Told off like a naughty boy for low HbA1c

Since my June visit to clinic this year, I've been struggling with a variety of other health problems among which, depression and anxiety have featured prominently. Obviously, this has made management of my diabetes a lot more challenging than usual and it's fair to say that I've had a lot of short-term spikes and quite a few hypos along the way. Yesterday at clinic it came to my diabetologist's attention that my recent HbA1c was 5.9% (41 in new units) and in his words this was 'dangerously low' and I was running the risk of a major hypoglycaemic episode.

However, instead of asking why for the first in the 10 years that I've been under his care, I'd presented with a 'bad' HbA1c and discussing strategies with me to help me get things back under control amid my other health problems, he launched into a tirade about how I was "running things too tightly" and that the clinic would take my pump away if I didn't ease up on things. It wasn't just what he said, it was the way he said it. I was left feeling like I'd been severely reprimanded and that my pleas about how other health issues were complicating things had just fallen on deaf ears. In fact, when I asked him to acknowledge the role that these other factors were/are playing in the recent demise of my control, he simply responded by saying that as a diabetic specialist those issues were not of his concern and he was only interested in me running my blood sugars higher than I have been doing.

I went looking for a sympathetic ear and the benefit of his specialist knowledge and instead just left feeling extremely distressed and entirely unheard. I'm half tempted to make an official complaint but as there isn't really any malpractice involved, I don't think it would get me anywhere.

Thanks for both of your replies, they are greatly appreciated.

Picklebean, I am currently in receipt of once-weekly CBT sessions and am also on a list to see a clinical psychologist. You are absolutely right when you say that depression has a major impact on diabetes management. The anxiety attacks too can mess up your regulatory hormones something rotten and that in turn plays havoc with blood sugars. That a specialist refuses to acknowledge this and treat accordingly is, indeed, very poor.

I guess a big issue for me is that I obsess terribly about the long-term effects of high blood sugars, even when they're only high for relatively short periods and that does cause me to over-compensate somewhat where correction doses are concerned, which can bring on hypos later. I always get very early warning symptoms, however, and in 27 years have never had a hypo that required the attention of a third party. It's very rare in fact that I ever fall below 3mmol, certainly not in those situations where I've bothered to test to confirm that I am actually going low. I do drive but am always super careful about testing beforehand and in 20 years of having a licence have yet to ever go low while behind the wheel. As my diabetes has always been so well controlled in the past, this response to my recent HbA1c was extreme to say the least.

Benedict, you are right in what you say but this was as much about the way the specialist spoke to me, as about what he actually said. If points for bedside manner were being given, this situation would warrant minus figures. As a patient struggling with a number of health conditions that are all affecting diabetes, you want a doctor to offer a modicum of understanding before sitting down with you and going through strategies to help you overcome your difficulties. Instead, I was scolded, threatened with pump removal and told I'd be passed over to the DSN who would discuss some drastic slashing of my insulin doses. Hardly sympathetic or diplomatic doctoring there, methinks.

Let me just say I greatly appreciate all the input and sympathetic comments from everybody who's contributed to this thread.

I'm not prepared to write this off as my consultant just having a bad day. If you choose a career in which your primary aim/function is to help people, then there are no excuses for you not doing that and for speaking to someone so tersely that they leave the room fighting back the tears. There are also no excuses for refusing to listen to the pleas of someone desperate to have it recognised that there are other things going on that are making good control a genuine challenge.

I have admitted that my blood sugars have been erratic since my last clinic visit, with quite a few hypos to speak of. What worries me now, however, is that if I get things back under control but present with another low HbA1c at the next visit (in 3 months!) that my pump might be in jeopardy. This puts me in a situation where I'm going to actually have to purposely run my sugars on the high side to get my next result up and I just can't help but feel that that is not a good thing. Aside from an adjustment to the basal profile on my pump, I didn't come away from the clinic with any strategies for dealing with those times when my other health problems put me in a situation where it seems that all the usual rules of diabetes management just go out of the window and I'm at a real loss to get on top of it.

Though she was already partially aware that something negative had transpired, I informed my DSN of the exact details the following day in an email, but, understandably, she declined to comment and simply said that she would be happy to see me before my next official clinic appointment to try and work something out with regard to managing things. That's something at least.

Meanwhile, I'm seriously considering writing directly to the consultant to make it clear just how unacceptable I found his behaviour and how I'm not prepared to accept anything similar in the future. All that worries me is that it could make things uncomfortable for me at my next visit. I'm really not a confrontational person and this could just be setting myself up for more upset. I don't know, I'm going to think it over for a few days.