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Diabetic Nurse

BBGRAMMY

BBGRAMMY

Active Member
Messages
26
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi all
Just to ask do you all have a diabetic nurse at your practice?

I don’t see a specialist nurse just the doctor.

I keep seeing posts relating helpful/unhelpful DNs. My GP gives me no guidance just wants me to discuss my ‘lifestyle’ and increase Metformin to another 500mg (2000mg daily). Been type 2 over 15 years.
 
Most GP practices don’t have a real DSN, which is a specialism usually only found in hospitals. (though they may be called that) they’re usually just a nurse who at that particular practice maybe has a bit more knowledge & takes the clinics. Most of us with T2 will never see a true DSN unless it’s through a hospital

I’m extremely lucky as my GP practice does have a true Diabetic Specialist Nurse, who is part time over 3 GP practices, she is also a big champion of low carb & keto which is great. I’ve never seen a GP for my diabetes since diagnosed 16 years ago, I have seen a GP when my test results threw something up that was concerning, my white blood count was high once & some liver results which turned out not to be diabetic related but an unconnected autoimmune condition
 
I also am very lucky then my practise has 2 DN's one I see regular and one I have seen when mine is on holiday or days off (she is only there 3 days a week)
So glad they are as seeing a Dr is not easy in the slightest
 
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There are two nurses at my practice who deal with all the diabetic patients. They do the routine tasks (BP, HbA1c, weight, etc) that the practice needs to do to get its QoF payments. I have no idea what training they have had. I haven't seen a GP (for anything) since 2019.
 
Not sure Canada had any relevance to your question @BBGRAMMY , but my Dr’s practise does not have a DN. He does seem very knowledgeable on diabetes related stuff. I consider myself lucky. I’ve only seen a DN at special diabetes clinics here.
 
My surgery doesn’t have a diabetes specialist nurse. Over the years since diagnosis for my reviews I have seen nurses, doctors and last year the surgery pharmacist. I thought seeing the pharmacist was telling, have they become so used to increasing meds at reviews, that they think a pharmacist is the man (or woman) for the job these days? He certainly expressed surprise at my non diabetic HbA1c!
 
We have a specialist DN at our GP surgery who undertakes the Diabetic reviews. There is also a dedicated bloods nurse who carries out A1cs and other blood tests. There is also a dedicated Asthma nurse who sometimes covers for the DN, and a couple of practice nurses. I think we are probably very fortunate.
 
I had a very good diabetes nurse who went on courses to keep up to date. She said that there weren’t many others like her, so a true diabetes nurse and sadly has been off ill since last March and I doubt she’ll return
The other nurse there I was not impressed with and last saw my GP to discuss my medication and results. Not happy
 
Thanks all for your replies. I’ve had a virus so not been on the forum to see the replies.
No diabetic nurse at my practice. It seems to vary from what I’m reading.
I’m seeing an advanced practice nurse on Thursday for my Hba1c results 56 which was lower 3 months ago at 53. They want to increase Metformin by 500mg. I will be then taking 2000mg daily. They have been taking my bgs every 3 months due to my anaemia.
Exercise hasn’t been a priority as I get tired. I know I have to do more. So onwards and upwards!
 
One question I’d be asking at your appt. is whether they are taking your anaemia into account when deciding to increase your meds, as anaemia can skew HbA1c results? There is an alternative test which maybe they would do for you which is unaffected by anaemia. I think it’s called the Fructosamine test. I think @Pipp can confirm the name.
 
Rachox said:
One question I’d be asking at your appt. is whether they are taking your anaemia into account when deciding to increase your meds, as anaemia can skew HbA1c results? There is an alternative test which maybe they would do for you which is unaffected by anaemia. I think it’s called the Fructosamine test. I think @Pipp can confirm the name.
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Sorry, @Rachox.
I am not sure what you are asking of me, here.
 
Rachox said:
One question I’d be asking at your appt. is whether they are taking your anaemia into account when deciding to increase your meds, as anaemia can skew HbA1c results? There is an alternative test which maybe they would do for you which is unaffected by anaemia. I think it’s called the Fructosamine test. I think @Pipp can confirm the name.
Click to expand...
I can confirm that a fructosamine test is an alternative used for hba1c if there is reason to not fully trust the hba1c, even though I have no personal experience with it.
BBGRAMMY said:
I’m seeing an advanced practice nurse on Thursday for my Hba1c results 56 which was lower 3 months ago at 53. They want to increase Metformin by 500mg. I will be then taking 2000mg daily. They have been taking my bgs every 3 months due to my anaemia.
Click to expand...
Worth discussing this with your practice nurse @BBGRAMMY .
 
Thank for discussing this. It’s really helpful. I
have used an AI and it gave me the same answer as you that Hba1c can be altered by anaemia. My dr is not open to these discussions. It’s an ongoing frustrating situation. As I have been anaemic off and on for all the time I have been diabetic. Numbers for haemoglobin are now up @ 121 normal is 115. However, there are two others linked to hb that are lower which he has read and classed as normal.
I’m seeing an advanced practice nurse and I will have this discussion. Experience tells me I will be seen as being awkward in not taking the extra 500mg. I’m upset and frustrated by the increase. Your input is gratefully received.
 
BBGRAMMY said:
Thank for discussing this. It’s really helpful. I
have used an AI and it gave me the same answer as you that Hba1c can be altered by anaemia. My dr is not open to these discussions. It’s an ongoing frustrating situation. As I have been anaemic off and on for all the time I have been diabetic. Numbers for haemoglobin are now up @ 121 normal is 115. However, there are two others linked to hb that are lower which he has read and classed as normal.
I’m seeing an advanced practice nurse and I will have this discussion. Experience tells me I will be seen as being awkward in not taking the extra 500mg. I’m upset and frustrated by the increase. Your input is gratefully received.
Click to expand...
AIs are unreliable, which is why their use is banned from the forum. You might be better to quote Bilous and Donnelly's "Handbook of Diabetes" ed 5 which says on page 81:

Box 9.3 Potential reasons for a misleading HbA1c.

Altered red blood cell turnover
• Blood loss
• Haemolysis
• Haemoglobinopathies and red cell disorders
• Myelodysplasia
• Pregnancy
• Iron deficiency

Interference with assay
• Persistent foetal haemoglobin
• Haemoglobin variant
• Carbamylation

Timing
• Too frequent testing

Imprecision
• Differences of approximately 4.4 mmol/mol (0.4%) reflect ± 2 SD for most modern assays

Variability in red blood cell membrane transport (slow/rapid glycators)

Ethnicity
African Americans have a 4.4 mmol/mol (0.4%) higher reading per average blood glucose (derived from CGM) than white Europids

NOTE Assays vary in regard to the effect of these factors on the reported result. Please check with your local laboratory.
 
I have the opposite issue - to much haemoglobin and have a frutosamine blood test instead of a HbA1c which my DN then converts into a A1c equivalent, the results take a little longer to come back as my local hospital has to send them out
 
Hi kennyA
I can understand the ban! This is why I didn’t quote this in my original message. However I have backed it up with information from other sources. Thanks for the heads up with AI
I have had two colonoscopies, polyps and a lipoma removed. I have mentioned this in previous posts. I’m fed up with my own rants.!
No bleeding just iron deficiency.
Thanks for the list! I only have one of these. B12 is also low normal.
The information is available as shown it is discussing this rationally with a gp who will listen is the issue. Thanks again.
 
BBGRAMMY said:
Thank for discussing this. It’s really helpful. I
have used an AI and it gave me the same answer as you that Hba1c can be altered by anaemia. My dr is not open to these discussions. It’s an ongoing frustrating situation. As I have been anaemic off and on for all the time I have been diabetic. Numbers for haemoglobin are now up @ 121 normal is 115. However, there are two others linked to hb that are lower which he has read and classed as normal.
I’m seeing an advanced practice nurse and I will have this discussion. Experience tells me I will be seen as being awkward in not taking the extra 500mg. I’m upset and frustrated by the increase. Your input is gratefully received.
Click to expand...
Its not a case of them seeing you as being "awkward" I would be getting a second opinion or seeing another doctor. I have found in my gp practice, the gps are not all made out of the same cloth. Just frustrates me seeing people having to fight for information or people not up or discussion. Hope you get sorted. Perhaps the advanced practice nurse will be more willing to discuss.
 
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