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who monitors diabetes?

Discussion in 'Ask A Question' started by anniep, Jun 18, 2010.

  1. anniep

    anniep · Well-Known Member

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    Can anybody tell me if it is usual for diabetes to be managed solely by the practise nurse? I have been with my current practise for 3 years and have moved from Impaired glucose tolerance to metformin.

    In that time I have never seen the doctor about my diabetes, only the practise nurse, who is certainly not a diabetes specialist she does everything from baby vaccinations to diabetes.

    I have very little confidence in her, for example she had apparantly never heard of the dawn phenomenon and when I asked for help on how to manage it, her only comment was "this is why they don't like you testing."
     
  2. ebony321

    ebony321 · Well-Known Member

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    I guess you could call me lucky but i have a main diabetes nurse at the hospital i can ring and email daily if need be and she is very good!

    I also have a diabetes nurse at my local GP but i only see or speak to her occasionally.

    I See a dietician when i come to appointments with my diabetes nurse at the hospital.

    i also have a diabetes consultant (doctor) on my annual reviews (which are every six months at the minute)

    ....

    Seems like you need to see about seeing someone with more experience definately... there is nothing wrong about not knowing things as nobody is perfect but her reply should have been to find out as much as she can for you and get back to you on it. not to brush you off like that.

    I think you should at least have someone you can contact if you really need to, a dietician if you would find that useful, and definately a doctor on your reviews!

    Do you live in a small town? as i can maybe see why you would see someone who is general rather than specific which is okay but only if you see a specialist along side!

    Definately enquire about getting more people involved in your care, especially as you take medication!

    Diabetes is a condition where it requires a good team to help you as there are very many factors about the care needed!
     
  3. anniep

    anniep · Well-Known Member

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    I managed with my previous doctor to stay as pre diabetic for some time, it was he who found out about the dawn pehonmenon - we couldn't understand why the the official fasting levels were way higher than mine. He went away and found out - which is fine I trusted him.
    He let me control it by low carbing and was fine with that if it kept my BG low and my weight down.

    I moved (you are right to a small town) and was put under the pracise nurse, who made me see the dietician and both of them told me off for low carbing, insisting I follow the accepted diet. I have been trying to folow their diet and feeling iller and more tired and hungrier and getting fatter and fatter. and my 1ac were going up and up despite metformin.

    Practice nurse won't listen about low carbing, tells me off for being non-compliant and even told my husband when he saw her about something for himslef, that i didn't look after myself.

    I have an erratic job and am not always in a position to take my evening meds -I am not always sure where i will be and when I will be eating. But again she has no understandign of the problem, thinks I am being difficult.

    I have, since her brush, off decided enough is enough, I was in control before and have taken back control by low carbing and my own BG tests are much better, I wait to see about the next 1ac and colesterol etc.

    I was really looking for what is usual so that when I go back for my next review I have a more informed position to ask for what I think I need, and not be fobbed off on the standard advice that she was told on her course.
     
  4. Janieb

    Janieb · Well-Known Member

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    I have my nurse who is cool and I can ring her when ever and you lot of course ( oh and my hubbie he seems to know when I'm about to become unwell before I do)
     
  5. ebony321

    ebony321 · Well-Known Member

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    ''I have an erratic job and am not always in a position to take my evening meds -I am not always sure where i will be and when I will be eating. But again she has no understandign of the problem, thinks I am being difficult.''

    I think this is a problem you definately need to solve! i understand that certain things in life will always cause problems, but if you don't take the medication you need to keep your diabetes in check then you may soon not be well enough to go to your job!

    ''I was really looking for what is usual so that when I go back for my next review I have a more informed position to ask for what I think I need, and not be fobbed off on the standard advice that she was told on her course.''

    i'm only t1 so i can't advise you perfectly as your t2 and ther emay be extra things you may need to know but i can hopefully start you off...

    For a review i would expect...

    Blood test results - HBA1c, Cholesterol, blood pressure, Lipids. Ask if they are all in a normal range and if not what you can do to see that they are, dont take a 'you dont need to know' as an answer!!

    You should be taking a morning sample of urine with you to test your kidney function.

    They should check your extremities for any signs of nueropathy.

    They should ask you if you have had a retinal screening in the past year and if not inform you how to arrange this.

    They should take your height and weight and record this and advise you if you are either under or over weight.

    They should look at your record of Blood glucose to see how your doing.

    They should also ask if you would like to see a dietician if you are struggling with anything relative.

    They should also ask about your medication and discuss any plans to reduce, increase it.

    This is also your oppurtunity to ask all the questions that you gather from your previous review, (i always write down questions over time to save and ask away :))

    Don't be afraid to challenge your nurse with low carbing, i'm surewhen she sees your improvement in results she will have no basis to argue. especially as she isn't a diabetes specialist and you both be sat there wit your results as proof low carb diet works for you.

    I'd also ask bout the problem regarding your medication as it's really not good you can't always take it. there's times in my life where having to take my medication is a pain in the back side but if i didnt take it i'd die. simple as that really. it won't happen as fast wth T2 but your more likely to accrue complications with poorly controlled BG. i'm sure there's a way around it if you can get the right care you deserve and someone who is willing to go through all possibilities with you so you, your life, job and diabetes can all be evenly balanced :)

    good luck,

    Hopefully someone will be alongto fill in my gaps :)

    If you aren't offered any of these certainy ask for them! and if the nurse can;t giveyou any of these tests or answers then ask to see someone who can!
     
  6. anniep

    anniep · Well-Known Member

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    Sorry I didn't explain the evening medication thing properly.

    Metformin has to be taken with or after food, and because as I said my evenings and meal times can be erratic I dlon't always get an suitable oportunity to take it. This means when I come in late at night I have to eat, whether I want to or not in order to take the metformin. Peviously with another doctor I had the same problem, but with different medication. This was solved by a slow release form of the medication, and I was trying to find out if there was something similar available with metformin.

    My weight is always an issue and I was trying to talk to her about this problem (eating extra late at night) but she just didn't get it and thought I was being uncooperative.

    I feel that I am not being taken seriously and treated like a child, this is the way it is done, now do it is the mesage that I get. Which if I felt my care was good I could handle, but I don't.

    At the moment I am also resisting statins, - my colesterol is 5.1 but I have had previous kidney problem (unrelated to diabetes) and don't want to take them

    I am not convinced I am always getting good advice and an wondering if I have the right to be seen by somebody else and not the practise nurse.
     
  7. badmedisin

    badmedisin · Well-Known Member

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    If you get better results with low carbing, the nurse will have to take your word for it and accept that it's your choice. It's not up to her to dictate your diet.

    As for the evening meds thing, can you take a packed lunch (well, dinner) with you and eat it at a better time? Personally, I will eat or test or inject whenever I need to, regardless of where I am. I have to prioritise my health over my job, and it's not like they could legally fire me for it!

    You have the right to decent healthcare even if you live in a small town :) Make them refer you to a specialist diabetes doctor. You have a complicated condition which needs to be treated by a doctor who knows about it, not by someone who sort of knows a little bit.

    Good luck!
     
  8. Synonym

    Synonym · Well-Known Member

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    Hi anniep :)

    Well, it sounds to me that you have once had control and lost it by doing what this nurse tells you to do. :roll: Now that you have gone back to doing what you know actually works you are starting to feel better and your BG level numbers are undoubtedly better. Far from being non-compliant you have tried and tested her way and found it not to work. As for her discussing you and your health with your husband you have every right to make a formal complaint. :evil:

    You do need to put your health before everything else - if your health fails you will not have a job and not much of a life or anything else either :!: Your priorities need to change :!: As I understand it there is a slow release form of metformin but it is almost not worth pursuing that line with your current care situation. Press for a referral to an Endocrinologist or if that is not forthcoming then do what I had to do and refer yourself. :roll: Ring up the local hospital or nearest large hospital ask for the Diabetes Clinic Secretary and tell her all about it! Hopefully if you can make a strong enough case they will arrange to see you. Let us know how you get on :!:

    You may well have been diagnosed for a while but the advice given on this Forum is not the standard advice which is, unfortunately, so often given to diabetes patients by the professionals.

    The advice posted on here by Ken and/or Sue, the Forum Monitors, for new T2s is as follows:

    “Welcome to the forum. here is the advice we usually give to newly diagnosed type 2 diabetics. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different .

    It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

    The main carbs to avoid or reduce are the complex or starchy carbohydrates such a bread, potatoes, pasta and rice also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

    The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating and then two hours after eating you will see the effect of certain foods on your blood glucose levels.

    Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

    When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.

    As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try !!

    As a Type 2 the latest 2010 NICE guidelines for Bg levels are as follows:
    Fasting (waking).......between 4 - 7 mmol/l.
    2 hrs after meals......no more than 8.5 mmol/l.
    If you are able to keep the post meal numbers lower, so much the better.

    It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.”
     
  9. anniep

    anniep · Well-Known Member

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    I can't blame the nurse for my loss of control, that was life (I moved home town and job and lost my surving parent within very short time. And lost control myslef, but when I went for my check up in attemp to regain control, I was told in no uncertain terms I mustn't low carb and was referred to the dietician who repeated the same advice just as strongly. And between not being used to being treatd like a naughty child and generally how low I was feeling I never argued, I got stuck in their way of doing things, and control was never regained.

    I have now decided enough is enough and I am taking charge. Very reluctanly I was given a prescription for strips, that work out at about 4 a week. But she has thankfully put them on my repeat prescription.

    I would wake up with BG at around 6.00 then by breakfast time they had risen to 8.00 and after the reccomened 2 slices of wholemeal toast BG would rise to 10-12 and stay there until 12.00 or 1.00 in the afternoon. If i didn't eat they still rose, nothing I could do would bring them down. When I said to the practice nurse that that must be having an effect on the HBa1c, she shrugged it off saying that the HBa1c was just an average and it wouldn't make that much difference.

    After the brush off over advice on the DP. I searched the internet and basically tried anything people had indicated helped them - nothing did help until I realised that if my body was not processing carbs in the mornning why on earth was I eating them? and decided not to eat carbs before noon. Now I have a cooked breakfast and my AM BG rises form 6.00ish to 8.00ish and then comes down again within 2 hours.

    I also discovered that when I was eating the reccomened pasta for my evening meal my BG were high and stubborn the next day, and even a small sandwhich at lunch time sent my levels rocketing, so anything with wheat in it has gone too. :( Potatoes are not so bad I seem to be able to tolerate about half a small jacket potatoe.

    My next lot of strips I am going to concentrate on other foods, testing at 2 3 & 4 hours after luch after lunch and tea. As I though I could tolerate pulses, but I was only measuring after 2 hours and read here that they may release their carbs later than that. So I need to see how my body is really reacting.

    The info and support here is giving me the confidence to fight back, but I hope the next reading is so much improved that she will not be able to argue her diet anymore.
     
  10. Synonym

    Synonym · Well-Known Member

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    Hello again anniep :)

    Whether she argues her diet or not it is your diabetes and your life so you are the only one who should be deciding what goes in to your mouth! :shock:

    You may well have to buy yourself more strips so that you can really get a handle on what your food is doing to your body and ultimately your condition; it could be the best investment you ever make!
     
  11. anniep

    anniep · Well-Known Member

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    I went to the doctors over something else last week and she wanted a blood test, so I jumped in and said that as my next a1c was due in 3 weeks could I have all the blood tests at once. No problem; so I have been back to the doctors this Am and she did a mini diabetes review for me (except for wee and weight), not the practice nurse, doctor knows I have given up anything with wheat in it and is not arguing with me. She has put off my review with the practise nurse for another three months to allow another 3 monthly a1c to see how the change of medication is working.

    results are-

    Nov 09 a1c 8.00 cholesterol 5.4: result metformin 4x500mg was prescribed

    Feb 10 a1c 7.4 cholesterol 5.0: with metformin, eating the 'right way' AND taking benecol

    July 10 a1c 6.4 cholesterol 4.2: with huge amounts of cheese but without benecol (it had too many carbs in it) and without starchy carbs - result doctor has halved my daily metformin.

    She did a whole raft of blood tests and she also says that everything was fine, absloutley firmly in the normal range, liver, kidney function etc.

    She also explained properly to me about statins that they seem to have a secondary effect for diabetics, in that even when their cholesterol is in the normal range, statins have a protective effect. So I have decided to take statins anyway even though my cholesterol is lowering. But it was my informed choice on clear info from the doctor with no pressure, she allowed me to say I will go away and think about it, she just gave met the info to read at my leisure, and make my own decision, she even explaind why she was giving me the dosage she was. Practise nurse had been pushing statins with no explanation just diabtics need them.

    No matter what happens with the PN now, she can't argue as the doctor knows I am avoiding the starchy carbs. And doc also knows I am testing to see what food works for me so PN also can't say I shouldn't be testing.

    feels like one up for the patient!

    And in the process I have now found the doctor at the practise who treats me like an adult.
     
  12. Synonym

    Synonym · Well-Known Member

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    Hello AnnieP :)

    So glad to hear that things are looking up and that you have found a doctor you can talk with adult to adult. 8) Keep doing what you are doing as it is clearly working!
     
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