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Great HbA1c result but got told off for it...

"Numbers and Words"don't mean a "Jot" to me as I do not even have a "Diabetes Nurse",my Doc has Never even offered me "Any Help",10 or more years ago he said My Weight could be down to my age,I was only 43 yrs for God's sake,He just does'nt give a ****.
 
Lisbonlion67 said:
What is "HbA1c"? that is how much my GP has discussed with me= "Sweet F A"
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Does anyone else feel that many GPs completely neglect their T2 patients? Are you allowed to request a referral to a hospital diabetic clinic or is that just for T1s and "other" diabetics now?
 
EllieM said:
Does anyone else feel that many GPs completely neglect their T2 patients? Are you allowed to request a referral to a hospital diabetic clinic or is that just for T1s and "other" diabetics now?
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It is normal for GPs to devolve T2 care to a senior nurse in the surgery. In general, these nurses have more knowledge about T2 than the GPs who simply do not have time to deal with all the hundreds of T2s in the practice. T2s are normally only referred to the hospital clinics if they are unusual cases that need specialist help. There is a laid down Diabetes Care Plan for T2s that surgeries are supposed to follow. My surgery follows it to the letter, and from what I read on the forum, so do most. There will always be the odd poor performer. I have never seen a GP for diabetes - not once, not even on diagnosis. I have seen the same lovely nurse since diagnosis over 4 years ago. She is brilliant.
 
I’m T2 diet controlled and my last hba1c was 35 and I was told by the nurse (not usual DN) that it was very good but I was not to go any lower! Due to stress over a major illness and operation it probably won’t be as I have been eating more carbs that usual but once I get back on track I will aim for as low as possible!
 
Daphne917 said:
I’m T2 diet controlled and my last hba1c was 35 and I was told by the nurse (not usual DN) that it was very good but I was not to go any lower! Due to stress over a major illness and operation it probably won’t be as I have been eating more carbs that usual but once I get back on track I will aim for as low as possible!
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HCPs DON'T think that they should be helping you to normalise your BG levels. £#&+
 
Congrats on such a great HBA1C, Mel.
Apart from perhaps lousy social skills on the part of your DN, you might wish to consider that the lower your HBA1C gets the more near hypo levels you are likely to experience.. At least that was the explanation my DN in Australia gave me (and very pleasantly I might add!). Hypos are the more immediate danger than high levels so as you reach what the lab might consider the ideal HBA1C your DN might be advising caution. Of course you do not wish to dash the dream of a perfect HBA1C but if she has had much experience your DN is actually doing you a favour. Below 53 is ideal, she may be just trying to give you the safer option. I would consider accepting her advice. And I say that having been on insulin for 51 years. Next time, try to politely tease out her of the rationale for her answer/advice.
 
NoKindOfSusie said:
Let's think up some new slogans for diabetes specialists I'LL GO FIRST.

"Defining a new low point in the quality of medical practice"
"Making all other fields of medicine feel better about themselves"
"Toying with the already-fragile psychology of really sick people"
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With all due respect I suggest you not go there. See my answer to Mel below.
 
kitedoc said:
With all due respect I suggest you not go there. See my answer to Mel below.
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The fact is that there are some medical professionals in the UK that get things badly wrong. And some fantastic ones. This is why people are still trying to get professionals to let us control our own insulin while in hospital, asking them to think about language use and to respect mental health. Without even starting on we are not waiting...
 
becca59 said:
What’s to say but well done!
The medical profession have not yet caught up with the flexibility and ability to control levels with the Libre. Your results are as good an advert for getting it on the NHS as any.
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With all due respect Becca, please read what I have written to Mel. This is nothing to do with DNs and doctors not being aware. This is about exercising caution. The lower I get with my insulin pump regime with my HBA1C the more likely I am to getting hypos. Hypos are going to damage me quicker and more readily than a few high BSLs. As long as my HBA1C is below 53 but NOT TOO LOW that is fine.
 
Diakat said:
The fact is that there are some medical professionals in the UK that get things badly wrong. And some fantastic ones. This is why people are still trying to get professionals to let us control our own insulin while in hospital, asking them to think about language use and to respect mental health. Without even starting on we are not waiting...
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With all due respect Diakat, see what reply I gave Mel. Her DN was probably giving her quite sound advice. Reducing the risk of hypos in the short term is more important than a few high BSLs. Yes, the lack of explanation is regrettable but a blank refusal does not help either. And from what I gather, the advice was about obtaining a higher but still perfectly acceptable HBA1C, not dictating insulin doses per se. Just saying, as a TID for 51 years.
 
db89 said:
I've given you a winner for your post as you are clearly going about your management the right way. Please don't be deterred by the conversation you've had - you have solid evidence to the contrary of what the practice nurse was suggesting.
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With all due respect please see my answer to Mel.
 
kitedoc said:
Congrats on such a great HBA1C, Mel.
Apart from perhaps lousy social skills on the part of your DN, you might wish to consider that the lower your HBA1C gets the more near hypo levels you are likely to experience.. At least that was the explanation my DN in Australia gave me (and very pleasantly I might add!). Hypos are the more immediate danger than high levels so as you reach what the lab might consider the ideal HBA1C your DN might be advising caution. Of course you do not wish to dash the dream of a perfect HBA1C but if she has had much experience your DN is actually doing you a favour. Below 53 is ideal, she may be just trying to give you the safer option. I would consider accepting her advice. And I say that having been on insulin for 51 years. Next time, try to politely tease out her of the rationale for her answer/advice.
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I think your advice is blinded to the technology currently in use by mel and others, and the nurse doesn't understand this either. My Hba1c estimated this month is 51 because I'm using a closed loop system, In this nurses world I would have to turn my loop off! and driving at 10mmol is absurd.
 
Engineer88 said:
I think your advice is blinded to the technology currently in use by mel and others, and the nurse doesn't understand this either. My Hba1c estimated this month is 51 because I'm using a closed loop system, In this nurses world I would have to turn my loop off! and driving at 10mmol is absurd.
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I think you are over-worrying. There would be no need to alter your regime. As I said getting HBA1C below 53 but NOT TOO LOW is the aim. Fortunately your closed loop is helping you achieve that. Doctors and DNs see many people and have seen those that crash with hypos if levels of HBA1C get too low. My DN in Australia works with some of the best endos in the country and she regularly advises persons on all sorts of pump regimes. She says: HBA1C is a guide. She has heard international and local expertss show CGM charts of people with perfect HBAiCs, on pumps etc. The fluctuations admittedly are more up and down than closed loop control generally is but it shows that the lower the HBA1C levels go in these samples of people's readings the more hypos occurred. MY DN has seen plenty of TIDs who have got into strife from overdoing the HBA1C reduction. So there is more risk when driving a car if your HBA1C is too low than if you are drivingac car with HBA1C of 51, or 56 etc.
 
Thanks for all the replies, @kitedoc - as I explained, this was the general practice nurse, not a specialist DN. She had no idea what a Libre even was. She didn’t believe me when I said I didn’t get hypos, which I don’t. She also insisted I must be having them at night - and I’ve got reams of CGM data to prove that I don’t. I have so little insulin in my system that a sudden hypo is extremely unlikely. As for driving, I make certain my BG is above six before I set off, just to be on the safe side. I know exactly how many dextrose tabs to take to raise it by whatever I need to.

I take just 17u of Tresiba in the morning, and when I fast, that gives me a completely flat and steady line throughout the day and night, apart from a small dawn rise at around 4am, for which I take up to two units of Novorapid. That’s usually it for the rest of the day, as I eat extremely low carb food, and the Tresiba covers my protein.

I appreciate HbA1c is an average, and doesn’t show swings in BG. But with my current insulin and food regime, I don’t get those swings. In fact, once I’ve worked out how to completely deal with the dawn rise and the slight insulin resistance a certain week of the month, I imagine my next one will be even lower.

I’m aiming to achieve normal blood sugar levels, safely, and with the complete backing of my diabetes consultant at the hospital. I refuse to run artificially high on the insistence of a non-specialist nurse at the GP surgery who just saw a number flagged up on the system and wouldn’t accept any explanations. Running at double the levels of a non-diabetic is asking for trouble. Your suggestion of 53 is an average of 8.1mmol on the meter. I’m sorry, but that’s totally unacceptable to me.
 
Mel dCP said:
Thanks for all the replies, @kitedoc - as I explained, this was the general practice nurse, not a specialist DN. She had no idea what a Libre even was. She didn’t believe me when I said I didn’t get hypos, which I don’t. She also insisted I must be having them at night - and I’ve got reams of CGM data to prove that I don’t. I have so little insulin in my system that a sudden hypo is extremely unlikely. As for driving, I make certain my BG is above six before I set off, just to be on the safe side. I know exactly how many dextrose tabs to take to raise it by whatever I need to.

I take just 17u of Tresiba in the morning, and when I fast, that gives me a completely flat and steady line throughout the day and night, apart from a small dawn rise at around 4am, for which I take up to two units of Novorapid. That’s usually it for the rest of the day, as I eat extremely low carb food, and the Tresiba covers my protein.

I appreciate HbA1c is an average, and doesn’t show swings in BG. But with my current insulin and food regime, I don’t get those swings. In fact, once I’ve worked out how to completely deal with the dawn rise and the slight insulin resistance a certain week of the month, I imagine my next one will be even lower.

I’m aiming to achieve normal blood sugar levels, safely, and with the complete backing of my diabetes consultant at the hospital. I refuse to run artificially high on the insistence of a non-specialist nurse at the GP surgery who just saw a number flagged up on the system and wouldn’t accept any explanations. Running at double the levels of a non-diabetic is asking for trouble. Your suggestion of 53 is an average of 8.1mmol on the meter. I’m sorry, but that’s totally unacceptable to me.
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Thank you Mel. With extra information. things become clearer. I think it is difficult for anyone to give you a fair answer without without enough facts such as your insulin requirements and how long you have had diabetes for. So sorry if hindsight makes things clearer. So unless the nurse had those parts of the picture she might have been assuming the need for caution. If you and your doctor have things sorted then fine. Just do not be surprised if things change over time.
 
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