Told off like a naughty boy for low HbA1c

[dowuchyalike]

Since my June visit to clinic this year, I've been struggling with a variety of other health problems among which, depression and anxiety have featured prominently. Obviously, this has made management of my diabetes a lot more challenging than usual and it's fair to say that I've had a lot of short-term spikes and quite a few hypos along the way. Yesterday at clinic it came to my diabetologist's attention that my recent HbA1c was 5.9% (41 in new units) and in his words this was 'dangerously low' and I was running the risk of a major hypoglycaemic episode.

However, instead of asking why for the first in the 10 years that I've been under his care, I'd presented with a 'bad' HbA1c and discussing strategies with me to help me get things back under control amid my other health problems, he launched into a tirade about how I was "running things too tightly" and that the clinic would take my pump away if I didn't ease up on things. It wasn't just what he said, it was the way he said it. I was left feeling like I'd been severely reprimanded and that my pleas about how other health issues were complicating things had just fallen on deaf ears. In fact, when I asked him to acknowledge the role that these other factors were/are playing in the recent demise of my control, he simply responded by saying that as a diabetic specialist those issues were not of his concern and he was only interested in me running my blood sugars higher than I have been doing.

I went looking for a sympathetic ear and the benefit of his specialist knowledge and instead just left feeling extremely distressed and entirely unheard. I'm half tempted to make an official complaint but as there isn't really any malpractice involved, I don't think it would get me anywhere.

 

[picklebean]

Hi there. I'm sorry you had such a negative experience. You say no malpractice was involved, but that doesn't mean you can't complain. I would if I were you. In my opinion it is this kind of non-joined-up thinking that often results in complications causing serious problems rather than being minor things that are easily dealt with.


I have had clinical depression for many years and have been T1 since childhood. I wasn't getting any support or help from anyone because I was 'too serious' to be offered simple counselling and 'not serious enough' to require urgent psychological help. It was my diabetes consultant who suggested that HE refer me to the psycholigcal services for therapy because mental health problems can have such a huge and negative impact on diabetes and I clearly needed some help. I did indeed end up getting a course of intensive therapy thanks to his intervention.


I think you're perfectly within your rights to make a complaint. Perhaps then you will start getting the help you need instead of being reprimanded for something that you are unable to control. Far from not being 'of concern' to your diabetic specialist, it is HIS JOB to help you manage your diabetes and if he doesn't realise that life and everything it throws at you, including depression, has a major impact on your diabetes management, then what the hell is he doing as a diabetic 'specialist'?!? :x


I'm sorry you're going through this. Diabetes is hard enough to control well at the best of times, but with a mental health issue it can get really complicated and very hard to deal with. I wish you luck!

 

[benedict]

I have experienced something similar.

My last HbA1c was 5.5% and my consultant asked me whether I'd be ok to show her my meter. So I handed over my meter whilst she checked for hypos and found that hypos were not particularly frequent amongst the result and accepted that I'd managed to keep tight control without running myself too low.

It felt like she was trying to catch me out but I accept that's part of her job to some extent. After all, I drive and she has some responsibility to check whether I am going too low from that perspective.

I think doctors are sometimes very quick to jump to assumptions. On the one hand, they need to be able to make decisions quickly as part of their role and I can imagine making some assumptions may need to be a part of this. However, this can also be taken a step too far.

I'm sorry to hear you had an unpleasant experience and hope your consultant will make an effort to listen to you and essentially work in partnership with you. I think in this case, I expect your doctor is most worried about the frequency of hypos you're having. It's worth bearing in mind that you are under your doctor's care. I know none of us like to think about it this way, but if we were to have a life threatening hypo, there is the possibility that they could be held responsible by our families. I always try to bear this in mind when speaking to healthcare staff.

All the best
Benedict

 

[dowuchyalike]

Thanks for both of your replies, they are greatly appreciated.

Picklebean, I am currently in receipt of once-weekly CBT sessions and am also on a list to see a clinical psychologist. You are absolutely right when you say that depression has a major impact on diabetes management. The anxiety attacks too can mess up your regulatory hormones something rotten and that in turn plays havoc with blood sugars. That a specialist refuses to acknowledge this and treat accordingly is, indeed, very poor.

I guess a big issue for me is that I obsess terribly about the long-term effects of high blood sugars, even when they're only high for relatively short periods and that does cause me to over-compensate somewhat where correction doses are concerned, which can bring on hypos later. I always get very early warning symptoms, however, and in 27 years have never had a hypo that required the attention of a third party. It's very rare in fact that I ever fall below 3mmol, certainly not in those situations where I've bothered to test to confirm that I am actually going low. I do drive but am always super careful about testing beforehand and in 20 years of having a licence have yet to ever go low while behind the wheel. As my diabetes has always been so well controlled in the past, this response to my recent HbA1c was extreme to say the least.

Benedict, you are right in what you say but this was as much about the way the specialist spoke to me, as about what he actually said. If points for bedside manner were being given, this situation would warrant minus figures. As a patient struggling with a number of health conditions that are all affecting diabetes, you want a doctor to offer a modicum of understanding before sitting down with you and going through strategies to help you overcome your difficulties. Instead, I was scolded, threatened with pump removal and told I'd be passed over to the DSN who would discuss some drastic slashing of my insulin doses. Hardly sympathetic or diplomatic doctoring there, methinks.

 

[Laubie]

Please make an official complaint about this! No one, even your Diabetic Consultant, should be able to talk to you like this. It is completely unprofessional to make you feel this way.
If you think it may be too extreme to make an 'official' complaint you can always try an communicate with the Consultant again - demand that he aknowledges the problems you are facing and their impact on your control and also that he offers an apology for the way you were spoken to. If he refuses, then tell him that you will be taking this further and making a complaint.
Too often doctors are allowed to get away with unprofessional behaviour, just because they are considered 'specialists'.
As for threatening you with taking away your pump, I think this is the most sickening part of all. That this doctor feels that he can threaten you with taking away the most important piece of diabetic apparatus you have (and are absolutely 100% entitled to) and that KEEPS YOU ALIVE is astounding. Your pump is clearly a very important part of how you manage your diabetes. I know it isn't for everyone, but for me (I have been on a pump since May) I don't think I could go back to injecting a basal-bolus regime. If they tried to take my pump away I would go to the media and slate them so their reputation was ruined - that is how strongly I feel about it!

Sorry - rant over now. But seriously, please don't let your doc get away with this. Would you get away with talking to someone like that in your job????
Take care.

 

[anna29]

Here is another perspective on this .

The specialist/consultant you have been with over the last 10years .
Has he seen you often whilst you have been under his care?
Have you got along well with him in the past?
Am asking these questions for a reason...

Did he sound stressed at all - when he launched into his tirade of telling you off .
It is pre-xmas time and some of the HCP's are packing the hours in currently...
I know this as fact - please note that I am 'not' trying to excuse his attitude at all.
Just merely pointing out some HCP's "are" packing the hours in and they are human also.
Get tired and stressed just like us !

I spoke to an orthopeadic consultant yesterday who is against the wall meeting clinic patient needs
against the clock of christmas next week .
Plus his own family have hardly seen him the last 2 months as he has waded through his work load.
The nurse's there were all saying the same thing .
Plus at my own GP's surgery [its a very small practice] have stayed open later
till 7pm the last 2weeks to cater for and meet patient needs and demands.

This is why I am offering this perspective to consider .

Anna.

 

[Ruth3]

I am a retired senior lecturer in nursing and midwifery and have found the medical profession can be arrogant and bullying, For some reason midwives even bully each other. I fight back by saying it's Dr actually when they use my first name or even my second name by 'really compassionate nurses'. You can become a Dr of Divinity or a right reverend on one website.

 

[Curleous]

Hi There
i too had a telling offf about my hb1ac which came back at 5.7 . My consultant wanted to look at my meter as well but i did not have it with me. He has asked me to increase to 6.5 so i am working towards that. His concerns were hypo umawareness whic is a dvla reportable offence. I dont want to lose license so have to take his word that 6.5 is best. I would be happier with 6.0 but hey ho..
I do have sub 4.0 readings but am aware when lo and will continue to get these when hb1ac is at 6.5 i guess.

Merry xmas all

Curleous

 

[iHs]

I think the consultant could have been a bit more sympathic towards your mental health problems but his speciality is diabetes and blood sugar levels. He is not a mental health specialist. Needless to say, there are many drugs for depression, anxiety that will cause bg levels to increase and there are some drugs that will in actual fact cause bg levels to drop. The consultant should be clued up enough to know about these drugs so I wonder why they are not. There was a time when a hospital consultant could refer patients on to get help that they need from other specialists working within the hospital but nowadays it is a case of seeing a GP to get the referal..... Sadly, the right hand doesn't communicate with the left anymore......

i have no intention of lowering my hba1c to below 6.8%. I am more like Carbrok in that respect. If it aint broke... dont fix it. My GP recommended that I get it lower but also agreed that low bg levels resulting in mild to serious hypos was not good for anyone so agreed that I should keep my a1c at the level that I have.

 

[pumppimp]

If the way the consultant spoke to you upset you I would complain, nothing would probably happen to him most likely he would be asked to apologise and that would be it. However he would then realise that the way he spoke to you was not profesional or caring or helpful and he would perhaps think twice before speaking to another paitent in the same way. I've had about 6 different consultants looking after me over the years and I feel there has only ever been one that was really enthusiastic and passionate about her speciality. The rest unfortunately I feel were just saddled with diabetes because there was nothing else they could get into. Having a consultant that supports you really does help you control your diabetes better, it's a shame we can't all have access to one.
On a different point why is 5.9% bad? My last HbA1c was 6.9% and I was getting told off that it was much too high for someone who had been on a pump 6 years. I was told that I must be very lazy in my control I needed to work harder and aim to get it around 5.5 - 6%. Albeit I don't have any trust in my consultant and he won't support taking on the funding for my pump. But isn't 6% the magic number that all consultants want us to work towards, so why would you get a telling off for it? I'm aimming towards the same number, as long as you still have good hypo awarness I don't see a problem. What does everyone else aim towards?

Having bad days yes we all have one but we all have to be professional in the work place to. If I had of talked to a client like that then I would have lost a contract and under disciplinary from my boss. I'm working long hours up to christmas as well especially as I shouldn't even be here as I'm supposed to be recovering at home from an op. I've got no sympathy for rude unhelpful doctors that's why they're paid the big bucks!!

 

[Patch]

It's a funny one. They try to avoid low HbA1c's for T1's because a SINGLE very low BG incident can be VERY dangerous. They would MUCH RATHER you had more instances of very high BG than a few instances of very low BG - because high BG's cause damage over a much greater time!

Unfortunately, a low HbA1c can be indicative of multiple very low BG incidences.

Don't forget - HbA1c's are just averages. The average of 1 and 10 is 5. But 5 is also the average of 6,4 and 5. So people with a perfectly steady BG (shall we say 5%?) can potentially have the same HbA1c as people with very eratic (high and low) BG's...

Since it is harder to maintain a steady BG, the Doc's assume that low(er) HbA1c's are indications of very low BG instances.

Keep yer chin up, mate. The emotional support that the doc's won't give you is available in buckets, right here. :thumbup:

 

[hanadr]

It depends on HOW this NORMAL HbA1c was achieved whether it is a danger sign or not. I read you are a T1, thus you MUST be using insulin. If you go through a LOT of swings in BG[ they call them excursions, ] A low A1c can be a danger sign, however if you keep close to Normal with few excursions up or down, you should be fine. A healthcare professional working with diabetes patients, SHOULD know that. Unfortunately they often only know of the ACCORD study, which in any case only refers to T2 and which claimed to find that people who recorded lower HbA1cs had a slightly greater risk of death. It's pretty much accepted nowadays that the ACCORD study is SERIOUSLY flawed and in any case it wasn't for T1patients
Hana

 

[dowuchyalike]

Let me just say I greatly appreciate all the input and sympathetic comments from everybody who's contributed to this thread.

I'm not prepared to write this off as my consultant just having a bad day. If you choose a career in which your primary aim/function is to help people, then there are no excuses for you not doing that and for speaking to someone so tersely that they leave the room fighting back the tears. There are also no excuses for refusing to listen to the pleas of someone desperate to have it recognised that there are other things going on that are making good control a genuine challenge.

I have admitted that my blood sugars have been erratic since my last clinic visit, with quite a few hypos to speak of. What worries me now, however, is that if I get things back under control but present with another low HbA1c at the next visit (in 3 months!) that my pump might be in jeopardy. This puts me in a situation where I'm going to actually have to purposely run my sugars on the high side to get my next result up and I just can't help but feel that that is not a good thing. Aside from an adjustment to the basal profile on my pump, I didn't come away from the clinic with any strategies for dealing with those times when my other health problems put me in a situation where it seems that all the usual rules of diabetes management just go out of the window and I'm at a real loss to get on top of it.

Though she was already partially aware that something negative had transpired, I informed my DSN of the exact details the following day in an email, but, understandably, she declined to comment and simply said that she would be happy to see me before my next official clinic appointment to try and work something out with regard to managing things. That's something at least.

Meanwhile, I'm seriously considering writing directly to the consultant to make it clear just how unacceptable I found his behaviour and how I'm not prepared to accept anything similar in the future. All that worries me is that it could make things uncomfortable for me at my next visit. I'm really not a confrontational person and this could just be setting myself up for more upset. I don't know, I'm going to think it over for a few days.