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No Blood testing to check progression by nurse

lucylocket61

lucylocket61

Expert
Messages
6,394
Location
Wrexham
Type of diabetes
Type 2
Treatment type
Diet only
I saw my DSN today and she was really informative. However, I am a bit stuck on something she said.

She said she didnt need to test my HbA1c unless I was exhibiting symptoms such as thirst, nightly running to the loo. I had a HbA1c test in Feb and apparently dont need another.

I asked how I was supposed to know if the diet and metformin was working and she said my symptoms and urine test every 3 months in the surgery would tell me.

Its a good job I am testing my own blood, isnt it!! I have got another prescription for another 50 strips :)

I also asked about my blood spiking at 9.4 after having pasta and what to do. She said to do nothing, if I follow the NHS diet all will be well and the spikes dont mater. They will just up my meds to accommodate my spikes if I show symptoms.

But I dont, and never have had symptoms of diabetes. It was found in a random blood test.

Its all a bit worrying.

Oh, and I need blood pressure tablets despite my blood pressure now being down to 127/71 and a weight loss of 2kg this month.(total 12kg now)
 
Get another doctor. Or talk to the practice manager. You DO need an hba1c regularly to check progress. If you wait for symptoms, it means the damage is already done. I only get HbA1c once a year, but i do get it and I'm ok with that because i test anyway. Can't comment on the blood pressure pills, but it sounds odd with your readings.
 
Not good Lucy, I think you should have regular checks but I know that doesn't always seem to be though necessary in some parts of the UK. I hope to goodness they intend to do a yearly HbA1c.
Re the BP medicine it's fairly common practice to prescribe a low dose of an ACE inhibitor (eg ramipril), or sometimes an ARB (aprovel) even when BP is normal.
These drugs are thought to protect the kidneys.
http://www.diabetes.org.uk/Guide-to-dia ... nhibitors/
 
Make an appointment with the gp and ignore the nurse. As Grazer said what she is saying is insane. If you wait for symptoms its too late. There are 9 tests that should be performed at least annually. Your nurse is just trying to save the practice money by not giving you the support you need.

They should be letting YOU drive how your want to manage your T2. They get £2000pa for having you on their books so tell them that and make it plain you expect all the tests and would appreciate quarterly HbA1c checks and quarterly cholesterol ones as well as part of measuring your progress within the care plan they have supposedly agreed with you (they have done that I take it?)

http://www.nhs.uk/NHSEngland/NSF/Pages/Diabetes.aspx

It is vital that people with diabetes receive all nine of the NICE recommended key health tests and measures. These tests help to monitor and manage the condition, as well as to reduce the risk of complications such as stroke, heart disease and amputations.
The nine annual health checks for people with diabetes are:
weight and BMI measurements
blood pressure
smoking status
blood test (HbA1c – blood glucose levels)
urinary albumin test (or protein test to measure the kidney function)
serum creatinine test (creatinine is an indicator for renal function)
cholesterol levels
eye check (retinopathy screening)
feet check

If you have diabetes and have not received all nine checks in the last year, talk to your GP or practice nurse.
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lucylocket61 said:
Sorry, I should have explained she meant I shouldnt need another until next Feb ie. one a year.
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Sounds about right Lucy!
 
It seems a long time to go without any proper testing by the doctors. Anything could happen. How do I know the diet and meds are working or not?

I am worried about this. I know my meter testing gives snapshots, but not the overall picture. How do the rest of you find out your progress (or not) in controlling your Diabetes?
 
lucylocket61 said:
It seems a long time to go without any proper testing by the doctors. Anything could happen. How do I know the diet and meds are working or not?

I am worried about this. I know my meter testing gives snapshots, but not the overall picture. How do the rest of you find out your progress (or not) in controlling your Diabetes?
Click to expand...


Just the same as you by monitoring my bg readings, I'm type 1 and only get my Hba1c tested every 9 months.
 
noblehead said:
Sounds about right Lucy!
Click to expand...

I thought the whole point of the new patient led approach is that it is patient led. Within reason Lucy should be able to say what targets she wants to try and achieve so in NHS speak that might be to agree a 6.5% HbA1c in 3 months time. If she says that then how will she know she achieved it if they won't test her. Would be fine if she was happy to wait a year for another test but she's not and therefore within reason the system should accommodate her requirements not the other way round. What's the point of trying to empower the patient to do the right thing if their wishes are ignored.
 
xyzzy said:
noblehead said:
Sounds about right Lucy!
Click to expand...

I thought the whole point of the new patient led approach is that it is patient led. Within reason Lucy should be able to say what targets she wants to try and achieve so in NHS speak that might be to agree a 6.5% HbA1c in 3 months time. If she says that then how will she know she achieved it if they won't test her. Would be fine if she was happy to wait a year for another test but she's not and therefore within reason the system should accommodate her requirements not the other way round. What's the point of trying to empower the patient to do the right thing if their wishes are ignored.
Click to expand...


I never mentioned any targets, what I was saying is an Hba1c test in February (9 months time) sounds about right for checking Hba1c, if she feels she can get it checked more regularly then all the better :thumbup:
 
About 18months ago I saw a consultant at the hospital at the request of my opthlmologist. I only needed two isits and was then discharged. he wrote to my Gps saying I should have 3monthly HBA1cs as this was the only way to keep a close eye on my bg levels. As I suffer from reinopathy and macular oedema this is vital,.

I have only ever manged one of these "exrra " tests. My practice is not set up to deal wih anything out of the ordinary.

I am too bust attending the hospital to keep fighting the nurses .

I mentioned to the Dr at my annual review a few weeks ago that although SHE accepts my home BP readings Nursie does not . She was NOT pleased. She is going to "Have a Word". I also brought up the matter of the HBA1Cs. She told me to make an appoointmebt in 3 months. I had to make another appointment the other day so thought I would kill two birds with one sone.

I couldn't believe it. After much discussion and many absences with nme hanging on , I was finally told that the receptionists would send me file with a note to the nurse, to check if i ereally needed it! Obviously the Dr's word counts for nothing needless to say I told her to forget that and that I would have a word with the Dr.

An annual HBA1C is just like a spot check. if this is the only check used and patients are discouraged from self testing it strikes me as a form of russian Roulette.

I test several times daily and his is mostly self funded . It is not that they restrict nmy strips I restrict them myself. Without this I wouldnt have a clue what was happening and lows are as bas as highs for me.
if self esing HBA1C kiwere cheaper and more easily available I would use hem.

It is a ridiculous situation. It would make sense to do an annual test if this reflected he previous year's levels but obviously a test which measures only 3 months if hat, is hardly providing the full icture,
 
I see my consultant (as you know not in the UK) at 6 monthly intervals because I am well controlled.(was fortnightly at the start) I get given 2 prescriptions for blood tests. One for an intervening HbA1c at 3 months , the second which might include other tests to be done before the next appointment. All test results are sent to the patient directly, my doctor would expect me to make an earlier appointment if the 3 monthly HbA1c showed a significant change. Actually It's totally left to me to organise all tests/doctors appointments; saves a lot of administrative costs but does mean that someone less proactive could easily let things slide.
 
Is there a doctor in your practise who specialises in diabetes that you could see to discuss the situation? My GP has an interest in diabetes and I have an Hb1Ac every 3 months. I expect that will be reduced to maybe twice a year in the not too distant future.
 
Once a year!! There is no way I would accept that. My last HbA1c was at the end of February, a week later I was diagnosed. My next one is already booked for June 27. That is 4 months, but as I accept it will have taken me a month if not a bit longer to get some sort of control, I am happy with 4 months (this time). In future I will make sure I get my HbA1c every three months. It is a test that we need regularly to show us if what we believe our meters are telling us is right, and therefore enable us to make changes or to carry on as we are. Once a year is just not good enough!
 
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