Fasting blood tests

[fatedsnowfox]

Hi there.

I have a male relative with type 1 diabetes. He's struggled massively getting it under control and has peripheral health problems (arthritis and depression). The doctors are absolutely fixated on his diabetes and are refusing to acknowledge his other problems until he takes a fasting blood test. He doesn't feel that he can go 12 hours without food without falling into severe hypo. The GP is completely intransigent and isn't offering any advice to him. Does anybody here have any experience of this, and how they handle having fasting bloods taken?

I'm really worried about him.

 

[noblehead]

The reason behind a fasting test is to see if his basal insulin is set at the right dose and is working effectively, its important to test regularly during the fasting period to make sure he doesn't go hypo and record all results and treatments in his diary. Ask your relative to speak with his diabetes nurse who will advise him on the best way to conduct a fasting test.

Nigel

 

[Sid Bonkers]

When I was on insulin and had to have a fasting blood test I would simply go to the hospital unit that took the blood at 8.00am when they opened and even if I was not first in line I would inform the nurse that I was on insulin and would be seen almost straight away, I would then go to the hospital restaurant inject my insulin and eat breakfast by about 8.30am which is when I would have eaten anyway. No problem.

Just get to the hospital early and announce your T1 status to one of the nurses or the receptionist if there is one

 

[goji]

Try and get the earliest appointment going so he can eat straight after.

It might be helpful if he had someone who could drive him to the fasting blood test appointment so he would feel less worried about going hypo. Could you or someone else offer to go with him? That might reassure him that he would have someone to assist him if he goes low.

He could test his own BS several times that morning to reassure himself before setting out that his BS is not too low. He should take some snacks along with him. If he feels he is going hypo on the way to the test or while waiting for the phlebotomist - he could always abandon the test and book it for another time.

The night before the test he could make sure he has eaten a lot and that his blood sugar isn't too low before the fasting cut-off time starts.

 

[fatedsnowfox]

These are all helpful points and I'll pass them along to him. There's just one thing, the doctor is saying 12 hour fast, and I think that's where the sticking point is. 8 hours is reasonable overnight, agreed. But 12? Is this just a case of the GP cocking up? Half a day seems a pretty steep expectation.

 

[donnellysdogs]

I don't personally think that a 12 hour fasting is extreme, I personally do not eat after 7pm and do not get up until 7am (ish), and probably do not eat actually untill about 9.30am.

He could run a fasting test himself a week before his blood test and measure at 2-3 hourly rates during the night, so to try and establish that he can get through a night without going hypo....if his levels dip, being a type 1 he should be able to adjust his insulin before the actual fasting night to ensure that he does not go low during the night.

on a separate not, diabetes, arthitis (pain management) and depression can all be hard factors to balance with each other. Your friend does need to be able to express hims/herself to the GP to tell the GP just how he feels. It may be that somebody should accompany on visits to the GP to ensure that the GP is taking all the conditions in to account.

I myself am totally managed by my hospital for my diabetes (type 1) which allows my GP to totally concentrate on my fibromyalgia-pain and depression). He will not touch anything at all concerning my diabetes, despite being the diabetes gp for the surgery. Would this be an option that your friend could ask the GP to consider?

 

[fatedsnowfox]

@donnellysdogs Can only ask I guess. The GP service in Nottingham (where he is) is pretty p*ss poor from personal experience. He's been through a couple of different GPs now and they all seem to behave in pretty much the same way, borderline apathetic. (A couple of times he's even had to fight to get a repeat prescription for insulin - that kind of thing) The whole situation has had him in tears, his mum has been to the doctor with him and it's not seemed to make the slightest difference. It's getting to the point where a stiffly worded letter dropping the "duty of care" bomb on them may be the only option.

With that said, I like the idea of your dry run suggestion; hopefully he'll read through these and take your experiences on board

 

[donnellysdogs]

If your friend is type 1-he may well find that hospital care from somebody that concentrates on diabetes all day is better for your friend.

For example, my DSN writes to my GP and tells him how many vials of insulin I need, and how many bloodstrips I need. My GP cannot argue.....as he has no control over my diabetes!!!!

Is he under hospital care at all?

 

[fatedsnowfox]

As far as I'm aware, the only hospital intervention has been when he's been seriously hyper and has needed hospitalising to bring his levels back down - this has happened twice in the past couple of years and has needed about 7 days as an in patient each time. For outpatient care? I don't think so, they just refer him back to his GP.

 

[iHs]

Hi

Do you know what type of insulin regime your relative is on? Is he injecting 4 - 6 times a day (bolus/basal) or twice a day (biphasic)?

If he is using twice daily insulin then doing a 12hr fast is going to be difficult as the latest he could eat a small snack to prevent hypo middle of the night is probably about 9.30pm.

 

[fatedsnowfox]

Hi there

It's novorapid and several times a day, it seems. I have to admit, I'm completely uninformed when it comes to regimens and the different types.

 

[donnellysdogs]

May be worhtwhile asking to get an appointment at hospital with Consultant. Make sure friend can be accompanied by somebody else.

Ask that diabetes be managed by hospital and request to be be seen on a regular ongoing basis. Have list of reasons why....at hand.

Ask that Consultant or DSN can write to GP requesting the correct levels of insulin and blood tests to be prescribed which suits your friends needs.

This would allow the time for the GP to just concentrate on arthritis and depression......

Has your friend had a positive confirmation of arthritis, and is your friend under any conultant for this?

Depression.....there are a number of cheap standard drugs given out as basics for persons with depression......if your friend is on drugs, and STILL feels depressed the your friend needs to see his GP about getting drugs that may suit better......

It sounds like your friend has great help from yourself, and you will find this website a great source of information and support and help. Me...I have found the best help here than I have had since diagnose 25+ years ago..... your friend needs support and help from HCP's as well as from friends and family. I suggest that you need to find a way to get appointments that specialists deal with specialist topics such as diabetes, and that the GP (general practitioner) deals with general levels of health such as depression......

 

[fatedsnowfox]

Sorry, to expand on that last post:

At one point he had two pens with a quick-acting insulin (the novorapid) and a slower release one. One pen broke and the GP refuses to prescribe a replacement (at least as far as I remember) So he's been left with only the fast acting insulin.

 

[fatedsnowfox]

@donnellysdogs - I do my best for him, but sometimes it feels like it's not enough. The whole situation with the doctor and his health has him in tears way more often than it should and it's all because it feels like nobody is listening to him. I don't live near Nottingham any more so I can't go with him to the appointments, so I end up feeling a bit impotent; hence trying the research through the forums. I'm relieved that my question has been taken seriously and I've had such a warm welcome - not all forums are as convival.

 

[iHs]

Errrrrrh

How is yr relative expected to administer the long acting insulin without an insulin pen? Is he withdrawing insulin using a syringe? Not sure why GP has refused to prescribe another pen but if it's because of the cost, then a complaint needs to be made.

 

[donnellysdogs]

Your friend will not be in a good way if diabetic type 1 and only using 1 type of insulin...

Me for one, if I know what pen is broken, I am mor ethan happy to send one if i Have it in the post to your friends.

Please get your friend to get an appointment with a consultant and DSN at the hospital asap.

Your friend needs to list down on a piece of paper exactly what is need to be said when your friend sees the diabetic consultant / nurse. Keep it specifically to diabetes.

Majke sure your friend is bloodtesting regularly and recording results. Your friend must have a hba1c test done (if possible) 2 weeks before appointment at the hospital. However, it does sound as if your friend just needs to go and sit at the diabetes clinic on MOnday until he can be seen to be quite honest. I am quite dramatic in some of the things I do, and I am not saying they are the best actions, but I would defintely consider doing this if I was your friend........

You may not be close as in the distance of miles.....but miles are not important with the internet and phones nowadays.......the mere fact that you are logging on here is a real concern, and you will find some great help and support. You should also feel very proud of yourself that you are such a good friend to have taken this step toward helping your friend.

PCT's, HCP's, GP's can seem a huge hurdle to get over and to get their help....here, you get the support to get a way to find that help....you will do it, and your friend will get the help needed, it may just be a bit more than a 100 metee sprint....... please let me know what type of pen was broken.... I am on a pump now, and I have back up pens, and also a supply of spare back up pens!!!!! If I can help I can get themn in post for Monday.... don't give addresses over normal postings.....only through private messages.......

 

[fatedsnowfox]

He's online now - I'll ask him to hop on and fill in any blanks

 

[iHs]

Hi

That's a good idea really as then he'll be able to ask stuff himself and tell us what's wrong.

 

[donnellysdogs]

Brilliant.....your friend needs a good friend like you and also needs help and support from others here.

Your friend can get better help, just finding the best way to get it.....

Fasting over 12 hours-is it required just for a blood test OR does your friend have to record levels during the night of fasting...sorry, should have asked this previously....

Support is fantastic here.... you did the best thing possible by logging on and asking the questions that you did......

 

[donnellysdogs]

iHs......LOL!!!!!!!!! Glad to see your responses!!!!! Bit of real sense from a professional amateur!!!!