Disappointing trip to practice nurse

[AlexMagd]

Well just back from my first trip to the practice nurse, and how disappointing. Not only got the usual spiel about not needing to use a meter to test but even got "your day to day blood sugars don't matter, as long as your HbA1C is improved". Not sure if she understands that they're connected...

I was really hoping to discuss some stuff with her relating to diet but she just kept telling me to eat 33% carbs, even when I told her that they give me blood sugar spikes.

It's so confusing! They tell us to manage the disease but discourage us from getting the means to do so, and that it's a serious condition but also that "it shouldn't dominate your life" and to only make minor lifestyle changes. I'm someone who very much likes clear rules to follow so this is a nightmare for me. I just don't know how to make my care team understand!

Has anyone had any good experiences with private practice or dieticians etc? Just to get some advice from people who actually know about diabetes?

 

[Chook]

The people who actually know about diabetes are us - the people who actually have it. I don't really bother taking on board all that my DN says because she's not the one who will suffer with the life altering complications if the information that she gives out is wrong.

Unfortunately even if your DN thinks that low carb is the best way forward she can't tell you that - they have guidelines they have to follow which are really out of touch with whats best for us Type 2s.

 

[Bluetit1802]

Don't be disappointed, it is a typical review I'm afraid.
As @Chook says, the only people that know about diabetes and how to control it are diabetics.
My nurse was genuinely astounded when I told her how high my spike was after eating her suggested lunch of a jacket potato and baked beans. I'm afraid most of us are on our own, but thank goodness we have the members of this forum to help!
The rules are fairly clear and simple - carbs convert to sugar so be careful how many you eat and use your meter to tell you if you are overdoing things, then learn from what your meter tells you.

 

[dbr10]

Well just back from my first trip to the practice nurse, and how disappointing. Not only got the usual spiel about not needing to use a meter to test but even got "your day to day blood sugars don't matter, as long as your HbA1C is improved". Not sure if she understands that they're connected...

I was really hoping to discuss some stuff with her relating to diet but she just kept telling me to eat 33% carbs, even when I told her that they give me blood sugar spikes.

It's so confusing! They tell us to manage the disease but discourage us from getting the means to do so, and that it's a serious condition but also that "it shouldn't dominate your life" and to only make minor lifestyle changes. I'm someone who very much likes clear rules to follow so this is a nightmare for me. I just don't know how to make my care team understand!

Has anyone had any good experiences with private practice or dieticians etc? Just to get some advice from people who actually know about diabetes?

My experience is exactly like yours unfortunately. Many of us have been there. It's a bit like they don't listen to the words coming out of their mouths.

 

[charliebarker]

I have my first review coming up in a couple of weeks - I think I'm just going to nod politely and 'astral-travel' while she's talking. I shall try and resist the urge to get cross and tell her that a small piece of wholemeal toast spiked my BS by 5mmol !!! (also cos stress seems to play havoc with my BS - keep calm and ignore the advice !!)

 

[AM1874]

Hi @AlexMagd ..
Sadly you have just encountered pretty much the same experience that I had back in March .. you will also find that this sort of nonsense from Doc and Nursie is shared by many members here. You will find the same sorry tales littered throughout the forum .. and the most annoying aspect of this is that all these so-called "experts" just keep churning out the same rubbish. So, I have developed a simple little mantra that I employ whenever I receive the same sort of "advice" from any HCPs ..
# Listen
# Nod
# Smile and say thank you
# Ignore

Works for me .. feel free to use it yourself

 

[Guzzler]

I know that my regular DN knows that the information she gives may not help by the things she lets slip. There are reasons why they tell us what they do. The main reason is that that is what they are trained to tell us. Then there is the fact that if they deviate from the NHS guidelines too far they face losing their jobs.
I told my DN that I know she cannot advocate a different approach to T2 Diabetes and that for her, it must be hard to watch patients continuing to fail in their efforts to improve their health and their prognosis'. Her answer was a nod of the head and the answer 'Keep doing what you are doing'. That is about as far as she could go.
The guidelines are said to be forty years out of date as is the public conception of what constitutes a healthy dietary approach whether Diabetic or not. The good news is that the tide is turning.

 

[derry60]

Well hope this is encouraging for you Alex. When I saw my nurse for the first time after receiving a letter regarding my sugar being too high and need to change my diet I was expecting the same response as you but to my surprise my nurse absolutely agreed with the Keto diet and said that she was on the same. She told me that Carbs made her feel bloated so stays away from heavy carbs and that she had lost weight. Next time I may get a different nurse who will probably disagree with the Keto diet and will start to give me diet advice, but I am ready for her. If she does I will listen and then say "Oh how strange, this is the exact diet that got me here in the first place. I ate healthily (Or so I thought) for years, couscous, brown rice, pasta, whole grain bread, Low-fat everything and gained weight and could not lose any weight,now I have cut out everything that you have suggested and put me on the scales and you will see that I have lost weight and my BG levels are down" I cannot wait to see what she says,so in one way I am hoping that I get a different nurse, I would have the odd pie but once a month back then..never ate hardly any cakes because I am more of a savoury person

 

[ally1]

I get plenty of information here. Members always answer my questions, more then my DN nurse. Even to the extent that the first DN nurse for almost 3 years had not once checked my feet even though I had been teller her about my numbness.

 

[Mike d]

Hi @AlexMagd ..
Sadly you have just encountered pretty much the same experience that I had back in March .. you will also find that this sort of nonsense from Doc and Nursie is shared by many members here. You will find the same sorry tales littered throughout the forum .. and the most annoying aspect of this is that all these so-called "experts" just keep churning out the same rubbish. So, I have developed a simple little mantra that I employ whenever I receive the same sort of "advice" from any HCPs ..
# Listen
# Nod
# Smile and say thank you
# Ignore

Works for me .. feel free to use it yourself

With respect, that's the last thing I'd do. They must be challenged otherwise they do it to the next poor patient

 

[Lamont D]

Well just back from my first trip to the practice nurse, and how disappointing. Not only got the usual spiel about not needing to use a meter to test but even got "your day to day blood sugars don't matter, as long as your HbA1C is improved". Not sure if she understands that they're connected...

I was really hoping to discuss some stuff with her relating to diet but she just kept telling me to eat 33% carbs, even when I told her that they give me blood sugar spikes.

It's so confusing! They tell us to manage the disease but discourage us from getting the means to do so, and that it's a serious condition but also that "it shouldn't dominate your life" and to only make minor lifestyle changes. I'm someone who very much likes clear rules to follow so this is a nightmare for me. I just don't know how to make my care team understand!

Has anyone had any good experiences with private practice or dieticians etc? Just to get some advice from people who actually know about diabetes?

As others have said, it is a recurring theme. You have unfortunately have one.

My medical team gave me similar advice and probably led me literally to seek medical advice from anywhere until I was referred to a really knowledgeable specialist endocrinologist, who recognised my symptoms for what it is!

But it is changing, I know that my surgery recommend low carb diet because the wife has T2!
I meet doctors as I travel through my work and I would say that the majority are now leaning towards a lower carb attitude to diet and ignoring the NICE guidelines.

And the truth is out there!

 

[Lamont D]

With respect, that's the last thing I'd do. They must be challenged otherwise they do it to the next poor patient

Hi @Mike D how you doing?

 

[Hiitsme]

I feel quite strongly that we need to gently educate the staff. My first DN was so surprised what Weetabix did to my blood sugars, she said she had never seen that before but possibly no one else had pointed it out. I was given a meter and told to test so I tested and tested and showed both GP and nurse my results. I think for me my HbA1c results meant that it was difficult for them to challenge what worked for me.

 

[AM1874]

With respect, that's the last thing I'd do. They must be challenged otherwise they do it to the next poor patient

Hi @Mike D ..
I have tried, believe me. Unfortunately, there is only one Doc at my practice who has any clue .. the six others, and the DN, practice nurses, practice manager and dietician all sing from the standard NHS hymn-sheets. They all say - eg: no need to test, use the "Eatwell" plate model, take statins, you won't have a hypo 'cos you're on Metformin. They don't book three monthly HbA1c or lipid panel tests unless you pressure them and/or book your own .. and last week they changed 12 monthly reviews to coincide with patients' birth months. I could go on .. and on.
I have spoken to the practice manager about this and about overall attitudes to DB within the practice. I also pointed out in February that there were no DB leaflets, brochures or information packs available in any of the patient areas. There are still none today. Again, I could go on .. but in all honesty, I have come to the sorry conclusion that it is a waste of my time that is better spent managing my own diabetes and living my own life as best I can

 

[AlexMagd]

Hi @Mike D ..
I have tried, believe me. Unfortunately, there is only one Doc at my practice who has any clue .. the six others, and the DN, practice nurses, practice manager and dietician all sing from the standard NHS hymn-sheets. They all say - eg: no need to test, use the "Eatwell" plate model, take statins, you won't have a hypo 'cos you're on Metformin. They don't book three monthly HbA1c or lipid panel tests unless you pressure them and/or book your own .. and last week they changed 12 monthly reviews to coincide with patients' birth months. I could go on .. and on.
I have spoken to the practice manager about this and about overall attitudes to DB within the practice. I also pointed out in February that there were no DB leaflets, brochures or information packs available in any of the patient areas. There are still none today. Again, I could go on .. but in all honesty, I have come to the sorry conclusion that it is a waste of my time that is better spent managing my own diabetes and living my own life as best I can

That's depressing to hear @AM1874 but not surprising I suppose given both the financial restrictions on the NHS and the fact that most GPs are indeed quite general in their studies and don't really know more than they're told about diabetes.

I have to admit though, that I was shocked to hear the practice nurse today somehow fail to connect the dots between daily blood sugar control and an improved HBa1C! It will be interesting in November when I get my second HbA1C to see how it comes out, and what they attribute that to.

On the plus side when I went back later in the day concerned about my ketone levels the doctor I saw wasn't too fussed about the fact I was going low-carb, as long as I was eating enough. He did push me to start on metformin, and mentioned something he called 'the legacy effect' which I've not seen mentioned on here before, but was generally pretty relaxed about it. So maybe not all bad!

 

[serenity648]

My DN didnt seem to know the difference between a fasting blood test result, and a HbA1c test result. She couldnt understand why my fasting finger prick test that morning, from her, during my annual review appointment with her, was different from my HbA1c result she had on her screen from my annual check the previous week. I did persevere and explain the difference and I think she got it. So sometimes trying to educate the medical staff is worth trying.

She still couldnt get why I avoided "carbs and sugars, as sugars are the things to watch out for, but carbs are good for me"

I went home and kicked a pillow around for a bit, then came on here for some reassurance and calming down lol

 

[ickihun]

That's depressing to hear [USER79847]@AM1874[/USER] but not surprising I suppose given both the financial restrictions on the NHS and the fact that most GPs are indeed quite general in their studies and don't really know more than they're told about diabetes.

I have to admit though, that I was shocked to hear the practice nurse today somehow fail to connect the dots between daily blood sugar control and an improved HBa1C! It will be interesting in November when I get my second HbA1C to see how it comes out, and what they attribute that to.

On the plus side when I went back later in the day concerned about my ketone levels the doctor I saw wasn't too fussed about the fact I was going low-carb, as long as I was eating enough. He did push me to start on metformin, and mentioned something he called 'the legacy effect' which I've not seen mentioned on here before, but was generally pretty relaxed about it. So maybe not all bad!

Metformin and statins only work to their full potential once taken longterm.
I don't take statins as my cholesterol is good, in all aspects. Metformin is my knight in shining armour. I wouldnt have my 2 beautiful kids without it. I wouldnt be losing weight, religiously. If i wasnt taking metformin for years continuously. a legacy, indeed!

 

[Chook]

That's depressing to hear @AM1874 but not surprising I suppose given both the financial restrictions on the NHS and the fact that most GPs are indeed quite general in their studies and don't really know more than they're told about diabetes.

I have to admit though, that I was shocked to hear the practice nurse today somehow fail to connect the dots between daily blood sugar control and an improved HBa1C! It will be interesting in November when I get my second HbA1C to see how it comes out, and what they attribute that to.

On the plus side when I went back later in the day concerned about my ketone levels the doctor I saw wasn't too fussed about the fact I was going low-carb, as long as I was eating enough. He did push me to start on metformin, and mentioned something he called 'the legacy effect' which I've not seen mentioned on here before, but was generally pretty relaxed about it. So maybe not all bad!

They'll probably attribute your second HbA1c result to you following their good advice - well, that's what has been said to me several times. I've not heard of the 'legacy effect' so I googled it and found this: http://www.jwatch.org/jw200810140000001/2008/10/14/legacy-effect-intensive-control-type-2-diabetes

 

[AlexMagd]

They'll probably attribute your second HbA1c result to you following their good advice - well, that's what has been said to me several times. I've not heard of the 'legacy effect' so I googled it and found this: http://www.jwatch.org/jw200810140000001/2008/10/14/legacy-effect-intensive-control-type-2-diabetes

Yes, he basically summarised it as the more aggressively blood sugar is controlled in the early stages of the disease, the more effective long term treatment is. So I suppose the idea is that if they can bring blood sugars down early, and use metformin to sensitise cells to insulin again, that in the longer term you might not develop as many complications, and generally have better controlled blood sugar. I'd not heard of it before but there are a few pieces of info floating around about it

 

[Mike d]

Hi @Mike D how you doing?

I am well and thank you for asking