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Type 2 Annual Review

F

Flora123

Well-Known Member
Messages
1,078
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I have my annual review with the DN next week and for some strange reason I’m nervous! What actually happens? We didn’t hit it off when I initially saw her as I questioned the eatwell guide I was given - even in those days I thought it was all wrong. My doc hasn’t taken much interest in me since last year. Anyway, just wanted to know what to expect. Thanks.
 
Well in my case, about 2 weeks before the review, I get called in for a blood test and to provide a urine sample. At the review we discuss the results, my feet are checked and I am weighed. I am lucky that my DN is in favour of low carb diets so she doesn't mention Eatwell and it's all very friendly.
 
I tend to feel anxious as, although my HbA1c has been normal for 5 years, I always feel that things could be slipping. I try to remember that the DN should be there to support my informed decisions not make judgements or spout outmoded dogma. I did hold my tongue when a health care assistant(!) who had replaced the previous DN said 'well at least I am not going to have to tell you off'. In my head was 'try it' followed by ' does this approach ever work' followed by 'more training desirable'. I want the blood tests, foot checks etc but I also get uptight about the staff that I may encounter during the annual review! So I sympathize Flora.
 
I have had two reviews with the doctor and two with a nurse! In the last 2 years. I am due another with the nurse. I don’t get to see the nurse who deals with diabetics as I never qualified officially as T2 so I don’t know her approach but there is a divergence in thinking between my preferred GP and the nurse that I do see. And the nurse that I do see hands me an Eatwell oriented printout each time. Thankfully when I see the doctor he brings everything around to LCHF thinking.
 
The results that you posted in your thread here are fantastic:
https://www.diabetes.co.uk/forum/threads/latest-test-results.165921/
Let your numbers do the talking first. That’s what I did. After I was congratulated on my excellent HbA1c, I said to the Dr then at a subsequent check up, the nurse, let me tell you how I did it!
Stick to your guns about cholesterol ratios, don’t let her just quote the total at you if she insists on statins based on that, especially if it’s against your will.
Just remember she is there to observe and advise, not to dictate treatment to you. You’re doing brilliantly, don’t let her make you think otherwise, we’re right behind you x
 
Totally understand your nervousness I too still find I’m nervous and I’m about to have my fourth annual review! It’s difficult when your views differ so much from your HCPs you just hope that they can see your results and support and congratulate you. I got a lot more support and positive stuff when I was taking the pills and eating eatwell for the first two years and staying in the diabetic range - but it’s been more variable since I made such amazing improvements with lCHF mainly because of my high cholesterol results......... my bloods due later this week and review end of next so I’m with you on The nerves. I’m sure it will go much better than you expect and meanwhile congratulations on your brilliant results
 

Thanks @Rachox. She was a bit shocked when she tested me with a finger prick at our last meeting and was a bit confused it was 6.0 after a meal (a week after DX). I am so much more clued up a year on but not sure I can hold my tongue this time round when she says I need lots of carbs.

So it seems it won’t be so bad. Wish he luck! Thanks everyone x
 
Hi. It's amazing how many DNs don't understand the subject. I'm lucky that my current DN encourages me to keep the carbs down and we can discuss diabetes sensibly. I would try to keep quiet and just nod. You can always say that when talking to other diabetic friends they have been told to keep the carbs down. If you want to take a hard line tell her that the Eatwell Plate/Guide was produced by the food industry (fact) and not by people with medical knowledge.
 
I am over 5 years down the line and have had many nurse reviews. I am still nervous before each one. I have no idea why because she is lovely and very good at her job. We just chat about anything. In the early days statins were always mentioned and I just said "no thank you", which usually prompted a discussion, and she agreed with my decision. She no longer mentions them. She used to tell me to eat wholemeal bread and we talked about lower carb breads. We no longer discuss diet. She takes my blood pressure and pulse, and tickles my feet, and sends a urine sample off to the lab. That is all. The other bits and bobs are done when I have my bloods taken a week or two prior to seeing her.
 
Interesting to hear that other surgeries order blood and urine tests before the annual review. This seems imminently sensible! I am given my blood test forms at the annual review and I have not ever been given a urine test.
 
Between the blood test and the review I get a summary in the post to consider and note any concerns. Waste of postage in my case as I read the results on line but a good idea non the less.
 
Dr Snoddy said:
Interesting to hear that other surgeries order blood and urine tests before the annual review. This seems imminently sensible! I am given my blood test forms at the annual review and I have not ever been given a urine test.
Click to expand...
I am given the blood test form at the end of my appointment to keep for the next annual review.
Then, when I get my invite, about 13 month later, I am expected to remember that I have this form and where it is so I can make my own appointment in time for the results to make it to the review.
When I expressed pleasure that I had remembered this, I was told "yeah most people forget so we don't have any results for them!"
There was no consideration of changing the process - they have been doing it the same way for the 15 years I have had diabetes.
 
I am expected to book a blood test the week before I see the DN. I used to go in blind with just the results from my own meter.
This time round I can access the results from my routine annual review of meds, etc, etc - but I wasn't due to see the DN yet as I saw her 3 times just after my diagnosis so the two reviews are out of step.
And because they called to ask me to come in, I checked on the new online system so I know why they want to see me early. It will be for the 'eating too much fat and now you need statins' talk.
 
I think my surgery must have one of those new fangled computer thingys as they remind me.
 
The nurse I have seen knows about LCHF. They were all given a presentation on it a couple of years ago by the GP that I see. But she isnt completely convinced and remains unsure owing to conflicting opinion and conflicting training, so she tells me.

I discussed it all briefly with her. She is a really nice lady and didnt want to be too hard on her.
 
Mine is all computerised. I get a reminder letter to see the HCA for the blood draw, weight and so on, and then she makes me an appointment there and then with the nurse. I don't see my blood test request papers. It is all on the computer, so I have to ask what is on it to make sure all the tests are included.
 
So I got a call to bring my annual review forward to this morning! All very friendly and the DN was very pleased with (most of) my results. She asked how I managed to get my bs down and impressed I was in remission. I explained about keto/low carb and got a mini chat about how important carbs are blah blah blah. She said my brain needs them etc. I explained about ketones and the brain likes them and I got a very blank stare and the topic swiftly moved on! She said she’s never seen anyone go from such a high Hba1c to so low in such a short time and maintain it. At least that was good. She seemed a bit confused when I broached the subject of carbs and said I thought the guide I was given was too high for me. She said it was low but I explained I couldn’t eat the five portions of carbs a day (adding up to around 150g +) and needed to stay under 20g. Apparently I’m a unique case!!

I was told my cholesterol was far too high (not a full lipid panel) and it was up and I should be referred to someone to try and get it down to 4!! I declined politely. I’ve had a recent cholesterol test with Medichecks and they thought although my total was higher than desired, my ratios were excellent
.

No other advice given except more tests in 6 months.
 
Well done for standing your ground!
 
It was frustrating that she said that everyone else could get to ”normal“ numbers with the food guidelines given and that I was obviously different in the fact I couldn’t eat a jacket potato and bread.


I also mentioned that I test a lot and I couldn’t have reduced my numbers without doing that. She said very few T2s test. The connection didn’t seem to be happening
 
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