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This just proves it all

Discussion in 'Type 2 Diabetes' started by sdgray22, Feb 14, 2012.

  1. xyzzy

    xyzzy Other · Well-Known Member

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    Exactly but if you actually come out and say things like that then you are either ignored, for example not one HCP who has read this thread and the two outrageous examples I gave earlier has actually condemned their fellow HCP's actions let alone agreed they should be fired - YET.

    Worse when anyone starts to question the status quo response of "we're under funded or badly trained" then regardless of whether that it true or not it's their problem not ours and is not a valid excuse what so ever. We are their customers and have a right to expect a far higher than a 50% satisfaction rating. Even the train operators recognise this!

    When the NHS was heavily funded just up to a few years prior to everything going wrong economically did it change its diabetic dietary guidelines?

    ... and before anyone even thinks it I have never voted Tory or for any right wing party in my life!
     
  2. hanadr

    hanadr · Expert

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    They give out the advice they've been taught to. Somehow they never seem to think about it. I always tell them my opinion on the advice to eat carbs. I also explain what happens to starches in the body.
    In a recent conversation with a DSN sister from a diabetes clinic, she said she's like to study some more molecular biology and biochemistry, because she didn't ever have it during her training and what I say is interesting. I never see this nurse as a patient, I meet her in a volunteer group at my local hospital. she's probably in her 40s; perhaps training is different nowadays!!!
    If elementary biochemistry isn't in a nurse's training, how can we expect them to understand their own advice?
    In my recent talk to the junior doctors at the BMA, I let them play with a blood glucose meter. They'd never done that before.
    All these Healthcare Professionals are giving advice on subjects, which they've only studied in a pretty superficial way. No wonder they daren't depart from *The party line*
    We who live with Diabetes MUST understand, in the interests self preservation
    Hana
     
  3. noblehead

    noblehead Type 1 · Guru
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  4. xyzzy

    xyzzy Other · Well-Known Member

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    I'm sorry noblehead and I do usually agree with your advice and posts but in this instance I feel you are wrong and that Sharon makes a valid point in one of her later posts that counters your argument completely.

    Effectively you are saying if we all shut up the problems will go away.

    Even if complaints only accounted for 5% or 10% of people on this forum that is still far too high when compared to other industry's, services and sectors.

    Have you ever considered why I am complaining rather than that xyzzy is just a complainer?
     
  5. borofergie

    borofergie Type 2 · Well-Known Member

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    C'mon Nigel, you need to mentally average across the whole forum, not just a single topic named "In praise of Health Care Professionals", which was designed to redress the balance against all the negative comments about HCPs (and pretty much failed in that regard).

    This isn't a criticism, but maybe your perception is biased by the fact that T1s necessarily get much better care. (I assume this, I tend to stick to the T2 areas of the board, as I have nothing much to add to discussions about T1 diabetes).

    Most of us T2s just get given some pills, told not to test our blood, and given some ambiguous message about the necessity of eating carbs with every meal. The message for all T2s needs to be "Carbohydrates turn to sugar in your blood, you're going to need to find a strategy for managing them".

    This isn't a low-carb debate, it's a statement of fact: if you are a diet or metformin controlled T2 diabetic you need to reduce the amount of carbohydrate you eat (or choose it more sensibly).

    I can't think of a single example of well controlled T2 on this forum who isn't managing their carbs (like me by low-carbing, like Sid by portion control, like Catherine by low-GI, like Grazer by shredded-wheat and Rioja :lol: ).

    Please don't make me spend my evening pulling together a list of all the confused T2 diabetics that have come to this forum in the last few months not understanding the influence that eating carbohydrate has on their BG.
     
  6. catherinecherub

    catherinecherub · Guest

    Type 2 diabetes used to be a condition confined to older people. There were enough specialists to go around. Now it is affecting all age groups and HCP's are inundated with patients. The NHS do not have the resources to educate all G.p's or to fund courses for specialist nurses, there is no money.

    If you go to a Specialist about another health problem, yes Type 2's do get other health problems, that specialist has a very basic knowledge of diabetes as does your G.P. I was told by a Gastroenterologist that I had mild diabetes. When I suggested that I could get the same complications as a Type1 if I did not manage it his reply was, "Well I never knew that". The NHS cannot keep up with the demands of an explosion of Type 2 diabetics and that is what is happening. Limited resources and limited education for HCP's to help this chronic condition. You cannot lay the blame at a particular HCP as to why you are not getting the right treatment.

    If, as you say you are in business, and your product gets raving reviews and customers are queueing up to purchase it then you employ more staff to deal with the increasing orders. That is a sensible business solution but the NHS does not work like that. There are budgets that cannot be exceeded because there is no more money.

    Researchers are trying very hard to come up with a "cure" for both Type 1 and 2 but nothing yet and the demands for Type2 are growing and growing as more and more people are diagnosed.

    Nursing as well as being a Dr. is a very demanding job and we cannot expect HCP's to educate themselves in their own time, they have a life outside of working hours like the rest of us. The same is happening for all chronic conditions not jut diabetes.
    More and more people are being diagnosed with cancers and asthma etc.... the population is getting older. Nobody wants to pay more taxes and so the problem goes on and on. Dr's see all manner of illnesses and not only diabetics. Whatever our illness, we want the best treatment but the money is not there.
     
  7. Grazer

    Grazer · Well-Known Member

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    Worth noting that even though I'm considered a "higher carb" T2 amongst diet- only's on this forum, I'm still down to 50% of GDA for a healthy male. So Stephen's right, we ALL low carb to a greater or lesser degree. Yet when I was sent to "specialist dietician" on diagnosis I was told I "didn't eat enough potatos for a big chap" when I outlined my diet - and that was my pre- diagnosis high carb diet! Almost every newbie on here asks about diet as their first question, and learns about carbs on here. Even if they don't, their questions betray an ignorance on the matter.So some message isn't getting through. Some like Sid had good initial advice, but I believe he went straight onto insulin? So would have had specialist advice. Which is Stephen's point- bog standard T2s don't.
     
  8. Grazer

    Grazer · Well-Known Member

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    But surely they shouldn't have to? How long did it take us to educate ourselves to a reasonable but basic level? Is it to much to expect that those charged with giving us advice on our diabetes should have been trained, IN WORK, to at least that basic level? But re - my post above, many patently aren't. Should a hospital dietician, that I'm sent to on diagnosis, be telling me to eat more spuds? She shouldn't have to study in her own time to learn about that. Incidentally, I studied in my own time for work - bet lots of others do too. Not having a go at you catherine, all your points are valid, but I think the basic education of people on this subject needs looking at.
     
  9. noblehead

    noblehead Type 1 · Guru
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  10. catherinecherub

    catherinecherub · Guest

    Grazer,

    What needs looking at is who is educating the Educators? That Dietitian was educated in her training which would have included diabetes so who gave her the duff information?

    My G.P. deserves an A+ for the guidance and information he gave me when I was diagnosed and I didn't need to see a Dietitian. I will ask him when I next see him where he got his information from.

    I work in Mental Health, the Cinderella of the Health Services and if you saw the cuts that we have to make involving patients, who are all somebody's mother, father, wife, husband, sister, brother, child, friend, neighbour.... it would break your heart.
     
  11. xyzzy

    xyzzy Other · Well-Known Member

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    That is not a valid excuse. It is your problem, as an HCP go do something about it, make more resources available by becoming more efficient or whatever it takes.

    I agree you can't lay the blame on a particular HCP about not getting the right treatment but you certainly can lay blame at the HCP's s in the examples I gave in earlier posts. Those examples have nothing to do with treatment and I and probably other readers of this thread have still to see an HCP comment about what they think an appropriate response should have been.

    Yes and in tough times in business "There are budgets that cannot be exceeded because there is no more money" but it doesn't stop me or Sharon trying our best to have a zero % complaints rate. We don't hide behind budgets as an excuse for poor service as it just doesn't work as our customers just end up go somewhere else. That's the advantage you have in being a monopoly but its not an excuse. Many business people use complaints as a positive thing and try to make their service better rather than becoming overly defensive and denying a problem exists.

    Yes I can. I have to educate myself in my own time as during normal working hours I am doing stuff for my customers. I work from 9.00am to 6.00pm Mon - Friday taking usually at most a 30 min lunch break. I then work again between 10.00pm and midnight on many nights not because I want to but because I have to to keep my clients happy and my business running. Sometimes if I have tight deadlines I'll sometimes have to work over the weekend as well. I usually take the week of Christmas off and one week or if I'm lucky two weeks off at other points throughout the year. Many people work those kind of hours and have to accept it.

    Sorry I do not mean to be confrontational but it just frustrates me that many and I concede not all HCP's just accept the status quo and never aim to make the NHS a better place for us "complainers" and "non complainers" a like. The only way it will change if is people inside the NHS do something positive about the endless inertia and bureaucracy.
     
  12. Daibell

    Daibell LADA · Master

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    As an engineer I spent a lot of time out of hours keeping up with my fast moving profession; you just can't do it in working hours. The problem is many diabetes 'expert' GPs in local practice also carry on all the other GP work and there is no way they can possibly keep up with all the illnesses they have to deal with. To be able to keep up with diabetes knowledge they have no choice but to narrow their range of patients but this only happens at hospital diabetes clinics? However many of us have come across the 'plenty of carbs' or in my case 'eat a normal healthy diet' etc. Now this is elementary dietary knowledge that there is no excuse for any HCP handling diabetics not to get right. I can understand not all diabetes HCPs being knowledgeable on the intricacies if insulin types and management but surely for diet there is no excuse?
     
  13. Unbeliever

    Unbeliever · Well-Known Member

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    I would question he whole business of managemen of diabetes in the Gp Practice. We discussed a short time ago what a DSN actually IS and , it apppears hat there is no standard qualification and that although some are highly qualified others are ,indeed, just "nominated" by the Practice.
    In my Practice the GPs refer evry query about diabetes to their DSN as they call her. There is also another nurse "trained in diabetes" The "DSN" mostly does deal only with diabetes. I doubt that she is qualified . It was she who assured me that
    pioglitazone was absoluely safe for my macular oedema - which was acually caused by rosiglitazone. The clue is in the question. This could have caused total blindness had I accepted her word as he Drs never challenge her prescripions ..She does not prescribe in her own name. She recently mentioned hat she understood there to be a new, injectible driug for T2s but she didn't know its name.?

    None of this would matter if she was just performing the occasional weight ,bp check etc or if she were working under the direcion of one of the drs. At the annual review the doctor will just work his/her way through the tick sheet and any questions are met with a recommendaion to ask our diabees specialist nurse" When I have mentioned my
    reservations I am told "she attends more courses than we do" So thats alright then.
    The fairly new Gps in the Practice have all been indoctrinated to tell T2s they do not need to test. other than that they will not comment about any diabetes -related subject.

    I find this very disturbing. Surely diabetes is a serious enough condiion to warrant some GP involvement?

    II firmly believe that these people do more harm than good.
    I can't buy the "overworked nurses" bit. That may well be the case in hospitals but not in most practices. The nurses in my practice are always looking for work. They call you in for no reason just to push up the clinic attendance rates.

    I am not thinking of myself. I buy most of my own test strips alhough I am allowed them on prescripion just to give them no excuse to try to change my meds etc. I would never dream of asking them for advice abou diabetes and i have ensured that, should my levels deteriorate I can be seen at the hospital clinic.

    I am just sorry for those who are on insulin unnecessarily merely because the PCT was offering "bounty payments" a few years ago or for anyone who has been given a drug which was contraindicated for them because the DSN was illinformed and he drs treat her as some sort of consultant in diabetes.

    Lest anyone think this is just a problem in my large practice I understand that one of the recommendations in Mr Lansley's new bill is to privatise diabetes care. This will be dealt wih in "Nurse -Led "faciliies. And may the Lord Have Mercy....

    I really believe we could manage wih far fewer "diabees"nurses in Practices- at least dealing with T2s . I hear the same thing from
    friends all over the country. Too many clinics for no good reason.
    When I was diagnosed test strips were handed out like sweeties . Unfortunately patients were not educaed in their proper use.
    Consequently self testing apppeared o be ineffective and uneconomical and now we all suffer. A while ago I started a thread DSN or test strips,
    If we had "real" DSNs . All well qualified and available to help and advise when required, the outcome would have been diffferen I am sure.
    At present . a DSN is what the doctos say she/ it is . The consultant in the hospital assures me it is quite common for GPs to leave everything to the aforementioned and patients everywhere just consider the "clinics" to be a useless box-ticking exercise which is often humiliating and and a cause of stress and anxiety rather than a source of advice and support.
     
  14. magicaldebs

    magicaldebs · Well-Known Member

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    I'm a nurse myself and I despair of some of the advice and care I've been given as a Diabetic. It's not enough to say that Practice Nurses and GPs see patients with a variety of chronic diseases therefore they cannot keep up to date. Keeping up to date or practising evidence based care, as it's called, is part of their job. They get to keep their professional registrations and get paid a decent wage to do just that. If they can't keep up to date with care for chronic diseases then who is going to?
    I'm sorry but we need an honest debate and discussion about this, without talk of nurses as angels and the like. Health professionals are just doing the job they are paid to do, let's start from there
     
  15. lovinglife

    lovinglife Type 2 · Well-Known Member

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  16. catherinecherub

    catherinecherub · Guest

    Having read through the recent posts I agree there are HCP's who leave a lot to be desired. There are HCP's who are extremely good at their job. I have never doubted any of this and never said that I do.
    I would also say that not all the nurses that see patients with diabetes are trained, they are not all DSN's. They are qualified nurses who are expected to do all sorts of jobs within the Surgery and only know a little about all of them.
    G.P.'s should take issues seriously and employ people trained in the care of diabetics. There are a lot of Health Care Assistants who stand in at G.P. Surgeries and you should always ask what their qualifications are. A uniform does not tell you much.
    If you want and expect the best care available then you have to be vocal and until people address the issues they have with the appropriate person this will not happen.. If someone is rude to you in a Surgery then you should take it up with the Practice Manager and higher and higher if you get no satisfaction. This is difficult for some but they can always enlist the help of friends, family or advocates. It is no good bitching about it and doing nothing as the cycle will continue.

    There are bean counters who need to see the bigger picture. The issue with this is who is in charge of the bean counters?
    You will not get nurses to work 24/7 and you cannot expect them to. I can only speak for nurses in a Hospital setting but do not know what happens in surgeries when time is needed to update skills. It could be that some surgeries are not amenable to helping them with this.
    An accepted definition of evidence based includes the best research evidence. Is low carb evidence based or is it anecdotal?

    The term low carb usually has professionals thinking Atkins and it is widely accepted that this should only be used short term. There is no valid definition of low carb as it has a wide use, even here, but saying you low carb then Medics will think you are eating 30 -50 carbs per day as per an Atkins diet. Even on this forum not everyone here who thinks that they are a low carber would be welcome on low carb sites as they eat too many carbs for the definition of those forums. "I have lowered my carbs to a level that keeps my blood sugars in check and means that I am not hungry and nor do I have any side effects from the diet" sounds better. :clap: There are diabetics who can eat a varied diet with plenty of carbs and still obtain good results.

    I am not the enemy here, I am just putting my opinion across and like backsides, we all have an opinion.

    On the other side of the argument, I saw a post on another forum where a man had been diagnosed with Type2 17yrs. ago and was complaining that his GP wanted to limit his test strips. As he took his blood sugars regularly after meals to see the results he thought this was unfair. If, after 17yrs as a Type2 you need to do as much testing as you did when diagnosed then there is something very wrong in your education and management of diabetes IMHO.
     
  17. Grazer

    Grazer · Well-Known Member

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    Keeps looking as if I'm having a go at you and I'm not - honest! But "lowering" carbs is ABSOLUTELY evidence based. All of us T2 on diet/metformin know you CAN'T control BGs without reducing carbs.

    Thereis a general definition I've seen which says lower than 70 for a man is low carb, 150 or less is moderate carb. Not really the point though - you don't need definitions (although it's easy to talk about a "reduced" carb diet if you want), you just need the nurses or whoever to know that a reduction is necessary. That can't be hard surely. And rather than medics "thinking" you're on an Atkins diet, they could of course ask.
    I do agree with you that after years we shouldn't need AS MANY test strips, and our petition acknowledges that, but our disease is progressive, and we do want to try out new things now and again, so the reductions I've heard of "once a week should be adequate" seem way short of the target. I don't think there should be a number. I think patients should justify and discuss how they use the strips on an individual basis. Some I'm sure use far more than they need.

    Overall, I think everyone is saying kinda the same thing here in different ways but managing to disagree with each other! :crazy:
     
  18. ladybird64

    ladybird64 Type 2 · Well-Known Member

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    Sorry, I do not have time nor inclination to measure my words carefully this morning-apologies in advance.

    No, HCP's cannot have specialist training in everything. But for goodness sake, we are talking about what some refer to as an epidemic! It's dead simple in my view. What is being done at present is not working, numbers are rising, complication numbers are rising so there is the evidence. Whatever the personal views on high carb, low carb yadda yadda, the one thing we all seem to agree on is that a REDUCTION in carb intake will improve diabetes, lower bg numbers and reduce the risk of complications.

    Or is that just too simple to contemplate?

    The info being given out, both verbal and in writing (leaflets etc) tends not to mention that a reduction in carb intake would pay dividends. That cannot be right. There may indeed be some who are very happy with their diabetes care and who are extremely well on the advice given to them. Excellent, I really mean that.
    But it stands to reason that if these people were in the majority, figures for complications would be falling, not rising.

    Too simplistic again?

    I look at the newly diagnosed section and I despair..sometimes I am just damned angry. Confused, upset, lost and angry are just some of the descriptions that crop up frequently. It's not right and it needs to change..that needs to come from within the HCP community.

    End of rant. Have a good day all.
     
  19. viviennem

    viviennem Type 2 · Well-Known Member

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    Catherinecherub posted:

    I'm not getting at you personally, Catherine, but the statement I have quoted above shows just how little most HCPs know about Dr Atkins' diet.

    The whole point of Atkins (which I would remind people is a weight-loss diet which has side-effects of excellent BG , blood pressure and cholesterol control) is that you start with 2 weeks of very low carb, then slowly increase your carb intake, week by week, until you start gaining weight again. Or in the case of diabetics, your blood glucose starts to go up again. That level of carb consumption is different for every person.

    I would also suggest that the people by whom "it is widely accepted" that it should only be used short-term are people who have little personal experience of it and have never either researched it properly or followed it through.

    As far as I am aware there have been no really long-term studies of Atkins followers to prove the consequences of its long-term use one way or the other.

    As most of you know by now, I am in general very happy with the care I get from my HCPs. Our practice nurse (who may not be a DSN but who knows a lot about it) and my regular GP know how I am managing my diabetes and support me wholeheartedly. The diabetes specialist GP is another story, but I keep out of his way, say yes or no as appropriate, and carry on doing my own thing.

    What alarms me is how slowly new information trickles down through the NHS. The research on cholesterol in eggs is a case in point. Also with general dietary advice; I went to see the dietitian (box ticking again!) in a group session where all the advice was about eating breakfast cereal and cutting out sugar. I kept quiet (mostly) because I didn't want to confuse the issue, but the dietitian had a quiet word afterwards (she had been warned about me by our nurse) and said she agreed with a lot of what I was doing but wasn't allowed to promote it to her patients!

    Would it be too difficult to say to people "carbohydrate turns into sugar inside you; take care what you eat"?

    This does, of course, assume that our wonderful education system has taught everyone what carbohydrate is and what foods it is found in!

    Sometimes I despair of this country. Ladybird has put it so well!

    Viv 8)

    Edited to improve the tone - I hope!
     
  20. Unbeliever

    Unbeliever · Well-Known Member

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    When we speak of nurses and T2s we are generally speaking of nurses in the Practice. Probably those of us who have seen both willl agree that we are dealing with different worlds.

    I personally, would not and do not tolerate anyone treating me with rudeness. But rudeness is not the issue most of the time.

    A Practice is a much smaller and more personal place than a hospital In many places the nurses are firmly entrenched part of he Team and have beee so for years.

    Does anyone really thik it would be possible to challenge tthe competence or commiment of a long term colleague wih anyone on the stafff. ?

    of course we dont expect a Practice Nurse with other duies to be an expert in diabetes. I don't expect GP's to be experts in anything.

    That is not the point.

    My beef is wih the system. If all we are offered is a nurse wih the honarary title of DSN to deal with our diabetes , if GPs
    refuse o be involved and refer us o this person then what can we as paients do. The fault lies with he system.

    The nurse is not urning down the extra money she gets for her honorary title on the grounds that she is not interested and maybe no capable of taking the responsibiliy. The Gps {poor underpaid creatures} aren't shouting from the rooftops or in their professional publiicaions hat the reatment of diabeies. paricularly T2 is inadequate at best. I blame them a

    I have known many nurses with principles who have refused to do certain jobs and taken on certain responsibilities for which they undertrained and are not prepared o take the responsibility.

    I attend the hospital on average about every four weeks and have done so for the past five years. I know many of them very well now and they seem almost of a different profession o those in the two practices for which I have been reated for diabees.

    It appears o be much easier to qualify as a sister in the pracices and Nursing Homes than it does in the Hospital All of the four Practice Nurses in my pracice are Sisters. Perhaps his means no more than the itle "DSN" in local Practice?

    The point is not about scarcity of resources but the best use of them. Most of these "DSN"s could be replaced by a decent pair of scales and BP Home monitors for all he use they are.

    I dont believe it is too much to ask hat the person designated as the Diabetes Specialist -particularly when she spends alll her itime seeing diabetics- actually knows a little about diabetes and 'or is prepared to answer questions and help patients. After all what are we talking about here? It is only usually on diagnosis and in the early stages most people need help.
    As we see here they often don't get it. if they appear to have a major problem they should be referrred to the hospital,
    If forums like his can help and often do hen It shoouldn't be beyond a DSN to do so. If the initial advice and treatment are adequate i shouldn't be necessary to see anyone very often. But when it is , then it should not be oo much to ask that we are entitled o the same treatment as other patients . We ought to be able to see a Doctor. No symptoms should be looked at in isolation particularly not by someone who may or may not be qualified.

    Surely noone could disagree that if diabetes , T2 anyway is to be left to the management of nurses in the local pracice hen these nurses should be properly trained , qualified , supervised and supported.

    I don't believe this will require further resources. It should not be necessary for most patients to be seen more than once a year or maybe twice i some cases. One properly qualified DSN could advise several pracices.

    The truth is that as, always happens people like a little auhority and power and a tille. It is looked upon as a reward for previous services and no an exrtra responsibility which mus be taken seriously. It is hardly surprising. I think it is a particular hazard in very hierarchical professions

    PPatients who are ill or distressed are not in a very good position to figh for their rights. Patients in a local practice sometimes only have he opion of moving to another pracice where hey will only face he same or possibly a wose situation
    The whole system needs to be looked at I am sure some people are sruggling to cope wih difficult circumstances and have had extra responsibilities forced upon them but that is beside the point. As someone says above that ishould ot be OUR problem
     
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