Hassled by nurse

[popps]

Hello all,

Just to summarise my experiences since diagnosis as described in previous threads. Initial diagnosis fasting levels 7.0 and 7.1. Meeting with nurse, who I didn't get along with. She advised me to eat lots of carbs. When I told her I was tackling the condition with exercise and diet alone and was not taking any medication her response was "not yet". Decided not to see her again and sought a direct appointment with my GP. He demonstrated a more enlightened approach and doesn't talk to me like an idiot. First A1c result following low/moderate diet and exercise = 5.0%. Asked the doctor when he advises next A1c and he says, considering the good results, 6 months, which takes me to approximately first couple of weeks of April 2009.

However, I recently received a letter from the aforementioned nurse stating I should attend the clinic for blood tests (A1c, cholesterol, etc.). This coincides approximately with a 3 months' interval since first A1c. Phoned the practice receptionist and explained the situation but today received an answer message on my phone from the nurse stating that I should take the blood tests as soon as possible and make an appointment with herself.

I'm resolute in deteminimg that I want to have my next A1c in April, not now, and that I want to discuss the subsequent results with my GP, not the nurse. I presume I have rights over these matters. Has anyone out there experienced similar conflicts of information between doctor and nurse?

 

[milly mole]

Of course you have rights,Popps!! I would arrange another appointment with your doctor and make it quite clear that you only want to be seen by him.Get him to tell the nurse this and transfer all diabetic care to him.
Obviously one of the old school 'just do as you are told' nurses that seem to proliferate amongst Practice nurses.

 

[Buachaille]

Why not go and let the beast remove sufficient blood for the various tests. Phone the surgery a week later and, if they are like the practice here, they will give you the results from the system with the Docs comments. Nurse not involved. If there is anything odd the Doc will want to see you and if you want anything explained in more detail no doubt he/she would be happy to kmake an appointment.

 

[chocoholic]

At least you have someone interested in doing full blood tests. I've been given my form for my 6 month check and they only want my total cholesterol level, renal profile and HbA1c......no trigs. asked for,no liver profile, no thyroid, no HDL/LDL breakdown of cholesterol....nothing else. I queried it and was just told "that'll do for now"! :roll:

 

[bunty]

I have a diabetic review this Thursday, with the nurse who runs the diabetes clinic at the surgery. She started off telling me to eat carbs with every meal etc etc...

But i reduced carbs and became her 'star patient' and for one whole year everything went well.

Four months ago things started to go awry for me and i cant really explain why. My HbA1c was 5.4 and the GP decided i should reduce my meds from 1000mg of Metformin (in 2 lots of 500mg) to one of 850mg and to 'have a less tight control' because, said the GP, my cholesterol had risen, i was having regular lows and she felt i was putting my body under too much stress.

Anyway, my GP is very nice and after some debate she and i reached a compromise, the first result of which i find this Thursday.

I agreed to the lower dose of Met and to be slightly less obsessive about my BG levels and she agreed to giving me quarterly HbA1c tests and quarterly cholesterol checks, too.

The nurse, meanwhile, asked me the secret of my success and when i explained i ignored her advice regarding carbs, she read up online and told me she wouldnt argue with me because whatever i was doing, was working and she had revised her thinking!

The GP, too, looked online and agreed with me that reducing carbs was the best approach but tempered that with saying that every 'low' i had reflected ultimately on my cholestterol levels and also strained the whole body.

So, we will see what the test results show. I cant say i am optimistic though cos since all this, i have stopped exercising (arthritis in my hip, knee and foot) and gained one entire stone!

I rarely have lows, though!

I believe in compromises, so whatever the result is, i shant be eating lots of carbs.

Perhaps if you make an appointment with the nurse and talk to her, person to person, and explain that you can prove, by showing her your BG averages, that lower carbs works, then she may be swayed? And the same with the GP, who must, like the nurse, see heaps of people every week, most of whom dont follow advice anyway!

Good luck!

bunty

 

[catherinecherub]

Thanks for that Bunty,
Interesting stuff.
Please let us know what happens on Thursday. I think you have a very good team and am interested as to the explanation why the cholesterol has risen.
I think this makes me more aware that we are all different and no one must feel a failure if they decide to manage their diabetes in a way that suits them.
Regards, Catherine.

 

[Trinkwasser]

At least you have someone interested in doing full blood tests. I've been given my form for my 6 month check and they only want my total cholesterol level, renal profile and HbA1c......no trigs. asked for,no liver profile, no thyroid, no HDL/LDL breakdown of cholesterol....nothing else. I queried it and was just told "that'll do for now"! :roll:

Bribe the vampire and get her to biro in the ones you need (that's what I do!)

The GP looks the other way because she gets the results (usually good) without getting the blame from the accountants

 

[Trinkwasser]

I'm resolute in deteminimg that I want to have my next A1c in April, not now, and that I want to discuss the subsequent results with my GP, not the nurse. I presume I have rights over these matters. Has anyone out there experienced similar conflicts of information between doctor and nurse?

Sounds like empire building/departmental politics.

Personally if you're given the opportunity to get tests more often I'd jump at it. When they come out as good as they sound as if they're going to be, she can't really say much.

Here a lot of the routine stuff is handed off to nurses, but the big difference is they are all pleasant and helpful and work *with* the doctors, and most importantly they all work *with* the patients.

 

[Stubydoo]

Popps,

Without wanting to state the obvious, you need to be particulary careful in listening to advice from GP practice nurses (...although it sounds like you've already established that). My experience is that they are not specialists in diabetes and probably know little more than the people who live with the condition on a daily basis.

I don't bother with my GP's practice nurse, i found her confrontational and poorly informed (i've had diabetes for 35 years, receiving pump treatment for the past 3...and i'm certainly no expert). In speaking with the specialist nurses at the hospital clinic (that's where i go every 3-6 months) it's all to do with the GP's funding. If you see your GP's nurse your GP can claim additional funds for attending a 'diabetic clinic' or similar, although there's nothing in place to monitor the level of service that you receive (...and i'm not suggesting that all GP nurses are bad, far from it). If you have reservations about the advice that you've received, or the manner in which it's delivered you need to let your GP know, explaining your concerns. If you have reservations and/or concerns i'd doubt that you're alone...

 

[docarhamilton]

I agree 100% with the last comments. My own Practice Nurse is great with Diabetes. She has the Diploma in Diabetes and works well with the Specialist Nurses at the hospital Diabetic clinic, but not all Nurses are as knowlegable. Also, if you just don't hit it off with your Nurse (or doctor for that matter!) you need to see someone else - someone you get on well with , trust and feel confident with. Being asked to come in for a check up doesn't mean you're obliged to do so. You can either just ignore the invitation or (better) phone to say you've made arrangements to see the doctor at a later date.
Dr. Andrew Hamilton, GP.

 

[Mimi]

Dear Popps

Thanks for raising this issue. I'm in the process of approaching my GP to get me off one particular nurse's list as I get so stressed befor seeing her it puts me off wanting to go at all. After reducing me to tears at one visit she then took my blood pressure and said " oh, that's a bit high". Also I find I have to counter all her pessimistic predictions about the future and she certainly offers no encouragement in self regulation for diabetes.

When I say that I'm in the process of asking to come off her list the hesitation is because I seem to still have the old fashioned attitude that Dr knows best and that you can't challenge the medical profession - but I'm learning!

By the way - great HbA1c scores!

Mimi.

 

[popps]

Hi, Mimi,

I get the impression that my nurse is used to dealing with elderly, compliant patients, and I'm a bit out of her comfort zone. She also gives me the impression that she's reading from a script. Hence her "order" that I should step on the scales so that she can record my weight. That's fully clothed, with both boots, a jacket and two pockets full of change! Is she only accustomed with dealing with obese people? At the time of diagnosis I weighed in at 10 stone 7, now I'm 9 stone 8. I'm quite capable of weighing myself and calculating my BMI. Why the orders and the "script reading"? I have high blood sugar levels, not dementia!

Sorry for the rant, Mimi, and good luck to you with your GP.

 

[bunty]

The nurse who runs the diabetes clinic at my surgery is very nice, if firmly entrenched in her doctrine. But she does respond to calm reason and has admitted that she is supposed to pass on the 'party line' but can accept that the low(er) carb approach produces excellent results.

The GP i see isnt the one i'm registered with. He and i share a hearty mutual dislike of one another and i have refused to see him under any circumstances for the past 5 years and frankly, i intend never to see him again. (long story, nothing to do with diabetes)

So, the GP i do see, is young, interested and prepared to allow me to put my case, so to speak. She asked me how i achieved 'possibly the best set of HbA1cs i've yet seen' and i told her and i told her about this forum.

The nurse swivels from touting the 'you dont need to test and eat plenty of wholemeal carbs with every meal' advice to 'you're doing so well, i cant really tell you to change anything'. She did laugh and say they were meant to urge everyone over 40 to take statins and would be paid for doing so but she and the GP i see both think that is nonsense and in fact advised me NOT to ask for them, seeing as i have no indicators that would suggest i needed them or would benefit from them.

I havent yet persuaded the nurse on the efficacy of regular testing for Type 2s nor to get her to agree that her suggestion i test once a week is a pointless waste of an expensive strip. However, to placate the surgery's star pupil, i am allowed twice as many strips as the norm, lol!

It must be really irritating to be sent to a nurse who appears not to have a decent grasp of modern diabetes care. I personally would find myself unwilling to see such a person but i dont know what alternatives there are.

And dieticians hack me right off! Because i have a severe food allergy,i have twice been sent by my immunologist to see one. The first drew a picture of a plate for me and asked me to draw in what i thought was a balanced meal. I declined to play that game.

The second sat with me and scoured her books and shelves of grub samples before admitting that 'i cant suggest anything you're not already doing, quite frankly and good luck in the supermarket!' At least she and i laughed together!

Maybe next visit i will ask my nurse to look online here and see what she says?

bunty

 

[Pickwick]

I have to admit I've changed my tune about practice nurses over the last couple of years. In this area there's only one practice nurse - or you do without, so no point complaining. No real choice of doctor in this rural area either - like it or lump it.

Can't say the diabetic practice nurse I was first assigned to was all that bad, though she seemed to fall more or less in line with my GP in the view that T2 is a self-inflicted injury suffered by fatties. My observation that I'd only gained serious weight around the time I got diabetes casually dismissed, and my claim that I eat like a pigeon clearly regarded as a lie. Don't eat so much and you'll lose weight - if that doesn't succeed then you're either lazy, gluttonous or self-deluding - probably all three.

But at least she gave me no problems with testing strips, even in the early days when I used a lot - I've learned since how rare that can be. She regarded the low-carb approach as dangerous nonsense ("for heaven's sake don't you start listening to those weirdos on the internet!") And though the strip problem never seemed to arise, she didn't see any value in the results - peaks weren't important, only the A1c test was relevant. In fact, even if you did test, only pre-prandial testing was appropriate (and even in the very early days that opinion seemed ridiculous).

In over 3 years, I've never seen my doctor again since that very few minutes he diagnosed and more or less dismissed me. And since then almost none of the ancillary tests and advice I'd been lead to expect. Almost every checkup I got - eyes, feet, etc - were the result of my own desk-pounding. I still don't have a local dentist. Worst of all, it was soon apparent to me that my practice nurse knew very little, in fact, about diabetes other than what she'd been formally taught a great many years ago - and saw no reason to address that failing. Frankly, I got to view visits to the clinic as a consummate waste of time.

But a change of practice nurse not long after brought wonders. The current nurse is younger, sympathetic, open minded and quite pretty to boot (OK I may be a mcp, but sometimes a sympathetic pretty face is better than medicine.) She's actually a pleasure to visit. She's NOT converted to the low-carb thing, but she seems happy for me to take charge of my own condition as long as she's kept in the picture. At first she encouraged only pre-prandial testing too, though she admitted later she'd been overwhelmed by patients' opinions on that matter. Even when she's clearly not too happy with my progress, she's always positive and encouraging - a huge change from the "do exactly as I tell you or the consequences will serve you right" attitude I'd encountered previously. She now openly admits she's learned a lot from her patients, but hinted that any departure from the party line in the NHS is simply not tolerated these days. I suspect she quietly bends the rules rather a lot.

But, as seems so common in the NHS, I don't think she's getting the support she feels she needs - that level being determined by accountants. And I think that's something we all need to keep in mind when dealing with non-MD medical professionals. She's recently become the lone practice nurse for 2 or 3 other disciplines in our small local hospital/medical practice - a building with admin staff so thick on the ground it's hard not to trip over them - clearly, patient care is NOT at the top of the financial priorities. It's quite apparent that her REAL job is simply to make sure that patients don't bother their majesties the doctors (4 of them who account for almost a million each year in salaries before the practice ever treats a patient) or take up too many 'limited' resources. She doesn't discuss such things with me of course, and when I put some of the above questions to her directly, she just shrugged and said "Don't get me started!" But it's not hard to read between the lines when she has to put me off for 3 weeks before she can do a blood test as - apparently - I've "had my share of resources" until that time.

So, popps - if there is a choice of nurses (there may not be) - then push until you get a nurse you can relate to - consider changing GP if that's what it takes. You shouldn't have to justify yourself, as any medical student knows that the nurse/patient relationship can be crucial.

I have a pretty strong character (whim of iron, SWMBO calls it) but even I have felt better - in myself if not always about my condition - by a sympathetic practice nurse who actually LISTENS.

Doctors???? Don't get me started....

 

[hanadr]

My darling DSN has retired and been replaced by a younger one who is nice, but not as knowledgeable. Sh e also said she "has to toe the party line"

 

[Henry W]

I have been following the advice on here to cut down on the carbs. Wondering now if I have overdone it.

Every day for breakfast I have two slices of granary bread toasted with low fat spread, tinned tomatoes and two slices of grilled bacon. Lunch grilled chicken or meat with green veg and supper, clear soup, or plate of smoked salmon.

Have noticed of late, despite drinking best part of a bottle of wine a day, the following:

Since September last year lost 2 stone. Was 18.5 st now 16.5. HBAcs 6.1. Cholesterol 3.9, LFTs normal, I nearly fell off the chair when my GP told me, so did he, he knows how much I drink.

However I do brisk walk the dogs 45 minutes every day, used to take me nearly an hour, now down to 45 mins, also play 18 holes golf 4 - 5 times a week on top of dog walks. (Self employed victim of credit crunch so no work to do at present.

The past week however, have noticed that hypos are getting worse, especially about 2 hours after a meal. Tested myself due to surprise at shakes and found this morning BS was down to 3.9, average before was around 7-8. 6 months ago was ranging between 14 and 18 first thing in the morning before eating.

Am taking 500mg of Metformin SR, once a day, was twice, but cut back, and 30mg gliclazide SR same time just before breakfast every day.

Today was worst as felt even worse after dog walk and was shaking so much had to eat a sandwich as could not hold a golf club or swing one due to the shakes.

Am going to make arrangement for next blood test, last one was end of November, so will repopr back the HBa results.

 

[Dennis]

It sounds like your weight loss and all that extra exercise may have considerably reduced your insulin resistance. That would mean that the insulin your body produces is being used more efficiently. One of the problems with gliclazide is that it signals your pancreas to produce extra insulin, whether the insulin is needed or not. It could be that you no longer need quite as big a boost and could manage on a lower gliclazide dose.

 

[humph]

My GP and Practice Nurse are the reason I have gone private.

Between them they couldn't see that taking a day of work to see the nurse and then another to see the doctor if my meds needed changing, I don't get paid for days off, was just madness. It actually works out cheaper for me to take one day off to see my specialist

It has been made plain to the surgery, that they have no input over my Diabetes control. Though I do cheat and use them for blood tests.

 

[sugar2]

Well, I only see the practice nurse once a year, so that the surgery gets some money, and garees to write me prescriptions. It is a bit of a waste of time, as the nurse in new to diabetes, but is a very nice lady! I am T1, and she doesn't know very much about that, but she is certainly understanding and keen to learn. She did manage to get me on a DAFNE (or CHOICES as it is known round here) course at a different hospital, buy sweet talking the staff there. My part ofthe bargain is that I report back toiher so that she can use teh information.

It doesn't sound too good, but I think that she is great. I attend a local specialist (well, that is what they say anyway!!) and the fact that she is interested and keen to help is encouraging. If she was the only source of help I had though, I might worry!

 

[hanadr]

New postby Henry W on Wed Feb 18, 2009 6:27 pm
I have been following the advice on here to cut down on the carbs. Wondering now if I have overdone it.

Every day for breakfast I have two slices of granary bread toasted with low fat spread, tinned tomatoes and two slices of grilled bacon. Lunch grilled chicken or meat with green veg and supper, clear soup, or plate of smoked salmon. that granary bread means you are not low carb That's your choice though

Have noticed of late, despite drinking best part of a bottle of wine a day, the following:

Since September last year lost 2 stone. Was 18.5 st now 16.5. HBAcs 6.1. Cholesterol 3.9, LFTs normal, I nearly fell off the chair when my GP told me, so did he, he knows how much I drink.
REd wine is obviously good for you as it is for quite afew diabetics

However I do brisk walk the dogs 45 minutes every day, used to take me nearly an hour, now down to 45 mins, also play 18 holes golf 4 - 5 times a week on top of dog walks. (Self employed victim of credit crunch so no work to do at present. dog walking is good

The past week however, have noticed that hypos are getting worse, especially about 2 hours after a meal. Tested myself due to surprise at shakes and found this morning BS was down to 3.9, average before was around 7-8. 6 months ago was ranging between 14 and 18 first thing in the morning before eating.
3.9 isn't a serious hypo. You would come out of that fine, without injury. I can function well down to about 2.5. You haven't quite adjusted to "Normal" BGs

Am taking 500mg of Metformin SR, once a day, was twice, but cut back, and 30mg gliclazide SR same time just before breakfast every day. It's the Gliclazide that causes hypos. Metformin doesn't ac in the same way

Today was worst as felt even worse after dog walk and was shaking so much had to eat a sandwich as could not hold a golf club or swing one due to the shakes. I would ditch the gliclazide. Nasty Stuff! I did

Am going to make arrangement for next blood test, last one was end of November, so will repopr back the HBa results.

Henry W