Choice of Diabetes Specialist Nurse?

[charleym]

Was wondering if other people are told they have to see the diabetes nurse at their GP surgery? I have a dedicated diabetes centre attached to East Surrey Hospital with nurses who actually know what they're talking about yet apparently have to see the one at my GP surgery instead else they won't provide the prescriptions.

Saw her yesterday for 6 month check up and she told me:
- Don't take insulin for snacks
- Only inject 3 times per day
- There's no such thing as correction doses, insulin only works if you eat with it and can't just lower your bg
- Carb counting is just for newly diagnosed diabetics, you don't do it long term unless you use a pump
- Insulin is for food not carbs so there is no such thing as a food that doesn't require insulin

She finished with 'I do understand type 1 is a little bit more complicated than type 2 but you're just making it difficult for yourself by over complicating things by counting everything, you'll make yourself stressed'

 

[blueeyed81]

What have I just read. I'd put in an official complaint, if she tells that info to a newly diagnosed she could seriously cause harm if not worse.

 

[EllsKBells]

I could be misunderstanding your situation, but if it is anything like mine, you will keep seeing the specialist nurses at the diabetes centre, but you have to see the one at your practise so they will keep signing off on your repeat prescriptions, otherwise they will send you a very rude letter like the one I got telling you that you may not have anymore prescriptions (ignoring the fact that I'd moved away and was registered with another practise... but that's another saga in its own right!) Think it's really to make sure that your practise's prescribing budget isn't just disappearing off into the ether, to be honest, although I agree that it is a total waste of time. Have definitely had some interesting experiences.

Would definitely second @blueeyed81 suggestion of making a complaint. You probably won't get very far, the NHS totally having buried its head in the sand about how this whole diabetes lark works, but you know, enough dissenting voices and maybe one day...

 

[noblehead]

yet apparently have to see the one at my GP surgery instead else they won't provide the prescriptions.

They are talking nonesense, I don't see my gp practice diabetes nurse and get my diabetes checks done under a hospital diabetes clinic, copies of the results and any other medical decisions are then forwarded to my gp.

Just get your DSN/Consultant to write to your gp surgery and put them right on this matter, they can't withhold prescriptions.

 

[charleym]

They told me before that I couldn't see two nurses so would have to just see GP one.
I worry it'll just make it awkward when I have to see her.... and probably should have said more at the time but was shocked and annoyed and it was 5.58pm so was basically being pushed out the office so she could go home. I made a complaint against the hospital when I was diagnosed and never even got an acknowledgement.
I wouldn't mind so much but my hba1c is rubbish and getting worse so help would actually be nice! I think they just see so few type 1s that they don't have up to date knowledge.

 

[Deleted member 308541]

I have a dedicated diabetes centre attached to East Surrey Hospital

That hospital is very close to where I used to live at Woodhatch before I came to Australia.

My Mum was a diabetic, as she did not look after herself she used to go there for treatment. In the end they sent her to a hospital in Dorking where she ended up dying of senile dementia and diabetic complications.

Best thing that happened as she was crazy as anything.

 

[charleym]

They are talking nonesense, I don't see my gp practice diabetes nurse and get my diabetes checks done under a hospital diabetes clinic, copies of the results and any other medical decisions are then forwarded to my gp.

Just get your DSN/Consultant to write to your gp surgery and put them right on this matter, they can't withhold prescriptions.

I'm seeing consultant tomorrow and intend to make a reasonable amount of fuss!

 

[noblehead]

I'm seeing consultant tomorrow and intend to make a reasonable amount of fuss!

Yes do that, if copies of your diabetes results/treatment are sent to your gp practice then there's no cause for concern by them.

Up until a year or so ago I kept getting letters from my surgery to go in for a diabetes check-up, each time I'd ring up and say that there wasn't any need as I was under the hospital clinic, the penny must have finally dropped as I've not heard from them for a while, but that said they never once threatened to withdraw my prescription.

Good luck tomorrow and hope all goes well

 

[CarbsRok]

Was wondering if other people are told they have to see the diabetes nurse at their GP surgery? I have a dedicated diabetes centre attached to East Surrey Hospital with nurses who actually know what they're talking about yet apparently have to see the one at my GP surgery instead else they won't provide the prescriptions.

Saw her yesterday for 6 month check up and she told me:
- Don't take insulin for snacks
- Only inject 3 times per day
- There's no such thing as correction doses, insulin only works if you eat with it and can't just lower your bg
- Carb counting is just for newly diagnosed diabetics, you don't do it long term unless you use a pump
- Insulin is for food not carbs so there is no such thing as a food that doesn't require insulin

She finished with 'I do understand type 1 is a little bit more complicated than type 2 but you're just making it difficult for yourself by over complicating things by counting everything, you'll make yourself stressed'

You do not have to see the practice nurse it's your choice just write them a letter or sign the form to say you do not wish to attend.

If you think about it logically, would you make an apt with your GP when you had no need to see him/her? Obviously you wouldn't so the same applies with the nurse she has made the apt for you to see her so just cancel it and tell her to take a hike.

When talking to my GP the other day he said they were obliged contractually to send me apts which is my right to refuse/cancel he said it was 3 times a year they were meant to write if I didn't respond. I suggested he put a red flag on the screen not to send any more apts because I wasn't going to cancel yet again neither was I going to turn up for the apt either.

 

[EllsKBells]

Yes, do get your consultant on side, they are brilliant about getting things sorted when GPs try to interfere. I know someone (a Type 1) who was told that she didn't need test strips by her GP, and the consultant soon sorted that out! My own experiences with GPs and diabetes... maybe I'll write a book one day! Good luck tomorrow!

@noblehead I honestly don't know why they bother sending my results on as they will only send them to the 'Diabetic Specialist' GP (who was very concerned that I was taking insulin to correct when I was high)... but they won't be getting opened any time soon, as she retired nearly a year ago and is yet to be replaced, thank goodness!

 

[noblehead]

I honestly don't know why they bother sending my results on as they will only send them to the 'Diabetic Specialist' GP (who was very concerned that I was taking insulin to correct when I was high)... but they won't be getting opened any time soon, as she retired nearly a year ago and is yet to be replaced, thank goodness!

I have two gp's who specialise in diabetes, I've only seen one to date and that was when my hospital clinic sent me over to the care of my gp surgery, when I was experiencing difficulties he didn't really have an answer so I asked to be switched back again to the hospital, that was several years ago and now that I'm on a pump the chances of being referred back again are slim

 

[azure]

My surgery makes me see the 'diabetic nurse' even though I see a consultant and DSNs at the hospital. I was told this was to discuss my blood tests (even though the consultant does that). I was also told I wouldn't have my prescription renewed if I didn't go.

It's a pointless waste of time.

 

[EllsKBells]

Haha, now that definitely sounds like a good plan!

Honestly, GPs handling diabetes, whether or not they are supposed to be 'specialists' scare me. It's nothing against (most of) them personally (although there are a few who need an 'attitude adjustment clap'), they just can't possibly know enough about everything, and most of what they do know, or think they know, is wrong.

 

[charleym]

I've been diagnosed for almost a year now and not seen the diabetes nurse at my GP practice once. And I won't either. There are only 2 type 1 diabetics at my practice. That's me and my daughter! They know less than me.

It's just a shame really cos mine is a lovely lady and genuinely trying to help... unfortunately I don't think she's had any type 1 training since the 1980s.
At least you're in same area as your daughter, really wish I was in same county as my mum as we could argue together!

 

[JMK1954]

Seriously, in my experience it's just wasting an appointment which could be used for somebody else if they make you see the nurse at the GP surgery as well as attending a hospital clinic. My last practice was a bit of a nuisance over this issue. The nurse kept sending letters and ringing me and I kept dropping replies off at the surgery in which I explained that since I saw a consultant and DSNs at a hospital clinic, I did not require an appointment. This was ignored until I brought it up at a GP appointment on an unrelated issue. When I was asked why I did not want to attend appts with the practice nurse, I reminded them about my hospital clinic and when finally told that the appts with the nurse would be useful as well, I replied that on the occasions when I had seen her, I had not found what she said useful in any way. After that the letters and phone calls finally stopped.

If the surgery is receiving letters from a consultant re any patient's diabetes, how can they claim they need to see the patient as well, unless there is a problem of some sort ? Is there a financial motive in this ?

 

[douglas99]

They have to see the patient to make sure the prescription is still valid.

Painkillers are a popular one, dead patients relatives can keep the prescription going and sell them on.
Then there are hundreds of reasons why other prescription may no longer be appropriate, which is why the rule is there, at least the doctor/nurse has to physically see the patient at set intervals.
Not everyone is as good at self care, and not everyone tells the truth over the phone.

Mine insist on seeing me once a year, even for minimal metformin as a type 2.
A check of bloods, BP, weight, review of medicine, check my feet, check my eye test results, and I'm good for another year.

Otherwise, I could have gone back to being an overweight couch potato, with BG through the roof again, and they wouldn't have a clue I needed some more help until I finished up in A&E.
And even if they receive letters from others, it's still their neck on the line if they issue prescriptions.
The hospital clinic should issue the meds, if they're responsible for your care.

So, the system is good, an odd few times you simply meet someone who may not be as good.

 

[Medusa41]

Was wondering if other people are told they have to see the diabetes nurse at their GP surgery? I have a dedicated diabetes centre attached to East Surrey Hospital with nurses who actually know what they're talking about yet apparently have to see the one at my GP surgery instead else they won't provide the prescriptions.

Saw her yesterday for 6 month check up and she told me:
- Don't take insulin for snacks
- Only inject 3 times per day
- There's no such thing as correction doses, insulin only works if you eat with it and can't just lower your bg
- Carb counting is just for newly diagnosed diabetics, you don't do it long term unless you use a pump
- Insulin is for food not carbs so there is no such thing as a food that doesn't require insulin

She finished with 'I do understand type 1 is a little bit more complicated than type 2 but you're just making it difficult for yourself by over complicating things by counting everything, you'll make yourself stressed'

Hi @charleym - That's shocking! I am also under The Earlswood Centre who are brilliant. I see the nurse at my GP surgery once a year - this is purely for her to check my BP & feet. What a shame that the advice was so outdated. Yes definitely put a complaint in.

 

[charleym]

Consultant said to just get away with seeing her as little as possible so basically once a year. He said this was for feet checking but she's never done it.
In the meantime he's going to emphasise in the notes from today that I do need to be counting carbs, correction doses etc to put her straight. Hopefully that will correct her a bit without having to make things uncomfortable.

 

[JMK1954]

My attitude is the same as your consultant's. The hospital checks my weight and does blood tests, a podiatrist looks at my feet at a separate appt. I arranged that because one previous nurse insisted I had loss of sensation. I didn't believe her and switched to a professional who deals with feet all the time. Result - no problem at all. I arrange retinal photographs once a year, when asked. I was diagnosed with type 1 in 1964 and when I see my GP it is over arthritis and other unrelated issues. There are many practice nurses with zero experience of type 1 and I have come across a few. They can do a lot of damage. All you can do is be polite and ignore the rubbish.

 

[Daibell]

Hi. What a sad situation for you. As I'm a mis-diagnosed LADA and still listed as T2. I have only ever been seen at my surgery but I was really lucky as the surgery DN used to work at the db clinic and started me on insulin and had great experience. She left but I now have alovely DN who is really just T2. My comments on your post include:
1) I take insulin for any snack with 40gm carb or higher if I remember!
2) 3x a day for insulin is stupid. It needs to be at least x4 if on Basal/Bolus and one Basal a day. This assumes all meals have, say, at least 40gm carb
3) Interestingly my expert DN said not to do correction doses either (must be the same silly Diabetes training?). I think most of us know you do correction doses when needed but mustn't stack insulin.
4) Carb-counting only for beginners -wot. I wonder whether she thinks carb-counting is weighting carbs on the scales?
5) The 'foods' thing sounds the usual NHS denial of carbs. Yes, fat and protein affect blood sugar a bit, but only a bit. What an ignorant comment.

If I were you I would do what you believe to be right and smile nicely at the DN, but let some of it pass over your head.