General pt 2 - Closed

I am extremely satisfied with my care. I alternate between my local surgery (Cowbridge) where there is a special diabetic clinic and the Princess of Wales Hospital Bridgend. the service is highly personalised and i do not feel in any way rushed. Over the last three to four years my blood suger control has improved somewhat. i have nothing but praise for the staff involved at both venues.

I am a T2 on Insulin, and am refered to the Diabetic Clinic at Nottingham City Hospital 30 mins drive away (no NHS transport available, no public transport). I feel that in the past 4 years my care has deteriorated.

I have been moved onto 6 monthly checkups, but in practice the appointments given are over 7 months ahead. For the past three cycles the clinic has unilaterally changed the original appointment and I have been "fitted in" to another session, meaning that the average is 8.5 months between clinics.
Because I have been fitted in I have to wait hours, and then get a very brief consultation. For my last the initial appointment was moved back 1 month by the hospital to clash with my holidays. To resolve this I had to be fitted in to a clinic 5 weeks later again. I was told to arrive a 2pm, & saw a House Officer at 5:15 for 5 mins. My check up comprised a urine test, a long wait in a narrow corridor and a brief chat - no blood pressure test, no examination but a referal to another consultant - 17 weeks wait.

I feel the goverment is right to increase the emphasis on Diabetes, we are facing a pandemic. But it must provide the resources. And it must also strive for a change in the culture of Diabetes Care. Concentrating care in specialist clinics leaves it difficult to access for the majority of patients. Cavalier changes to appointments just make life more difficult. We are supposed to be getting a "Patient Led NHS" - lets start with Diabetes.

I would like to see
- Routine checkups at a Medical Centre convenient to me - why not train up senior nurses to perform routine checkups.
- Retinal examinations at local Opticians
- Podiatry available to all that need it. I need it to prevet problems developing, but the local service cannot cope with those whose problems are already severe, so if you can still walk you need to find & pay for private Chiropody.
- Respect for patients.

Please excuse the delay. It does not come easily for some medics to recognize there are people out here whose background gives them insights into the mutual problems that the blinkered medical approach does not always provide. It is part of my mission to encourage medics to be more curious and adventurous - like any well run company. In other words, kiss a few frogs (but not lethal ones) and discover that one finds the occasional prince(ss).

Your description of the OptimumCarbDiet (OCD) as a “halfway-house” between starchy diets and low-carb diets could make it sound vaguely derived. It is in fact an actual weight of any food (or mixture of foods) that, for the Type 2 diabetic’s condition, must not be exceeded if the eater wishes to keep their blood glucose below 9-10 mmol/L by diet-only control. Dr Bernstein tells people to find these for themselves, but OCD provides a relationship that saves them most of this (considerable) testing. (The OCD research apart, I only need to test once weekly). Add in OCD’s numerous refinements, and my blood sugar never knowingly goes above 9.0 mmol/L. One might eat less and stay lower. When eating out I follow OCD principles.

The carb weights eaten in OCD are high enough to meet the ADA and DUK healthy eating guidelines. OCD enables and recommends rigorous adherence to these guidelines, but patients follow them more casually. It also recommends 5 fruit and veg daily, etc. So by providing both an acceptably low HbA1c while still being on the side of the ADA/DUK angels, OCD defines the grey middle ground that led to starchy diet and low-carb diet over-compensation. If the diabetic’s condition is such that they can safely eat so little carb that the amount is below the ADA/DUK’s guidelines, the medic has to decide whether they drop to Joslin’s 40% carb, go to even lower carb, or enlist the aid of medication. The Patient’s Printout can be edited by the medic accordingly.

I believe that DietControlDiabetes (DCD), with its OCD, is head-and-shoulders above anything else available for maintaining Type 2 diet-alone control over the medium term (and I hope long term). It does require commitment by the diabetic, which not all are able or willing to give - because it provides a whole hog of information needed to fulfil the individual’s potential. Although OCD is not complicated, to do a better job one does need its extra hard data and better diabetic education. Those willing to benefit should not be held back by having access to only the present dumbed down incomplete knowledge. OCD is essentially ordinary eating (ie: nothing weird), with quantity and timing constraints, so does not need extensive trials. For others and those on medication, DESMOND is probably the best available. So medics in diabetes should have both available.

Some GPs have baulked at DCD because of the extra time needed initially to convey the information. (It is actually highly streamlined.) This should be more than repaid downstream. In my eighth year since diagnosis, I need only two visits annually to my Practice Nurse and am very happy with that.

I certainly agree with Nigel about “lip service”. Too many fine words are spoken and written about diabetes. They waste person-decades of reading time, subsequently disappoint, and ultimately disillusion. An example came when I tried to bring OCD’s breakthrough approach, to keeping people off medication and DCD’s comprehensive education for medics and patients, to the attention of the individual who described their own job (in a “Diabetes Update” interview) as: “There are lots of levers out there. What’s needed is someone to take an overview and make sure every possible lever is being used for diabetes. That’s where I fit in.” I asked this individual in person to look at the DCD/OCD compact disk, and they refused point blank.

The paragraph of my Website, which mentioned a pharmaceutical company sponsored the first Dialogue, also recorded that my contribution on DCD/OCD had not been included in the first Dialogue’s Web pages or in its printed report. I wrote to the organizers complaining about the “remarkably bad judgement” in allowing such sponsorship.

According to Roger, if you follow his diet you only need to test once a week

'The OCD research apart, I only need to test once weekly'

Sounds potentially dangerous to me!!!