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Diabetes nurses are making up rules to suit them

T

Tracey167

Well-Known Member
Messages
309
Location
Essex
Type of diabetes
Type 1
Treatment type
Insulin
Hi All

Went to see the Diabetic Nurse on Tuesday ( the reason I say the Diabetic Nurse is because I never see the same one twice) and went through my sugar readings with her as I suffer with hypos and have no awareness and in the past week or two it seems the hypos are nearly every day probably hot weather isn't helping. I was given a new glucose meter the week before the AVIVA EXPERT so I can now work out my carbs and insulin with ease. I was abit taken back by a couple of things the nurse said to me, when she asked me how I was getting on with the meter I told her I was doing fine but still having hypos she answered ' well you have only had it a week you have to give it a chance ' give it a chance to do what ? its not going to stop hypos its telling me what insulin I need to inject for what carbs i'm eating. Then when she was looking at my blood glucose book and working out when the hypos were happening she told me they don't count sugar reading between 4.0 and 3.6 as hypo only from 3.5 and below well from all the books and info I have read and been told in all the years i've been diabetic when your sugar levels reach 4.0 you are going hypo what's changed, the way I see it once your sugar levels reach 4.0 then like mine they can drop like a brick. Has anyone heard this about sugar levels between 4.0 and 3.6 not being counted as hypo.

To say the least i'm am getting really fed up with these diabetic nurses .

tracey167
 
As I am new to hypos I asked the nurse when she considers when one is having a hypo and she said anything below 4.0 is classed as a hypo.
 
I have always been told that hypos readings start from 4 and below. Also I have always been told if you adjust your insulin t can take up to a week to adjust in your blood sugars.. Anyone else been told this?


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I was told 3.9 and below is hypo and above 13.3 is hyper


Diagnosed Type II 1998 1 x 80 mg Gliclazide, 4 x 500mg Metformin and 1 x 100mg Sitagliptin - HbA1c - 48 mmol/mol
 
Oops, try that again! I've always been told by my nurse that hypos are below 4.0 and generally this is the point at whih I start to feel a bit off. However last year I completed the DAFNE course (not sure if you've heard of this, it's Dose Adjustment for Normal Eating) which is similar to the type if thing your new glucose mere is doing for you. The DAFNE principles consider hypos as being anything less than 3.5, so maybe your nurse is taking her figures from some sort of thing like that? I personally think that's too low and so still stick with 4.0. I think the best thing to do is stick with what you've been told previously as this is what most people, and nurses/ doctors, consider as hypoglycaemia. Hope things smooth out a bit for you and you get your hypo awareness sorted
best wishes,
Maxine


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Hi

Because of the way bolus insulins lower bg levels fairly fast, 4mmol although not really hypo, is thought to be the lowest diabetics should be with regards to eating food or eating some jellybabies and for people to try not to let bg levels drop any further. But, your dsn is correct and you are as well. Years ago when the older insulin regimes were being used a bg level of 2.8mmol was if I remember reading in a 'Balance' magazine, was the true hypo level and needed treating with some glucose tabs or lucozade.

Its true to say that this spell of hot weather is making many diabetics experience drops in their bg levels so the amount of low bg levels you got is to be expected. Now that you have got an Expert meter there are settings on it that can be altered so that you give yourself less insulin. As you've got little awareness,, you can alter the target settings on the meter so instead of a target between 4mmol and 8mmol, you can alter the target to 5mmol and 8.5mmol and then the meter will calculate a level of bolus to get you to a bg level of about 7mmol before you eat food instead of 6mmol. You can also alter the carb ratios to allow for you to get a higher bg level.
So the dsn is correct... alter the settings on the Expert and calculate to allow for you to get a higher bg level and hopefully you will have less hypos and get a better well being...
 
According to my nurse and other I have worked with, you should have at least 2-3 hypos per week (in child practice at least). Less 2 means not enough insulin, more than 2/3 means too much insulin apparently


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My diabetologist only worries about sub 65mg/dl (3.6mmol/l) as hypo but would want me to do something about levels of 70mg/dl . I think that the rounded figures show that it the levels are approximate.
(4mmmo/l =72mg/dl)

This accords with this slide from DAFNE
http://www.dafne.uk.com/uploads/224/doc ... ptions.pdf
 

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From what I have been told medically speaking anything below a 4 is now classified as a hypo. It does differ from diabetic to diabetic, they are ultimately speaking only guidelines. You should look at how you feel, if you feel the hypo at 3.5 then it's a hypo. It is definitely low enough to qualify as a hypo.
 
Some years ago, the mantra "four's the floor" was coined It was meant for use in the old days, when people had fewer options of control and mainly relevant if insulin had recently been taken and the level might still be dropping.
3.5, when it's a while since you had your insulin and it's activity is finished.It is not dangerous. Non-diabetics often drop to 3.5 simply from hunger.
Understanding what is happening is what keeps you safe
Hana
 
Hi All thanks for all your replies, I am beginning to get used to the Aviva expert and how to use it, my dietatian set it all up for me, and I make sure that if I am doing any kind of walking or exercise I take this into account when I do a glucose/carbs. the thing that annoyed me no two diabetes nurses tell me the same thing, I have always counted anything levels below 4.0 as hypo and what I have always been told. I haven't done the DAFNE course yet so I am going to continue with any level below 4.0 as hypo. I will chat with my consultant in September because I have a few concerns with the diabetic nurses and how they treat us diabetics, a lot of them I have seen seem to talk to me as if I don't know what im doing and talk to me as if im stupid. But what im going to tell my consultant is that I have been diabetic for 30 years now to be spoken to as if im a child is not acceptable like I told my dietatan I have probably been diabetic longer than they have been a diabetic nurse.

tracey167
 
Another point is meter accuracy. If we accept that it is +-10%. the 4.0 BG now becomes 3.6-4.4 so if we get a reading of 3.7 is it a "real" hypo or a meter inaccuracy?
 
Fours the floor to my mind is excellent advice for us type 1's, personally I try and stay away from the low 4's and eat a small snack whenever I find myself at those level.

Tracey, I do hope the consultant listens to your concerns and things change for you!
 
Hi Tracey,
I class under 4 as hypo, but I guess what the nurse was trying to get at was that there are different classes of hypos. 3.6-4 I would class as a low, a little blip from running around too much or a slight miscalculation with insulin doses, usually quite simple to sort out and don't cause any problems. 3.5 and under would be a bit more serious and take longer to come round from, usually caused by a big miscalculation doing too much exercise or getting pretty stressed from something. If someone is constantly dropping to levels 3.5 and below something is wrong with their insulin doses for their lifestyle, and that's the area the nurse was probably looking for.
I'm guessing she probably didn't express that in the best way and if your constantly not getting good advise and care from the nurses definitely bring it up, if they are like that with you they probably are with most patients.
 
Hi All .

As I start sweating a lot at a blood sugar reading of 4.2 .
I have to treat it early enough to prevent it going rapidly downhill 'fast'
and then run the risk of being unable to fix it fast or safe enough .
This is why I preset my hypo level at a 4.2 as I can recognise the sweats
as earlier indication of my own hypo's.
The Expert meter will alert me to act upon this - with it being pre-set in .

Though the motto/mantra of 4 the floor - I can grasp and understand .
Given the fact I start to sweat profusely at a 4.2 blood sugar level .
My animal insulin does give me great hypo awareness I must admit .

Tracey167 could you work towards possibly seeing the same DSN each time?
I requested this - as if you are told varying things/factors via different DSN's
it just confuses things 'more' for you .
Consistency is good - as they get to know you more - and you get to know them
and hear the same 'previous' healthcare advice etc ...
Just an extra thought for you to consider .
Glad you are feeling more confident with your Expert meter , you 'will' soon
fathom out all it has to offer . :thumbup:

Anna .
 
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