How good is your DSN?

[Jasmin2000]

I moved to UK from Germany to study. In Germany, we meet our GP regularly for updates, Q&A, examinations, etc. So I was surprised in UK that I've never met my GP and only get seen by a DSN, who doesn't seem to know much about te day to day life of a diabetic.

On recent visits I've had a full marketing pitch for the Libre 3 - but wasn't told that the sensor doesn't measure BG but IFG, no mention of the lag, and apparently I don't need to do fingerpricks anymore. On the second visit I asked about counter-regulatory BG spikes, such as the dawn phenomenon, but the DSN said she had no experience in that area and 'anyway, an A1C of 8 is OK for some people'. She prescribed statins because 'you are diabetic' - no refeernce was made to my serum lipid profile, etc. and I was told there were no side-effects.

Is this all there is to be expected from a UK DSN or have I gor a dud? Who do you ask about your specific situation and what those side-effects may do in your specific case?

 

[ianf0ster]

@Jasmin2000 Unfortunately that sort of DSN is still quite common. Even GP's can be as ignorant. But some (both DSNs and GPs) are pretty good.
Oh and one other thing, quite a few people now who thing they are seeing a qualified nurse of GP, are only seeing somebody who has done 2/5th of the training (in the case of doctors) - they are called Physician Associates, and only have 2yrs study and can't prescribe or order X-rays etc. Similar thing with nurses.

 

[Hopeful34]

Is this a DNS at your drs, or a hospital team? If the former, I'd suggest asking for a referral to the hospital where you will see an endocrinologist and a DNS with a lot more training than a GP based one.
It's normal for health care professionals to push statins for type 1 Diabetics, but you don't have to accept them.
I'm assuming you had bloods done prior to your appointment. If you register for it with your surgery, you can see the results online.
I'm very fortunate, in that I see a fantastic endo, DNS and dietitian, every 6 months at a hospital clinic. Emails or telephone calls to the DNS are always replied to promptly.

 

[Jasmin2000]

@ianf0ster many thanks for your insights. At least I know what to expect from a DSN and in the worst case that's very little.

@Hopeful34 - thanks also for the infos - I was describing the DSN at my GPs surgery. Now I have got a referral to the local hospital and am booked in for next week. I don't know if this person is an endo but I hope so.

I had bloods done before being prescribed statins and all serum lipids were slap bang in the middle of the recommended range, as were liver and kidney values. In fact there were no risk scores that warranted any treatment and I was told it was because I was diabetic.

My bloods and risks have not changed for years and In Germany I was told statins were not recommended for cardio protection in diabetics, as diet can achieve the same thing (at least for me) and indeed it has. Anyways, I'll wait for the hospital meeting to see what they say.

Thanks again for the helpful fact-finding.

 

[Outlier]

Mine was initially pretty dogmatic and no help at all, but since she has seen I have brought down my readings to non-diabetic levels and maintained it, she has become much mellower, and even offered a compliment on my investigation of modern statins research when the GP had delegated the task of getting me on statins. Nobody has yet asked me what I've actually done to get these blood readings, though. I like her a lot more than I did from our first two interactions.

 

[jjraak]

Is this a DNS at your drs, or a hospital team? If the former, I'd suggest asking for a referral to the hospital where you will see an endocrinologist and a DNS with a lot more training than a GP based one.
It's normal for health care professionals to push statins for type 1 Diabetics, but you don't have to accept them.
I'm assuming you had bloods done prior to your appointment. If you register for it with your surgery, you can see the results online.
I'm very fortunate, in that I see a fantastic endo, DNS and dietitian, every 6 months at a hospital clinic. Emails or telephone calls to the DNS are always replied to promptly.

I think there's an assumption type 1 and type two get anywhere near the same access to treatments or professionals.

Not meaning any offence.

Best I've been offered is a fleeting visit with doc, then ofc to any available diabetic nurse.

But the o/p's experience does reflect of what I've read and personally experienced.

And if all type 2 asked for a referral, that would most likely just delay any type 1 who quite likely does requires it more.

 

[Hopeful34]

think there's an assumption type 1 and type two get anywhere near the same access to treatments or professionals.

No offence taken, but I'm very well aware of the differences in access to treatment and professionals that occurs for type 1 and 2 having cared for a type 2 diabetic relative, and also reading the posts by type 2's on the forum, and having friends who are type 2.
However, I was replying to a post from someone who's profile says is type 1. If they had been type 2 my response would have been different.

 

[jjraak]

No offence taken, but I'm very well aware of the differences in access to treatment and professionals that occurs for type 1 and 2 having cared for a type 2 diabetic relative, and also reading the posts by type 2's on the forum, and having friends who are type 2.
However, I was replying to a post from someone who's profile says is type 1. If they had been type 2 my response would have been different.

Ooh.

Humble apologies....
Not sure how I saw T2D...

Teach me to fully read before replying.

 

[Hopeful34]

No worries @jjraak it's easy to do.

Take care.

 

[Deleted member 527103]

I have annual(ish) appointments with a hospital based DSN. She knows more about living with Type 1 than the endo and is also very responsive to emails.
I once met the DSN at my GP surgery. It felt as if she struggled to spell "Type 1" and was reading from a list of questions she didn't understand. She asked how many units of Lantus I take a day and was confused when I told her "None. The Lantus, which I request less than once a year, is a backup in case my pump fails." She also asked if I had ever experienced a hypo. My records show I have had Type 1 for 20 years. Not sure if she appreciated being told that anyone with Type 1 who had never experienced a hypo after that time was either lying or running their BG high.

As far as Libre reading ISR (as all CGMs do). it is true there is a delay between ISR and BG. However, it is also true that the algorithm that converts from ISR to BG, accommodates this delay and is only a problem if there is a significant change in trend during the last 15 minutes. If this is happening, your BG was probably high ore low and the advice (even from Abbott) is to check against finger pricks.

With regards to statins, this is standard guidelines from NICE for everyone with diabetes over the age of 40 due to the increased risk of CVD in people with diabetes. I was recently told this was due to us experiencing greater fluctuations in BG which puts strain on our heart, even if there are no risk factors in our lipid results.

Finally, my GP and I do not know each other. I don't even know their name. I have a local GP surgery I visit if I am ill and get whoever is available. Since my diabetes diagnosis, they have had no input into my diabetes management. This suits me as I prefer a specialist endo to manage my diabetes rather than a general practitioner who knows a little about everything.

 

[Jaylee]

I moved to UK from Germany to study. In Germany, we meet our GP regularly for updates, Q&A, examinations, etc. So I was surprised in UK that I've never met my GP and only get seen by a DSN, who doesn't seem to know much about te day to day life of a diabetic.

On recent visits I've had a full marketing pitch for the Libre 3 - but wasn't told that the sensor doesn't measure BG but IFG, no mention of the lag, and apparently I don't need to do fingerpricks anymore. On the second visit I asked about counter-regulatory BG spikes, such as the dawn phenomenon, but the DSN said she had no experience in that area and 'anyway, an A1C of 8 is OK for some people'. She prescribed statins because 'you are diabetic' - no refeernce was made to my serum lipid profile, etc. and I was told there were no side-effects.

Is this all there is to be expected from a UK DSN or have I gor a dud? Who do you ask about your specific situation and what those side-effects may do in your specific case?

Hi,

This about sums up my experience. (Though I’ve never had any marketing for any of the Libres from them.)
Mine seems more focused after feet, blood taking & urine samples on box ticking a “mental health” survey…? (Plus the blind statin push.)

Oddly, I was at an organised T1 meet a few days ago. (In a different county to mine.) There was a local DSN sitting in doing a little “Q&A.” She actually knew her T1 onions..

As for my endo?? I only show up to let DVLA know, I go..

 

[Jasmin2000]

I once met the DSN at my GP surgery. It felt as if she struggled to spell "Type 1" and was reading from a list of questions she didn't understand.....

Thanks for the feedback @In Response, I think that's the one I now have

As far as Libre reading ISR (as all CGMs do). it is true there is a delay between ISR and BG. However, it is also true that the algorithm that converts from ISR to BG, accommodates this delay and is only a problem if there is a significant change in trend during the last 15 minutes. If this is happening, your BG was probably high ore low and the advice (even from Abbott) is to check against finger pricks.

I'm a bit confused here - the algorithm doesn't convert to BG (on my Libre) - it's called 'sensor glucose' and is the ISR as you called it (or interstitial fluid glucose, IFG). It also doesn't 'accommodate' the lag between BG and IFG at all. My BG curves are always 5-20 mins ahead of the sensor curves.

What the algorithm does do is to fit a series of readings into a curve, and if there's an outlier, say a sudden jump to 9.5 (see image below) preceded and followed by a 7.5, then it will ignore the 9.5 and draw a lower curve. But as I said this curve is still lagging behind the BG curve.

With regards to statins, this is standard guidelines from NICE for everyone with diabetes over the age of 40 due to the increased risk of CVD in people with diabetes. I was recently told this was due to us experiencing greater fluctuations in BG which puts strain on our heart, even if there are no risk factors in our lipid results.

Hmm.. but they are prescribing based on clinical results for 'the average diabetic' and this guy doesn't exist as we all have different lifestyles. Whilst that may be OK for some the GP must assess need based on individual patients. Also, if 'strain on the heart' is what is bothering them then why am I getting a cholesterol medication and not a low-dose beta-blocker?

 

[Hopeful34]

Also, if 'strain on the heart' is what is bothering them then why am I getting a cholesterol medication and not a low-dose beta-blocker?

I would ask this at your next hospital appt @Jasmin2000 My endo recommends his patients start a low dose blood pressure medication when they're 40, even if their blood pressure isn't high, to protect their kidneys and microvascular system.