Anybody else panic at the doctor's?

[NewTD2]

Sure, no problem. I’m currently laid up having broken my leg falling off my bike (No, exercise IS good for diabetes, at least if done sensibly!). So, for the next 3 weeks or so I have time on my hands though posting here is something I wouldn’t normally have time to do. The disintegrating NHS is wholly another subject all together. I’d like to think that most of us DO care but it’s not easy when you’re fighting fires every day of every week. I hope that you get the care that you deserve.

Dr Bailey,

Can I please private message you?

Dirty to hear about your broken leg.

I hope you recover very soon!

Andrew

 

[Rob Bailey]

I think HbA1c of 46 is very good. What do others think?

An HbA1c of 46 is excellent if you are Type 2. So good in fact that if you had never had one done before you would not be diagnosed with diabetes although you would be classified as being at high risk of developing diabetes (42-47 to be precise). A word of warning for those with type 1 (and indeed some with Type 2, especially those on insulin.) 46 is too low and almost certainly means you are having too many hypos. The mantra of “lower is better” is not always true. For Type 1 (with perhaps the exception of pregnancy, where really tight control IS important), mid fifties or so is probably about optimal. Hypos are NOT trivial and can cause lasting damage to the brain.

 

[Rob Bailey]

Dr Bailey,

Can I please private message you?

Dirty to hear about your broken leg.

I hope you recover very soon!

Andrew

No problem. You can find me on Facebook and use messenger if you make it clear who you are (but once I’m back at work the replies might dry up!)

 

[NoKindOfSusie]

I hope this won't come off as a stupid question, but here's the situation. I don't have a GP in London (I'm not from the UK originally and I never have had, I was indestructible of course.)

I want to absolutely minimise the contact I have with any sort of medical professional, no offence but they are not doing anything very useful and we don't really get on (what is it with diabetes specialists and refusing to answer questions).

Anyway currently the only way I have of getting repeat prescriptions for stuff is via the hospital, which can't really go on for ever, although of course now it does have to go on forever, so.

The problem is, will any GP see me as a bad risk, a pain in the neck, someone who will be sick forever and just soak up their time, not someone they want on their books, and so on. I am not used to being in this situation, I am used to happily ticking the "no pre-existing conditions" box whenever it comes up, and I feel very awkward just walking in and going "hello can I sign up please, I'm chronically unwell." Especially given the news that the NHS is basically dying moment by moment. It's not very easy.

Are they going to want to run a whole barrage of tests and stuff? I'm not really up for that, I have enough bits of metal stuck in me.

 

[JoeT1]

An HbA1c of 46 is excellent if you are Type 2. So good in fact that if you had never had one done before you would not be diagnosed with diabetes although you would be classified as being at high risk of developing diabetes (42-47 to be precise). A word of warning for those with type 1 (and indeed some with Type 2, especially those on insulin.) 46 is too low and almost certainly means you are having too many hypos. The mantra of “lower is better” is not always true. For Type 1 (with perhaps the exception of pregnancy, where really tight control IS important), mid fifties or so is probably about optimal. Hypos are NOT trivial and can cause lasting damage to the brain.

Wow, this is something I haven't really taken into consideration that much. My mantra has been, the lower the better, so when I am say sitting on 7.5mmol before dinner, I may look to correct on that, running the risk of a hypo.

My DSN did tell me that getting 54 (8.5mmol) as a HBA1C result would be just fine, it'd in fact, be good. I have been shooting for lower (only diagnosed in October). Maybe I should ease up a little to stop running the risks of hypos?

 

[Rob Bailey]

I hope this won't come off as a stupid question, but here's the situation. I don't have a GP in London (I'm not from the UK originally and I never have had, I was indestructible of course.)

I want to absolutely minimise the contact I have with any sort of medical professional, no offence but they are not doing anything very useful and we don't really get on (what is it with diabetes specialists and refusing to answer questions).

Anyway currently the only way I have of getting repeat prescriptions for stuff is via the hospital, which can't really go on for ever, although of course now it does have to go on forever, so.

The problem is, will any GP see me as a bad risk, a pain in the neck, someone who will be sick forever and just soak up their time, not someone they want on their books, and so on. I am not used to being in this situation, I am used to happily ticking the "no pre-existing conditions" box whenever it comes up, and I feel very awkward just walking in and going "hello can I sign up please, I'm chronically unwell."

No GP Practice should refuse any patient on the grounds they have a long term condition. Some of us DO care and passionately so. I may not always agree with my patients but I will always try to answer their questions and explain, particularly if I disagree. Unfortunately medicine is not a business where the customer is always right, but then again, neither are the doctors!

 

[NoKindOfSusie]

Unfortunately medicine is not a business where the customer is always right, but then again, neither are the doctors!

Ha I wish they'd tell me I was doing it wrong, I wish they'd tell me anything. The answer to everything is "hmm well everyone's different," or "well, we'll have to wait and see," or "why don't we see how we're doing next time" or "well, I may have said that X was the target last time but now I'm saying Y is the target for no reason other than to make you feel better." So what is the target? "well everyone's different."

Grrrrr.

How many ways are there to say "I don't know?"

Is there some reason that medical people are resistant to saying that? I guess if I'd been to school for six years and trained on the job for years more I'd probably not want to say "hmm, I've no idea" but it must happen!

 

[Circuspony]

I hope this won't come off as a stupid question, but here's the situation. I don't have a GP in London (I'm not from the UK originally and I never have had, I was indestructible of course.)

I want to absolutely minimise the contact I have with any sort of medical professional, no offence but they are not doing anything very useful and we don't really get on (what is it with diabetes specialists and refusing to answer questions).

Anyway currently the only way I have of getting repeat prescriptions for stuff is via the hospital, which can't really go on for ever, although of course now it does have to go on forever, so.

The problem is, will any GP see me as a bad risk, a pain in the neck, someone who will be sick forever and just soak up their time, not someone they want on their books, and so on. I am not used to being in this situation, I am used to happily ticking the "no pre-existing conditions" box whenever it comes up, and I feel very awkward just walking in and going "hello can I sign up please, I'm chronically unwell." Especially given the news that the NHS is basically dying moment by moment. It's not very easy.

Are they going to want to run a whole barrage of tests and stuff? I'm not really up for that, I have enough bits of metal stuck in me.

You should definitely register. Despite how it comes across on this site sometimes, the vast majority of GPs want to support you and make you well. Most of the time they only have a 10 minute slot with you, so will probably just ask how you are getting on and refer to the hospital for any further treatment. BUT - they can sort your prescriptions and, in the case of my local surgery, provide you with somewhere to offload sharps bins. Plus you are a bit more vulnerable to other stuff now so if you are registered then at least you can ring through if there is a problem - such as the flu that your homeland is offloading on us!

 

[Antje77]

46 is too low and almost certainly means you are having too many hypos.

Not true for everyone. It would be nice if proffesionals would see case to case. I have the proof of my Libre that I'm not going hypo all the time, and when I do I usually don't go below 3,6. (still normal for healthy people and only counted as hypo to avoid dangerous hypo's. I do treat as hypo though when below 3,9). Despite this proof my DN still doesn't like it that my hba1c is under 40. I do like it, especially as taking the right amount of insulin is much easier when I'm not too high. As long as I can keep it low without nasty hypo's and without too much hassle I'll do that. At least with the Libre she has to believe me when I say I'm staying in the safe zone, no idea what would have happened without it.

(type lada or type2, diagnosed a bit over a year ago, on moderate carbs and tresiba + fiasp. And a lucky ******* that my diabetes is relatively easy to control. At least for now)

And sorry for derailing this thread.

 

[NoKindOfSusie]

I'd rather have too many hypos than one amputation.

 

[Georgehiggins]

My GP told me that my A1c of 46% is “normal”, which clearly isn’t!!!

She hasn’t got a clue about diabetes so I changed GP/surgery straightaway!

46 is good when your t2 diabetic the perfect is 49 I’m coming down from 69 to 61

 

[tigger]

@NewTD2 I'm a bit confused as to whether you're type 1 or 2 but if type 1 and in London (judging by Barnet) you can go to any of the London hospitals. Just call up them up, interview them on key points that matter to you and ask how to self refer. I live in the Barnet CCG but get seen at one of the inner London teaching hospitals and have been with them for a long time. GPs don't have enough experience to provide this type of care and let's not get started on some of the DSNs.....

 

[Rob Bailey]

Not true for everyone. It would be nice if proffesionals would see case to case. I have the proof of my Libre that I'm not going hypo all the time, and when I do I usually don't go below 3,6. (still normal for healthy people and only counted as hypo to avoid dangerous hypo's. I do treat as hypo though when below 3,9). Despite this proof my DN still doesn't like it that my hba1c is under 40. I do like it, especially as taking the right amount of insulin is much easier when I'm not too high. As long as I can keep it low without nasty hypo's and without too much hassle I'll do that. At least with the Libre she has to believe me when I say I'm staying in the safe zone, no idea what would have happened without it.

(type lada or type2, diagnosed a bit over a year ago, on moderate carbs and tresiba + fiasp. And a lucky ******* that my diabetes is relatively easy to control. At least for now)

And sorry for derailing this thread.

My note of caution about hypos is based on statistics: Those patients with T1 diabetes with very low HbA1c levels are at higher risk of permanent disability and death than those with slightly higher readings. Having said that there are 2 obvious points. Firstly, you are a person, not a statistic (as I think Abraham Lincoln said: “there are lies, damned lies and statistics “!). Secondly statistics do of course lag some time behind the here and now and we may have to revise our views with the arrival of Libre and other continuous glucose monitors. My dream is that we will have an artificial pancreas one day that is as good as the real thing; that’s where the future lies until the elusive cure is found . Personally I would kill for an HbA1c like yours if I was confident I was not getting any significant hypos. I know it is not really for this thread, but you are a great example of why CCGs are so short sighted by refusing to allow Libre and the like on NHS prescription. Carry on as you are and you will never end up with sight, kidney or vascular problems (which are hugely expensive to deal with) because of your diabetes, but being cash strapped as they are they cannot see the longer picture. I think that you make an excellent point, but still need to beware the dreaded hypos!

 

[annieblade]

My doctor and nursing staff have struggled to help me as most of their knowledge is on T2 or insulin dependent lifetime T1s. I am a mature onset T1 in honeymoon, not on insulin. They have listened and done their best but it is outside of their usual field of knowledge (they are, after all, General Practitioners). So they referred me back to a specialist diabetes consultant and clinic to get me the help and support I need. Just ask for a referral to a diabetes specialist - I think all of us need this help from time to time.

 

[NewTD2]

@NewTD2 I'm a bit confused as to whether you're type 1 or 2 but if type 1 and in London (judging by Barnet) you can go to any of the London hospitals. Just call up them up, interview them on key points that matter to you and ask how to self refer. I live in the Barnet CCG but get seen at one of the inner London teaching hospitals and have been with them for a long time. GPs don't have enough experience to provide this type of care and let's not get started on some of the DSNs.....

T2

Thank you!

 

[bulkbiker]

An HbA1c of 46 is excellent if you are Type 2.

I'm sorry but I heartily disagree with that statement. 46 is well into the pre diabetes category so to tell someone with Type 2 that is excellent is hardly going to encourage them to get it lower.

 

[dbr10]

I'm sorry but I heartily disagree with that statement. 46 is well into the pre diabetes category so to tell someone with Type 2 that is excellent is hardly going to encourage them to get it lower.

It's the sort of reading doctors and DN say is okay but isn't.

 

[NoKindOfSusie]

My note of caution about hypos is based on statistics: Those patients with T1 diabetes with very low HbA1c levels are at higher risk of permanent disability and death than those with slightly higher readings.

Oh.

Nobody told me that.

I am sort of running out of reasons to be scared. It's sort of cathartic. At some point, you know you're so screwed it's hardly worth screaming about it anymore.

 

[phoenix]

Hi Susie,
How about a contract. You get yourself sorted, so will I.

Ive been putting off registering with a GP for about 6 weeks and yes I am panicking at the thought of actually doing it .

I officially left France at the end of November. I have six months supplies of pump consumables, 4 months of strips and enough insulin for about the same time .
I have to explain to a GP that may think only young people get T1 that I was diagnosed 14 years ago at the age of 53 (and yes they did all the tests and I had to spend 10 days in hospital and no I'm not as thin as I was at diagnosis)
I have to explain to a new GP that I use a pump but unfortunately I am using an old pump.This is becaus the French now rent pumps by the day rather than buying them as they used to do.The company that rents them out insisted I had to return it. Fortunately, the nurse who I have seen for the last 12 years about my pump felt dreadful about her employer's ruling and made sure I had enough supplies and we checked my old 'mothballed'pump was still functioning . Since I really need a new pump, I need to ask my new GP for a referral to a department that I know is 'pump' friendly.
Oh and I need to tell the GP that I also have hypothyroid and I need a prescription for thyroxine
I have got documentation : Here is my prescription and here are all my x rays, blood tests, mammograms, scans etc for the past 14 years; Sorry but they are all in French and use different units to the UK.

How to approach it, I don't really know but like you Susie I need to face it.
Any tips Dr Bailey?

 

[donnellysdogs]

A newbie to UK needs to sign up asap to NHS system.... and being on a pump a GP should refer you steaight away to a hospital specialising in pump management. You need to make it clear to a new GP that the pump aspect should be clearly defined in request for endocrine consultant at the hospital..

In UK docs are not trained at all on pumps and the other thing you need tonadd is that this referral needs to be urgent as funding and accounts for the pump have to be set up and can cause a delay in you getting the equipment you need..