National Health failing diabetics

Jo123

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717
What shocking statistics, but even when they do all the checks as with my mum, they tell her anything under 7 for her hba1c is excellent, hers is just under 7 and she has numerous diabetic complications and feels ill most of the time. Whenever she takes a 2 hr pp it is always well over 7 so obviously her BG's are too high, but because the doctors tell her her control is excellent she does nothing.
To summarize my point in my mum's case, even when the doctors do all the checks they are still not helping people deal with their diabetes effectively, what a waste of time.
 

RebeccaSmith

Well-Known Member
Messages
70
In my opinion the NHS is quite good. I did not have as many symptoms as a lot of type 1 diabetics, but my doctor immediately did a BG test, which came back very high. He called the peadiatritions immediately and I was greeted by a pead. the next day. He stated that I did not have diabetes, as I showed little symptoms and my BG was normal when he tested me, although he referred me for a Hba1c that day which came back as high and I was declared a type 1 diabetic on the 7th Nov. 2008. My hba1c was about 14.6 when I was diagnosed and it is now 6.1, which is perfectly normal and in range.
I do however think that the emotional support is a complete and utter let down when concerning the NHS. I went to my doctor for sadness and possible depression, and as I am 16, he stated he was extremely reluctant to give me anti-depressents, and suggests seeing a psychologist. There is a 6 month wait to see one and I feel that all people with diabetes should be offered immediate support as it is more than likely they will need this support.
 

jopar

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2,222
The report was quite shocking in many respects and in many areas of diabetic care the NHS needs to rethink there strategies concerning treatment, care provisions, education and who is responsible in providing this all.

But before totally laying the blame at the foot of the NHS service door, we need to consider who’s is responsible for what…

The report states that there have seen a lack of annual review of HbA1c’s, eye screening and other basic annual tests that as diabetics should receive…

I wonder how many of these lacks of annual reviews is down to the diabetic themselves, with DOA. An appointment has been made for the diabetic, they don’t bother showing or bother to rearrange a new appointment… (check any clinic or doctors surgery and ask how many DOA they had in the last month you might be surprised, I know in my doctors practice the average is 70 a month)

Take eye screening, this has be introduced in the last couple of years for diabetics over the age of 12, before this it was the responsibility of the diabetic to arrange there own annual review with there opticians, which many didn’t bother with, so the NHS decided to set up the screening program to compensate and encourage diabetics to do as they should..

How many diabetics who do go to clinic, actually turn up with no monitoring dairies to show and still expected to receive answers to there problems with control?

How many diabetics do not take medication or follow advice concerning there care and good practice when they leave clinic?

Even though yes there are many ways that the NHS lacks in consistent founded care and advice, policies seemly changing not only from PCT, but also from doctor surgery clinics and hospital clinics…

But the diabetic themselves have a duty of care to themselves, after all we managed our diabetes on a day to day basis, we need to know when our reviews show take place, educate ourselves in our condition and ensure that we help the NHS provide the care and commitment to us that we need…
 

Buachaille

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I think that what many fail to take into account is that onus for change and improvement lies almost entirely, and in my view properly, with the individual. At the extreme, I often see a diabetic (late 30's) in my local pub who, after 6 or 7 pints of lager, will produce an insulin pen, dial-up the dose and publicly inject into his beer gut. Similarly, I have a friend of 40 years, whose wife is a Nursing Sister, that is presented with a coffee and a plate of biscuits and cakes which he is relaxed about eating - although he could be doing with taking a couple of stones off and getting his HBa1c below 7. However, they are of the view that I take it too seriously. I don't think I do, I have a drink most days - either two 35ml of a straight spirit or a large glass of red wine - but I am fairly fastidious when it comes to what I eat and achieve my control mainly by portion size and the total avoidance of desserts and the other odd item that I like eg pasta.

If GP services are failing to undertake annual or other recommended regular tests its up to the patient to raise the issue. I wonder, however, how many patients fail to attend appointments. Similarly, as far as some diabetics are concerned you can take the horses to the water but you can't make them drink and all too often the attitude to possible complications is 'it won't happen to me'. Some Health Professionals must find it soul destroying to see good advice ignored.

Sadly, also, not everyone diagnosed with diabetes fully understands the position that they find themselves in. I attended a 2 hour session when first diagnosed which covered some of the basic do's and don'ts. There was 12 people in the group aged between 40 and 65. Some examples of the proceedings:

One female in her early forties asked the dietician if it was OK to eat eggs. The response from the dietician was "Yes, like anything else In moderation, but how do you cook them". The reply was 'On the cooker'. (The same individual later admitted to smoking at least 40 a day and mentioned that her diabetes was discovered when she had her first heart attack a month or so earlier.)

A male in the same age bracket asked if his one glass of wine per week would take him over the weekly limit - despite the fact that the graphic being shown clearly set out units and measures.

A man in his 50's said he was going to Portugal on holiday later in the week and asked if it was OK to eat Portuguese food - or should he take British food with him!!

An extremely obese individual said he would not be able to lose weight because he liked his grub too much. When he described his diet the only meal without chips seemed to be breakfast

Had enough material for a 40 minute comedy sketch - which I passed on to a scriptwriting friend.
 
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catherinecherub

Guest
Whilst I agree that it is difficult to educate a lot of people about their diabetes it is equally true that a lot of people aren't getting the basics. You only have to read the boards here to see that dietary advice is severley lacking for the newly diagnosed. Acceptable readings differ between one G.P. practice to another and the interpretation of N.I.C.E. guidlines also varies. To withhold test strips from a newly diagnosed is what I consider to be a severe lack of understanding by that person's healthcare team. It is the most basic thing that a diabetic needs in the early stages.
We could all tell stories about what had been said about and by uneducated diabetics but that doesn't detract from the fact that not all diabetics are being cared for properly.
 

Buachaille

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As far as diet is concerned it will almost inevitably be that advice given will vary and will not suit everyone. I was given the party line when diagnosed and started to lose weight and got my HBa1c down from double figures to below 7 very quickly. However, when weight loss stalled, even with reduced portion sizes, I decided to further reduce my intake and the only way to do that as far as I could see was to avoid avoid bread, potatoes, pasta, rice and couscous (had already totally given up on biscuits and things baked, sweets, chocolate, some fruits (grapes etc). Apart from pasta, I have some of the 'staple' carbs but very little. I don't count every day, but on Monday the only visible 'carbs' I had was from one slice of Oatmeal bread. I should add that this is not my normal days input - tonight I have fish and will have one small potato in the form of chips.

On blood sugar levels, the other half of this household has T2 diabetes and has had for about 12 years. I shudder at the HBa1c that her GP and Consultant say in her circumstances reflect good control. But, they are looking at the wider situation and, given other health issues, I can see that they are encouraging attempts to get lower levels but recognise the limitations. She was hospitalised for a few week a couple of years ago because of an unrelated illness. The hospital Consultant in tandem with the Pharmacist reviewed her diabetic medication and made major changes - mainly by removing some of the medication which they considered contradicted others. The combination of medications was, in their views 'ridiculous'. Within a very few days all was not well and the former regime determined by her diabetic Consultant was restored. Served to demonstrate to me that how treatment progresses for an individual is open to 'professional' opinion.

Nice 'guidelines', as I have said elsewhere are simply 'guidelines'. They are not prescriptive and are open to individual interpretation. Until and unless the NHS publish mandatory rules, health Professionals will interpret these guidelines as they see fit. The danger of 'rules' regarding treatment of diabetes is that medicine and treatment strategies undoubtedly evolve for any number of reasons and rules in the longer term, unless frequently reviewed and revised, would most probably end up being constraints.

On testing. I know any number of diabetics that would test until the cows come home if they were asked to do so - but I doubt that it would improve their diabetic control. When diagnosed I tested twice a day. I never did the postprandial testing many recommend, I simply recorded the twice daily readings on a spreadsheet, calculated a trend line and watched the trends move towards my personal targets. Any unexpected rise was considered. But within 6 months I was inside the upper/lower limits I set and now after 18 months my blood glucose and Hba1c is within the 4.6 - 5.5 that many think of as the 'normal' range. For a long time I have tested twice a week on random days normally before breakfast.
 
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catherinecherub

Guest
With regard to the testing of your blood sugars. I agree that some people are obsessive but I am referring to the newly diagnosed who are not offered test strips. How do they know if they are coping? Twice a week testing would be better for them than nothing. Strips are pricey and not everyone can fund them themselves. at approx. £25 per 50. You had the test strips at diagnosis, a luxury for some now, many newly diagnosed are not getting them. There was a poster the other day and her visit to the D.N. for advice was badly managed in as much as her dietary advice was that she shouldn't eat doughnuts. No mention of what she should be eating and no test strips. I would question if that was an interpretation of the N.I.C.E. guidlines or a D.N. who is out of her depth.
The article demonstrates that there are some good, some bad levels of diabetic care and some patients who are inquisitive and willing to learn and some that bury their head in the sand.
Changes will only be made if we as diabetics question what we are told if we are unsure and help each other on forums such as this.
 

milly mole

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Thank God for places like this where we can come and read about 'real' diabetes and then go back to doctor armed with questions.The trouble is we trust our medics,that's as it should be but when the info is flawed to begin with we are on a hiding to nothing.
I agree with Buachaille though.Loads of diabetics just couldn't give a stuff about their condition, they take their meds and think that will control their condition.
It's not fair that the ones that really want to get to grips with their diabetes should be lumped in with the complacent ones.Don't be a sheep!!Go to the doctor armed with questions,graphs,food diaries!!Prove that you really want to get on top of your diabetes.Be ready to counter the platitudes about 'Oh you don't need to test ' with cogent argument about why you do need to test etc.
 

Trinkwasser

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I blame the PCTs, spending pounds in order to save pennies as usual. Average A1c is over 9%, one GP whose average was 8.4% was *congratulated*. Without test strips to see the harm resulting from eating the healthy High Carb Low Fat diet which is still generally pushed, and with the "blame the patient" mentality put about by the media you can understand why they would consider diabetes to be something they can skimp on. Even when people *do* follow the instructions they are given carefully they still do badly: must be the patient's fault not the diet so why waste further money monitoring their failure?
 

hanadr

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I don't think it will get better, rather the opposite. after all we're already being demonised as having brought our problems on ourselves by our dreadful lifestyles. Plus we cost too much
 

RebeccaSmith

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70
I think this is more to do with type2 diabetics that type1.
I get given a continual supply of blood glucose testing strips, ketone testing stips, needles for my pen and needles for my tester, and I have also been given 2 spare blood testers. I haven't paid a penny for this, and to top it off, all my equipment came in a free reebok bag...I thought that that was a little uneccasary.
The dietitions are awful however. When I was diagnosed, I had to discuss my diet. I said that I lived off of wine gums, chocolate, crisps and sandwhiches. To this, she turned around and said, "not anymore, you need to change your diet. You can have one small party chocolate such as a celebration a week and you must avoid sugary foods. Have 6 jelly babys if a hypo is occuring." Yeah right. Like a sixteen year old will cut off all means of sugar. I was a sugar addict, and I still am - I just eat the sugar with foods and make sure my insulin dose is highered. I haven't had a hyper in about a month now.
This is obviously a lot harder for type2 diabetics to cope with, as they have no means of dropping their sugars. Although, having high sugars would be a perfect time to scoot of to the gym, as this would lower blood sugar levels. I think it's plain ignorant that some of the diabetics on this site are not receving neccasary items to control their diabetes, such as blood testing strips. The NHS should focus less on offering free cosmetic surgery to those who claim to be depressed, and give type 2 diabetics better oppertunities. It would result in less complications in life such as retinopathy and foot issues, and so would result in a gain of profit from the NHS. Priorties need to be set straight.
 

Buachaille

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I am not demoralised by my dreadful 'lifestyle', I had what might be considered a very healthy and 'fruit full' lifestyle - no junk food, lots and lots of fruit (kilo of grapes, or nectarines,peaches or pears et al sometimes with cheese for lunch and veg, meat oily fish, pasta etc - but it seems I was feeding the dragon within, particularly with the volume of fruit sugars. Relax.

As for upping the insulin to cover what is consumed. Says it all does it not - free insulin for all, diabetics problem solved. Why not just try....... Getting better or best control is not rocket science. Its not that hard. How much less insulin might you have to inject if a little self discipline was applied. What might increasing levels of injected insulin mean to you over a lifetime?

For T2s - "This is obviously a lot harder for type2 diabetics to cope with, as they have no means of dropping their sugars".

Lets get even more real, T2s have every means of dropping their sugars - common sense and a love for an uncomplicated future. I made it and am confident that with confidence and inner encouragement many others do/can/will.

Let go of the possible cause of the diabetic diagnosis - what you stuff or don't stuff in your face is the key to diabetic control.
 

ally5555

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Messages
850
Can I offer a perspective from the other side!

I agree with you that provision is patchy , that maybe due to funding but also a lack of enthusiasm from the medics - may GPs just are 'nt interested in diabetes.

Funding can vary from trust to trust - 1 see this in my own area as I work for 2 big GP practices but the other 8 near by have little or no cover. That is un fair. Diabetes education sessions are patchy too - I have access to course locally and am also invoved in sessions for type 2s. We have an excellent retinal screeing service that recalls patients annually.

The people who post on here obviusly have a keen interest in their health but sadly not everyone thinks like that. I have lost track of the pts who are like this , dna appointments with everyone - that is so frustrating.

Obviously as a Dietitian I see and hear alot from pts and I really think that dietitians who work in diabetes must be experienced - it is complex. Sadly it is often left to the basic grades who need more expereince.

On a lighter note - I once had a pt who I had talked to about grilling food - he reported back to me that it was fine but he had a problem with eggs they slipped thro the grill pan!

Follow up is imporatnt as I am sure you all find that after an appointment you have not taken it all in and that often leads to misunderstandings.
So being the other side of the fence is also fraught with frustrations - such is life !
 

Trinkwasser

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2,468
RebeccaSmith said:
I think this is more to do with type2 diabetics that type1.
I get given a continual supply of blood glucose testing strips, ketone testing stips, needles for my pen and needles for my tester, and I have also been given 2 spare blood testers. I haven't paid a penny for this, and to top it off, all my equipment came in a free reebok bag...I thought that that was a little uneccasary.

IMNSHO they do that deliberately to differentiate between you virtuous Type 1s who have a Real Illness™ and Type 2s who have a Lifestyle Condition.

The dietitions are awful however. When I was diagnosed, I had to discuss my diet. I said that I lived off of wine gums, chocolate, crisps and sandwhiches. To this, she turned around and said, "not anymore, you need to change your diet. You can have one small party chocolate such as a celebration a week and you must avoid sugary foods. Have 6 jelly babys if a hypo is occuring." Yeah right. Like a sixteen year old will cut off all means of sugar. I was a sugar addict, and I still am - I just eat the sugar with foods and make sure my insulin dose is highered. I haven't had a hyper in about a month now.

You may choose to modify that as you get older and learn more.

What REALLY annoyed me about the dietician was that I was actually quite accurate as to what I ate, and I tried hard to follow her recommendations. When this made my lipids even worse and caused me to put on weight for the first time in my life she refused to believe me and accused me of "noncompliance"

History has shown that her diet was a disaster and I'm far from alone in this. Yet too many "medical professionals" still fail to see the huge problems high carb low fat diets cause to so many patients and when they do see it they prefer to blame "noncompliance" rather than the diet
 

crushersmum

Active Member
Messages
28
Type of diabetes
Parent
Treatment type
I do not have diabetes
Yes there may problems with long term care - but in emergencies the NHS is excellent. My teenage son has been admitted to hospital 7 times in the last 6 months - due to using the diabetes as a weapon against parents & in every case he has had instant attention and totally excellent care. AS for HBA1C - it gets tested every time he is admitted - which seems to be at least once a month right now.
Sorry to hear that some of you don't get such a great survice but I am right now eternally greatful that however badly he tries to self harm the NHS have always brought him through alive on the other side. The only bit that fails is the the physichiatric help which took 6 months to happen 2 years ago & even when he is beeing admitted every 2 weeks he only gets one appointment per month to help him sort out the problems - meaning that he hits another crisis before the next appointment :?

Crushersmum