Your primary care team T2D

[jjraak]

Hi.

Been T2D for about a year now.

And found great help and support on here.
thank you DCUK.

Just read a post that made me Ponder
what MY Primary Health care team is.

For me those early days were a quick appointment with a doctor relating to something else.
A blood test that came back saying i was TYPE 2..a leaflet regarding it,
a quick chat, while my head was spinning, then out the door all in 10mins.

Now i appreciate that doctors are Busy, and have to have a very broad knowledge base,
so unrealistic to expect them be experts in just the one field T2D.

But it's been a source of some concern, when i read how many come here with similar stories,
then i read the follow ups, punctuated with poor behaviour, less then supportive positions and in all honesty
rather behind the curve regarding how we can and should treat this disease.

I guess while i agree fully that Type 1 is for me much more worthy of better support,
the lack of it as a T2D, does make me envious.

I am reminded (not unrealistically, really) how many post where a T1D tries to help on a T2D topic,
with go see your 'TEAM' only for me to Think...What is this TEAM they speak of,
we DON'T have a health care team, like they do, and in fact i wonder if many of us have one at all.

I get an appointment with MY doctor (i adopted one..i like her)..but i'll have to wait for that appointment, 3-6 weeks
if i want to be seen quicker it's whoever is available..and we spend a portion of the 10 mins catching up on who i am)

My Diabetic nurse? Seen two separate people, both did the foot check.
Nice but hardly a detailed examination of how i'm doing..More a quick overview

I thought this was Normal.

so i was just wondering how MUCH support do others get as T2D ?
does anyone T2D, have a relationship with anyone on their GP's diabetic team, or is it all a Group effort.?

Cheers

EDIT: link now in my post BUT for those on Metformin
Please do spend a few minutes watching this,
it MIGHT just be one the best value 5 minutes you'll ever spend

 

[Guzzler]

Never seen a GP about Diabetes. Never seen a DSN. My only team consist of Practice nurses and a Health Care Assistant.
I am envious that you got a leaflet!

 

[Listlad]

so i was just wondering how MUCH support do others get as T2D ?

Not very much but am working on it...

Working on leaflets
Working on supporting the GP’s

I am lucky as my preferred GP is good. And have had some good albeit it short discussions with him about diabetes.

 

[jjraak]

Never seen a GP about Diabetes. Never seen a DSN. My only team consist of Practice nurses and a Health Care Assistant.
I am envious that you got a leaflet!

hahahahaha...Love it.

But how sad, that something so important..( well it is to us, surely), should be so poorly implemented

I do note how well you are managing your health.
long may it continue.

 

[jjraak]

Not very much but am working on it...

Working on leaflets
Working on supporting the GP’s

I am lucky as my preferred GP is good.

And you and so many others in the Field, are our way forward, @Listlad

Many thanks for your efforts.
not just for me but for those that follow.

 

[Deleted member 308541]

Basically just my GP.

I have seen a CDE a couple of times when she has a clinic at the same medical centre, she is only a phone call a way if I want to make an appointment if I want to see her about something diabetic.

I have yearly eye test / checks at OPSM, with referal to the two main opthalmologists in Bundaberg if needed.

I get five free podiatrist visits a year for foot checkups and toenail prunings.

Blood tests every three months at the pathology shop at the private hospital a couple of blocks away.

Last but not forgotten is my friendly pharmicist he has good advice if needed.

 

[Fndwheelie]

Well I can’t remember seeing a GP about diabetes, I think I got a letter from my surgery telling me to book an appointment with a nurse at the surgery that deals with diabetes. I saw her every 3-4 months after blood tests where she upped my tablet medication. Then I got to a point where she added insulin, and I got phone calls once a week for about a month where she adjusted my dose, then a 3 month blood test and more phone calls. At least it’s always the same nurse, but I just kinda wait for her to call me.

 

[Guzzler]

hahahahaha...Love it.

But how sad, that something so important..( well it is to us, surely), should be so poorly implemented

I do note how well you are managing your health.
long may it continue.

To be fair, there are just so many of us and the system is so underfunded that those with the most need (ongoing complications) must take precedence but, having said that, with an overhaul many of those complications could be avoided in the first place.
This 'New Money' that our new PM has gladly given the NHS turns out to money that had already been allocated and is in effect yet another cut to funding.

 

[lucylocket61]

I have a practice nurse, who has done diabetic training. Thats it. My whole 'team' except the guy who does the camera in my eyes thingy (sorry cant remember the word)

 

[Antje77]

I've been a supposed T2 for over 2 years, despite being treated with a typical T1 insulin regime, and only this year switched from GP to internist/diabetes nurse at hospital.
The only person I've ever seen about diabetes before switching to the hospital was the specialist practice nurse at my GP's office. Only saw my GP about it when I got my diabetes diagnosis, everything else has been up to the practice nurse, and she was also the person to call with questions (but only on thursdays between 1 and 2 pm).

I do refer to peoples team when I answer questions on the forum, mainly because I don't know if they are seen by a practice nurse, a GP, a DN, a DSN, an endo, an internist or someone else.
I'll try to remember to refer to HCP in the future, you're right, that makes more sense.

 

[mouseee]

I have had a long phone chat with the GP and a health check with an HCA.

I had a message from the surgery to book a DSN appointment but when I rang they didn't have any appointments and I was told to ring back in a couple of weeks.

Thank goodness I found this forum! It worries me that lots of people are not as proactive as forum members are and so are paving the way for bigger issues. I have been able to make a positive start over the last two weeks!

 

[Bluetit1802]

I was diagnosed on a routine health check that was done by a practice nurse. Before I was told that I was T2 I coincidentally had an appointment with an oncologist, just a couple of days after my routine blood test. The oncologist saw my test results on her screen and said "oh ... I see you are diabetic". I replied "no, I'm not!" She told me to contact the surgery. Needless to say, the drive home from the hospital was a tad fraught. I telephoned the surgery and was given an appointment with the nurse.

The nurse was lovely. I still see her. She explained about my diagnosis, told me the numbers, gave me a glossy booklet telling me all about T2 and how the pancreas works etc. She took more bloods saying these would confirm the diagnosis or otherwise, and made me a follow up appointment to see her. The second test confirmed it, I went for the second appointment with the nurse and we discussed diet, lifestyle and all that stuff. She gave me a print out of all the test results when I asked her. She did the referrals for the eye screening and the X-Pert course, and did a foot check. She sent me on my way saying she would see me again in 3 months. No medication needed.

I continued to have 3 month tests and reviews, then moved to 6 monthly, then I was told it would be annually. I pulled a face at this, so the nurse and I agreed between us that I could have blood tests every 6 months but would only see her annually unless the blood tests were abnormal in some way. That is how it has remained.

The nurse is a nursing sister, but not a DSN. She goes on courses, is well informed, is a prescribing nurse, knows a lot about cholesterol, and I love her to bits.

I have never seen a GP in respect of diabetes, but not long after my diagnosis I received a letter from my GP asking me to make a non-urgent appointment. At this appointment all she wanted to do was push statins on me, because "we give all diabetics statins". My diabetes was not discussed. However, last year I was so fed up with my constant higher than expected HbA1c results that she arranged for me to have duplicate tests - one at the normal lab and one at a lab outside our area that uses different machinery. I call that supportive.

 

[There is no Spoon]

so i was just wondering how MUCH support do others get as T2D ?

My experience has been less that Stella.
Basically here's a leaflet about eating lots of carbs and go find out about diabetes yourself, do you know what Google is?

And that sums up the problem in my opinion, I'm one of the lucky ones who did not need a lot of help to get through this I learned 2 facts early on and hitched my wagon to them, the turned out to work for me. But there are plenty of people out there who do need the extra help and support being handed a leaflet about eating lots of small meals with plenty of carbs and told to look at Google is not support.

My DN seems to always be constantly surprised by my results, amazed that I lost the weight so quickly, that I lowered my bg levels by so much and that my cholesterol went down as I said it would.

She is always supportive after the fact.

 

[jjraak]

@helensaramay
thank you for the input.

I hope i din't come off as disputing the needs of any type 1.

i have a good friend with type 1, who until i was diagnosed
i didn't really understand the difficulties or dangers her condition COULD cause her,

I do know now, thanks to learning so much from all the Type 2's who lead me to safety AND the type 1's
for who i am most grateful, who also lent support and good advise.
whether directly to me or via the posts they made that kept me informed on so many levels.
...yours included.

The purpose of the post was firstly to have a focus point of where we are, as T2,
and probably more importantly as a rallying point for where we SHOULD be heading.

the post's above and many others from bewildered Type 2's, just make it clear the system,
IF there is one... is fractured, if not totally broken and no longer FIT for purpose.

but where do we go from here.?
well for me, lets see where we are before seeing where we are going.

IF the projections are to be believed more will join this happy band and
be left as destitute of support and information as i was.

I get the letter for eye checks, i get the foot checks, i even get a HBA1c blood check.
BUT like most of things i have learned about type 2..I have HAD to learn the things i NEED to know

things like the fact b12 could be compromised by Metformin.
I'd say that was a BASIC bit of knowledge EVERY type 2 should know.
and should be offered as part of the HBA1c check, i believe..

yet it wasn't for me..i had to request it.

yet it's NEVER been mentioned, along with so many other things we don't get told or
are not spoken of in any depth.

so how Could ANY of us possibly know, if we don't get told OR
are nor not lucky enough to have joined this wonderful band of fellow sufferers.

(*B12 depletion is a serious issue and needs to be addressed as soon as it becomes known )



I just want 'Better' for all us as we are, here today, and for all those who will follow.

Shouldn't the Basic human RIGHT, be to be treated with the latest up to date methods rather then
outdated methods, that have such a high failure rate, shouldn't THAT be a CHOICE we all should have ?

EDIT:
i am reminded of this post .
https://www.livingloud.org.uk/single-post/2018/12/14/International-Diabetes-Summit-2018

A report published this year showed that DESMOND in Leicester shifted the baseline from 64mmol to 55mmol,

now I'm not an esteemed diabetologist but even I understand that 55mmol is still diabetes, right?

Yet they celebrate this failure as a success and
persist with this programme.

Cheers for the Post @helensaramay
wish you well for the future.
your post have helped me, and must be an inspiration for many with Type 1

 

[Deleted member 308541]

I forgot to mention in my previous post at #6, that I gave up a couple of podiatrist visits to have two visits to a "nutritionist" here in Bundy.

Now the health care plans are free of charge to see the relevant practitioner, so with the two visits she was going to charge me for $200.00 for the them. Needless to say I told her where to go, I put a complaint into my GP but she is still on the list.

She also gets on the local radio in the morning spruikng the government food wheel and carbs are good, fats bad etc.

 

[MeiChanski]

Hello, I think it depends on the CCG? Before I moved my DSN at the time said she was seeing T2s as well as pregnant women with diabetes and this is at a diabetes clinic in a hospital. If I'm honest I do agree to some extent that T2s should be seen by a specialist despite the difference between T1 and 2, as many have encountered that GPs are more or less helpful.
My GP admits that whatever issues I'm facing with my diabetes is out of his expertise and he writes to my consultant if matters are urgent. So depending on the matter of urgency - I either see my consultant every 2-4 months or every 6 months and I see my DSN every 2 months.
Seeing a specialist doesn't mean he or she is great either, I was under a consultant who didn't give much advice for my hypos and anxiety. She recommended DAFNE and checked my feet but that was it. My new consultant decided to change my insulin regime and prescribe the libre, would I have gotten the same back in London? possibly a firm nope. Nonetheless I thank my previous consultant for recommending DAFNE.

 

[There is no Spoon]

I just want 'Better' for all us as we are, and for all those who will follow.
Shouldn't the Basic human RIGHT be to be treated with the latest up to date methods rather then outdated methods, that have such a high failure rate, be a CHOICE we all should have ?.

I guess the problem with up to date methods is they still have to be tried and tested.

And the they have to prove that the previously tried and tested methods were wrong. But how can they be they were tried and tested?

There was a time when tying a frog to your head was thought of as a cure for the flu.
That time was TUESDAY, April 18, 2017 https://www.webmd.com/cold-and-flu/news/20170418/slimy-frog-might-be-a-flu-fighter

Up to date still has to be proven and we are getting there.



P.s in the mean time https://books.google.co.uk/books?id...ng a frog to your head to cure a cold&f=false

 

[TriciaWs]

I was diagnosed 13 months ago, within the first month I had a second blood test, then saw the diabetic nurse at the surgery and had a foot check with another nurse, then had appointments for a followup in a month, then 2 months after (with another blood test), then because I was doing well a six month gap (another round of bloods). Also referrals to the hospital for diabetic eye screening, podiatry clinic and to a dietician (option for the Desmond course instead).
At the one year point I had blood tests, saw the diabetic nurse, eye screening, podiatry, etc. I've also been put onto annual NHS sight tests with an optician.

In between I do not have a named contact, but then my HbA1c dropped very fast after going low carb.

Everything I got from my GP's surgery is in the official NICE guidance.

 

[Goonergal]

Reading through I feel relatively fortunate.

I was diagnosed by a GP who ordered an HbA1c as part of a suite of blood tests when I showed up with a nasty abdominal abscess that wouldn’t heal. As a result all my diabetes related appointments for almost a year were all with that GP. She obliquely referred me to this website - she mentioned it and having not heard of it, I assumed she was talking about the ‘other’ one as I had heard of them. Luckily my internet search led me here.....and at a subsequent appointment when I was talking about the site and clarified that it was this one I was using she confirmed that it was this one she meant.

I’d have liked her to be more overt about it but she was supportive of my dietary changes. She’s left the practice now, and my diabetes appointments (such as they are) are with practice nurses. They’ve been great - my results have sparked a lot of interest and positive engagement. One of the nurses (whom I’ve yet to meet) is apparently a Jason Fung fan. The one I’ve seen more often has taken copies of the various booklets that were put together by forum members before the meet-up last year and is very interested.

I really believe that taking a lifestyle approach to treating not just diabetes but other conditions too, could really save the NHS time and money in the long run. Dr Unwin’s practice is a really good example of that, but the question is how to get the approach adopted more widely. I think the answer may lie with every one of us that has made successful changes being active in trying to encourage change in our local area.

Edited to correct typo.

 

[Route 66]

Support from my Primary Health Team is quite hit and miss.

I was originally diagnosed in hospital following a Heart Attack and subsequent angioplasty 12 weeks ago.

Whilst in hospital, the diabetic nurse came along and said, by the way "You are also diabetic" here is a meter, test strips and lancets. She talked me through injecting insulin, watched me do it once, gave me a logbook to fill in and showed me how to carry out a finger prick. I never saw her again during my four day stay in hospital and was told that the outreach team would contact me the week after I was discharged. I left hospital feeling shocked, confused and scared at the diagnosis. There had been very little discussion about the illness and what it would mean to me. When I got home on the Saturday morning, I discovered that she had only given me 6 x test strips for the meter. 0/10

The following week there was no follow up call from the outreach team and ten weeks later they still havn't called. 0/10

The same week I was contacted by my GP and she arranged a review appointment with her later the same week. She was very reassuring and helpful and organised an appointment later that week with the Practise Diabetic Nurse. The GP also referred me to the Podiatry Team for a foot check. 10/10

My first meeting with the Practise Diabetic Nurse went well. She explained about diabetes and that I was on insulin in order to protect the heart. She was a lot more informed than the hospital team. At a later date, the plan was to phase me over to tablets instead. She talked about diet gave me my hbac1 reading from when I was in hospital, took another blood test, checked my feet and arranged a retinopathy test and for me to attend an Empower Course. She wasn't happy with the logbook that the hospital had supplied and gave me one that she considered more suitable. She also advised me that I could call her anytime if I had concerns. Since then,she has seen me every two weeks and has been excellent and kept me fully informed. She also made sure that I got 100 test strips a month. 10/10

Three weeks later and I get a letter from the hospital Podiatry Team which tells me that I have been triaged by them and they do not consider that I need an appointment. I have no idea what this is based on as they havn't seen my feet. 0/10

Five weeks in and I get a letter from the Diabetic Consultant at the hospital telling me that a letter will follow with an appointment date to see her and forms are enclosed for me to arrange a blood test two weeks before seeing her. I also get an appointment for the Retinopothy Test. 5/10

The staff at the eye clinic were great explaining everything that they would be doing and what to expect. Unfortunately no-one told me to take a pair of sunglasses with me. They test result came through within 3 weeks 9/10

Two weeks ago, I thought I would ring the hospital as I still havn't received an appointment to see the Consultant. The booking line tells me that they do not have a referral (Even though I received an earlier letter!!!!). They suggest that I ring the Consultants Secretary - I try but she is only an answerphone and she is on holiday for 2 weeks. I ring again and they put me through to the outreach team. They are also an answerphone and they will ring back the same day. I am still waiting for the call. Will I get an appointment? I really don't know. 0/10

It strikes me that if you get a good GP Practise, they are worth their weight in gold as you cannot rely on any support from the hospital.