Support in diffferent areas

Colin Crowhurst said:

He is under the normal GP/DSN rather than a specialist clinic!

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I assume he has T2, unlike yourself, because you posted in the T2 forum?
If he has T2, I'd urge him to read up about the condition (like on this forum), and use a meter before and after meals.

T2 care is often not the best, as many posts on the forum prove. But there is a lot people can do themselves, if they are motivated to do so!
Here's JoKalsbeek piece on T2, he might find it very useful: https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html

Colin Crowhurst said:

I have been fortunate ( i think!) in my area (Norfolk UK) of getting excellent advice which has worked for me.

However a relative in another health authority (Merton and Sutton UK) is getting what looks to me to be rubbish advice; what are other people opinions of the best way to challenge this?

His HbA1C score two years ago was 97 and does not appear to be improving. So its not a question of waiting to see if its working for him in my humble opinion now.

Opinions from within this health area GREATLY appreciated

He is under the normal GP/DSN rather than a specialist clinic!

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To be honest, the care and treatment for T2s tends to be very different indeed from that offered to T1s.

Most T2s are cared for under their GP. Medical education in effective management of T2 is, in my view, grossly deficient. To be honest, there are some who do well in that environment, but for most, the advice to base meals around healthy carbs isn't overly helpful - especially in the absence of testing, to assess the impact of food and drink on their blood sugars.

For many - I hesitate, despite temptation to say most - T2s who do well or very well do so because they have taken control of their situation and done their own research.

To be honest, if your relative's A1c is running as high as you allude, then that's not great news. To be honest, I would suggest your relative does their own research, or join a forum, very much like this one.

If his A1c has been running that high for some time, it could be advantageous to bring it down steadily. Too rapid a decrease can leak to eye problems, which are usually transient, but alarming and demotivational if they occur.

Should you need it, or feel you would like to read it, this link is the NICE Guidelines for T2 management: https://www.nice.org.uk/guidance/ng28

Colin Crowhurst said:

I do have a question for others on a bolus/basal regime; he is currently being given a huge bolus (60 units) and only one Basal ( post? breakfast of 6 units)
My limited knowledge of this regimen suggests that there should be a basal with each meal? this would to my logic indicate that during the day his figures would not continue to rise throughout the day? Comments please.

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Basal is the one you only take once a day, regardless of food (or sometimes twice, depending on brand).
Bolus is the one you take with meals.

What are the names of the insulins he's on, and does he take insulin with other meals than his breakfast?

Even with only testing once or twice a day you can build a picture if you vary the times of day you test.

Colin Crowhurst said:

That conversation to come tomorrow with the DSN is likely to get messy me thinks!

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I can't add any advice around medication management, or strategies to use in conjunction with that medication, it's way out of my league and experience level.

However, I live in an area where the advice and care has been less than stellar since my diagnosis 4 months ago. My local surgery tried every trick in the book to swerve any responsibility for offering advice after I was diagnosed. You sound like you're fired up, which is good, because the one piece of advice I can offer is to be unrelenting when it comes to pushing for the care your relative deserves. If they're resistant to offering constructive advice, don't be fobbed off, don't allow them to ignore you, and unapologetically make a pain in the a** out of yourself. Sometimes it's the only way unfortunately.

Colin Crowhurst said:

Dont get me started on testing; the "nurse" that attended today to give him his insulin thought once a day testing is ok????????

When i went to collect a full prescription of testing strips today for him (nearly run out!) they allocated one pot of 50 for 28 days....... That conversation to come tomorrow with the DSN is likely to get messy me thinks!

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I’m in Berkshire, I was told I was testing too much, x2 a day!! My HbA1c was 134! I was ‘lucky’ to be carted off to hospital and they had me in a drip, injections I think, gave me a monitor and strips, but if they hadn’t I bet I’d have nothing.
My husband researched the US sites for information

It occurs to me that the best advice for someone 'new' to the condition is to listen to those with the actual experience of dealing with it.

I am full of admiration and gratitude for those that have offered their advice on this forum, convinced that had I not come across this when diagnosed, I would not have achieved an improved condition such as I have.
The advice is here from those that live with it, and it would be a shame to ignore all that first hand evidential stuff.