Yet another DSN who isn't a lot of use

Pneu said:

I don't think anyone on here is saying that HbA1c's are the be all and end all... but with 70% of people failing to meet the current targets then something must be wrong... the current approach and guidelines can not be working if this is the case. T

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I don't believe it is the guidelines at fault here but the people who for whatever reason just dont care, you have to remember that not everyone is as proactive as you and I.

I can't really put it any better than fullfathomfive

fullfathomfive said:

Even if the 'correct information, training, monitoring, etc...' were available and 100% irrefutable, people are still people. They still smoke, drink to excess, fail to attend appointments etc. We all do things that we know are not good for us.

Maybe a lot of people are simply ignoring advice (whether this advice is correct or not).

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Sid Bonkers said:

I don't believe it is the guidelines at fault here but the people who for whatever reason just dont care, you have to remember that not everyone is as proactive as you and I.

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I've no doubt Sid that there are people who even when armed with the very best information and offered all kinds of support will still make "poor choices" -- although we each have our own priorities and the right to our own decisions -- BUT I wonder how many are given the option to make that "informed decision"?

Some may say that it is up to each of us to inform ourselves but when we go to HCPs for professional advice and they (not all of them by any means) assume before we even get started that Type 2's are non-compliant by nature (after all we "let ourselves get this way" right?) then why even bother to set high standards for us? This can become a self-fulfilling prophecy where we end up "living-down" to their expectations.

There are excellent HCPs out there and I don't know how prevalent this negative attitude is but I have come across it from some HCPs.

pianoman said:

Is hypo-unawareness inevitable in a Type 1 with stable, near-normal BGs or does this vary from person to person?

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I think these graphs from the DCCT are telling.
However, I think that some (but not all) T1s are fortunate that modern insulins (and pumps and even cgms) enable them to achieve lower HbA1cs relatively safely... however some people seem to have less easily controlled T1 and all T1s may perhaps go through periods where things are less easy than at other times.


Since being on the pump I rarely have levels below about 3.4mmol that I don't catch, however there are times like when running and swimming that the symptoms of going low are purely a loss of energy or a mental unwillingness to continue.
Before going on the the pump (and being able to lower my basal before exercise,) I had some times when I got very low (ie my meter said lo, bu I've never needed someone elses assitancet) . My HbA1c has been in the 5s for the last 6 years. It was as low as 4.9% before going on the pump . I'm much happier and more aware with it in the 5.6-5.8 area.

pianoman said:

Some may say that it is up to each of us to inform ourselves but when we go to HCPs for professional advice and they (not all of them by any means) assume before we even get started that Type 2's are non-compliant by nature (after all we "let ourselves get this way" right?) then why even bother to set high standards for us? This can become a self-fulfilling prophecy where we end up "living-down" to their expectations.

There are excellent HCPs out there and I don't know how prevalent this negative attitude is but I have come across it from some HCPs.

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Good point. My first consultant basically told me to stop talking and that he was asking the questions. As a cardio technician and mostly as someone who wouldn't be spoken to in such a manner I had the confidence to put him in his place. Unfortunately, I know from experience that there are many people who won't argue, many who can't articulate themselves very well and quite a few who don't realise or refuse to realise the seriousness of their situation.

It is a two way thing but equally we can't assume that HCP's are all good/bad or that we, as patients, all know what's best for us.

I'm, obviously, a fantastic HCP. :mrgreen:

phoenix said:

snip...

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Testing and common sense is the key here... if you go out of routine.. then test more frequently.. if you get an unexpected reading.. testing 15 / 30 minutes later to see which way sugars are moving etc...

It is more hassle and more testing but then that's the price of 5% Hba1c's

Sid Bonkers said:

I don't believe it is the guidelines at fault here but the people who for whatever reason just dont care, you have to remember that not everyone is as proactive as you and I.

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Two thirds of type 2s meet the NICE guidelines and less than a third of type 1s. So either
a) type 1s are inherently more likely to "just not care" than type 2s
b) it's not about people not caring about their health, it's about the fact that it is very difficult to get your bg below 7.5 if your pancreas isn't giving you any help.

I've met a lot of t1s in the course of my research, most of whom had non-target HbA1cs. Not one of them didn't care about their health. All of them knew the risks. Many of them had really poor self esteem because they'd spent their entire lives from early childhood being told they had 'bad' or 'poor' HbA1cs despite all their efforts.
Maybe it makes observers feel better to assume that those who can't reach the targets aren't really trying. But that doesn't fit with my experience.

Snodger said:

b) it's not about people not caring about their health, it's about the fact that it is very difficult to get your bg below 7.5 if your pancreas isn't giving you any help.

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Seriously? and I mean that with no disrespect... but that's an average blood glucose of around 9 mmol/l... just carb-counting, knowing your ratio's and regular testing pre and post meal must get you close to that?

Now what I find easier to believe is that people are not taught to do that as standard.. you have to apply for a carb-counting course... you aren't encourage to check 6 / 8 times a day.. you are given a generic ratio's and not taught how to re-calculate your own..

Every three months I sit in the waiting room at the diabetes clinic.. and I hear people talking and the majority are so ill-informed... I am certain it is an education issue..

No need to apologies...

If this site teaches us anything its 'think for yourself!'

Pneu said:

Snodger said:

b) it's not about people not caring about their health, it's about the fact that it is very difficult to get your bg below 7.5 if your pancreas isn't giving you any help.

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Seriously? and I mean that with no disrespect... but that's an average blood glucose of around 9 mmol/l... just carb-counting, knowing your ratio's and regular testing pre and post meal must get you close to that?

Now what I find easier to believe is that people are not taught to do that as standard.. you have to apply for a carb-counting course... you aren't encourage to check 6 / 8 times a day.. you are given a generic ratio's and not taught how to re-calculate your own..

Every three months I sit in the waiting room at the diabetes clinic.. and I hear people talking and the majority are so ill-informed... I am certain it is an education issue..

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I've had high hba1c and 'normal' hba1c (my lowest as a diabetic was 4.5) so I'm not having this argument to defend my own personal bg control. Because I've managed at times to get it down to normoglycaemia, I know how hard it is to do long-term - particularly if you are trying to do other things as well eg bring up a family; particularly if you are unlucky enough to come up against workplace prejudice; particularly if you are under a lot of stress, or very affected by other hormone fluctuations, or a number of other things that aren't your fault. For many women, periods can totally screw up bg control - doesn't make us stupid or lazy, we're just full of complicated hormones.
If these things haven't affected you, and you can easily manage normal bgs, that's great for you. But not everyone finds it easy even if they are trying very hard.
As for education and carb-counting, I agree entirely that a more people could benefit from it, I'm totally with you on that. I am a big fan of courses like DAFNE for lots of reasons...but I've just done a review of all the dafne evaluations (and the pre-dafne ones from Germany) and the average post-dafne Hba1c was still over 8%. So that's people who are educated and doing exactly the things you say - and it's still NOT EASY!

Snodger said:

I've had high hba1c and 'normal' hba1c (my lowest as a diabetic was 4.5) so I'm not having this argument to defend my own personal bg control. Because I've managed at times to get it down to normoglycaemia, I know how hard it is to do long-term - particularly if you are trying to do other things as well eg bring up a family; particularly if you are unlucky enough to come up against workplace prejudice; particularly if you are under a lot of stress, or very affected by other hormone fluctuations, or a number of other things that aren't your fault. For many women, periods can totally screw up bg control - doesn't make us stupid or lazy, we're just full of complicated hormones.
If these things haven't affected you, and you can easily manage normal bgs, that's great for you. But not everyone finds it easy even if they are trying very hard.
As for education and carb-counting, I agree entirely that a more people could benefit from it, I'm totally with you on that. I am a big fan of courses like DAFNE for lots of reasons...but I've just done a review of all the dafne evaluations (and the pre-dafne ones from Germany) and the average post-dafne Hba1c was still over 8%. So that's people who are educated and doing exactly the things you say - and it's still NOT EASY!

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Sorry I am not trying to be confrontational and please don't take it as a question over your own personal control, I am just trying to understand the issue!

I quiet agree that keeping good long term control is not easy... and everyone is going to have good and bad periods of control... coupled with out complications / life commitments I think that we have all had or will all have these... My partner had a very complicated pregnancy with our daughter and we were in and out of hospital a lot; quiet touch and go for both of them at points. Over that six month period my control did slip somewhat so I can understand if diabetes isn't your primary concern your control not being 100% there..

I can therefore understand that sometimes people may not be within the safe range.. and some of those people falling outside are new and therefore still getting there control.. but that must leave a sizeable percentage who consistently have 'poor' control and there must be away in which these people can get help to achieve better control.

I didn't feel offended or got-at, don't worry... And sorry if I came over a bit strong. I just wanted to put the other side, having worked quite a lot lately on this issue.
And I think we are in agreement anyway that people need info, help and support.

minitata said:

I'm someone who easily panics, starts to stammer and then gives up. This means that is the nurse at clinic starts into me I panic. It then undermines my confidence in myself. That's why I posted this thread; I need someone to convince me that the 'experts' are not necessarily the be all and end all in life. I've been trying to decide whether I should follow what she says, and this forum has decided me that I should control my own diabetes.

At the end of every day I have a habit of replaying all the conversations I've had (verbal or written) during the day; and invariable find myself an idiot.

Sorry
MTT

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Don't be so hard on yourself. I too afterwards wished I would have said something or would have said it differently but you are the "expert" on you! I refuse to see anyone associated with diabetic education. I will only work with my doctor and he respects my decision. A few years ago, before I was diagnosed but my husband was diagnosed, he went through a diabetic education program at the hospital. The diabetic educator would always call the house to check in with him and he didn't want to talk to her so I ended up talking to her and she told me more than once that as a wife it was my job to make sure he was eating right...***? She obviously didn't know me well...that did not go over well. One day when she called, I requested that she not call and talk to me again. The next time she called, I told her if she called one more time I would file harrassment charges on her and that for her information, it was my husband's disease that he had to take ownership for. I was there to support him and yes I made him appropriate meals, although that is not a requirement for a wife, but I wasn't putting the food in his mouth...he was. Then I proceeded to ask her if she wanted me to wipe his ### too. At that point she hung up. So, I do not have a good attitude toward any diabetic educator.