Issues with Nurse Practitioner

[pam_x_pam]

Hey all
I been having some issues with my GPs practice nurse. She's the one looking after my diabetes.
I been type 2 for over 10 years, very well managed.
At start of this year my mental health has declined rapidly and I was put on some medication which, unfortunately, mess with my sugars.

I been having readings as high at 10 fasting, on average my fasting reading is between 8 and 9, which I know is too high.
My pre meal readings are anything between 8-10 and post meal (no matter what I eat) are always above 11!
Some days they get ad high as 14, even 17.

I also get hypos at night - know this thanks to libre sensor I bought, but also woke up few times and testes and I can go as low as 2.


I shown all of this to the nurse practitioner who taken my hb1ac and decided everything is fine as my results was 46.

She shad my after meal sugars are fine?! And they always going to be high after food. And my pre meals are single figures so who cares?!

I am on 1000mg metformin twice a day and 10mg of empagliflozin once a day.
I follow lowish carb diet of no more than 100g per day but if feels like anything sends my sugars high.
If my sugar goes over 10, I get very sleepy and moremoften than not need to have a nap.

How do I get her to help me? I am only 31 and I feel like she's dismissing me because of my mental health. I was told to "get my head in order" and "watch what I eat" and lose weight which would obviously help but nothing is working.

Any ideas? Based on the recommendations, my sugarsnare way too high.

What do I do?!

 

[madistheword]

OK so "the sort your head out" comment was not helpful and I am angry that she said that ( these comments tend to reflect the thoughts of those that say that sort of stuff have about themselves so please remember that). Can you speak to your gp. Can you get a referral to the DN at your local hospital. Can you complain that you are not happy with the care ( do so rationaly and calmly you are much harder to dismiss that way). Can you change your gp practice?. Dont just accept what's she's saying. Go the full Karen as Karen's get stuff done.

 

[pam_x_pam]

OK so "the sort your head out" comment was not helpful and I am angry that she said that ( these comments tend to reflect the thoughts of those that say that sort of stuff have about themselves so please remember that). Can you speak to your gp. Can you get a referral to the DN at your local hospital. Can you complain that you are not happy with the care ( do so rationaly and calmly you are much harder to dismiss that way). Can you change your gp practice?. Dont just accept what's she's saying. Go the full Karen as Karen's get stuff done.

I can try getting in to see GP, however , ever since on GP left the practice its all been downhill. I don't have much trust in them, since they dismissed my mental health in December 2022 causing a sharp decline in January 2023.

I am waiting to change practices at the moment, I had procedure done in April and want the results before I change, too scared it will get lost.

Last time I spoke to my GP about my sugars she didn't see the need for medication? But there is a new GP so maybe she/he will listen.

It does feel like they doing their best to push me out of the practice as they are not equipped or willing to deal with my mental health issues they have missed initially.

I am absolutely terrified of Practice Manager so I don't think I would be able to complain.

I will try and get referral to Hospital, thank you.
I was with hospital during my pregnancy and remember being on very strict guidelines, so all this is making me trust the GP even less.

 

[Lainie71]

I can try getting in to see GP, however , ever since on GP left the practice its all been downhill. I don't have much trust in them, since they dismissed my mental health in December 2022 causing a sharp decline in January 2023.

I am waiting to change practices at the moment, I had procedure done in April and want the results before I change, too scared it will get lost.

Last time I spoke to my GP about my sugars she didn't see the need for medication? But there is a new GP so maybe she/he will listen.

It does feel like they doing their best to push me out of the practice as they are not equipped or willing to deal with my mental health issues they have missed initially.

I am absolutely terrified of Practice Manager so I don't think I would be able to complain.

I will try and get referral to Hospital, thank you.
I was with hospital during my pregnancy and remember being on very strict guidelines, so all this is making me trust the GP even less.

You should never be terrified of the Practice Manager, makes me so annoyed and I have been there, sometimes its really difficult and I get that, especially when you are not in a good headspace. I had my tummy poked and told to "lose that" by a GP who I tore down when I felt a bit better. The way things are going with the NHS I do wonder if this is there strategy to demoralise mental health patients and diabetic ones also. Hope you get it sorted, get and a second opinion, it always seems different with another set of eyes

 

[PenguinMum]

No health professional should ever tell a patient to get their head in order! Its unprofessional, unhelpful and could be damaging. I am wondering what the new meds are that you feel messes with your BG, you don’t have to say what they are, but I wonder if they could be substituted for something more suitable. The other thing that struck me was you might need to tighten your carb intake levels. It might be worth trying to reduce to a lower daily level and keep records of your readings before/after eating but since you are medicated you should ideally be able to this hand in hand with your nurse to keep hypos at bay. Don’t under estimate stress raising BG also. I hope you can find a way through this with the support of a competent and kind professional. I suspect many in the NHS are stressed so much themselves that they likely don’t realise how they come across to patients atm. Best wishes.

 

[pam_x_pam]

No health professional should ever tell a patient to get their head in order! Its unprofessional, unhelpful and could be damaging. I am wondering what the new meds are that you feel messes with your BG, you don’t have to say what they are, but I wonder if they could be substituted for something more suitable. The other thing that struck me was you might need to tighten your carb intake levels. It might be worth trying to reduce to a lower daily level and keep records of your readings before/after eating but since you are medicated you should ideally be able to this hand in hand with your nurse to keep hypos at bay. Don’t under estimate stress raising BG also. I hope you can find a way through this with the support of a competent and kind professional. I suspect many in the NHS are stressed so much themselves that they likely don’t realise how they come across to patients atm. Best wishes.

Thanks for suggestions, I will look into my diet more, I am already pretty restricted but will see what I can do.

I am on risperidone, suspected schizophrenia. They tried a few different drugs, and this one is only one that calms down the symptoms and let's me live somewhat normal life, so I would be very scared to try something new.

The GP practice seems to not want to accept my mental health issues since they have missed symptoms and complaints which led to.me almost taking an overdose.

 

[HSSS]

The other thing that struck me was you might need to tighten your carb intake levels. It might be worth trying to reduce to a lower daily level

Usually I would 100% agree as that’s still a fair few carbs. But the op is on emplagflozin. An sglt2 medication that has the small but increased risk of euglycemic DKA (normal blood glucose but dka nonetheless so harder to spot) when combined with a low carb diet. So perhaps a different diabetes medication would allow for carbs to be lowered more safely. That way better control and hopefully longer term less medication.

 

[HSSS]

Oh and I agree with the others. The treatment you’ve head is both unprofessional and not at all helpful in managing glucose. Her goals are spectacularly unambitious and I wonder if she‘d be so happy if it were her glucose of that of her loved ones. I bet her patients are considered progressive as expected! See the dr, change practices, make a complaint or ideally all 3

 

[pam_x_pam]

I have asked my husband to ring the GP.see if I can talk to somone today. My glucose has been consistently over 10 and as high as 15 today, I got tummy ache and headache. Just feel like ****.

I will change practices once the results are in from my procedure, I'd be scared they get lost otherwise.

 

[finzi1966]

I think apart from anything else this shows the limitations of HbA1C- 46 is indeed a pretty satisfactory number but in your case it’s probably as a result of the hypos - the fasting and post-prandial figures you mention don’t really fit with an HbA1C of 46.

I really hope that by “get your head in order” she meant “prioritise your mental health for now” because to that limited extent I’d agree with her, but of course the problem is that what she said was crass, and it’s left you feeling unsupported and stressed, and that’s not going to be helping either your mental health OR your blood sugars.

 

[PenguinMum]

Usually I would 100% agree as that’s still a fair few carbs. But the op is on emplagflozin. An sglt2 medication that has the small but increased risk of euglycemic DKA (normal blood glucose but dka nonetheless so harder to spot) when combined with a low carb diet. So perhaps a different diabetes medication would allow for carbs to be lowered more safely. That way better control and hopefully longer term less medication.

Thanks for pointing this out and for your knowledge on the meds.

 

[pam_x_pam]

Got a call back from the new GP. He agreed those levels are not normal and if I feel sick and sleepy, I need my ketone checked. He suggested I go to AE if the tummy ache is very bad, otherwise come to the practice first thing in the morning.

Glucose is currently above 10 before I even had my dinner...

 

[Daibell]

Hi. If you are slim and possibly losing weight then at your (young) age it's always possible you aren't T2 but T1. If this is the case then do ask the GP for a referral to the diabetes clinic for the two T1 tests. I've been down that route.

 

[pam_x_pam]

Hi. If you are slim and possibly losing weight then at your (young) age it's always possible you aren't T2 but T1. If this is the case then do ask the GP for a referral to the diabetes clinic for the two T1 tests. I've been down that route.

Nowhere near slim unfortunately, have quiet bit of weight on me but also have family history on T1 on my mums side. Both her and my grandmother are T1
As far as I am aware I was never tested for T1.

 

[MrsA2]

Also check out the side effects of risperidone.
Weight gain , tiredness, aches among others.

Risperidone – an antipyschotic medicine used to help symptoms of mental health conditions

NHS medicines information on risperidone – how it works, side effects, dosage and who can take it.

www.nhs.uk

 

[pam_x_pam]

Also check out the side effects of risperidone.
Weight gain , tiredness, aches among others.

Risperidone – an antipyschotic medicine used to help symptoms of mental health conditions

NHS medicines information on risperidone – how it works, side effects, dosage and who can take it.

www.nhs.uk

I know all about the side effects. One of the is increased blood sugar. Which I have. I am fully aware this all may be just side effects of my meds but at the same time, even if it is, it shouldn't be left untreated surly?
High sugar levels are dangerous no?

 

[AndBreathe]

I know all about the side effects. One of the is increased blood sugar. Which I have. I am fully aware this all may be just side effects of my meds but at the same time, even if it is, it shouldn't be left untreated surly?
High sugar levels are dangerous no?

Your sugar levels are certainly higher than is desirable, but unlikely to be dangerous at the numbers you have reported.

I do have concerns about you having tummy ache along with your increased numbers, as that could be a symptom of ketoacidosis, which is a dangerous condition. Usually it only happens with very high sugars, but the medication you are on can, in rarer ocassions, lead to DKA with lower numbers. That is why your GP suggested you present at A&E. if the tummy ache worsens. I would also add it would be of concern if you were sick.

If sick, please go to A&E to be checked out.

I don't post any of that to scare you, but to just raise awareness. If you feel you are unsafe, please call 111 who should be able to guide you accordingly.

Let us know how you get along.

 

[pam_x_pam]

Your sugar levels are certainly higher than is desirable, but unlikely to be dangerous at the numbers you have reported.

I do have concerns about you having tummy ache along with your increased numbers, as that could be a symptom of ketoacidosis, which is a dangerous condition. Usually it only happens with very high sugars, but the medication you are on can, in rarer ocassions, lead to DKA with lower numbers. That is why your GP suggested you present at A&E. if the tummy ache worsens. I would also add it would be of concern if you were sick.

If sick, please go to A&E to be checked out.

I don't post any of that to scare you, but to just raise awareness. If you feel you are unsafe, please call 111 who should be able to guide you accordingly.

Let us know how you get along.

I am currently in AE after talking it over with my partner. I was against it because my mental health makes it hard to be in crowded unknown places but you are right it can be dangerous.
I haven't been eating today due to the tummy ache and some nausea, but my numbers are still over 10.

It's all new to me, even tho I been type 2 for some time now but I have had brilliant control up to thus year.

Thank you all for help and good words

 

[AndBreathe]

I am currently in AE after talking it over with my partner. I was against it because my mental health makes it hard to be in crowded unknown places but you are right it can be dangerous.
I haven't been eating today due to the tummy ache and some nausea, but my numbers are still over 10.

It's all new to me, even tho I been type 2 for some time now but I have had brilliant control up to thus year.

Thank you all for help and good words

Pam, you really are in the best place to ensure you are safe tonight. Always, always, better safe than sorry.

 

[MrsA2]

I know all about the side effects. One of the is increased blood sugar. Which I have. I am fully aware this all may be just side effects of my meds but at the same time, even if it is, it shouldn't be left untreated surly?
High sugar levels are dangerous no?

Yes, all medication should be included in any review/treatment but a gp or endocrinologist may not know much about rispidone so make sure you tell them