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Best Plan Of Action For Annual Review For Hypertension, Cholesterol And Hba1c.

Discussion in 'Prediabetes' started by gardengnome42, Aug 13, 2018.

  1. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    What always used to happen is that I would take a week or more of BP readings in to the dr. Mostly she didn't bother taking my BP in the surgery as it was always off the page and she understood this.

    Now the drs don't do reviews, it is either an HCA or a nurse. The nurse however does take the BP then gets agitated that inevitably it is way too high. At this point I always feel she would be raising my medication level if I allowed her to! She then sends me on my way telling me to make an appointment for an HbA1c test, electrolites and a non fasting cholesterol test at a later date so I never get her opinion on the results. The HbA1c has been rising recently [I have been prediabetic for some time and have it done every 6 months] and my cholesterol is probably too high [6.7] but the HDL is really good at 2.6 making the ratio 2.6. The non-hdl is 4.1. I have refused a statin.

    My question is do I ask for the blood tests before the appointment with the nurse in order to discuss any queries with her and am I in order to ask for a fasting cholesterol test as without it I have no idea what my trigs are. Is there anything else I should be mentioning? And just in passing - is controlled hypertension a risk for diabetes?
     
  2. britishpub

    britishpub Type 2 · Well-Known Member

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    Yes.

    Get your blood taken before the appointment so that you can have a proper discussion/debate and also a clearer understanding of your results.

    Uncontrolled hypertension is certainly a risk factor for anyone with T2D, but if it is properly controlled it will be much less so.
     
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  3. hankjam

    hankjam Type 2 (in remission!) · Well-Known Member

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    My surgery sends out an "invite" saying make a bloods appointment and then two weeks after a review meeting appointment, where BP et al will be measured and results of bloods discussed.... or not as the case might be.
    I measure my BP at home and it can be quite different to the one offs taken in the surgery.... :)
     
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  4. bulkbiker

    bulkbiker Type 2 · Expert

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    For a diabetes review I would usually book up for a blood test well before the nurse visit.
    I then check the results online before attending the review ( or normally not bothering with the review at all).
     
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  5. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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  6. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    The most sensible course of action is to have the blood tests first, and fast for them whatever you have been told. Book a morning appointment so fasting will be easier. Then make sure you see all your results, either on line or from a print out (you are entitled to these and can normally have them after ringing the receptionist). Then, and only then, go and see the nurse. You will be armed with all your results and have had chance to analyse them well before your review.

    Fasting is only necessary for the triglycerides, and to get these you need to ask for a full lipid panel.
     
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  7. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Thanks everyone. In the past I've just seen the GP for my annual review and she has ordered the various blood tests afterwards which I have seen online but never had the chance to discuss. This year I had a text from the surgery inviting me to make an appointment for a review but no suggestion of blood tests first. So on all your recommendations I will phone and ask before making the appointment. In particular I need to ask for a full fasting cholesterol test. I needed to know to what I was entitled to ask for before getting some bossy receptionist telling me that I can't have it. I feel concerned that the HbA1c will have risen as my efforts at low carbing seem to be getting me nowhere. Too frequently I have a fasting test that shows over 7.0 which I know is bad.
     
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  8. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Thank you Bluetit, it's helpful to know what to ask for as I don't think I would have known to ask for a full lipid panel. I don't know about other surgeries but in the past I have had huge difficulties with ours, due to an impossibly bossy practice manager who is a complete control freak.
     
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  9. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    How do you manage to get away with not having a review at all?
     
  10. Tipetoo

    Tipetoo Type 2 · Well-Known Member

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    I do not have a review either.

    I ask my GP for a blood test request form for the pathology shop for all of the needed blood tests that I have every six months, this includes a Rule Of Three card.

    I take a months worth of charts and log book pages from the Abbot Freedom Lite meter when I get a new NDSS strip application form every six months.

    If I feel like having a talk with a private diabetic educator I can make an appointment to see her if I need clarification on something. I have seen her twice in the last two and a half years and she is happy with me being on a lower carb meal plan.

    My GP is happy with the way I have control of my T2, and is always supportive.
     
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  11. bulkbiker

    bulkbiker Type 2 · Expert

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    Don’t book it.. simples.. I think my local surgery is pretty bad to be fair...as do a couple of the GPs who work there according to what they said after the last PPG.
     
  12. zand

    zand Type 2 · Expert

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    Yeh I think your surgery is unusual. I get texts and then phone calls when I don't book a review ...until I get fed up with the harassment and finally cave in lol.
     
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  13. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    I only have one review a year with my nurse, a couple of weeks after my blood tests, which I see on-line. She does the foot tickling and sends my urine sample off to the lab for a full analysis. She goes over my results and is very pleased with not just my results but because I am proactive in managing my diabetes, which she thinks is quite rare. We chat about all and sundry, and I enjoy it. I do have an interim set of blood tests at the 6 month point, and see the results on line, but don't see anyone. My GP has phoned me on the odd occasion to warn me about my cholesterol total, but she is only doing her job and no longer mentions statins.
     
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  14. Mr_Pot

    Mr_Pot Type 2 · Well-Known Member

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    My experience is almost identical. I like to get the full blood and urine tests, which could be an early indication of something diabetes related or not.
     
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  15. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    As anticipated: I phoned the surgery to make an appointment for the various blood tests prior to my review and the receptionist said that blood test requests had to be given by a clinician. She could make me an appointment to see a nurse for the request and then another to discuss the results at a review. I told her it was a waste of NHS funds and my time and to forget the whole thing!
    Is the problem that I am only pre diabetic, not fully T2? The review they always remind me about is for asthma and hypertension neither of which require blood tests although the dr has always ordered them after the hypertension review [kidney function, electrolytes etc]. They then throw in the HbA1c which comes back as borderline with a note 'See the nurse'.
     
    #15 gardengnome42, Aug 16, 2018 at 10:38 AM
    Last edited: Aug 16, 2018
  16. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    This was a receptionist. Perhaps consider ringing again and asking for a telephone appointment with the nurse rather than a personal visit. I agree with the receptionist that it is a clinician that has to order the blood tests. At my surgery this is done as the first stage. Once the bloods have been taken I have to make an appointment with the nurse, by which time I have the results.

    Are you due a blood test, how often do you have them? With pre-diabetics it is usually only once a year. Maybe you are jumping the gun a bit.
     
  17. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Maybe you are right, I am jumping the gun. Time was I never visited a doctor unless there was something wrong but then I was 'invited' for an NHS Health Check and the rot set in. It made me obsess about things that at one time I would never have bothered with. At the same time it has also made me aware that drs are not always right and it is our lives and up to each of us to look after ourselves and not just to keep popping pills.
    First off they found I had hypertension and about that time I also found out that the surgery gets extra funds for every patient found to have that, or diabetes. About a year later I asked for my medical notes online and found the HbA1c was 41 yet nobody had said that was too high and almost into borderline diabetes. They had made their money out of me with the hypertension so why bother. I felt I was a cash cow and totally trapped in the system. Next they give you a Qrisk assessment and offer a statin - money this time for Big Pharma. Initially statins were for anyone with a risk of 20%> until it was lowered to 10% in one swoop with no sound reason other than over medicalising the healthy.
    But then you start to realise that you can never be healthy again if the NHS has anything to do with it. They have you in their sights for ever constantly bombarding you with texts and emails for tests for this and tests for that, not to mention reviews! If they don't make us all into hypochondriacs then we all become aware of stuff we otherwise would have had a healthy disregard for.
    So rant over and back to the beginning! Maybe I am jumping the gun: I am not yet diabetic and with luck it will never happen, I do need an annual review for asthma and hypertension with the GP or the nurse[every 6 months I send in an 8 day reading chart] and they ask for an electrolytes blood test annually which happens after the review. I have probably asked for an HbA1c at the same time. Maybe this year I won't ask and see if it is offered.
     
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  18. DCUKMod

    DCUKMod I reversed my Type 2 · Moderator
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    Gardengnome - Does your surgery do telephone consultations? That'd be perfect for this, if you have to "see a clinician".

    I use telephone consultations where possible, as they are usually much sooner than a face to face, unless urgent, and provided no examination is required, they work well for everyone. In fact when discussing some forthcoming bloods with my GP a few months ago, I commented I'd make a telcon appointment, but she commented it had been a long time since she'd seen me and in fact hadn't actually seen me since starting meds to perk up my thyroid function.

    Once she had laid eyes on me, she seemed perfectly content to revert to telcons again.
     
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