RANT

I heard from a friend in his mid-seventies living alone, had a triple - bypass a few years ago and is suffering from a rare form of congenital glaucoma, oh yes, and type 2 diabetes diagnosed last year. He is an intelligent, alert person who spends much of his time helping others in various ways.  Unfortunately for him, as is often the case with his generation, he regards the medical profession as infallible. He has never been overweight and is very active - walking, swimming and gardening. 

When he was first diagnosed, I gave him some advice about his diet and obtained a meter and strips for him. Unfortunately, he has never used the latter, as guess what? Yes, the nurse told him it wasn't necessary.

Just recently he has been worried about his retinal scan as last year's showed some changes.  He has also recently had an annual review {with the nurse} and rang me today to tell me all about it. 

First he said he had been given metformin. Not the SR version of course. The nurse appeared to want him to consider this as some kind of reward for halving his HBA1C. Then he told me the numbers which he had been cagey about in the past. Last year's HBA1C had been 24. It is now "down " to 12 - so you see she was right. He hadn't needed to test.

Excuse me, but he hadn't received any dietary advice from her at all, as he is not overweight. Since reducing his carbs moderately, he has lost a stone in weight and has much more energy. The Nurse also told him that if metformin didn't work for him she would give him "something else.” He naturally took this to mean an alternative. She may have meant the SR metformin but I know these people and I think she meant additional medication. He was quite pleased with it all, convinced he had the whole thing under control. His eye condition had improved too. Still, a little niggling doubt remained.

He has been a little inclined to regard me as "The Voice of Doom" regarding his diabetes. Listening to Nursie was so much easier and more reassuring. She didn't demand that he stick pins in himself, for a start. So what did I do? I paid him the respect of telling him the truth so he could decide for himself.

She had prescribed metformin tablets to take him to December. I told him to go back and ask for the SR version if he had problems. I told him that 12 was still too high but that he should continue with his diet and that he would see a gradual steady reduction in his levels and that he should test, if only occasionally, he already has all the information on this. I told him that he must take control for himself and that I feared the nurse was being ageist in thinking he would not wish to be given the whole picture or couldn’t cope with it.

This is an intelligent and resilient man who watched a dear friend die horrifically from diabetes complications. He understands the seriousness of the condition. All he did wrong was to believe the HCP. The progress he has made, as he said himself, has been entirely due to the advice he had from me. I hope the ridiculously high numbers he has been running at, have not caused his heart any further damage. What were they thinking to leave him for so long without checking? Why only prescribe metformin now? I was a patient at the same Practice for many years, so I don't even consider writing to them as an option. It would be futile. A disgraceful state of affairs.

Some of these people truly have a licence to kill.

Kath