First appt with Consultant - What to ask etc?

[MrsKitty]

Hi,

I am 35 years old and was diagnosed with T1 Diabetes in February of this year. I have my first appointment with the Consultant at the hospital this afternoon, and have just realised that I should probably be a bit more prepared than I am with some questions etc! I think, having just 'got on with it' for the last 5 months, and spending a fair bit of time lurking around on this and other sites I've not really thought about what to expect from this appointment.

So, what I'm asking, I suppose, is what should I expect from this appointment? What role does the Consultant play in my ongoing care? What role do the DSN play? (I've not spoken to them since about April as I feel like things are going reasonably well at the moment and haven't had any reason to call them.) What questions would be good to ask the Consultant?

A brief bit about my experience so far:
I'm on Novorapid and Lantus, which the DSN agree to put me on (rather than 2 injections per day?) to allow me a bit more flexibility as I am a shift worker.

On diagnosis I was told to take 8 units with every meal, plus my Lantus, and to just eat a "normal healthy diet". Of course by following this advice I quickly found myself having several hypos a day. Finally after about 6 weeks I got to see the dietician whole explained how to count carbs and match my insulin to my carbs. Since then things have been going pretty well, and I generally try to stick to 30-60g carbs per meal, and therefore 3 to 6 units of novorapid per meal. I'm pretty cross about how I was told to take insulin but with no real guidance about food in the beginning - I think it was dangerous, frankly, and resulted in one hypo where I went down to 1.7 which was quite scary. Should I complain about this to the Consultant, or just get over it? (I don't want to start out looking like someone who's going to be complaining about stuff!)

I'm hoping to do the DAFNE course, but I believe I need to have been diabetic for 6mths + before I can go on the waiting list. The dietician said that the way she has shown me to carb count match insulin is the basic principle of Dafne, but I'd like to do the course anyway - I'm sure there's alot I could learn from it.

Oh, I've rambled on a bit now - The basic reason for my post is "What should I ask, and why" so if anyone has any suggestions, please let me know!

 

[daisy1]

Hi Mrs Kitty and welcome to the forum Here is some basic information written for new members on how to manage your diabetes. The last link consists of questions to ask at a clinic appointment which I think should cover what you need to see your consultant. It's best to write down your list of questions as you might find you forget when you are there. You can ask as many questions as you like on here as there is always someone here who will have an answer for you.

Here is the advice that Ken and I, as Forum Monitors, usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

For more information on CARBOHYDRATE see here:

viewtopic.php?f=3&t=20306

This is NOT a low carb diet suggestion, just a reduction in your intake of carbohydrate. You have to decide yourself how much of a reduction will keep your blood glucose levels in control.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.


As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try!!

For TIPS FOR STRIPS see here:

viewtopic.php?f=20&t=19002#p173253

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2011 NICE guidelines for Bg levels are as follows:
Fasting (waking and before meals).......between 4 - 7 mmol/l...(Type 1 & 2)
2 hrs after meals........................no more than 8.5 mmol/l.....( Type 2)

2hrs after meals......................... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do at least 30 minutes moderate exercise a day, it can be split into 10 min sessions to start with. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Finally a few QUESTIONS TO ASK AT DIABETES CLINIC.

viewtopic.php?f=20&t=17091



Sue/Ken.

 

[MrsKitty]

Fantastic - Thank you.

Probably should have thought to have a quick look around the boards for that list, but the appointment's kind of crept up on me (I know, I know, been waiting for it for months, but I've had a busy weekend!)

 

[ClaireG 06]

Hi and welcome to the forum Mrs Kitty

Good luck with your consultants appointment today. As Daisy said writting your questions down is a good idea. I always do this now, otherwise i forget something!

 

[Snodger]

only just seen your post so sorry if you have already left for your appo...

With regard to the role your consultant, DSN (and GP, and optician) will play in your care, that will vary from one place to the next - so that question itself is a very good one to ask. Ask WHO will be administering all of the 9 checks you are entitled to.
The 9 checks are: HbA1c ('average' blood sugar test). Blood pressure. Weight. Foot checks. Smoking check (ie do you smoke). Retinal screening (eye check, often done by eye specialist rather than hospital consultant). Creatinine levels (blood test). Cholesterol levels (blood test). Urine test for protein in the urine.
I think for the first ever appointment, don't bring up the bad advice you had earlier. That is not to say you should ignore it - you are absolutely right to be angry - but appointments are all too short and it's best to get as much as you can out of it for you. But I would maybe at the end say that you have some concerns and would like to know who to write to about it. Then you can put it in a letter or email and put your points across calmly. You are absolutely right to want to make a point of it. There are some very good doctors out there, but there is also some scarily simplistic, even dangerous advice given out as well, and it does need to be challenged when it occurs.

 

[jgibson1962]

I've been a T1 since July and have my first consultants appointment in a couple of weeks. To be honest i really cant think of what to ask, as everything so far has been answered by the nurse and dietician and everything is ticking over nicely. So i think i will go in with an empty head and let him tell me the technical details of my T1 and question him as we go along.