Review Appointment

[Thermal]

Coming up to the first anniversary of my Type 2 diagnosis. Had a check at 6 months where my HBA1c was 5.2, but I was still a bit concerned that my Fasting BG was over 7 most mornings. Nurse advised not to worry, that as my HBA1c was fine all was good.

Just been sent a letter for my next appointment, but with no blood test requests. I'm not sure I see the point of just a chat. I know all is going OK, as my fasting over the recent 6 months has come down to 6.4 to 6.9, compared to over 7 in the previous 6 months. I'm diet and exercise controlled, and one of the lucky ones where the GP will prescribe testing strips. But at least with the blood tests they could confirm if anything else needs attention, e.g. my cholesterol was a touch high, but I asked not to go onto statins initially, I would see what diet control did.

Is it normal to have a review without blood tests?

 

[viviennem]

Have they actually told you you're not having blood tests? In your place I would work on the assumption that they will be taking blood, and go fasting.

If the appointment's at a silly time of day for fasting - eg mid-afternoon - phone up to check.

Let us know how you go on!

Viv 8)

 

[Snodger]

Sounds as if things are going really well for you.
You should have blood and urine tests, eye and foot check once a year. They are perhaps just wanting to discuss your overall self management this time and plan to do the tests at your annual appointment. BUT! The appo is there to help you, so if you don't think it's going to be helpful, then I'd raise that with them. If you want bloods done, say you would like that and you'll come in to discuss the results - but unless the appo is of value to YOU (and not just to them) then there is no point in it.

 

[IanD]

Assume the annual review includes full blood tests & ask the practice for a blood test appt.

 

[Unbeliever]

Theyr want you to attend these reviews because this is how they get their funding. Unfortunately they often epect the patient to be psychic too..
One of the most difficult tthings when you are first diagnosed is getting to know the ropes about this sort of hing. Even when you explain this to them they don't seem to get it.
I have found that even when you try to clarify these hings there is still confusion. I once had 2x HBA1Cs in a month because people couldn't get their act ogether.
I agree with Snodger that you have to make the appointment useful to you, Think of all the questios you would like to ask in view of your experiences so far - and attempt to get them to explain the system to you .
It is a small matter to them but so important to the patient to know what is necessary.

In my practice the left hand doesn't know what the right hand is doing but if anything goes wrong i is he patient's fault!

In view of the funding issue they are unlikely to let you get away with not attending even if you don't see the point. So make it work for you.

Often its just a matter of weighing you and checking your BP.

 

[Thermal]

Thanks all for useful comments.

Viv...they don't do bloods at our surgery, you get a blood form to take to the blood session at the community hospital. And appt is 1.30pm

I phoned them, cancelled this appt, and agreed to phone again Wednesday to discuss with the nurse who co-ordinates these before I rebook.

Snodger, thanks for that. To be honest I don't need my bloods done for anything other than personal confirmation that my control has improved slightly. My eye test is booked separately, my feet are fine (I'm seeing the chiropodist for something else). I'm confident my kidney function is good, but would happily drop a sample in to the surgery on my way to work.

Unbeliever, didn't realise about the funding, that's interesting. The only question I have is about my BG rising after my morning exercise class, and what I should do re eating before/ after class, and I asked that at my review in April (but the nurse couldn't answer it anyway).

Oh well, I'll see what they say on Wednesday. Thanks again

 

[hallii]

When I want my A1c tested I request it, I have never been refused.

I argued that some test strips on script would be better, but no, I can't have any test strips but can have an A1c when I request. I now buy my own strips and only have an HbA1c when I feel like it (about 6 monthly) which I usually request or I might not get one! There are only so many blood lettings I can take!

H

 

[Daibell]

According to NHS diabetes guideleines you definitely should be having an HbA1C test at least annually. This normally includes a (pointless?) fasting test as well so needs to be done first thing in the morning. The HbA1C can be done at any time of day. I would ask the surgery to provide a blood test form. My GP always gives me a blood test form and urine sample bottle when I leave my appointment ready to use for the next one. You should really have a kidney test via urine sample once a year although with good BS control it may not be needed?

 

[Thermal]

Thanks. I did have HbA1c done in April, so I am meeting the annual requirements, I just think that they should do everything in one annual appointment rather than bring me in 6 monthly for a 'chat.'

I called the surgery today, and as was suggested above there was no way they would consider me not attending (I was told very seriously that the Doctor had considered my case and decided I must be seen!) so in the end I decided to play nicely and see what happens. At least they can't try to get me to toe the Government line on statins if they don't have any cholesterol readings ;-)

Hey ho

 

[Snodger]

Thanks. I did have HbA1c done in April, so I am meeting the annual requirements, I just think that they should do everything in one annual appointment rather than bring me in 6 monthly for a 'chat.'

I called the surgery today, and as was suggested above there was no way they would consider me not attending (I was told very seriously that the Doctor had considered my case and decided I must be seen!) so in the end I decided to play nicely and see what happens. At least they can't try to get me to toe the Government line on statins if they don't have any cholesterol readings ;-)

Hey ho

let us know what happens. Don't let them fob you off - get an answer as to why they think this appointment is valuable TO YOU.
this kind of thing - doctors not even bothering to explain why they are making us jump through pointless hoops - makes me so angry. I'm in the middle of a fight with my GP whose reaction to me going to a DAFNE course is to reduce my test strip prescription by a third. I think I'd better get off the computer and go and chill out before the stress makes my bg go through the roof.

 

[Unbeliever]

I keeep having to point out to my {huh} DSN that SHE is the cause of my high bp whenever I go near the surgery {fine in hospial when I am having needles stuck in my eyes}.
The stress I have suffered in the last few weeks rying to ge my hospital appointment sorted out - the appointment clerk apparently disagreed with the surgeon about the procedure I should have and the degree of urgency involved has made my previously low and sable bg and bp readings very errratic.
Interference by the Practice Nurse [not even the Diabetic specialis nurse , has mean that I had to attend the hospital a fewweeks ago wihout having had the flu jab and now I have to put it off again because he net needle in the eye job is on Wednesday next week {despite the admissions officer} If my original plan had been adhered to all could have been sorted in 2 visits insead of the DSN and I chasing each other around for three weeks and my still not having the flu jab.
The nurse who was to do my OCT last time collapsed in front of me with flu last week.
It is very difficult to get any sense from anyone I find . It is inefficient and wasteful. Any initiative by the paient is penalised rather than welcomed. Common sense is totally lacking.

 

[Thermal]

let us know what happens. Don't let them fob you off - get an answer as to why they think this appointment is valuable TO YOU.
this kind of thing - doctors not even bothering to explain why they are making us jump through pointless hoops - makes me so angry. I'm in the middle of a fight with my GP whose reaction to me going to a DAFNE course is to reduce my test strip prescription by a third. I think I'd better get off the computer and go and chill out before the stress makes my bg go through the roof.

Will do. I'm not very good at being told what to do :lol: I may end up being naughty :twisted:

Sorry to hear about your test strip issues....it's mad!

 

[philfatkid]

According to NHS diabetes guideleines you definitely should be having an HbA1C test at least annually. This normally includes a (pointless?) fasting test as well so needs to be done first thing in the morning.

The fasting blood test is for your cholesterol reading and nothing to do with your blood sugar readings.

 

[ladybird64]

I'm not an experienced diabetic but I have never heard that before!

My GP said the fasting test was for glucose reading?

 

[viviennem]

When they do my full blood tests they always do a fasting BG test as well as everything else. I think they like you to be fasting for the cholesterol test, but no-one has ever told me why.

I too have wondered why they bother to do a fasting BG test, since my fasting level as worked out by the lab is always higher than my 'on waking' fasting test. But then I thought - a non-diabetic's pancreas would have coped with the 'Dawn Phenomenon' and the rise from waking, by secreting insulin to bring it down. So if your fasting test at the surgery is continuing to go high, it shows that either the pancreas still can't cope or that you've got insulin resistance.

Nor has anyone explained to me why the fingerprick test I did using my own meter, at the same time as the nurse was taking all my blood samples, showed 5.3 though my fasting test back from the lab was 7! I know meters aren't 100% accurate, but if my meter is consistently giving me readings 1.7mmol/l lower than the figure really is, how come my HbA1c was 5.2? Should those lovely 4.8s really have been 6.1? :?

Never mind! I suppose it's like my bathroom scales - they may not be accurate, but at least they're consistent!

Viv 8)

 

[Daibell]

Hi Philfatkid

An interesting point ref fasting test and cholesterol test etc. I think you're right as my blood test sheet for my consultation for next year lists Lipid Profile i.e. cholesterol etc and says it needs to be a fasting sample whereas all the other listed tests don't say fasting so there is a point to it after all!

 

[Thermal]

Well, today was finally the day for my review. Decide to behave myself as the nurse is very nice. She checked urine (fine), blood pressure (Fine & improved), random blood glucose (fine) and feet (fine). Discussed how I was feeling (fine), how my weight was (Improved) and how well my head was around the whole diabetes lifestyle (fine too)

Finished the appointment by saying she would see me in 6 months, when they would do blood tests, then if my bloods were fine she would switch me to annual review, as there was really very little to talk about at this six monthly one! I explained that I had contacted the surgery to say I didn't see much point in this appointment myself but they had insisted. Hmm yes she said, that's the doctor's preference, but there's really no need when you have no complications and are in control!