Are DSNs there just to make you feel like S**t?

It's annoying isn't it? Although I'm not on a pump (sitting waiting in a lengthy queue for one at the moment), my experience of DSN's and consultants is that they have been warm and welcoming...and totally fixated on a number. And that's what it all boils down to doesn't it? Good numbers equate to bonus payments for the department you are attached to. In 20 years of having type 1 I struggle to recall any appointment when anything about my life - you know the stuff that happens when you're not injecting, testing, correcting, etc - has been raised by my consultant and queried as to how that may just impact on my control and sense of well-being.

At my last appointment, the hospital I'm attached to had been given funding for a psychiatric nurse to help them in this very area. The consultant explained that as a profession they were not good at asking the social questions, which are important in giving a context of overall health and well-being. I nodded my head in complete agreement with this assessment (I'm a social worker so have a fair bit of understanding on the impact of various stressors and trauma on a person's health) and told the psychiatric nurse she could intervene at any point in the doctor patient chat. After that promising start, the consultant then proceeded to NOT ask one single question about my personal life - did I work? if so what I did for a living? how do I relax? do I have a social life? am I close with family? what are the stresses in my life? mental health? etc etc. There was a shared interest in exercise which was touched on briefly so a small discussion took place on that. The psychiatric nurse said nothing. My point is, that there was no personal touch and no effort to get a grasp on who I was as a person and whether there were any issues that were adversely affecting my diabetes within my life in general. I'm relatively lucky. I do have a stressful job but I have strong support from friends and family who keep me entertained and who I can talk to. I came out of that appointment thinking that if someone was genuinely stressed out and depressed, then the medical professional would not have picked up on that. Sadly diabetics are 60% more likely than non-diabetics to suffer from depression. Even sadder is the tendency to focus on the changes that haven't been made, rather than the changes that have.

So in short (after another lengthy rant by me), good on you for recognising the positive changes you have made to your life. Improvements that are sustainable are made in small steps; not in giant leaps. And you are way more than just a number. We all are. Other things are as important. Take care.

No, for some of them it's a perk of the job <G>

You can't win really Engineer! I was at the hospital on Friday and got nagged about my HbA1c of 5.4%. Consultant wants me to run my BGs higher!

Smidge

How disappointing Engineer. Sometimes you need some reassurance if nothing else and if even that isn't forthcoming it makes you wonder why you should attend appointments, knowing that you'll come away feeling despondent. I've had a such a positive experience it's a real shame this isn't the norm. All you can do is hold your head high, stay strong, and keep plugging away at your control knowing that here you have the support that is sadly lacking at your clinic.

Craig - I only went to my pump clinic last week and was fortunate enough to bump into my consultant that I had for 20+ years before I switched over to the pump. We had this very conversation (as it was he who spotted something wasn't quite right when I was feeling down - he referred me to a psychotherapist and I had treatment for clinical depression within a couple of weeks). I said that the only bad thing about switching to a pump was that he didn't run the clinic and instead (even in his opinion) I had a 'Professor' who can only be described as 'clinical', all numbers and not interested in anything that can't be broken down and scrutinized. He admitted that he is all for the personal approach and he teaches that to his students. If a patient feels like they're going to be criticised at clinic they will either not bother going or won't be honest when they do go. It's unfortunate but I don't see it changing.

I must admit I've always been in good terms with my DSN's and always look forward to seeing them at appointments, I think like all other professions you get good ones and the not so good ones......to put it politely!

My DSN is great ! Just lucky I guess reading things here. She did make me chuckle a little today when she asked me "how my erections were" lol ! Even she laughed !


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I go to my local hospital which has a designated diabetes unit, also linked with Bristol University as a teaching fellowship. I've been going there for the entirety of my diabetes (30 years) and luckily most of the consultants/nurses are still there so we all know each other really well. I had to pop in one day last year after not going there for a couple of years (I can't remember why not), as I thought I might have early dka and it was seriously like catching up with old friends. I got the necessary reassurance, had a long chat, saw lots of smiley faces and went away happy. I know I'm lucky in this respect and not everyone has this experience but it is for this very reason I'll never want to be looked after by my gp clinic. I'm sorry it's not the same for you.

Can you switch clinics or are you stuck with this one because of your pump?

My GP surgery DSN hates my hba1c of 5.3 and want it much higher . My endo consultant is very happy though and so is the diabetes nurse in the endo clinic. It all depends on whether they are really in the zone or just repeating the same tired old script they learnt 20 years ago...



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smidge said:

You can't win really Engineer! I was at the hospital on Friday and got nagged about my HbA1c of 5.4%. Consultant wants me to run my BGs higher!

Smidge

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Was that because of the current hysteria about hypos Smidge? I {I appreciate the dangers of course but they extend even to T2 s nowadays..If I som uch as mention I should think about eating after a lengthy wait, I am immmediately surrounded by nurses trying to pour mlk down my throat its very nice to lnow they care but not sure they totally understand}

Engineer88 said:

We didnt even touch on Hba1c's at this meeting on monday - I have an appoint with the consultant on the 24th so expect that then.

I dont know if I'm 'stuck' with this clinic but depending how the 24th goes I may get myself refered elsewhere. I was balling my eyes out on the phone to mum yesterday because of it, its got me down that much

The problem I find is my GP surgary isn't much better and I just cant aford private at the moment *le sigh*

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With the time inbetween your appointments - you have got us to offload and discuss things with
Support is vital for us all - especially when we have to walk a solo journey with our diabetes condition .

Engineer

For the time being, I would urge you to stay with the present hospital unless you have really good reason for wanting to change (a lot more than not getting on with the pump dsn). We can all get out of the wrong side of the bed at times and end up upsetting people when we dont really mean to... Ive done it a few times

Re... basal testing..... a few years ago this didnt seem as important to do then as it is now. My old consultant only advised it for no more than 4-5hrs and even then wasnt that fussed about it but said to get bg levels set at about 7mmol which at the time seemed to me to be a good safeguard against going hypo so I just altered the basals to suit the action of the bolus and got by that way. The only basal test I did without eating food was the one that went on through the night. I was just going so hypo that I had no alternative but to change the basal delivery so I slowly got that sorted and was quite pleased with myself especially as I did it all off my own back, looking in the manual etc.

It could be argued that as youve got the cgm, then getting your basal rates sorted so that you dont go hypo too often or too high before you correct, isnt that important. If you didnt have the cgm, then yes you should do some basal testing or you'll be forever pricking your finger to do a bg test as you wont know how high or low you'll be going.....

It does take time and effort to get a pump up and working ok. About a good 6-12 months and then during that time, most of the pump problems will have been dealt with and they when they repeat themselves, they will just be annoying but not cause utter pannick.....

Give the hospital a chance as you may find that the consultant is ok.... Remember that the dsn also had the Animas rep with her when you spoke with them so it sort of didnt look too good when they saw your results. Animas rep wants to see everyone perfect with their pump and you of course werent so put the dsn in a bit of a spot..... Maybe when you see the dsn again, things will be different. Dont take it personally.....

all the best
x

Unbeliever said:

Was that because of the current hysteria about hypos Smidge? I {I appreciate the dangers of course but they extend even to T2 s nowadays..If I som uch as mention I should think about eating after a lengthy wait, I am immmediately surrounded by nurses trying to pour mlk down my throat its very nice to lnow they care but not sure they totally understand}

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Yes, that was it exactly. My consultant explaind that he was on my side but...driving regulations, yada, hypos, yada, temporary overnight monitor (I sometimes wake with good fasting, sometimes low and sometimes high) so expensive when my HbA1c is so good I could just raise BG a little before bed (he means double-figures before bed to make sure it doesn't fall low overnight) - wouldn't affect HbA1c or inrease risk too much, yada, hbA1c below 6 shown to increase risk of heart disease yada, yada, yada!!!

One of my more depressing hospital visits!

Mind you, I got my own back when he said that his BG is sometimes 10 after a carb-heavy meal and I explained that if I wasn't diabetic and my BG went as high as that I'd be worried and go for a diabetes test. He laughed.

Smidge

You can get some good ones my one tolerates me and I can be very stubborn it's not just about the numbers. When I've been low in the past Dsn has been supportive and always asks what's going on etc

Consultant same asks about work other activities etc.

I hear ya! What I hate is that they treat all diabetics the same & that the same theory should work for everyone when it does not! Having said that I am very lucky to have a DSN who is also type 1! She is amazing & knows the trials, tribulations & pitfalls we go through! I love dealing only with her but sometimes I have to deal with others when she is not available & I don't like it.


Diabetic Warrior since 2005