Please help improve diabetes care

There have been a couple of topics today,Tony, where you could be in a position to help.
First, the lack of knowledge on non-diabetes wards about insulin etc.An info pack for use on these wards seems like a way forward as all nurses(myself included )cannot be expected to be an expert on everything.
Second,dietetics in hospital re.diabetes.

Knowledge is the key to control

£5.00 a month membership fee might not sound a great deal, and for those of us able to work it isn't.
However for people unable to work for whatever reason, and are in receipt of benefits £5 is an awful lot of money.


>^..^<

Thanks for taking on board my comments & I wholeheartedly agree about means testing.

On a completely different tack (told you I was blonde) my local hosp had a dedicated diabetic ward complete with specialist nurses. Thanks to b****y red tape it's now an isolation ward for c.diff.
Diabetics are now put wherever there's a bed & treated by nurses who don't have a clue. I doubt some of them have seen a bm machine before let alone a vial of insulin

>^..^<

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />Ash, if the NHS was a private system - then you would have to pay full price for all your neds and needles and test strips. 50-60 million US Americans have no health insurance- I wonder how these diabetics do (1-2% prevalence- 500,000 to 1,000,000 uninsured citizens in the richiest most powerful country in the world)?

The NHS can't be perfect, but it is better than the vast majority of countries I can think of (apart from Scandinavia- but they have a huge income tax levy far in XS of the UK).

I have seent the drawbacks to the NHS myself recently in getting a certain aspect of my osteomyelitis treatment organised. I am just glad I live in the UK.

They quality of care accross the NHS is far higher than that I came accross in the time I was a medical student for a while in the US.

I think one of the biggest problems to solve is the postcode lottery (especially comparing SW12 with G12). NICE/SMC guidance should be adopted universally.

Marty B
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The problem is that the NICE guidelines are very poorly written, and as such give the PCTs far too much leeway for interpretation depending on their mood.

Perhaps its the inconsistencies which really rankle.

Still, it doesn't help me that the NICE guidelines have been interpreted by my PCT.

Is this a countrywide decision regarding the testing strips.

My opinion of PCTs is fairly low. They seem to be fairly self serving

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by ash</i>

My opinion of PCTs is fairly low.
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Ash, I think your opinion of PCTs is quite generous. From what I have seen of the one that administers South West Surrey I would rate them somewhere below tax inspectors, estate agents and serial killers.

Take a look at this petition regarding self testing for T2s.

It is at odds with the PCTs rules.

http://www.number-10.gov.uk/output/Page11621.asp

My practice nurse sad to me last night that there was nothing to stop me buying test strips myself if I wanted to test my BG at home more often that once every 11 days [!]

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by ash</i>
<br />Take a look at this petition regarding self testing for T2s.

It is at odds with the PCTs rules.

http://www.number-10.gov.uk/output/Page11621.asp

My practice nurse sad to me last night that there was nothing to stop me buying test strips myself if I wanted to test my BG at home more often that once every 11 days [!]

<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

This was my petition. I wrote it (you can check by following the link on that page)

Details of petition:

"I understand that a government policy is about to be passed limiting Type 2 diabetics to 100 test strips per year. The decision being partly based on the expense of the strips and partly on the fact that the medical profession seem to hold the opinion that T2s can do nothing with the results of their testing. This view is far from the truth, a determined diabetic can use the results of their testing to adjust their diet to obliterate high spikes in blood sugar caused by different foods, in order to avoid longer term complications. In addition they can adjust exercise to bring down any unexpected high readings. Surely to goodness avoiding long term complications such as amputation of extremeties, kidney dialysis and heart problems will save the NHS money in the long run! Motivated diabetics on medication or even diet and exercise should be given the tools to monitor their disease and adjust their lifestyle to minimise complications. Withdrawing test strips will severely limit their ability to achieve the control so important to avoiding such complications. I am asking, therefore, that you oppose this governmental measure in the interests of the health of the diabetic community."

The Government response, as you will see, is beneath and I urge any T2 who is refused strips to print it out and take it along to their Doctors. It is indeed contrary to what the PCTs are saying, but surely the Goverment are a higher authority than any local PCT?

In addition the proposed new NICE guidelines (see http://www.diabetes-support.org.uk/T2DN ... nsultation[1].pdf say on Page 12 :-

"1.4 Self-monitoring of plasma glucose
1.4.1.1 Self-monitoring of plasma glucose should be offered to newly diagnosed people with type 2 diabetes as an integral part of self-management education. The purpose of SMPG should be discussed and agreed.
1.4.1.2 Self-monitoring of plasma glucose should be available to:
• those on insulin treatment
• those on oral glucose-lowering medications to provide information on hypoglycaemia
• assess changes in glucose control due to medications and lifestyle changes
• monitor changes during intercurrent illness
• ensure safety during activities including driving.
1.4.1.3 Assess Assess at least annually in a structured format self-monitoring skills, the quality and frequency of testing, the use made of the results obtained, impact on quality of life, and the equipment used."

I urge T2s to print out the NICE guidelines and use those too to "persuade" or even bludgeon your Dr into allowing testing. If further ammunition is required, write to your MP. I have done that also and have a reply from the Rt Hon Rosie Winterton, Minister for Health, that states that T2s should be allowed test strips.

I have no particular personal axe to grind as I am not T2 and do not have any problems getting strips - I am on insulin. However, I do see it as the "thin end of the wedge" and I feel very strongly that all diabetics could have better care and T2s in particular.

Patti
On Levemir/Novorapid. Last hba1c 5.3

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by Pattidevans</i>
<br /><blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by ash</i>
<br />Take a look at this petition regarding self testing for T2s.

It is at odds with the PCTs rules.

http://www.number-10.gov.uk/output/Page11621.asp

My practice nurse sad to me last night that there was nothing to stop me buying test strips myself if I wanted to test my BG at home more often that once every 11 days [!]

<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

This was my petition. I wrote it (you can check by following the link on that page)

Details of petition:

"I understand that a government policy is about to be passed limiting Type 2 diabetics to 100 test strips per year. The decision being partly based on the expense of the strips and partly on the fact that the medical profession seem to hold the opinion that T2s can do nothing with the results of their testing. This view is far from the truth, a determined diabetic can use the results of their testing to adjust their diet to obliterate high spikes in blood sugar caused by different foods, in order to avoid longer term complications. In addition they can adjust exercise to bring down any unexpected high readings. Surely to goodness avoiding long term complications such as amputation of extremeties, kidney dialysis and heart problems will save the NHS money in the long run! Motivated diabetics on medication or even diet and exercise should be given the tools to monitor their disease and adjust their lifestyle to minimise complications. Withdrawing test strips will severely limit their ability to achieve the control so important to avoiding such complications. I am asking, therefore, that you oppose this governmental measure in the interests of the health of the diabetic community."

The Government response, as you will see, is beneath and I urge any T2 who is refused strips to print it out and take it along to their Doctors. It is indeed contrary to what the PCTs are saying, but surely the Goverment are a higher authority than any local PCT?

In addition the proposed new NICE guidelines (see http://www.diabetes-support.org.uk/T2DN ... nsultation[1].pdf say on Page 12 :-

"1.4 Self-monitoring of plasma glucose
1.4.1.1 Self-monitoring of plasma glucose should be offered to newly diagnosed people with type 2 diabetes as an integral part of self-management education. The purpose of SMPG should be discussed and agreed.
1.4.1.2 Self-monitoring of plasma glucose should be available to:
• those on insulin treatment
• those on oral glucose-lowering medications to provide information on hypoglycaemia
• assess changes in glucose control due to medications and lifestyle changes
• monitor changes during intercurrent illness
• ensure safety during activities including driving.
1.4.1.3 Assess Assess at least annually in a structured format self-monitoring skills, the quality and frequency of testing, the use made of the results obtained, impact on quality of life, and the equipment used."

I urge T2s to print out the NICE guidelines and use those too to "persuade" or even bludgeon your Dr into allowing testing. If further ammunition is required, write to your MP. I have done that also and have a reply from the Rt Hon Rosie Winterton, Minister for Health, that states that T2s should be allowed test strips.

I have no particular personal axe to grind as I am not T2 and do not have any problems getting strips - I am on insulin. However, I do see it as the "thin end of the wedge" and I feel very strongly that all diabetics could have better care and T2s in particular.

Patti
On Levemir/Novorapid. Last hba1c 5.3
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Thank you for the effort Patti 8)

Why in light of this are the PCTs issuing these guidelines. My OH works for a GPs and she said that the docs got a letter from the local PCT with the instruction to limit or stop testing strip issuing for non insulin dependent T2s

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote">

Thank you for the effort Patti 8)

Why in light of this are the PCTs issuing these guidelines. My OH works for a GPs and she said that the docs got a letter from the local PCT with the instruction to limit or stop testing strip issuing for non insulin dependent T2s
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Money... nothing else... and wind of a very flawed survey that said T2s couldn't/or wouldn't benefit from testing. In fact the T2s were told "test, but don't vary your regime" How on earth could they benefit?

Also the PCTs are the bean counters don't forget... so challenge the GP - show him that that isn't what NICE or the government are saying!

My nurse thinks it's highly beneficial for T2s to test so long as they know what to do with the results - the GPs practice nurse that I see that is. I had a long convo with her last Friday, whilst I was in for my results. The last time I went she asked if I could cut down and I'd said "NO, is the short answer to that.... the long answer is, if you want me to do that you can have my insulin and needles back because I'm not in a mind to commit suicide". so this time I just asked if they were still being pressured. They are, but they're not bending to it... so some GPs are determined to do what they believe in.

Patti
On Levemir/Novorapid. Last hba1c 5.3

Hi,

Firstly, I'm in a bit a limbo, as I haven't "officially" been diagnosed yet. Since Christmas I have had a number of symptoms and had various tests, including 3 blood tests 2 standard and a fasting blood test, but my doctor has advised me that she is almost positive that I am type II diabetic. I am due to have another fasting blood test this week.

If there is anyone who can tell me what a positive type II test would be I'd be grateful.

In my search for information, which has been extensive I have come across a "cure" for type II. Desperate for hope, before I ask my doctor about the diet and I was wondering if anyone has seen this link, tried this diet and if anyone has had any success. It seems similar to the flaxseed oil post. I'd greatly appreciate the feedback.

http://www.cancertutor.com/Diabetes/Dia ... ype_II.htm

You'll notice that it is very specific about the oil and names Barlean's oil, again has anyone tried this.

I'd really appreciate any advice that anyone could offer.

If you read this link posted by one of our users you will see that it is similar to the one you have been reading although he recommends different oils.

http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?t=1204

Knowledge is the key to control

Hi Tony,

Re dieticians. I think that I am in the "don't bother with them camp, as I used to see one every now and again. I haven't been referred to one for ages though. The advice I got was basic, healthy diet stuff, and nothing to do with diabetes specifically. Now, I do know that diabetics, lie everyone else should aim for a healthy diet, and the advice I got was sound...but it was useless in helping me control my diabetes.
I think the rather contradictary findings of your survey show the difference between expectations and reality! You go along, expecting them (nievely) to give you a magic formula of what and how to eat, and come away with nothing that you didn't know before.
Just my opinion of course. I haven't done teh DAFNE course, so I may have unrealistically high expectations of this too...but it does sounds more useful than 10 minutes on diet alone. It seems that teh dieticians talk about food, and don't talk about insulin, and the Drs talk about insulin, and don't mention food!

Hi Redathena,

The website you have found is an American one and the products mentioned (like Barleans flax oil) are available over there but not here. However there are various omega-3 and omega-6 alternatives available in the UK in both liquid and capsule form.

One thing to bear in mind about that website is that the writer's opinion is that Type 2 diabetes is caused only by trans-fatty (i.e. hydrogenated) oils. Successive governments over many years, both here and in the US, have recommended that we should all stop eating animal fats and replace them with vegetable oils, nearly all of which were hydrogenated. It is now proven that trans fats cause cell resistance so therefore likely that trans-fat cell resistance is a contributory factor, but is not necessarily the only cause. If it was the only cause then everyone in the country who has used vegetable oil and/or switched from butter to an oil-based spread would be diabetic!

By following the article's recommended course of treatment you will certainly reduce your cell resistance (and will also improve your cholesterol levels) but, unless cell resistance is the only cause of your diabetes, you will not be cured.

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by Redathena</i>
<br />Hi,

If there is anyone who can tell me what a positive type II test would be I'd be grateful.

<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

I think what you need is a standard 75g glucose tolerance test. This shows how your blood glucose level changes after a glucose load.

There are well-validated criteria for saying after that whether you are normal, have impaired glucose tolerance or diabetes.

TW