Disappointing trip to practice nurse

[bulkbiker]

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

Yes but why not just bring blood sugars down by dietary changes faster than metformin can and leave the drugs as a reserve for the future if required (hopefully never)?

 

[Mike d]

Hi @Mike D ..
I have tried, believe me. 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

I guess I have a very much take no prisoners approach. You're a great poster and the messages are full of help and care.

I just happen to take it further with idiots who place in jeopardy, the health of others with advice when they know nothing

 

[KathyCP]

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?

It was thanks to a private nutritionist that I started a LCHF diet, and I hate to think how long I could have gone on trying to do things the 'right' way and follow all the official advice about 33% carbs and low fat, if I hadn't been lucky enough to have someone recommend him to me. My GP and the diabetic nurse at the practice were very impressed with my last HbA1c (36), but they both responded as if I had done something really, really unusual - I do find it rather sad that the people who are supposed to be helping us with this condition are so ignorant about it, and it's tragic for people who haven't yet discovered for themselves how awful the official advice about food is.

 

[NoCrbs4Me]

Has anyone had any good experiences with private practice or dieticians etc?

I've had some positive experiences. They've all learned something from me, although I haven't learnt much from them. I've had some interesting conversations.

 

[derry60]

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

Oh the wonderful Eat Well plate. I had that as well. It did absolutely nothing for me, but if I had taken even the smallest amount of potatoes off the Eat Well Plate, I would have fared much better. I now realise that Brown rice, wholewheat pasta and bread just does not help me at all. I just felt bloated and put weight on even with small portions

 

[derry60]

I guess I have a very much take no prisoners approach. You're a great poster and the messages are full of help and care.

I just happen to take it further with idiots who place in jeopardy, the health of others with advice when they know nothing

If I am not sure on something or need advice I come here. The nutritional sheet that they gave me was laughable. It must have covered just half a page on what I call a cheap piece of paper. I said to the nurse " I do not think that I will end up with any GCSE's on good nutrition for whats on this piece of paper" She fully agreed.

 

[Prem51]

I suppose I'm lucky in a way that my DN didn't give me any dietary advice. She left that to the DESMOND course, and only does the feet testing and weighs me. She did say I was the surgery's 'star patient' after last year's HbA1c test, but didn't ask how I had reduced my bs and weight. I think she might prefer not to know!

 

[Bluetit1802]

My nurse is fully aware of the way I eat, and that I test a lot, and that I use a Libre. We have a lovely chat about things, and I enthuse about the virtues of the Lidl high protein rolls. On my on-line medical notes there is a section she has to fill in, one of which refers to diet. On her screen there are tick boxes. On my screen just what she has ticked. She ticks the high fibre box!!! I take it there is no tick box for low carb.

 

[Chook]

My last DN was (said she was) thrilled by my HbA1c but was less than thrilled when I said it had nothing to do with meds or the diet sheet they give me each year. I explained about low carb and then I got the lecture about must eating carbs with every meal and eating carby snacks between meals and that we have to eat over (I think it was) 120g carbs a day so that our brains can function. I told her that I had been low carbing on less than 30g carbs a day for two years and that, as far as I'm aware my brain is still functioning....

Its really like they turn their brains off when it comes to giving us 'nutritional advice' they really can't seem to see whats in front of them - and I hate to say it but if they are getting it so far wrong with something as simple as the way us T2s react to carbs then what else are they getting wrong?

 

[Squire Fulwood]

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

No, not really. I had to control myself at the dietitians because she said that (something) was like a doggie and a bunny racing round a track. If I hadn't got out of there I would not have been able to control my laughter.

My DN is a closet low carber but she has to follow the rules laid down by her masters but she is lovely to talk to. I just go there for a chat really.

 

[Pinkorchid]

I never go into details about how I eat with my DN and she doesn't ask she is just pleased with my results

 

[Chook]

I never go into details about how I eat with my DN and she doesn't ask she is just pleased with my results

Lucky!! I would say a good half of my 40 minute annual review is taken up in discussion about the correct foods to eat. .

 

[Art Of Flowers]

I had a recent check up with a diabetes nurse. My usual nurse is pretty good, even gave me a Accu Chek Mobile glucose meter plus some prescriptions for test cassettes and lancets. This time I had another DN from Germany. She seemed really happy with my results and understood the benefits of a low carb diet. She also was doing intermittent fasting herself, so knew that it was helpful to control weight and blood sugar.

 

[dbr10]

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

True.

 

[maureen5752]

Evening. Yesterday again I was told to eat some carbs with each meal, also they've cut my testing strips in half & told if I need to test, once a day or once a week is plenty!!! But that type 2's don't need to test!!! I give up. Makes you feel like doctors nurses don't care. All I hear is the eat well plate. !!! Good evening to you all

 

[wallydug]

I booked a follow up appointment with a diabetes nurse at my GP practice because I was having a hypo every evening after following their dietary advice at my regular diabetes review. It was obvious to me that my medication wasn't matched with the dietary changes they advised. The diabetes nurse I saw didn't have a clue. The session was totally chaotic, and every time I asked her a 'why' question she became angry and aggressive with me, said she was just trying to help me.

I was told to cut the dosage of Gliclazide that I was taking with my main meal and to stop testing because cutting the dosage of Gliclazide would prevent the hypos so I would not need to test. I asked how she could be so certain of that, and she went apeshit, accusing me of being rude to her.

Anyway... I cut down on the Gliclazide, but I kept testing. Not only did the hypos continue, but on one occasion my blood sugar level fell to 2.8 and I was feeling extremely unwell.

Other times I was having hypos between 3.2 and 3.8 with no symptoms. This is worrying me a great deal because if I followed her advice and didn't test, I would be having regular hypos but without knowing.

So now I don't trust anything anyone at my GP practice tells me about diabetes. I feel like the NHS is totally letting me down.

Now I am deliberately eating badly in order to make sure my blood sugar levels stay high. I don't know what else to do.

 

[Alexandra100]

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

Sadly the article seems to be available to subscribers only.

 

[Brunneria]

Evening. Yesterday again I was told to eat some carbs with each meal, also they've cut my testing strips in half & told if I need to test, once a day or once a week is plenty!!! But that type 2's don't need to test!!! I give up. Makes you feel like doctors nurses don't care. All I hear is the eat well plate. !!! Good evening to you all

Your profile says you are insulin dependent.
If you are on insulin, you MUST have access to test strips.
I am going to tag in tim2000s because he is an expert at communicating with health care professionals, and he understands the importance of testing - and he may be able to offer you some advice.

My own suggestion would be to write a letter of complaint to your surgery, quoting the NICE guidelines on testing for insulin dependent diabetics, and (if you drive) the DVLA rules on testing and blood glucose levels when behind the wheel.

Edited to un-tag Tim2000s since maureen has now confrimed that she isn't insulin dependant and her profile is showing the wrong meds.

 

[Alexandra100]

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?

You might find it helpful to read Jenny Ruhl's book "Your Diabetes Questions Answered". She has written other books, but this is the one I found in my local library. I took out about 6 books on diabetes and this one seemed to me head and shoulders above the others. Ms Ruhl has successfully managed her own diabetes for many years and has been researching the subject since she was diagnosed. Her approach is low carb and she says nothing that would surprise on these forums, but she is never fanatical. She is concerned that people should not burn out due to following a diet that is too strict for them to maintain over the years. She writes at length about how to understand and manage your GP! (Including not to expect too much of him/her!!!) Everything she states is documented and she warns against being fooled by junk research. She also has a site packed with detailed information: http://www.phlaunt.com/diabetes/ but I find it's sometimes easier to take it in in book form.

 

[Brunneria]

I booked a follow up appointment with a diabetes nurse at my GP practice because I was having a hypo every evening after following their dietary advice at my regular diabetes review. It was obvious to me that my medication wasn't matched with the dietary changes they advised. The diabetes nurse I saw didn't have a clue. The session was totally chaotic, and every time I asked her a 'why' question she became angry and aggressive with me, said she was just trying to help me.

I was told to cut the dosage of Gliclazide that I was taking with my main meal and to stop testing because cutting the dosage of Gliclazide would prevent the hypos so I would not need to test. I asked how she could be so certain of that, and she went apeshit, accusing me of being rude to her.

Anyway... I cut down on the Gliclazide, but I kept testing. Not only did the hypos continue, but on one occasion my blood sugar level fell to 2.8 and I was feeling extremely unwell.

Other times I was having hypos between 3.2 and 3.8 with no symptoms. This is worrying me a great deal because if I followed her advice and didn't test, I would be having regular hypos but without knowing.

So now I don't trust anything anyone at my GP practice tells me about diabetes. I feel like the NHS is totally letting me down.

Now I am deliberately eating badly in order to make sure my blood sugar levels stay high. I don't know what else to do.

It sounds like you need more skilled advice than is available at your surgery.
Can you produce evidence of your readings when hypo? And send or take them to your next appointment? That appointment needs to be soon. You may need another urgent medical review, or a referral to your nearest diabetic clinic.

You most certainly should NOT be experiencing daily hypos and having to eat 'up' to your oral medication.

If you are also becoming hypo unaware, then you could do with some advice around that too, which would be available at a clinic.