I'm a bit baffled. I developed T2D 11 years ago. I've since moved GP surgeries twice, receiving what I thought to be good care from the diabetes nurses. Admittedly their advice has differed hugely, and has also differed from that at the T2D programme run by the local hospital. But I felt that I was talking to people who knew something about T2D and that their different opinions could be questioned and clarified. Since moving to my current GP practice I see a variety of nurses in the diabetes team, but I don't get the feeling that they have much knowledge. At one appointment they might tell me to change my metformin dose from the morning to evening, at the next the same nurse will be querulous and ask why I changed. I feel as if they look at a flowchart but don't listen to any problems I might have, and they're definitely not interested in any data that I get from my Libre 2+ sensors that the GP practice prescribes for me. They tell me the software is too expensive to monitor it themselves (my understanding is that it's free, ditto training and installation) but won't look at the printouts I take. Anything I take to appointments is pushed back at me to take home, without reading. But I feel that my time-in-range data is useful, ditto the way my glucose rises way above range towards late morning even on a low-carb diet. It disappoints me that they won't even look at it.
I wonder if my expectations are too high, based on previous experience. At my last GP surgery the excellent diabetes nurse had just finished a masters degree, had brilliant dietary advice and was very sympathetic and encouraging. Unfortunately she left.
I recently left the ASCEND-PLUS trial after being put on the placebo. My HbA1C has risen quite substantially but it's my time-in-range that worries me most. When I mentioned to the nurse that some people on this forum, who'd also left the trial after being on the placebo, had been prescribed Rybelsus by their GP practice after they described how much difference it had made to them. She said that that kind of thing shouldn't be discussed on forums and I shouldn't have been able to read about what other people are prescribed. It feels to me that they have a very paternalistic culture and it almost feels as if I walk into the stone age when I walk into the appointment room.
Other than doing blood, urine, weight and foot tests, and then not coming up with any solutions if my HbA1C doesn't meet their expectations (each nurse tells me I should have a different target) and basically just fiddling with the timing of metformin and wondering in a disparaging way why I'm on empaglaflozin (it was prescribed by a consultant, which they should be able to see on my chart), should I be expecting any discussion of recent research, any thoughts on what might work better, any explanation of how they've come up with whatever target they give me on the day, etc etc? I mentioned to several local friends with T2D that it feels to me like they've had maybe 2 weeks training at that surgery and they all agreed - one laughed and said she didn't think they'd even had that much. Is there a way to find out what training they've had? Because it seems to me that their inability and reluctance to discuss my own observations and thoughts, and the fact they have never had anything interesting to say, might be defensive due to lack of knowledge. If I could find out who's good, in that surgery or nearby surgeries, I'd happily do my best to be seen by those people.
Are there any questions I can ask them to find out if they've completed suitable post-qualification training (and when) without sounding rude? Or might there be a register somewhere? I'm desperate to have an adult conversation with someone who'd be interested in my Libre data and also in what other options might be out there.
I'm reaching the point of trying to find a private practice that can help but I wouldn't know how to start looking.
eta, I've checked the Nursing and Midwifery Council register and there are no "subsequent qualifications" listed for the diabetes nurses I see. If they've done specialist DSN training, should it be seen on here? Or are DSN's registered elsewhere?
I wonder if my expectations are too high, based on previous experience. At my last GP surgery the excellent diabetes nurse had just finished a masters degree, had brilliant dietary advice and was very sympathetic and encouraging. Unfortunately she left.
I recently left the ASCEND-PLUS trial after being put on the placebo. My HbA1C has risen quite substantially but it's my time-in-range that worries me most. When I mentioned to the nurse that some people on this forum, who'd also left the trial after being on the placebo, had been prescribed Rybelsus by their GP practice after they described how much difference it had made to them. She said that that kind of thing shouldn't be discussed on forums and I shouldn't have been able to read about what other people are prescribed. It feels to me that they have a very paternalistic culture and it almost feels as if I walk into the stone age when I walk into the appointment room.
Other than doing blood, urine, weight and foot tests, and then not coming up with any solutions if my HbA1C doesn't meet their expectations (each nurse tells me I should have a different target) and basically just fiddling with the timing of metformin and wondering in a disparaging way why I'm on empaglaflozin (it was prescribed by a consultant, which they should be able to see on my chart), should I be expecting any discussion of recent research, any thoughts on what might work better, any explanation of how they've come up with whatever target they give me on the day, etc etc? I mentioned to several local friends with T2D that it feels to me like they've had maybe 2 weeks training at that surgery and they all agreed - one laughed and said she didn't think they'd even had that much. Is there a way to find out what training they've had? Because it seems to me that their inability and reluctance to discuss my own observations and thoughts, and the fact they have never had anything interesting to say, might be defensive due to lack of knowledge. If I could find out who's good, in that surgery or nearby surgeries, I'd happily do my best to be seen by those people.
Are there any questions I can ask them to find out if they've completed suitable post-qualification training (and when) without sounding rude? Or might there be a register somewhere? I'm desperate to have an adult conversation with someone who'd be interested in my Libre data and also in what other options might be out there.
I'm reaching the point of trying to find a private practice that can help but I wouldn't know how to start looking.
eta, I've checked the Nursing and Midwifery Council register and there are no "subsequent qualifications" listed for the diabetes nurses I see. If they've done specialist DSN training, should it be seen on here? Or are DSN's registered elsewhere?
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That's where I started. I then looked at the official professional registers. Unfortunately nurses don't have to enter their advanced training on the UK register. There is a specialised register but you can't search by name, you need a PIN that's unique to the practitioner. Asking for their PIN could be seen as rude. I'm just not sure how to start the converstaion about their training and qualifications. The NHS is extremely paternalistic and you can easily be labeled as a "naughty patient". My GP loves that I am so knowledgeable and that I come prepared with research and opinions. She says she wishes all patients were like me. But she admits that diabetes is not her specialised area. She has said that she'll happily listen to what the nurse says, if the nurse is unable to precribe the meds I want herself. But the nurse refused to do that - she said that if my GP tried to prescribe Ryblesus she'd fail. 