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Type 2 Medical School Training

V

viviennem

Well-Known Member
Messages
3,140
Location
Wensleydale, North Yorkshire
Type of diabetes
Treatment type
Other
Dislikes
Football. Bad manners.
Hi everybody! It's a long time since I've been around, but I have a serious question to ask:

Can anyone tell me how much training in Type 2 is included in a medical degree?

I have been self-managing brilliantly for 5 years now, with strips when I needed them and all sorts of help and encouragement. Now my practice has a new "specialist" GP, who has told me I can no longer have test strips on repeat prescription, as there is "no clinical necessity" for me to test!

Oh yes? How does he think I have achieved the close control I have?

I get about 1 pot of 50 every 2 months, which I don't think is excessive.

Anyway, I am taking this all the way if I have to, right through complaints procedures and so forth - but it would be useful to have some baseline information on Med School diabetic training. I am pretty sure I know more about my Type 2 (Type 2 in general!) than he does, but I don't want to upset him too much from the start.

Viviennem
 
I once had a GP, whose specialty was diabetes. He really didn't do anything specific to change my lifestyle or my weight. He didn't recognise my symptoms for RH!
His one liner I distinctly remember was 'it's all to do with your diabetes. That's part of the disease!'

Bloody useless!
 
It doesn't matter how much he knows by the sound of it -- he's toeing the NHS line. The policy for T2 is no meter, no strips.
It may be that some enlightened GPs are genuinely agonising over what to tell us, in which case I wish they'd hurry up and resolve their ethical/career dilemma because a lot of people are suffering unnecessarily.
Well done @viviennem and good luck in your crusade.
 
Nice: https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#self-monitoring-of-plasma-glucose
The NHS isn't alone in this . It's stance is very similar to the one taken here in France (only here they are more explicit about only funding a limited amount of strips in the context of education) and in many other places both in Europe and elsewhere.
British GPs are allowed to be a little more independent than in many places and we see on here that a few can be convinced of the benefit of self monitoring.
We see results on here from motivated people and there is no doubt, it really helps them.
The problem is that a major Cochrane review of studies of people 'in general' shows little benefit after 6 months and goes away after 12. http://www.ncbi.nlm.nih.gov/pubmed/22258959 Any training that a GP has may well include this evidence.
(and tbh there was a time when it was quite obvious that a number of those with prescriptions sold their strips on Ebay- to those who wanted them but couldn't get prescriptions)

DUK doesn't like it ; hence the pack
 
I don't think it matters how much training in T2 a GP has, when it comes to this issue. And I think you would be wasting your time to make a complaint about it. Plenty of others have tried. I suggest buying the cheapest strips you can get. As you don't use many then the cost will be minimal. Sometimes we have to contribute to the cost of our health care and that's life.

Here's a link for the sd codefree meter http://www.homehealth-uk.com/medical/blood_glucose_monitor_testing.htm
The discount codes for the strips are --5 packs. 264086-----10 packs. 975833
 
It is the NICE guidelines that matter, and they are ambiguous enough that his attitude is justifiable (in a dimly lit room, when squinting)

You can complain, and you may get your strips, but it will be ultimately down to the decision of the individuals involved.

Can you go via the practice nurse?

Personally, I buy my own meter and strips (SD Codefree)
At your rate of consumption (50 strips in 60 days) that would cost me approx £3.50 a month.
 
Thank you all. Not quite what I was looking for, so I'll have to go on seeking.

One of the reasons I asked was following on from a conversation I had with my young cousin, an excellent nurse with a nursing degree. I asked her: if I was brought in to A&E, unconscious, and you found out from my ID that I'm Type 2, what is the first thing you'd do? Answer: set up an insulin drip! Oh dear!

Turns out her training had covered Type 1 reasonably well, but barely any mention of Type 2. I have a sneaking feeling that GP training is the same. The practice "Diabetic Specialist" GP usually has no extra experience - has just drawn the short straw for the admin!

Sadly our lovely Practice Nurse, who knew more about diabetes in general and Type 2 in particular, than all the doctors put together, retired last Christmas. I haven't fully sounded out the new one yet, but I will be doing soon.

I shall stick to my Abbott meter, and buy my strips direct. Now I have PIP I can just about afford it. I just don't see why I should!

Viv
 

I see your point. Perhaps your ID should include instructions on treating a patient with T2!
 
in my experience over the last 20 plus years of being type 2 every GP, dentist, podiatrist and all other medical people blame every ailment that ive had since 1994 on my type 2 diabetes. It seems they use it as an easy and lazy excuse for a diagnosis.

I sometimes feel if i went to docs with an axe embedded deep in my skull my doc would point to my not great blood sugar levels for my headache
 
I seem to have the opposite problem, which can be just as bad in some ways. They fail to take my diabetes into account and make treatment decisions as if I don't have it. Although I will say my dentist is very good. First dentist to tell me the truth about my gum disease (worsened by diabetes) - that I need to do certain things to avoid losing all my teeth eventually! I had seen 3 other dentists in the last 5 years who never mentioned that if your gums are receding, there is a risk of this happening further down the line. I'm pretty angry with them for that.
 
Just an update - I haven't answered my question about GP training yet, but I have had a satisfactory outcome.

I wrote a 3-page essay to the practice about why I should still have my strips - and lo and behold! there they were at my next "repeat" request. Subsequently I saw the specialist GP, who said - "keep your strips; whatever you're doing, it's working".

He also told me that it wasn't a practice decision, it was a Clinical Commissioning Group directive - and pulled a face! So I have sent a variant of the same letter to the CCG, who have duly acknowledged receipt. They are having a meeting locally in 10 days time - sadly I'm on holiday, or I would definitely be raising the subject in the question-and-answer session!

What it comes down to, is that they are trying to save money. I only test now about 1 week in 5, just to make sure everything's okay, as I know what I can and can't eat. I'm very stressed at the moment, and in constant low-level pain, both of which push my bg up a bit. My next HbA1c (next Wednesday) should be interesting!

Watch this space!

viv13
 
If you do find out how much training the medics are given ..do please post as I would be very interested to know
 
in our Practice the GP responsible for overseeing diabetes was "given" the task. He has no soecialusm in diabetes or interest in it at all. He just has to try and get our practice up to the required DES/QOF standards expected for the practice to receive good ratings and their full income.

If asked to prescribe insulin for a pump the GP wouldn't be anle to find it on the system so would be sent to the DSN for her to do. This did happen to me.
 
GLad to hear you got the strips. What's the cause of the pain?
 
I work in a Med School, I will try to find out for you. Also, GPs get in the region of 3000 pounds per diagnosed diabetic. i used this as ammunition when arguing for a meter and strips, I simply pointed out that as they were in receipt of this money, due to MY diabetes, then spending some of it on ME would be a good use of it and save the NHS money further down the line. It worked, good job too as if left to the GPs advice "dont eat processed or white food and watch your portions" and one test per year I would be very poorly by now.
 
£3000 !! Thats more than dementia diagnosis!! Yet they ate complaining their incomes are going down!! With more getting diagnosed it should be a huge gain to them!! Is that £3000 over the life of a diagnosed diabetic from all their DES/QOF payments fir hitting their targets (so many GPs don't hit them!!) or a payment upon diagnosis?
 
Giving money to GPs when diabetics are diagnosed is an incentive for them to do nothing about preventing diabetes, particularly in those with prediabetes. A bad policy decision in my view.
 
When I saw my GP and got my strips back, I asked him who was to blame, the practice or the Clinical Commissioning Group? It was the CCG, of course! So I sent them a copy of my letter to the practice, and got a letter back to the effect that I was to discuss it with my GP and if he was happy, then I could keep testing! So there's a victory of sorts, and maybe a bit of a precedent for others. I'm disappointed, though, that the latest NICE Guidelines seem to be weaker re Type 2s than the previous ones were.

The additional irony is that the CCG letter suggested that my blood glucose control was too tight, and could be dangerous for a Type 2! My latest HbA1c was 5.5, which I'm very pleased about, given the stress and pain. What's wrong with that? I suppose they expect me to have hypos - do these people know anything??? (and if you stop my test strips, how am I supposed to know if I'm hypo? )

The pain, by the way, is degenerative osteoarthritis of the spine, lumbar spinal stenosis, and now a scoliosis in the lumbar/sacro-iliac region. I'm lucky these days if I can walk 100 yards without a rest. However, I've just met a lovely spinal surgeon who thinks he can help, so I'm feeling quite positive at the moment - though it's taken a lot of hassling to get this far.

So with any luck, that's the end of the test strip saga.

Viviennem
 
Thankyou for the much needed laugh!
 
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