What would be your ideal care model for the NHS with your Type 2 Diabetes?

Being as stubborn as the proverbial mule, I would have refused to eat the white bread at all. I would have kicked up a stink. Would they force bread on a coeliac ? Then don't force it on me.

When I was in hospital, my husband and mother brought me food in, so that I didn't have to eat hospital food. TWO of the junior doctors told me that they had contracted food poisoning from eating it.


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After a general, just tell them you feel sick.
Then again, after a general, you normally do.

To be honest, I wasn't expecting to be fed anything less than an hour after coming out of theatre and was not in the best frame of mind to argue.

My reason for posting was to make the point that a nurse believed Metformin was an instant remedy my raised blood sugars.

That's back to the original question then.

Should every nurse/HCP, or even anyone you encounter in a similar environment, be a specialist on all diabetes, all drugs/diabetic drugs, and then again, what grade was the nurse trying to feed you, or was it simply someone employed to bring you round, stop you choking, and get help for anything more complicated than that?

SunnyExpat said:

That's back to the original question then.

Should every nurse/HCP, or even anyone you encounter in a similar environment, be a specialist on all diabetes, all drugs/diabetic drugs, and then again, what grade was the nurse trying to feed you, or was it simply someone employed to bring you round, stop you choking, and get help for anything more complicated than that?

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Turn it around into a factory setting!

If you needed an electrician would you send for an engineer?
If you needed a toilet fixing would you send for a carpenter?
If you wanted a computer fixing wound you send for a carpet fitter?

And so on.

It doesn't work that way in the health service because these specialist are for some reason not on duty!

Try and get a cardiologist on a Sunday evening!!

The front line including nursing staff are asked to do things and care for patients that are way out of their experience.
Diabetes comes a good way behind all the other emergency situations.
It's called triage!

nosher8355 said:

Turn it around into a factory setting!

If you needed an electrician would you send for an engineer?
If you needed a toilet fixing would you send for a carpenter?
If you wanted a computer fixing wound you send for a carpet fitter?

And so on.

It doesn't work that way in the health service because these specialist are for some reason not on duty!

Try and get a cardiologist on a Sunday evening!!

The front line including nursing staff are asked to do things and care for patients that are way out of their experience.
Diabetes comes a good way behind all the other emergency situations.
It's called triage!

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I agree entirely.
It's unrealistic to expect every HCP to be an expert on everything, it's a completely thankless job at times.

So, what realistic model would we expect?

I love this thread so much, it is very good, such an important topic, and cool to see all the individual suggestions.

http://i2.nyt.com/images/2015/08/28/science/bodyfat-bmi/bodyfat-bmi-jumbo-v2.png

I would like doctor to raise the fact that type 2 do not have to be progressive.

Also that bodyfat and bmi do not have to be related. 16 percent of women with a normal or underweight bmi had more than 35 percent of bodyfat for instance!

SunnyExpat said:

I agree entirely.
It's unrealistic to expect every HCP to be an expert on everything, it's a completely thankless job at times.

So, what realistic model would we expect?

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I would expect a diabetic trained person that tours wards and could be on hand for good advice rather than just ignorance.

I rather naively expected a ward nurse administering medicines to have a basic knowledge of what they do

Administrator said:

Yes, for sure!

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There is a bit of an art to writing questionnaires and surveys. I am no expert, but have done a few. If you would like a proof reader or some constructive criticism, just drop me a line

Celeriac said:

Being as stubborn as the proverbial mule, I would have refused to eat the white bread at all. I would have kicked up a stink. Would they force bread on a coeliac ? Then don't force it on me.

When I was in hospital, my husband and mother brought me food in, so that I didn't have to eat hospital food. TWO of the junior doctors told me that they had contracted food poisoning from eating it.


Sent from the Diabetes Forum App

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Personally, provided I was not prone to extreme reactions from some additional carb, I'd have eaten what I could; viewing it as ticking a box to be discharged. But, that's just me.

If course, that doesn't make the treatment or approach right, but I would be tackling my personal circumstances at the time. We each have to work with what we have.

AndBreathe said:

Personally, provided I was not prone to extreme reactions from some additional carb, I'd have eaten what I could; viewing it as ticking a box to be discharged. But, that's just me.

If course, that doesn't make the treatment or approach right, but I would be tackling my personal circumstances at the time. We each have to work with what we have.

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And that was EXACTLY my situation. I was in as a day case for morning surgery and before being disharged in the afternoon I had to prove to the nurse assigned to me that I could hold down food and a hot drink and go the toilet. I saw it as a means to an end. After eating and drinking successfully, the nurse walked me to the toilet and while I was in the cubicle, rang my lift to say I was ready to be collected.

What shocked me was the nurse's lack of knowledge of how metformin works.

poshtotty said:

And that was EXACTLY my situation. I was in as a day case for morning surgery and before being disharged in the afternoon I had to prove to the nurse assigned to me that I could hold down food and a hot drink and go the toilet. I saw it as a means to an end. After eating and drinking successfully, the nurse walked me to the toilet and while I was in the cubicle, rang my lift to say I was ready to be collected.

What shocked me was the nurse's lack of knowledge of how metformin works.

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Well, to be honest, if the average practise nurse, doing diabetic reviews has so little (apparent) clue, why could we expect a general nurse in a day surgery unit to be any different?

Again, that doesn't make it right.

I hope you're recovering from your surgery well.

AndBreathe said:

Well, to be honest, if the average practise nurse, doing diabetic reviews has so little (apparent) clue, why could we expect a general nurse in a day surgery unit to be any different?

Again, that doesn't make it right.

I hope you're recovering from your surgery well.

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Wouldn't you expect a prescribing doctor on an overnight ward to understand that a person on MDI does not necessarily have the same amounts of insulin all the time?

Hubby and I had a heated debate with the lady prescribing doctor on my ward recently. She wanted to write down how much insulin I use and wanted to know the set amount of units I have...she just did not have a clue that I bolus or basal according to food, activity, bloods...

A complaint has been logged...

Although I didn't exactly feel supported by the nurse who gave me my blood test results and T2 diagnosis, with little specific advice of any sort, one thing she did tell me to do was contact the providers of the local X-PERT course. I didn't get on that for months after the diagnosis, but it turned out to be excellent.

It gave me immediate contact with a group of people who were also T2, a complete mixture, too. We definitely weren't all overweight and unfit! There was the serious input, but also lots of the teaching was in the form of small group activities which were more like party games at times, which got us helping each other, and wasn't what any of us expected.

The person who presented the sessions was superb, and by the end, you could see how it was designed to include everyone, regardless of how much they really understood things at the beginning. She did end up saying we were one of her best-ever groups as regards helpfulness, friendliness, participation, etc, but it made me think what the X-PERT people are doing is a pretty good model of how to get everyone taking responsibility for managing their own condition, learning at a speed you could cope with, making changes you could sustain, etc.

I'm thinking of the appointment where the diagnosis is given first of all. My feeling is that we need to get back down to basics with information and approach, not bombarding the patient with info that they may not be able to take in. In no particular order..

Explain that carbohydrate is sugar, this is what it turns to in the blood. How many people arrive at this forum not realising that carbs have a major role to play, that say that have cut out sweet things like coke and chocolate? We make the link here on the forum but it is often missed out at the first appt- it needs to be spelt out clearly. Not just the newly diagnosed being told they need to give up sugar.

Offer a meter and test strips for a short period of time and give the target levels to be attained. Yes, I know, and I'm of the belief they should be freely prescribed for those who want them, but giving them to somebody, say for a month, with a follow up appt will show if they intend to use the info to make changes. I agree that not everybody is willing, and I'd rather they go to those who will use them, than end up on Ebay.

Banish the Eatwell plate to a galaxy far, far away. Again, keep it simple - people are more likely to follow advice if they don't feel overwhelmed. Tell them to halve the amounts of bread, pasta, rice and potatoes that they usually eat and increase the veg and protein.

I know the thoughts of many about LCHF, but the bottom line is that the NHS does not share this viewpoint, and will not advise a newly diagnosed patient to follow that way of eating. Harm minimisation should be the key, getting someone to reduce their carbs initially and lower their blood glucose levels.

Obviously it would be great if they could be pointed in this direction, but I think it's safe to say they will normally (if at all) be pointed towards DUK, as they are the recognised charity. I found this forum by accident, thinking it was DUK and I would hazard a guess there are a lot of us who did the same thing. Guess we can only hope with that one.

I had/have an excellent diabetic nurse (Sandra) at my Doctors surgery. When I was first diagnosed she sat me down explained the condition and why it's bad for the body and important to get a good level of control. It was quite basic and at times a little patronising, but I could see where she was coming from and how it might be necessary in some cases. We went through my day to day life and diet pointed out things that could change and made an action plan... Nothing on paper just a verbal agreement. I was given some medication and a lot of literature to go through as well as my next appointment. It seems overwhelming but I left the room feeling upbeat. I had an idea of the changes I needed to make and the resources to learn more. The more I read the more I wanted to understand so in my next few appointment I had a whole barrage of questions and in the first three weeks my fasting blood went from 11.6 down to 7.4! Over the next few months I'd pestered Sandra so much I almost felt like an expert.

Over the first year of diagnosis Sandra was my crutch and my rock. I'm not sure if my enthusiasm brought the best out of her or vice versa. I do know though that without her I'd have never been able to make the change I have... I remember one conversation with her where she told me I'd have this condition for life and there's no way to cure it. I looked at her and said watch me, she just laughed and wished me luck. A years later I was off all medication and down 13stone and my prescription for test strips taken away by my doctor This was a hard transition as I was using this as a way to gage my food intake and it took some getting used to. Another year later my HbA1c was 5.2 and steady and my appointments down to just one review a year.... I've been told I can request more if I need to.

I think everybody needs a Sandra, I know I did.

NikiBlowman said:

I had/have an excellent diabetic nurse (Sandra) at my Doctors surgery. When I was first diagnosed she sat me down explained the condition and why it's bad for the body and important to get a good level of control. It was quite basic and at times a little patronising, but I could see where she was coming from and how it might be necessary in some cases. We went through my day to day life and diet pointed out things that could change and made an action plan... Nothing on paper just a verbal agreement. I was given some medication and a lot of literature to go through as well as my next appointment. It seems overwhelming but I left the room feeling upbeat. I had an idea of the changes I needed to make and the resources to learn more. The more I read the more I wanted to understand so in my next few appointment I had a whole barrage of questions and in the first three weeks my fasting blood went from 11.6 down to 7.4! Over the next few months I'd pestered Sandra so much I almost felt like an expert.

Over the first year of diagnosis Sandra was my crutch and my rock. I'm not sure if my enthusiasm brought the best out of her or vice versa. I do know though that without her I'd have never been able to make the change I have... I remember one conversation with her where she told me I'd have this condition for life and there's no way to cure it. I looked at her and said watch me, she just laughed and wished me luck. A years later I was off all medication and down 13stone and my prescription for test strips taken away by my doctor This was a hard transition as I was using this as a way to gage my food intake and it took some getting used to. Another year later my HbA1c was 5.2 and steady and my appointments down to just one review a year.... I've been told I can request more if I need to.

I think everybody needs a Sandra, I know I did.

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Well done. I feel this shows that really good support, and willingness to change, at diagnosis is what is needed. Those first few months is where help is really needed.