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Whose advice to follow, the DN's or the GP's?

A

Ailidh

Active Member
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34
Hi.
Diagnosed June 15th, first DN appointment June 30th (tomorrow).

In the mean time, I had to see the GP, the anxiety disorder that had partly caused my early retirement on health grounds was running wild.

He immediately gave me Metformin, suggested I up my evening Amitriptyline from 10mg to 20mg, and contact a local wellness clinic to ask for counselling.

I haven't needed to alter the Amitriptyline, my sleep, which had become suddenly poor and was freaking me out, is improving again.
I won't contact the wellness clinic because I already have sessions with the hospital oncology psychologist, so there's no point getting conflicting advice.

I Did take the Metformin, I think today was my 5th tablet (500mg once a day for a week, then twice a day). So far, usually, about 2 hours after lunch I have to rush to the loo. Occasionally in the evening too. It's not helping the anxiety any. I've let myself get too introspective, and need to get out of the house, into fresh air and humanity - but can't risk being caught short; and round the anxiety goes again.

From what I understood of the DN's telephone conversation when she gave me the diagnosis, blood number 7, by the way, still don't understand exactly what that means but it doesn't sound screamingly high (while, of course, to be taken very seriously), I would be trying the diet and exercise route. The GP has given me (unsolicited) meds. Whose advice should I follow? Is a DN, presumably an expert, more senior in the matter than a GP?

I fully understand that I might choose neither, and follow the advice I read on here but within this particular context: Who at a GP practice has the more right to issue advice, the Specialist nurse or the General doctor?
Ta.
 
In my case the ultimate responsibility is with the GP since any test results have to be seen by him before anyone else gets them. Having said that he does not like to tread on the toes of the DN. In the past, if ever I have tried to give him information or ask a question about diabetes he has always said to bring it up with the DN.

It makes sense to me. If it was any other way they would be in conflict all the time and get nowhere.
 
Ailidh said:
Hi.
Diagnosed June 15th, first DN appointment June 30th (tomorrow).

In the mean time, I had to see the GP, the anxiety disorder that had partly caused my early retirement on health grounds was running wild.

He immediately gave me Metformin, suggested I up my evening Amitriptyline from 10mg to 20mg, and contact a local wellness clinic to ask for counselling.

I haven't needed to alter the Amitriptyline, my sleep, which had become suddenly poor and was freaking me out, is improving again.
I won't contact the wellness clinic because I already have sessions with the hospital oncology psychologist, so there's no point getting conflicting advice.

I Did take the Metformin, I think today was my 5th tablet (500mg once a day for a week, then twice a day). So far, usually, about 2 hours after lunch I have to rush to the loo. Occasionally in the evening too. It's not helping the anxiety any. I've let myself get too introspective, and need to get out of the house, into fresh air and humanity - but can't risk being caught short; and round the anxiety goes again.

From what I understood of the DN's telephone conversation when she gave me the diagnosis, blood number 7, by the way, still don't understand exactly what that means but it doesn't sound screamingly high (while, of course, to be taken very seriously), I would be trying the diet and exercise route. The GP has given me (unsolicited) meds. Whose advice should I follow? Is a DN, presumably an expert, more senior in the matter than a GP?

I fully understand that I might choose neither, and follow the advice I read on here but within this particular context: Who at a GP practice has the more right to issue advice, the Specialist nurse or the General doctor?
Ta.
Click to expand...

To be honest, my take on GP Practise "specialists" is that they are usually generalists who take an interest in the topic; in this case Diabetes. But, really, without listening to your DN's views it's hard to suggest where you should listen (or not).

In your shoes, I'd go with an open mind tomorrow, but probably expect she will recommend lots of carbs and no testing. That's the more usual approach, and anything else is a bonus. I'd also tell her of your symptoms from Metformin, and its impact on your anxiety and tell her you would like to try for a period with meds (provided that's what you would actually like to do.)

I'm not giving you advice here, and we are all individuals in our body make up and outlook, but at diagnosis my bloods were quite a bit higher than yours, and I managed to get things down to non-diabetic levels by my first review. I think I was somewhat lucky, as not everybody can manage it; for a million and one reasons, I'm just highlighting that, given will-power and good fortune, it can be done. If you don't try, you'll never know.

So, again. Please don't decide to go tomorrow with closed ears, but listen to what she has to say, as she'll know far more about your overall circumstances than I do. For instance, you mention oncology in your last post, so I'm assuming you've had a skirmish with the Big C along the way somewhere, and that may be impacting on some of the guidance you are being given. I know of a couple of posters who have either undergone treatment for cancer either just before or just after diagnosis, and both have done exceptionally well. One now has bloods on the diagnosis threshold, and the other is declared to be in remission, so don't let that get in the way.

Good luck with it all, and come back and let us know what she says and what you decide. It's your body, your condition and they are your choices.
 
The reason for the upset tum is normally to many carbs have been eaten. Another option is slow release metformin.
The dsn you refer to is this the nurse at the GP practise? If so she is a practise nurse with a certificate obtained after a couple of hours doing an on line course.
Go as already suggested with an open mind and don't prejudge.
 
Thank you, both.

I think the DN said when she rang me that the results hadn't been seen by a doctor yet but as they'd be passed to her anyway, she was giving me them.

Yes, I'd like to try what diet and exercise alone would do first, if that's appropriate. It's not that I mind medication but a) the runs are tedious (although none today, so far!) and don't help the anxiety and b) the huge warning from the pharmacist to make sure I don't miss meals in case I go into a hypo coma and die doesn't help the anxiety either!

Yup, 2 years in remission from lymphoma.

Thanks for your advice to a flailer :)
 
Ailidh said:
the huge warning from the pharmacist to make sure I don't miss meals in case I go into a hypo coma and die doesn't help the anxiety either!
Click to expand...
Your pharmacist should know better, Metformin does not cause hypos so worry not
 
Hi. The bottom line as they say is that you should ask the surgery to change your Metformin script to Metformin SR (Slow Release). The NHS prescribes the plain version becuase it's cheaper but it often results in visits to the loo; don't put up with it. BTW GPs and DNs vary a lot and only experience with those in your surgery and reading the posts on this forum will help guide you.
 
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