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First visit to Diabetic Nurse; not a great experience

J

JIS

Active Member
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29
Since diagnosis last week, I have done much reading; so I went to the "long" (30 mins) appointment with one or two questions. To be honest, I felt like I was on a conveyer belt. My HCA1c level was 43 and the entire time was spent in looking at leaflets on diet. It was I who mentioned the need to self test for BG leves at least 4 times at day and she looked surprised and said; "well you can if you like"; but she implied that it really wasn't necessary as my BG, whilst being at 7.7 (after fasting) 2 weeks ago, really was "only borderline" Diabetes.
The 30 minutes was up and I was handed an unopened BG meter and told that I would need to read the instructions. As I left I asked her if I could schedule a C-Peptide test. She looked at me as though I had spoken a foreign language and said "well I dont even know what that's for".

Back home I opened the box containing the "Gluco/RX Nexux" TD-4277 monitoring system. Guess what, no matter how many times I read and re-read the instructions (and I am a techie guy!) I could not get the needle to fire deep enough to deliver more than a tiny pin of blood. So we are back to the nurse (different one) to replace the puncture gun "thingy".

Overall, a poor experience where I came away feeling that, had I not done my reading (and joined this forum), that I was merely being sent away with a "recommended diet and exercise" which would "naturally" bring down my weight, BP, cholesterol and likely also control my BG levels and that we would monitor this periodically ....

I will be taking this much more seriously than that.
 
There is a perception of ignorance I must admit.
I went to the doctors as I had high blood pressure.
Doctor 1: Measured it, it was high, but he said I needed 4 more readings. He also ordered a fasting blood glucose test.
Had it, and went back to see doctor 2.
Doctor 1 had asked for a HbA1C test, as my reading came back as 6.4
Doctor 2 sent me of a GTT. Asked about my blood pressure again, he measured it, it was high, he said to measure it over a few weeks. Asked if I should get a Cholesterol test done at the same time. He said I had one in Nov, it was 4.9 but the LDL's was high.
I had one in November alright, 2011!!!
Then I phoned for my GTT results. Told to see a doctor, so went into to see doctor 3, and she put me on BP tablets and said I was borderline diabetic, before reading was 7.0 and after reading was 12.1!This was last Friday.

Had a call with a Diabetic nurse to set up appointment. As I have to go for a kidney function test to check how the BP tablets are working, I asked her if I could get my Cholesterol and HbA1C test at the same time. She said it was too early for HbA1C, I would need 3 months of dieting to see a difference. A DIFFERENCE from what??? I have nothing to compare it against.

Sunday went on a VLC Diet, have lost 10 lbs so far.

BP down from 145/92ish to 132/82. Fasting blood glucose is down to 6.3

I am starting to think, that I have better control over my health...
 
Hi. I'll be honest an HBa1C of 43 is excellent and effectively 'normal' so you have no worries on that score. Continuing a sensible diet should be all that's needed at this time. If the NHS diet sheet talks about having starchy carbs with every meal then ignore it; you need to keep the carbs low and low-GI. I would suggest you only need to monitor occasionally to find out which foods and how much affect you. If you are a bit overweight then I would suspect your 'early' diabetes is type 2 with some insulin resistance? If so, then a c-peptide test would not be worth doing as it's best used when the HBa1C is into the 7s or above and late onset T1 or just T1 is suspected. Worrying that the nurse didn't know what a c-peptide test was.
 
It's tick box healthcare, the same approach as those national car repair chains. There is little attempt to find out what is going on, carefully diagnose and then agree a course of action and then monitor progress.

GP: What can we do for you?
Me: You called me and asked me to come and see you.

DN: We need to fine tune your medication.
Me: I'm not on any.

Clearly, they don't even read the notes
 
Thanks for replies :)

OK; I returned to the clinic and was squeezed in; was given another "pricking device" which works.

First result (90 minutes after eating a small sandwich) was 10.9 ; I thought that this was relatively high?

My partner Chrissie then suggested I test her (she's not diabetic) and she came out at 10.1 having eaten exactly the same sandwich as the same time as me.

It's early days, I know ... thanks all

John
 
That's interesting - it seems to show that even non-diabetics "spike" after high carb foods. It would have been interesting to see what happened after a further half hour - I think the reason we are told to test two hours after foods is that this is the time by which it would be expected that a non-diabetics blood would have got back to normal. Try again another time with both you and Chrissie and see what her blood is compared to yours at two hours.


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Finzi said:
That's interesting - it seems to show that even non-diabetics "spike" after high carb foods. It would have been interesting to see what happened after a further half hour - I think the reason we are told to test two hours after foods is that this is the time by which it would be expected that a non-diabetics blood would have got back to normal. Try again another time with both you and Chrissie and see what her blood is compared to yours at two hours.
Click to expand...

That's right Finzi. When you eat carbs you have both a glucose and insulin response. The difference between the diabetic and non diabetic is that the insulin reponse is not as effective. There are different reasons for this, not enough being produced or there is some resistance to insulin for example. But, the glucose level in the blood rises in all cases. The presence of glucose triggers the insulin response. As BG rises, more insulin is released. The BG rises within the first 30 mins and is at highest levels between 30 and 60 mins. By 120 mins, in normally healthy people, it is roughly back to the start level. Diabetics on the otherhand have different shaped curves. The initial rise is there and in some, but not all, the peak values are similar but, it takes longer to come down, because the insulin is less effective. In others, the peak is higher because the insulin response is late as well as less effective, so the BG can build to higher levels, but these peaks are not dramatically higher. For these patients, the time to return to normal is usually even longer than other diabetics. Different foods also produce different curves.
 
It's really interesting, isn't it? I think in my case that I'm very sensitive to carbs, so it only takes a very small amount to make me spike at two hours (I don't do one hour testing). But because I don't generally splurge, even when I've slipped up, the spikes aren't terribly high (my two highest recently have been 8.1 after battered fish, and 8.8 after a 1 inch square portion of chocolate cake). They were both back to normal at three hours. But I dread to think what it would be if I had a real splurge and ate, say, a portion of fish and chips, or two thick slices of white toast...mmmmm)


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It is yes. Returning to normal after 3 hours isn't bad, some people are still high before they start their next main meal. Your peak will be higher than the 8s yu mention, but they'd be between 30 and 60 mins. There are loads of publications on tests. This old one shows the complexity of glucose and insulin responses for different fruits, 'Postprandial glucose and insulin responses to various tropical fruits of equivalent carbohydrate content in non-insulin-dependent diabetes mellitus.'

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Abstract:
The plasma glucose and insulin responses were determined in 10 NIDDM female patients following the ingestion of tropical fruit containing 25 g of carbohydrate. The five tropical fruits were pineapple, mango, banana, durian and rambutan. Blood was drawn at 0, 30, 60, 120 and 180 min, respectively. The results showed that the glucose-response curves to mango and banana were significantly less than those to rambutan, durian and pineapple (P less than 0.05). Only the glucose area after mango ingestion was significantly less than the glucose areas of the other fruits (P less than 0.05). The insulin response curve and insulin area after durian ingestion was statistically greater than after ingestion of the others. We concluded that after mango ingestion, the glucose area was lower than it had been after rambutan, durian and pineapple ingestion and the insulin area was lower than that after durian ingestion of equivalent carbohydrate content in type 2 (NIDDM) diabetes.

*******

Now, you say you are sensitive to carbs but, what the above shows is that not all carbs are equal. The study used the equivalent of 25g of carbs in each fruit and even comparing tropical fruits, mango is better than the others. Moreover, durian, whatever that is, had a greater insulin response than the others. In your batter and cake examples, the carbs are in the flour and white flour is just as bad as eating sugar for most people. Also, the fat consumed with carbs affects the insulin response and different types of fat affect it in different ways. You have therefore quite a complex matrix of different types of carb and different types of fat producing a variety of results. The only practical way of knowing how foods work for you is to test and, if you have the time, cook your own using fresh ingredients.

One day finzi I will batter a fish using wholegrain or kibbled wheat and let you know what the result was. I will of course have to sacrifice my health to a chip shop battered fish for comparison. At the moment I am experimenting with sourdoughs and leavens. If I can get these starters right they should be for suitable for several different whole grain breads.
 
Sorry to hear the trouble you have been having, certainly not a good experience on your first visit.

I am lucky that my Diabetic Nurse is fantastic. I don't know what I would do without her! There is another Diabetic Nurse and I'm afraid her attitude is pretty much like the one you seen. It really puts people off wanting to ask for help and should not be the case!

I hope this forum will help you find your way and wish you all the best! It will take time for everything to settle but you will get there!

Lyndesay

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