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Worst review with DSN

Discussion in 'Type 2 Diabetes' started by akindrat18, May 8, 2017.

  1. akindrat18

    akindrat18 Type 2 · Well-Known Member

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    My appointment today with the DSN to discuss my high blood sugars went no where. I've been told to stick to injecting 10 units of novorapid with each meal and not 30, but 36 units of tresiba. I showed her my blood sugar levels over the past month and she was like ”they're a bit high".

    She even brought up the eat well plate, asking me if I have been following it and then when I asked about carb counting and going onto a DAFNE course, she said that I don't need to as it's for people with type 1 and that the DESMOND course is more suitable.

    I feel so angry right now at them, they are just not listening to me.
     
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  2. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    Can you take your concerns to your doctor?
    Perhaps if you alert him to the high readings - or conversely lower your carbs a little so that they are not outpacing the insulin?
     
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  3. Winnie53

    Winnie53 Type 2 · Well-Known Member

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    That's odd. Seems like attending the training for type 1's would be more useful because you're injecting insulin, but I'm type 2 and don't inject insulin, nor do I live in the UK. Think strategically. Perhaps you could request more information on both classes, decide which you believe would be most helpful, then make a second request.
     
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  4. Diakat

    Diakat Type 1 · Moderator
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    Can you write her a letter stating that you are concerned at the lack of attention to your wishes and that the blood levels you are experiencing are a worry for you and a risk to your mental health as well as physical. Request in the letter to see a consultant and attend structured education. Keep a copy and send a copy to your GP.
    Having it in writing and with the formal requests may make her pay more attention.
    You deserve better than this.
     
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  5. covknit

    covknit Prefer not to say · Well-Known Member

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    Somewhere I read an article about how to identify a good gp from a bad. Amongst the list was an entry saying that if the gp referred your routine diabetes care to a diabetic nurse we should know the nature of the nurses qualifications and the date of their most recent update training. I am sure that the article was aimed at patients outside the UK, probably the USA but the point made should not be lost on us. You could ascertain what the qualification and training regime for NHS diabetic nurses is. I would like to know for my own information. With that information in mind prepare a new data sheet to represent your own results. Then make another appointment with your dn to discuss your case with your latest meter readings. During your conversation you can say something along the lines of "I read recently that XYZ is the latest thinking, when was your last update course?" If you can do it non confrontationally you may be able to work together in increasing each others knowledge. In a less than that ideal world you should at least gain an insight into the era of the tickbox list being used.
     
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  6. Deleted Account

    Deleted Account · Guest

    I attended a DAFNE-like course and found it mostly carb counting which would seem appropriate whichever type of diabetes you have (regardless whether you use insulin).
    Unfortunately, the best way of knowing about diabetes is having it yourself. As a result, many of us end up doing a lot of research ourselves rather than relying on health care professionals who don't always understand what it is like. Hence, fora like this one: if the successful treatment for all was to take 3 tablets every day with no side-effects, we'd have nothing to talk about.
    If you want to learn about carb counting, have you looked at the on-line courses? Whilst you may not have the chance to discuss the course with others in the room, you can go at your own pace, replay bits you weren't sure about and skip the blatantly obvious and condescending bits.
    Someone recently mentioned a course that had just been updated. Apologies, I cannot find the reference again. Hopefully, someone else reading this will be better at searching than I.

    As frustrating as it may seem to have to do it all yourself, there are many people on here who have done just that with fantastic results: wanting to do it is the first step, so well done.
     
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  7. alandmcleod

    alandmcleod · Newbie

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    I share you anger. Basically, if a DBS
    I share your anger. Essentially, if a DSN isn't diabetic themselves they don't know s**t. I'm told "Eat pasta, eat brown rice" if I do my sugars rise to 18. As we all know now, diabetes control is not one-size-fits-all. What works for me won't necessarily work for you and vice-versa. Good book - Blood Sugar 101. Cut the carbs and you'll be good to go. all the best
     
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  8. Tron-Ir3

    Tron-Ir3 Type 1 · Newbie

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    @akindrat18
    Hi totally see your point in regards to not listening.
    I have Type 1 and I have been a diabetic for almost 30yrs, I recall being told that I need 10 units before every meal. Remember getting hypos when I don't eat enough or the carbs don't add up etc.
    Started adjusting my intake on the type of meal I was about to eat, at the time I thought to myself if I at times don't eat much or if I slightly a little more would it not be common sense to do this, told the nurse during check up and they where not happy with me.
    Anoway instill adjust my insulin depending on my food in take and now as I work abroad they doctors and nurses there says it's good that I adjust as it's not set in stone it's a boarder guide line.

    OK so after all this time I have lost the ability to detect a hypo coming but I have came up with a way for colleagues, friends and family to alert me.
    I told them to ask me simple arithmetic questions if I can't answers these within 2secs I need food or something sweet.
    This trick saved me a few times, not sure why it works but I think when my sugar level drops my brain goes into to slow motion even for simple tasks.

    But yes I think I do feel better adjusting my intake depending on the meal in front of me :)
     
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  9. jonjaz

    jonjaz Type 2 · Member

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    Bet she was skinny !
     
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  10. shelleyh

    shelleyh Type 1 · Member

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    Is this the DSN at your GP or at the hospital? I too was totally dissatisfied with my diabetic care at my local hospital so requested that I was seen at another hospital. It was the best thing I have done as far as diabetic care is concerned. I attend Addenbrooks in Cambridge now and although it is a longer distance to travel, it is so worthwhile.

    If it is the GP Surgery I would make an appointment to talk to the GP and voice your concern over lack of advice to reduce your blood sugars. If you are still not convinced, change your GP. You deserve to be looked after and advised correctly.
    Good luck
     
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  11. srm100841

    srm100841 · Well-Known Member

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    My
    Following my initial diagnosis in 2002 of T2, I was referred to a dietician by my diabetic nurse. The dietician followed the 'accepted guidelines' of balanced meals but more or less eating what I wanted apart from the obvious things like sugars, sweets, confectionery, cakes etc. Predictably over the years my BG levels continued to rise. When told that the next step was insulin (I have a morbid fear of needles) I started researching the web and came across this site and got interested in the low carb diet. I started on a fairly strict regime of 50 carbs per day spread over 3 meals. As a consequence within 8 weeks my levels dipped from 11 to somewhere in the 6's. Since then I've managed to both control my BG levels to below 6 and reduced my pill medication from 320 gms per day of gliclazide to just 20!!

    When I last saw my doctor some 4 years ago he looked quizically when I mentioned my low carb success and was a bit disparaging. My faith in the views of professionals relating to diabetes is pretty low. My advice is to do your own research and conduct some of your own experiments to see what works for you.
     
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  12. worcesterwoman

    worcesterwoman HCP · Active Member

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    Oh yes, I can relate to this! Spent around 4 + ears asking for help with blood glucose being too high, everyone will frown and tut but not offer the right support. Like you I am Type 2 and on insulin, Apidra and Humiln I. My previous long term was 75 but this week I was absolutely stunned to get the news that I am now 47. Totally amazed. My saving grace was developing Bell's Palsy and needing to take short term high does steroids which usually send your readings high. Because of this I was referred to the hospital diabetic nurse who sat with me and talked me through what to do and also give me an Insulinx meter which was later changed to an AccuChek Aviva Expert meter. She programmed in my expected carb ratios and the meter then advises on insulin dosages. I have been working with her since last November and this week she discharged me, I am over the moon.
    It can be done but I had to experience a lot of negatives from the GP surgery, the best perhaps being ' you don't want all that insulin swishing around your body' well hello, I am taking much more than previously with amazing results. I did ask the hospital nurse about the increased doses I was on as I felt they were high and she turned and said they have patients on hundreds of units so mine was small fry.
    Ask to be referred to the hospital diabetic services, ask about carbs and an insulin meter, it can be done when you get a chance to work with the right professional and with the right tools and medication.
    I spent years beating myself up and being made to feel useless at controlling my readings, it has really knocked me, but now I am slowly crawling out of my hole.
    See your GP talk carbs, insulin, better glucose meter (needs to be set up by a Diabetic specialist nurse) tell them I sent you! All the best and don't beat yourself up when you haven't been given carb ratios to work with.
     
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  13. Paul520785

    Paul520785 Type 1 · Well-Known Member

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    I have so much sympathy on this. As a type 1 for over 55 years I have experienced much worse - and been so angry that I swore at the staff in the surgery (Received a letter saying if I ever did that again they would kick me out) <>
    After a long battle with the surgery about my Diabetic treatment I raised a complaint with the NHS - 4 months on attended a meeting with a senior partner with the outcome of - "Yes you are absolutely correct but we have resisted because we did not know how you were controlling your blood sugar. You have no complications , a very appropriate HAB1C? level and the lack of complication has saved the NHS a fortune." Really annoyed that they said they did not know haw I achieved control - They have been told verbally and with written summaries regularly over 15 years.
    This has to be either no time to listen or just too ignorant to ask if they do not understand.
    Yes I am being nasty, but, I feel I have earned the right!

    So my advice (for what it's worth) see each person, explain what you want and why - then work thro' DSN , GP . Consultant , NHS complaint until you get what you want or an alternative with the explanation as to why! It helps if you keep notes and dates so you can explain the sequence of events if asked!

    As stated in other answers >> do your own research and conduct your own experiments to see what works for you.
     
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  14. ickihun

    ickihun Type 2 · Master

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    I too flurished on more insulin @worcesterwoman . I even lost weight.
    I find thou my Insulin Resistance is very very easily influenced. Any variation and it goes mad.
     
  15. Oldvatr

    Oldvatr Type 2 · Well-Known Member

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    You and I seem to be on parallel paths. My bgl was higher than yours when threatened with insulin (regularly clocking 32+ mmol/l. I was put on Gliclazide 320 mg too, but now down to 40 and hoping to split it on next review with GP. My HCP team are very supportive of my LC diet, and I am declared resolved.. There was some initial resistance to LCHF diet, but that changed when I presented my testing results in a spreadsheet, complete with graphs and a food log.
     
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  16. logindetails

    logindetails Type 1 · Well-Known Member

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    Are you counting carbs? You don't need a DAFNE course to start counting. The amount of carbs in a food is listed on the back of the packet or can easily be found by googling. Try and stick to below 100g of carbs per day (less if you can) and initially try 1 unit of novorapid per 10g of carbs - test after 3 hours to see if the dose needs to be adjusted (a little at a time). Use your meter regularly, it's your best friend.
     
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  17. Vaper

    Vaper Type 1 · Active Member

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    Hi I'm type 1 but was misdiagnosed for the first year and used the insulin as you are. Sometimes we don't like what we hear but what you are saying your dsn is saying to you sounds right. Desmond is the right course for you and your insulin will be a fixed dose so you have no need to count carbs. You do need to use the eat well plate as type 2 is helped stay in control by eating ratios of carbs proteins and vegetables. It takes time for your levels to drop and I do hear you when you say they are high mine were in the same ball park as yours. If they don't drop after trying her recommendations for say a month then ask for a GAD test although this is best done before you start on any form of insulin. Diabetes can be and is at times a struggle and I'm sure you will get there but you do need to follow the dsn advice.
     
  18. alisonatwallsend

    alisonatwallsend Type 2 · Member

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    Hi - I had to send this message - saying how much I DISAGREE with Vaper's last response to you!!!

    I refused metformin and statins entirely - researched and then told the diabetic nurse I was going to try the LC/HF Lifestyle change and wait until after the initial 12 weeks to see the results, before I would consider any meds at all.

    I DID MY HOMEWORK/RESEARCH, but have found my NHS diabetes nurse and doctor really don't know as much about the subject as I do now (VERY WORRYING). I then went on their DESMOND course, and came away really disappointed in it. I felt they only gave information on reducing quantities, sugars and some carbs maybe - emphasis on eating less of everything.

    They could have more usefully utilised the course to suggest other possible ways to try (eg., low GI; Mediterranean; LC/HF
     
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  19. alisonatwallsend

    alisonatwallsend Type 2 · Member

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    sorry - sent that before finishing the message by mistake.

    I felt the course is now OUT-DATED and severely biased. I felt that not many people there would succeed following their limited advice. As we know 'what suits one person may not help another', so they COULD and should have broadened the possible diets and lifestyle changes that others could try!

    Indeed so far I have not found much support from NHS diabetic staff/doctors in general - they just want to put everyone on medication - possibly an easy option for them!? They are at least 'negative' and non-committal on LC/HF - won't support it but don't stand in your way if one wants to 'go it alone' and try the LC/HF lifestyle change. They said - "but what do you do after the 12 weeks???" - Answer "It's a Lifestyle change, not just another diet fad".

    Obviously they have not done more up-to-date research and considered alternative methods (nor does anyone want to consider the possibility that the information they had 40 years ago might not have been correct; that there may be better lifestyle changes out there which could be more sustainable for some people faced with Type 2 diabetes).

    I have lost nearly 4 stone and at my last results (last summer) I had almost reversed my diabetes and was told I did not need to take the Metformin. It has been hard over the winter to manage, but I really want the next 'yearly tests' to see how I did over that period. I have now found 3 COOKBOOKS which have 'opened my eyes' and really made me understand the foods I need to eat to stay healthy (proteins, fats, and Green veg & nuts for fibre). etc. I don't starve, am never hungry, I am fitter at 60+ than I have been in years; am mentally alert; race up hills and walk my dogs for hours - before going to work. I FEEL GREAT, and all without recourse to meds! It's worth considering that there are other ways to control/possibly reverse your diabetes.
     
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  20. Damtov8

    Damtov8 Type 2 · Well-Known Member

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    Visit the Type 2 Diabetes Rebels on Facebook. They helped me reduce my HbA1c from over 12% down to 5.8% in less than 6 months with Low carb high fat special diet.
    My sceptical GP has nothing to say. They can shove their 30g of carbs a meal where the sun don't shine. I wat less than 30g carbs a day now and no meds.
     
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