Newly diagnosed, dreadful healthcare experience…

MsClarita

Member
Messages
14
Type of diabetes
Type 1
Treatment type
Insulin
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Pigeons!
Hi all! New to the forum and newly diagnosed T1. Was admitted to hospital with DKA five weeks ago, and diagnosed at 37. I was in hospital for 10 days, three in ICU and then on the ward.

I cannot fault the nurses on my ward, they were wonderful and I will never, ever forget their kindness and compassion. But I feel I am having a shocker with the diabetic nurse and outpatient care. It’s making me feel very anxious, and Im usually a very laid back person. I’ll try to keep it brief, but I’m interested in other people’s experiences.

The DN came to see me a few days after I was admitted. I was on a feeding tube and drips. She showed me how to use the glucose kit, gave me a leaflet about hypos, about driving, and a magazine from a charity. She was with me about 10 mins. Told me to eat a “balanced diet” and then left. I was still pretty out of it.

I was on a fixed dose of fast acting and long acting insulin, and the nurses were injecting for me. Two of them showed me how to do it, so for my final two days in hospital I was doing that myself.

i was then given conflicting information about whether I should adjust my dose of insulin depending on how much I eat. A consultant said yes, and gave me a link to a website, a doctor said no, I was on fixed doses. My sugars were running high while I was in hospital, and my ketones were being checked regularly. I only had two ketone testing strips in my own kit to take home. When it came to discharge, I wasn’t ready because I didn’t have any clarity on my insulin dosing, nor did I have enough ketone strips to test with the frequency they had been doing. In the end, the sister told me to stay another night and that she would arrange for the DN to come and see me again to clear up my questions the next day.

DN said I was on fixed doses of insulin, and that she would call me in a week to get my testing numbers. I spoke to her the following week, and she increased my Novorapid by a unit at breakfast and lunch. The following week, my sugars were running high, and I became afraid of eating. I was tracking everything I ate, and reduced my carbs even further than I had since pre-diagnosis. I couldn’t get hold of the DN. I finally managed to speak to someone last week, who said I was due an appointment with the DN but it had been cancelled. I didn’t even know I had an appointment, let alone that it had been cancelled! I got quite upset, and she went through my numbers with me and increased my Lantus by two units, and my pre dinner novo by one. She said my nurse would call me this week.

My numbers are still high in the mornings - double figures, between 10 and 12, then sometimes higher before breakfast. I’ve further reduced my carbs in the mornings, so I’m now only having about 12g compared with about 30. Numbers are coming down after that for the rest of the day. But this restriction isn’t doing me any good. I’ve a history of eating disorders, and I lost a LOT of weight in the weeks leading to my diagnosis.

I’ve just had a separate call from outpatients cancelling an appointment that was scheduled with the endocrinology department, which was supposed to be tomorrow, but will now be on 17 August. I asked her to check when my next DN appointment is, and that isn’t until 17 July! So in the four weeks since I was discharged, I’ve spoken to my DN once, and have been left of a fixed dose of insulin. By 17 July it will be seven weeks since I was discharged, and six since I last spoke to her.

Is this normal?

So sorry to leave such an epic first post, I am so frustrated and stressed out about it and I didn’t know where else to turn.
 

ert

Well-Known Member
Messages
2,588
Type of diabetes
Type 1
Treatment type
Insulin
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diabetes
fasting
I'm sorry you are having a difficult time. Let your blood sugars reduce slowly as it will affect your eyesight in the short term if they come down too quickly. Fixed doses of insulin are common when you're first diagnosed. Remember to treat blood sugar management as a marathon rather than a sprint.
To get ready for MDI and counting carbs, I suggest you write down a diary of your waking, before bed, before meal finger pricks, your insulin dosing and times, and a food diary. After you have 3 or 4 days worth, email it in and ask to speak to your DN. You will have to be pushy and phone every day until you get a response.
In the meantime have a look at https://www.bertieonline.org.uk/home and https://www.amazon.co.uk/dp/B00FOQS66U/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1
If you can afford a freestyle libre sensor, I suggest you invest in these. It's a game-changer.
 

Antje77

Oracle
Retired Moderator
Messages
19,486
Type of diabetes
LADA
Treatment type
Insulin
Hi @MsClarita , and welcome to the forum.

I'm sorry you are experiencing such a lack of care and guidance, does seem quite wrong to me.
i was then given conflicting information about whether I should adjust my dose of insulin depending on how much I eat. A consultant said yes, and gave me a link to a website, a doctor said no, I was on fixed doses.
Both answers make sense. Some HCP's put people on fixed doses first, to allow for some time to adjust to all the changes, other HCP's like to make a start with adjusting doses to food right away. Both approaches make sense, what's best is mainly dependent on the patient.
What's not right of course is two people telling you to do opposite things, great way to confuse a new T1 even more!

After a while, most T1's count the carbs and calculate their doses depending on their meal (and the longer you're in, the more factors you'll learn to take into consideration apart from the carb content, but you can't learn everything at once!). In the UK many T1's get referred to a course called DAFNE (Dose Adjustment For Normal Eating), but usually not right away. Not sure how this works exactly, my country doesn't have courses like that.

My numbers are still high in the mornings - double figures, between 10 and 12, then sometimes higher before breakfast. I’ve further reduced my carbs in the mornings, so I’m now only having about 12g compared with about 30. Numbers are coming down after that for the rest of the day.
The numbers look very good actually, considering you've only just started your journey! It does take time to find the right dose (or insulin to carbs ratio's).
The cutting down on carbs to accomodate for your fixed dose of insulin works to get lower numbers, but it won't work to show you or your diabetes nurse how much insulin you need for your preferred meals. If you slowly come down after eating breakfast, your DN will assume your breakfast dose is correct or even a bit to high, so make sure she knows you've adjusted your food and would like to go back to a higher carb breakfast.
I do hope you're making up for eating less carbs by eating more proteins and fats, you need the calories.

I’ve just had a separate call from outpatients cancelling an appointment that was scheduled with the endocrinology department, which was supposed to be tomorrow, but will now be on 17 August. I asked her to check when my next DN appointment is, and that isn’t until 17 July!
Like @ert said, keep pushing! The one making the schedules may not realise you're new and in desperate need of more guidance! For the old salts it doesn't matter if an appointment is postponed for a couple of months, but for a newbie those appointments are rather urgent!

Wish you all the best!
 

Gemma2

Well-Known Member
Messages
179
Type of diabetes
Type 1
Treatment type
Insulin
From my own experience -ANXIETY- push my sugars high.
Best wishes and Good Luck.
 

KK123

Well-Known Member
Messages
3,967
Type of diabetes
Type 1
Treatment type
Insulin
Hi @MsClarita, I feel for you, I really do. It is quite common unfortunately (Pandemic or no). I will never understand how they can glibly wave goodbye to a newly diagnosed type 1 diabetic after 2 days in hospital, given that the person probably got rushed there in chaotic circumstances. I cannot think of any other life threatening disease that is treated so casually when a person is told out of the blue they have it. You are given advice on 'diet' and the stupid eatwell plate regardless of what your previous diet may have been, you are handed dangerous medication with no real understanding of how it even works or what it is supposed to be doing, just told 'take this insulin with food' basically. I understand that they don't want you in hospital for ever but the aftercare when you leave is often dismal. All I can say is you have come to the right place to gain an understanding of how it (supposedly) works, so have a good old read. When I left hospital I weighed and recorded everything I ate, then after much experimenting, worked out roughly how many units of insulin I needed per 10 carbs, (the ratio). It took a fair few months before I settled down and had the confidence to take the approach that I rule the diabetes, not the other way round. I gradually introduced my pre diagnosis exercise routine and now, 4 years later am perfectly fine. They do like to start you off on a fixed amount so they can gauge your carb/insulin ratio but I found I preferred to adjust my insulin myself (with lots of checking obviously) and with the advice of a diabetes Nurse at the end of a phone. Remember YOU are in charge of yourself, don't worry about making a nuisance of yourself, phone them if you need advice or want to make an adjustment or to tell them your numbers are still high, etc, I'm afraid the horrible reality is they have zillions of people to deal with and will rarely contact you. x
 
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dan_zero

Member
Messages
6
Type of diabetes
Type 1
Treatment type
Insulin
Hi @MsClarita - I'm also newly diagnosed (a week ago) with T1 and I'm sorry to hear about your bad experience. Mine was not quite as bad... after finally getting A1c checked (took 2 weeks to get an appointment to take blood) my GP sent me straight to the hospital. BG and ketones were high, but I was not in DKA. They took some blood, pushed some fluids in and gave me some insulin. I was then given the basal and bolus pens and a BG tester by a nurse who didn't know how to work the carelance and suggested I just prick my fingers with the lancet directly. I was shown how to inject insulin, and then told to go home and eat something. I was there all of 2 hours, I think. They told me to come back the next morning to see the diabetic specialist nurse.
The next day things got better, as the DSN's were wonderful. I was there the whole morning and they took me through everything I needed to know, and offered me the option to carb count and dose adjust - which I did. The dietician was in so I got to see her too. One of the nurses in particular was amazing, and phoned me every 2 hours to check BG and how I was feeling. The next day, her day off, she also phoned me 3 times. She offered me an appointment for a week's time to assess things, and to bring my partner to go through hypo education. In short, I really felt looked after by the DSN team!

One complaint I do have is that I asked about Libre 2 and was told I would not likely get this on the NHS for at least 12 months. I'd like to understand their reasoning for this better, and will bring it up at tomorrow's appointment.

-Dan
 
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MrsA2

Expert
Messages
5,686
Type of diabetes
Type 2
Treatment type
Diet only
One complaint I do have is that I asked about Libre 2 and was told I would not likely get this on the NHS for at least 12 months. I'd like to understand their reasoning for this better, and will bring it up at tomorrow's appointment.
The truth is cost, but they won't admit to that. It will be fun to see what they come up with
 

KK123

Well-Known Member
Messages
3,967
Type of diabetes
Type 1
Treatment type
Insulin
One complaint I do have is that I asked about Libre 2 and was told I would not likely get this on the NHS for at least 12 months

I think cost does come into it but on a recent type 1 course the question was asked. They said that newly diagnosed individuals need to get a good understanding of carb counting & insulin dosage in the first few months in order to give them a good understanding of how it works, how their body reacts to various other factors and generally to get used to being a diabetic. To use a CGM or device that 'did some things for you' at the start meant you may become dependent on it completely and if it failed you would have no idea of the MDI method. I interpreted this as getting a good grounding of the 'basics' first. Of course some people are quicker than others and feel getting straight in there with devices is a good thing but I suppose it's a balance based on individuality.....and the cost!!!! Again though, the cost of 200 plus strips a month equates to the cost of a libre so check the libre criteria if you are checking more than 8 times a day as this is used to help determine eligibility.
 

dan_zero

Member
Messages
6
Type of diabetes
Type 1
Treatment type
Insulin
Thanks, @KK123, that makes sense. TBH I am interested in CGM just so I can see the trends (a single finger-prick gives you a snapshot, not the trend) and also to help control spikes. I haven't introduced exercise yet (still only been a week since diagnosis) but I can imagine this will mess things up. I'll ask the question and keep pushing for it :)

-Dan
 
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MsClarita

Member
Messages
14
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Pigeons!
Thank you all SO much for your detailed replies, they have all given me a lot of reassurance. I’m going to keep trying my DN today and hope I get through, but knowing that higher sugars are usual at the start makes me feel a lot better.

im quite up on nutrition, I’ve always had an interest in it…the eat well plate makes me laugh.

I’m feeling much better today, mentally, than yesterday. I’ve been back doing yoga this week, though starting out with gentle flow rather than my usual practice, and I can’t wait to return to the gym. One step at a time though.

@dan_zero … sorry to hear you’re a new addition to the newbie club.
 
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becca59

Well-Known Member
Messages
2,874
Type of diabetes
Type 1
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Insulin
Tried to post the link but failed miserably. Type into Google -Type 1 diabetes in adults diagnosis and management. It is the nice guidelines and well worth a read through to gen up on what you should expect.