GP -v- Specialist

[Sharlieboo]

Hi all,

I've just had a truly awful appt with my GP.

In summary I was diagnosed as Type 2 by my GP last Dec and due to normal BMI yet high bg readings (18 - 19) was put straight onto metformin. Around Feb time the nurse practitioner changed my meds to prolonged release metformin and doubled the dose. Since that time I've lost about 1/2 stone in weight to a BMI of 23, have watched my diet but bg is stubbonly stuck at around 9.2 at each 3 monthly check-up. My GP was on hol and another doc at my surgery saw me on referal after my last check because nurse practioner thought I needed increased meds. He put me on gliclazide in addition to the metformin and also said he thought chance I might not be Type 2 - might be MODY or some other type so he referred me to the Diabetic Clinic at the hospital and told me to come back 3 wks after start of taking the glic. I arranged that appt for today not knowing that my hosp appt by chance would come through for yesterday.

So yesterday I saw the specialist who thought I was too old for MODY (I'm 36) but didn't want to entirely rule it out. She agreed with 'locum' doc that not necessarily Type 2 either and may possibly have early onset Type 1. So I had some blood tests done and will get the results in 6 weeks, or so. In the meantime she said to see my doc and for doc to prescribe a monitor and some testing strips and for me to test twice a day, at random times before meals eg; before breakfast and tea one day, before lunch and at bedtime the next etc. She also said that if my diary still showed raised bg doc should up my gliclazide dose in the meantime pending the results of the blood tests. She said likely my meds woudl change whether I remained dx type 2 or changed to type 1 etc.

So I saw my GP today. She said what the specialist had suggested about the monitoring was against all normal procedure and she wouldn't prescribe any of it, stating monitors are down to the hospital in any event and that even type 1s only get one box of test strips per year. I was stunned. She's kept hold of the prescription request note from the hospital and is going to call them on Tuesday so I have to wait to find out whether I should be testing or not and presumably as to who will be prescribing. I'd buy the things myself but we're on a tight budget due to hubby being out of work due to redundancy since April and I work p/t and we have two small kids.

Is it normal for GPs and specialists to disagree in this way? What happens if I turn out to be type 1? Will I have the same battle to get a monitor and testing strips?

I've gained 4lbs in weight in the 3 weeks I've been on the gliclazide. It's really depressing. They won't change it to something else, understandably, until they know precisely what type of diabetic I am. Is there something I should be mentioning/asking for as an alternative?

I've lost all faith in my GP :-(

Sharlie

 

[cugila]

This is frankly appalling ! Your GP (General Practitioner) is setting themselves up against a Consultant, someone who has had many extra years training to be in the position.

TBH I think this is something that the GP and Consultant need to discuss. Contact your Consultant direct and inform him/her of what took place. Explain how you feel and that you have lost confidence in your GP. Hopefully, any Consultant worthy of the name will get on to the GP and hopefully sort things out.

It may be correct that your GP doesn't have any meters available and that you need to get one through the Diabetic Clinic.

This all smacks of being down to costs.....nothing more. For any GP to state that they only give one BOX of strips a year to a type 1 is scandalous !

If you are still denied any strips, complain to the Practice Manager, then the PCT if needs be. Do not accept this. You may have to find another more Diabetic friendly GP.......anything has to be better than this disgraceful attitude.

My own GP never questions ANY prescription or recommendation from my Consultant. How it should be.

Ken

 

[IanD]

I hope they sort out their differences - you do need a meter, at least while you are getting control.

Have they given you a diet ? The general reduced carb advice you get from Ken or Sue should help you more than the official DUK diet.

 

[Sharlieboo]

Hi,

I already try to keep my carbs fairly low although do admit to having a bit of a treat at the weekend. Giving up lots of potatoes, pasta and bread has actually been harder than giving up chocolate and sweet stuff. I tried switching a small bowl of shredded wheat or cornflakes for a protein based breakfast but just couldn't do it. I admitted this to the np when I saw her but the general feeling is that with my diet, allowing for the odd treat, my weight and all the meds I'm on, I should really be getting a lower reading than 9.

I've also just been diagnosed with kidney stones and on doing some googling have found that they are often caused by eating too much leafy green veg, nuts etc ... and, of course, these are things I've increased in my diet since being dx diabetic. :roll:

 

[Tracey167]

Hi

My god your G.P sould'nt be a G.P she obviously does'nt know a thing about diabetes type 1 or 2, i'm a type 1 and have been for nearly 28 years and i have to do 4 BG tests a day sometimes more if i go hypo so where she gets type 1's only get 1 box of test stripes a year from she must be living in the dark ages. And yes consultants and specialists know alot more than any G.P does. Well I hope you get it all sorted soon.

 

[Jen&Khaleb]

I've had the same problem with Paediatrician -v- Endocrinologist. Such conflicting information but I do find I tell the Paed's doctor that what he wants wont work and the Endo and I think much more alike.

 

[Cowboyjim]

Sorry to hear your story... bad enough with DM let alone this lack of sympathy...
I have yet to see my actual assigned GP...was diagnosed by one, seen another then another until I got the one who really knows his stuff... he is Indian... just ring the surgery and see whoever is around so you can get a second opinion... just a thought. 8)

 

[sugar2]

Hmmm. I did get my meter from the hospital...maybe call ack and ask to speak to the specilist nurse...who I am sure could sort you out with a meter...and then you have to get the GP to prescribe the strips...hopefully this is what they will sort out on Tuesday?

This is really not fair, as you are clearly trying your best here and need their support.

I actually have a metrer that I no longer use..with some strips and a lancet device. If it is of any use, pm me, and I am happy to put it in the post. You will need to give the lancet a sterilize, but the rest should be fine.

 

[iHs]

Hi

Not sure if you would be able to get a meter from a D clinic unless you were using med that lowered bg levels such as insulin etc but there's no harm in asking as many reps do leave their products with the dsns.

Failing the above, ring DUK and ask for a sample copy of Balance magazine foc and then you should be able to get yrself a meter if you say that you use insulin and need to test 4 times a day. The cost of the meter is set off against the profit made from the test strips. Get the strips from eBay or a chemist if yr GP wont prescribe.

 

[Sharlieboo]

It's all be sorted out now - thankfully. I've been going round in circles being told different things though for best part of a week.

GP spoke to consultant at the diabetic centre as to why she felt I needed to test. Cons clarified why but hadn't realised it was down to her to sort out a monitor for me whilst I was there in clinic. So I was told to go and pick one up from the hospital and GP would prescribe test strips. Only change being I'm only to test for 2 weeks and not up until my next appt. If my levels remain raised over 2 weeks of testing then my glic dosage is to go up pending results of the all the bloods I've had taken to establish exactly what type of diabetes I have.

I was pulling my hair out at one point because hospital said that I wasn't to have a monitor even though gp and cons had agreed I should collect one from the hospital. That took some sorting out but now I'm due to go and collect one on Friday so, fingers crossed, it will be an end to the whole sorry monitor saga.

 

[Marky4]

hmm still sounds like your GP dealt with it very badly. Certainly in the way he/she dealt with you, and the things you were told. Which must have caused quite a lot of stress. You have two children, and responsibilities - and have a right in this country to help and support.

Remember you can change your GP if you are not happy with the advice or help you have received. Do it politely and calmly. I have done this once or twice for various things. Some GP's have no people skills - as soon as you see someone new, you will realise you made the right decision.

 

[Sharlieboo]

Thanks, and you're right, I am considering changing GP.

The nurse at the hospital was great yesterday, very helpful. She was also apologetic that I'd been messed around so much. She couldn't understand why my GP couldn't just have arranged the script and 10 mins needed to ensure I was shown how to use the monitor. She gave me enough strips and lancets for almost all of the 2 weeks I need to test even though I wasn't technically her patient. The diabetes cons spotted me on my way out and again said sorry for way I'd been treated. She told me she had had 'a good telling off from the GP'. I think she was shocked by my GP's behaviour.

Typically I phoned my GP to ask for the script for the remaining lancets and strips and she called me a 'star' for getting the monitor etc.

I'm relieved it's all sorted out now. A bit confused by the readings so far though. 7.9 before lunch yesterday ... big drop to 4.7 just before dinner, so I was expecting a similar reading just before breakfast but it was 7.6. The tricky thing will be limiting myself to testing randomly before meals twice a day ... I suddenly have the urge to keep testing lol.

 

[Marky4]

Yeah those are still not bad readings though. Many of us have to avoid readings of 10+ all the time

 

[ancientdiabetic]

Hi there what yu say about your gp's ethics is apalling. Have you thought about contacting a meter company direct I do and they send me free meters when I request them . I was under the impression that drug companies like to distribute m eters because they make their money from the test stips which are very costly. Give lifescan a ring . . its a free phone number and you can google it good luck me dear.
ancient

 

[Sue Morton]

Hi why not just look on this site where you can apply for a Bayer contour meter you get 25 strips free as well as the finger pricking gadget and needles. The test strips are expensive though if you buy them from Bayer around £23 but you can get them off of eBAY for around £16.99.

Your readings don't look to bad but where your reading dropped to 4.7 what did you eat at your meal before this was it different to that when you had the 7odd reading :?: Also did you eat at different times = if the gap between when you had breakfast and then lunch is a longer gap one day to another this could result in the lower reading i.e. 4 hours compared to 3 hours etc.

They say to test before and 2 hours after a meal - your BS after a meal should be no more the 8.5 if its lower all the better.

Also what you can eat one day or even for years your body all of a sudden can react to that food so what you seem to be able to eat one day you can't another so we as diabetics need to test regularly to make sure what we eat our body isn't reacting to. For example I had some polish rye & wheat bread and my reading was 5.1 then 6.1 brillaint I can have toast which I love didn't test the next day but did on the 4th 9 something and the next day 10 something so not so brilliant and back to the porridge. Had I just tested the once then I could have carried on eating the bread. To me this illustrates the need to test and keep an eye on what I eat and how I react.

I also have spag bol now and again but always test after to check that I am still able to eat it sometimes I do a 2 hr and 4 hr test as the carbs take longer to react. At the moment so long as I keep my portion small I am okay.

All our bodies are different and what one can eat another can't.

I hope all goes well and we type 2s that have to get our own meters and buy our own test strips really appreciate how important testing is or we wouldn't fund our own strips which I think is terrible if you are trying to control your diabetis and taking it very serious to prevent any long term affect of the diabetis. Which will in the end save the NHS further costs.

Having the Hbca whatever its called test (can never remember it as still new to this myself March 2010 diagnosed) doesnt show the peaks and falls of your BS it just shows a general view of the last 3 weeks of your BS it doesn't show where you may have peaked if you eaten the wrong food or dipped if your not eating right.

There is a lot about not getting the test strips on this forum so you are not alone in this matter.

All the best
Sue

 

[Sharlieboo]

Thanks, once again.

I've been testing for a few days now and my readings have gone up to between 9 - 12.7. I had a couple of glasses of red wine on Saturday night though - but ate sparsely yesterday. I was expecting it all to come down this morning before breakfast but still 12.3. No doubt I'll get a good idea of foods triggering it soon enough.

I don't know if I mentioned it previously but my husband is out of work at the moment due to redundancy and I work p/t due to having two small kids so we're on a tight budget - hence my frustration with gp & hosp disagreeing over who should prescribe the very thing both agree I should do. When the prescription runs out and my husband finds another job I think I will find it useful to carry on testing - assuming my dx remains as type 2. If my dx is something else I may have to continue testing more regularly in any event. I did actually want to buy my own meter and test months ago when first diagnosed by all the medical professionals kept talking me out of it :roll: