledge.

I have assumed that his/her attention was focused on T1D patients.
eg. My daughter has T1D and has had a fearful struggle with 2 births and various pumps, and I would regard her needs as far greater than mine.

pete

A pregnancy with diabetes of whatever type is a higher risk than without, but I wouldn't say that T1's have greater needs in general than T2s, it's all individual. Any co-existing condition in addition to diabetes may necessitate a greater amount of medical care. If there was a diabetes specialist GP at my surgery and he hadn't seen me, I'd consider him neglectful at best! But then the last time I was in hospital I was told "You realise, you can just ask to speak to a diabetic consultant?" My response was, "Can I?? Get them in here!!". Perhaps you just need to ask :)

Do you have to see the nurse everytime you require a prescription?
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #35 on: 05 November 2016, 10:51:25 PM »


I have assumed that his/her attention was focused on T1D patients.
eg. My daughter has T1D and has had a fearful struggle with 2 births and various pumps, and I would regard her needs as far greater than mine.

pete
Peter as a rule the GPs do not manage T1s.   T1s are managed by hospital diabetic clinics run by Consultants, particularly if they are on pumps.  GPs do not have the expertise, nor do they have any kind of expertise as a rule to manage T2s.  They normally pass it off to the nurse who has had about 2 days course.  My surgery "Diabetes Specialist GP" was asking me how my BGs were after I had crawled in with a broken verterbra (I had had an accident that broke my spine, 17 stitches in my head and concussion.  I only wanted a sick note) and I said "well not good, they are about 12ish" and he told me that was not acceptable.  I said to him that since my body had an extreme trauma and I was obviously producing cortisol 12ish was the best I could expect.  He looked at me blankly.  He had no idea about cortisol, it's affects on BG or anything else.  He is the one GP in the practice I will not see ever again.

Do you not have repeat prescriptions?
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Liam

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Re: reducing gliclazide - bad idea?
« Reply #36 on: 05 November 2016, 10:59:49 PM »
I read the 'get repeats' as sort of needing to see someone every now and then to have them reissued. Bit like how we were talking about having to have a BP done now and then to get BP lowering meds the other day.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #37 on: 06 November 2016, 03:58:35 PM »
[...] One of the big things I've learned about type IIs on this forum is that doesn't need to always be the case.

thanks Liam - glad I got here :-)

pete

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #38 on: 06 November 2016, 04:01:29 PM »
[
Quote

Perhaps you just need to ask :)

Do you have to see the nurse everytime you require a prescription?

OK, good idea re GP. I'll ask next time.

I only need to see the nurse once every 6 months on average and my prescriptions come through
 until the review date.
If I fail to attend, the next prescription is withheld

pete

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #39 on: 06 November 2016, 04:05:00 PM »
Quote
Peter as a rule the GPs do not manage T1s.  [...]

Thanks Patti, horrendous GP tale :-( I might just insist on meeting the practice GP diabetes 'specialist' just to see how smart they are.

Yes, I have repeat prescriptions

pete

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #40 on: 06 November 2016, 05:29:15 PM »
Might be an idea to see him to discuss your medications actually Peter.

I am actually very lucky, my consultant and the team at the hospital diabetic clinic I attend are absolutely lovely and extremely helpful.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #41 on: 07 November 2016, 11:01:59 AM »
Might be an idea to see him to discuss your medications actually Peter.

I am actually very lucky, my consultant and the team at the hospital diabetic clinic I attend are absolutely lovely and extremely helpful.

good idea Patti. Which hospital do you attend?

pete

Offline sedge

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Re: reducing gliclazide - bad idea?
« Reply #42 on: 07 November 2016, 03:37:38 PM »
Dunno where Patti is at the mo Peter, but as I've just been catching up on the thread, I'll answer - Truro (she lives in deepest Cornwall)  - but all areas have different ways of dealing with things.  I'm under Coventry for healthcare but the main Uni Hospital (UHCW) is so huge and so busy (can take you 20mins to get in near any of the carparks and then the rest of that hour to find a space and there's no direct bus service from where we are) so I opt to use the clinic at Rugby St Cross.  Again being T1 our surgery has hardly anything to do with my management and if I ask anything they always ask me 'What do the hospital say?' whereupon I think 'You pillock - do you think I'd be asking you if I'd asked them?' LOL but say 'Well funnily enough they don't happen to know that I twisted my ankle this morning/woke up last Tuesday with my shoulder in agony/have a cut that won't heal' or whatever it happens to be.

I know that a LOT of T2s are seen at both the main UHCW clinic and the one at Rugby but what the criteria are for being referred I'm clueless, however another of our T2 members who lives near me but gets her healthcare courtesy of North Warwickshire, has recently started on insulin so her GP (who has mainly been really good, always willing to offer her the newer T2 drugs not long after they first appeared and actually being 'specialist' generally so she hasn't needed any other input - referred her straight to the local hospital D Clinic to start on it because they are so much better than GP surgeries with initial titration and the encumbent teething problems we all have with the marvellous stuff.  AFAIK she can ring the specialist nurses at the drop of a hat - and to be honest - ALL hospital D clinics are exceedingly approachable, even when you aren't on their list cos the day to day management of D  which all patients have to do, not the medics - is the paramount thing whoever you are.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #43 on: 07 November 2016, 04:02:08 PM »
Yes, Jenny is right, Royal Cornwall Hospital Treliske in Truro, though that's because that's where the pump clinic is.  There is a diabetes clinic held in the local hospital in Penzance but I got passed onto Truro when I went on a pump.

They do see T2s, I know because I have been involved more than once in clinical trials/research and had to go there on days when they have general clinics, but mostly it's those T2s who have nasty complications.  You can tell just by looking around the waiting room and seeing the bandaged extremities.

At the moment I am involved in a clinical trial for the Abbott Freestyle Libre flash glucose monitoring system.
and I have had to go up there on Thursday mornings which is the diabetic pregnancy clinic.  Some of those ladies will be T2, some T1.  I was a bit shocked last week to arrive only to see a heavily pregnant lady puffing away on a cigarette outside the door like her life depended on it.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Venomous

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Re: reducing gliclazide - bad idea?
« Reply #44 on: 07 November 2016, 06:13:09 PM »
I'm T2, I am referred to the hospital clinic if I ask the GP something she isn't sure of, like "Would you please prescribe me a GLP-1 to take alongside my insulin?".

My GP will send me to the hospital clinic, their diabetes specialist doctor will then decide what meds I should take and they then write to the GP who actually give me the meds on the hospital's say so... It's an inefficient process really and as I'm impatient I often wish the GP would just do as I request! A new thing they started just recently is I also have to see the pharmacist at the GP surgery who goes through my blood tests and meds and decides what to increase or decrease and calls the hospital to check it.   I think I see the GP pharmacist as my meds probably cost them a good whack financially but I have no idea if all the other diabetics do that too.

When I was pregnant I saw the diabetic obstetric consultant weekly, but that's maybe because I've previously had a full term stillbirth.

I'm sadly not surprised to hear about the lady smoking outside clinic :(
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.