Annb
Expert
Ah makes sense now. Actually, I don't think any of the nurses at the Western Isles Diabetes Centre know very much about T2 on insulin. Since I am not able to be active, I don't have to worry about dosing for activity but neither do I know about doing a basal test in someone on pre-food insulin. They've certainly never been keen on discussing how to manage my diabetes with insulin so, you're quite right - I've learned more from this forum than from diabetes specialist nurses here, but I'm still missing a lot because I don't know to look for things.@Annb , thought to take it here before I get a telling off by my colleagues.
In both our countries, as a rule of thumb T1s are treated by an endo/diabetes specialist nurse team through the hospital, and T2s are treated by GP/GP diabetes nurse.
This isn't a rule set in stone, some T1s are under GP care and some T2s are under specialist care, especially if they are on a basal/bolus type of treatment like yourself.
I was given the choice when after 2 years of T2 I was rediagnosed with T1.
My treatment already went well and I liked my GP's practice nurse but I still chose to switch to a hospital team, mainly because I felt they would be more up to date than my practice nurse if ever I wanted something unusual, she was already out of her depth with the way I was dosing.
GP's and GP's diabetes nurses tend to not be as familiar with the complexities of insulin dosing, most of their patients are on orals or a twice a day insulin with strict rules on eating.
They do not know about prebolusing, bolusing for Foot on the Floor or Dawn Phenomenon, how to adjust doses with increased activity, how to correct or how to do a basal test in someone on mealtime insulin as well.
Which is why you've learned so much about those things through the forum over the past couple of years, things are so much better now you've gained confidence and experience with dosing in different circumstances!
And your practice nurse is likely out of her depth with what you are doing because you're using quite a lot "T1" techniques by now.
Two things I've never heard of that you mention: prebolusing and bolusing for Dawn Phenomenon. I do bolus when BG runs very high (reaching 14+ and rising) but the nurses are very uncomfortable with that. The Centre staff seem quite comfortable with BGs around 10 or 11 - which I am not. I think they have that attitude that says, "it can only get worse". They think also that because I am 77 BG is bound to be higher. I don't know if that is true or not.
I daresay I shall continue learning from the forum forever - or for as long as I last.
