Diabetes Clinics/Nurses/Doctors

Can one of you mods or admins make this sticky? (at least for a few days). It will be really interesting to see the results of lots of members.

I answered yes absolutely...but this was about my clinic who give me fantastic advice. Thing is, at teh same clinic, I know another (senior!!) consultant would give me shocking advice.

Bumping this up again cos I'm interested in seeing the results.

Hate to be negative but I have had to vote 'Conflicting Information' as I have received both excellent advice and some that was less than satisfactory.

The 'diabetes nurse' at my GP surgery saying that she didnt know anything about insulin was one of the less satisfactory moments :lol: Still she earned that valuable QOF cash for the GP by weighing me and pricking my feet :roll:

Thanks to Benedict this is now sticky for a couple of weeks.

there's no "don't know" box... I've only just been diagnosed and I don't know yet if the advice I'm getting is good or not...

I now give them advice - & they don't argue.

I know this post is probably aimed at UK peeps.... but I noticed on this forum that not many mention anything about management from endocrinologists (endo). Here in Aust we get referred to publicly run diabetic clinics and diagnosed by endocrinologists who consult to those clinics. We have the option of seeing them privately too. It doesn't matter what type of diabetes you have... you normally get the same treatment. I noticed some comments on this forum suggesting that only type 1's in UK get to see endocrinologists.... why is that? They are the specialists, not the GPs. Also endo's have the ability to thoroughly check your hormone situation... that's how I got diagnosed with another hormonal condition which I didn't know I had when I was diagnosed with diabetes by the endo. I'm just curious as it seems diabetics get treated/managed differently around the world. Here GP's are quick to refer you to specialists when needed as they just do the general management stuff based on advice from specialists usually.

mep
you just explained why so much diabetes care in Britain is sub-standard.
I was diagnosed T2 nearly 10 years ago, but have never seen the endocrinologist, except in the course of voluntary work and my T1 husbands care.
Since T1 has nearly all the complications that are possible, I don't know if I'm missing so much.
Many Ddiabetics in the UK never see anyone other than a DSN Diabetes Specialist Nurse. The course these people have to pass to qualify is very rigorous, but also very out of date. Most nurses know little or nothing about metabolism or molecular biology. I believe they try their best, but dare not "think outside the box"
Hana

hanadr said:

mep
you just explained why so much diabetes care in Britain is sub-standard.
I was diagnosed T2 nearly 10 years ago, but have never seen the endocrinologist, except in the course of voluntary work and my T1 husbands care.
Since T1 has nearly all the complications that are possible, I don't know if I'm missing so much.
Many Ddiabetics in the UK never see anyone other than a DSN Diabetes Specialist Nurse. The course these people have to pass to qualify is very rigorous, but also very out of date. Most nurses know little or nothing about metabolism or molecular biology. I believe they try their best, but dare not "think outside the box"
Hana

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that's a worry that you only get to see a nurse :shock:
My usual visit to the diabetes clinic every 3-6 months is I firstly have to see a nurse for general checks, then I see my endocrinologist, then I get to speak to a diabetes educator, and a dietitian if I need to. This can be done all in the one appointment. So the clinic is set up to cater for all diabetic needs. They are usually co-located with podiatrists too.
It's a shame you don't get the same care.... coz you all deserve this.

My GP is good in giving general advice... but he always reminds me he is no specialist. The nurse at my GP's surgery also only gives basic general info. But the clinic are specialists and they don't mind you ringing them for help either... they will often ask me to report to my endo by phone to report my BGL readings when required. They've been really good this way and they've given me advice over the phone. That's the kind of care everyone should be getting really.

I have never seen an endocrinologist. How would one help?

Dr, practice nurse, & podietrist are all supportive, & the dietitian who gave me the DUK/NHS diet has now revised her recommendations.

I do see a consultant when I go to the hospital with my T2 blind friend. Always a different one, & they don't seemed bother about an HbA1c around 10. "You only have a problem if you feel unwell."

Her nurses - now come in 2x daily to inject insulin - & have told her not to allow me to take a reading. It's their job. They tell her off if I do. They get an average of about 15 - usually soon after a meal, but it's not much better before meals - never below 10.

that doesn't sound like good management Ian... your poor friend.

An endo is a hormone specialist. It was only through my endo that I found out hormones actually play a part in controlling your blood pressure and cholesterol also. This is why they are concerned in managing BGLs, BP, and cholesterol for diabetics.

But the endo would be a lot more useful as they have the experience behind them and here they're not happy at all unless your HbA1c is <7% ..... although the less the better. Also here it's only the endo's that can order the C-peptide and GAD tests... GP's can only order the HbA1c test. But technically they say diabetes is under control when <7%. But my endo pretty much discusses everything with me. They even offer a diabetes social worker... which I only found out through him as he spent a session explaining to me the importance of mental health for diabetics. My endo teaches other endos apparently... so he is well respected here. He works alongside another well known and respected endo here too.

We don't get good care because of the way the service is organised and funded. It will take years to sort it out properly.

I think it is all about hospitals and GP Practices in competition for the same money.

Diabetes care has been delegated or [relegated] to the GPs. Who in turn delegate as much as possible to the Practice DSN? Now exactly what might a DSN be? In hospitals i usually means a highly rained and qualified and ofen experienced person.
In he GP's practice it can mean anything they want it o mean.
There is no single, recognised qualification. Because of cuts in funding hospitals only see theose patients who do not have good control.
In some areas this applies o T"s and T1s. The others see the possibly almost toally unqualified "DSN" . The more diabeic patients are are lef o he nurses@ care the more the doctors beconme out of ouch with the treatment and laest hinkig abourt he condiion.

because the local practices have to pay for referrals to consulants it is almost impossible to get one. Paients are labelled non-compliant or have heir meds increased inapprpriately sometimes to keep wihin the arge levels where thwy migh have sees a specialist in the past.
This obviously doesn' happen everywhere but that in itself is noy=t a good thing.
I believ much could be done to improve matters without necessarily costing a grea deal of money.
This won't happen because he system is presently in a state of flux.

Much of what is currently known as "diabetes care" doesn't deserve the name and is a total waste of money. It is paying lip service
to the concept.
I particularly find the use of the term "Healthcare team " laughable . Who? :?:

I would much prefer that they would leave me alone. The box-ticking exercises aka clinics are a total waste of time for many of us..
They may be of help to some and that,s fine. Maybe we should be allowed to opt out of this system and allowed access to people who actually know something about diabetes but less frequently.
As most T2s at least ,manage their own condition, after a time this shouldn't be impossible. Maybe we should have a choice about where and how the £2k allocated for our care should be spent. A pipe dream of course.
Insead of which many of us try to avoid our HCps and see them as a hindrance to our control. Not their fault always but the fault of the guidelines they are given.

I don't see any of his changing in the near future, There is tooo much in the pipeline already - and change began years ago.
maybe we should all move to Australia.?

I've ticked the top one because I think I do get excellent care. I see the practice nurse for my 3-monthly checks, and I see my own GP when necessary. They know what I'm doing, and let me get on with it. I get my retinal checks and I see a podiatrist.

I avoid the "diabetic specialist" GP like the plague! She agrees to low-carb "as long as it's low-fat too". :***: , and she thinks I test too much - I get 50 strips per month. Also she's longing to shove statins down my throat.

Although I'm happy with my care, I'm not sure about everyone else's in the same practice. A friend of mine, diagnosed with much higher levels than me, was given a metre and strips (everyone is) and told to test a couple of times a week. His wife looks after his diet, but more on the "no sugar" basis - though she has moderated his total carb intake.

The dietitian toes the NHS party line, and sees people in groups. I wouldn't mind a one-to-one with her. I haven't seen the DSN - he covers a number of practices throughout rural North Yorkshire.

As for a specialist, or a hospital clininc . . . !

Having read that back, maybe I ought to change my mind. It seems you have to learn a lot yourself and work with my practice; otherwise I would have to say they do the full range of NHS-recommended care but don't like to think outside the box.

Viv 8)

viviennem said:

I avoid the "diabetic specialist" GP like the plague! She agrees to low-carb "as long as it's low-fat too". :***: , and she thinks I test too much - I get 50 strips per month. Also she's longing to shove statins down my throat.

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:***: She's obviously thick. Next time you go back, tell her that you followed her advice to the letter and are now eating an 80% protein diet, and that your kidneys hurt and that you're urinating blood. :thumbdown:

She'd probably believe me! and have me shot - she doesn't like me very much :lol:

Viv 8)

viviennem said:

She'd probably believe me! and have me shot - she doesn't like me very much :lol:

Viv 8)

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I can well believe it Viv! She probably has no idea how to cope with an intelligent person with a mind of her own!

They are , for the most part, not equpped to deal with anything but the basics and with patients who don't talk back.

I always have more confidence in HCP's ready to admit that they don't have all the answers because nothing is black and white and we are all different.

Practice DSN's often don't have the confidence to be like that and consider any discussion as a challenge to their authority.
I am sure many are aware of the inadequacy of the training they are given and the authoritarian atitude is their only defence

This is not good for those of us who only have access to a Nurse.Just as many GP's used to hide behind "dragon receptionists"
Many nowadays appear to hide behind the DSN.. No doubt they also feel they are not adequately equipped to treat diabetes.

have voted for the majority. My Diabetes team are great. My GP questionable!