Your primary care team T2D

[Diakat]

My DSN left, I then fell through the cracks and had no appointments for over two years until I called the hospital. I was given a consultant appt but have not yet met my new nurse. I have been refused DAFNE because “you are too well controlled” . a nurse at the GP does foot checks, every time she takes blood she asks if I’m OK with needles.

 

[Bluetit1802]

Perhaps more regular healthchecks for everyone would help

In England (and maybe the rest of the UK) people aged 40 and above are supposed to be called in for a health check that includes the usual raft of blood tests. The exceptions to this are those with existing illnesses who already have regular checks. Those where a problem is discovered are treated accordingly. Those without problems are given repeat checks every 3 or 5 years depending on circumstances. This is what happens at my surgery. My healthy daughter and her husband were invited once they had passed the age of 40. Their tests included an HbA1c. They have recently been called again for a 5 year check, and this also included an HbA1c.
I don't know if all surgeries do this, but it was an NHS recommendation several years ago, and of course I have no idea if everyone takes up the invitation. I very much doubt it.

 

[ianf0ster]

Like many T2's my diagnosis was done by a Nurse (I don't know if my GP practice has more than one nurse specialising in Diabetes or not).
The advice both from her and later from on of the 3 GPs who specialise in Diabetes was pretty standard i.e. poor.
I have had a retinopathy (eye) test, but apparently they no longer do foot checks - not that I have ever had problems with my feet.

All the leaflets I was given (varying from poor to not too harmful) reference the 'other site'- so I was lucky that I found this one before being given those leaflets.
As far as I'm concerned I don't like a lot of interaction with HCPs unless I absolutely need it. With these forums and a LCHF lifestyle, I doubt I will need anything more than regular Hba1c tests for a while until I firmly crush T2.

 

[jjraak]

.This thread has made me wonder about the value of good care for people with type 2. As some people with type 2 are able to put it into remission which greatly reduces the chance of complications ... and reduce cost to the tax payer ... doesn't it make sense to get them on the right track as soon as possible?

Perhaps more regular health checks for everyone would help.
Given the nature of type 2 diabetes, people with type 2 have often had the condition for years before they know and, over this time, the diabetes may have been harming their bodies.
So I would expect finding out as early as possible and treating it correctly could save money and lives.

The "advantage" of type 1 is that it usually comes on pretty quickly and is diagnosed before it has the chance to do long term damage.
.

A great answer @helensaramay

Effective..(most likely judging by so many on here) AND Cost effective in short and long term, you would think.

It does seem very hit and miss at the moment, with some outstanding Gp's and some not so good.

Does seem to me we need a better code of practice that while not dictating the course we must take
does give us adequate information with which to make our decisions.

For me that WOULD include a:
1# a B12 check at first instance perhaps, (most certainly within 3 months on Metformin) just to have a baseline to watch for any deterioration, and certainly at minimum each year, as a given when having the HBA1c blood test.


Any one else have want to add one point to the wishlist ?..
( i could add more, but hopefully others will fill in the ones i'd like and the ones i haven't even considered yet )

Pretty Sure @Debandez , @Listlad and others tirelessly working on our behalf on the front line, might find it useful to have as they try to reform the medical advice given from within the practices they operate in.


Tbh i hadn't consider that an 'advantage' @helensaramay .but it does make some macabre sense,, given the gravity of the immediate impact if not tackled early.

We all need a little support and guidance early on until we find our feet and begin to understand what is wrong and the best way for US to help OURSELVES to get as close to 'better' or a 'normal' life as possible, whatever condition we suffer from.

 

[Guzzler]

A great answer @helensaramay

Effective..(most likely judging by so many on here) AND Cost effective in short and long term, you would think.

It does seem very hit and miss at the moment, with some outstanding Gp's and some not so good.

Does seem to me we need a better code of practice that while not dictating the course we must take
does give us adequate information with which to make our decisions.

For me that WOULD include a:
1# a B12 check at first instance perhaps, (most certainly within 3 months on Metformin) just to have a baseline to watch for any deterioration, and certainly at minimum each year, as a given when having the HBA1c blood test.


Any one else have want to add one point to the wishlist ?..
( i could add more, but hopefully others will fill in the ones i'd like and the ones i haven't even considered yet )

Pretty Sure @Debandez , @Listlad and others tirelessly working on our behalf on the front line, might find it useful to have as they try to reform the medical advice given from within the practices they operate in.


Tbh i hadn't consider that an 'advantage' but does make some macabre sense,, given the gravity of the immediate impact if not tackled early.

We all need a little support and guidance early on until we find our feet and begin to understand what is wrong and the best way for US to help OURSELVES to get as close to 'better' or a 'normal' life as possible, whatever condition we suffer from.

Just as an aside, I would be more inclined to have doctors review the effects of statin treatment on those with Diabetes as well as Metformin. Seems madness imo to prescribe Metformin to help with bg levels and at the same appointment prescribe a statin that will have negative effects on bg as well as the more insidious side effects they have. Just a penn'orth.

 

[Listlad]

Absolutely not.

I am not disagreeing with you that, judging by what I read on this forum, people with type 2* need better support. We all do.
This thread has made me wonder about the value of good care for people with type 2. As some people with type 2 are able to put it into remission which greatly reduces the chance of complications ... and reduce cost to the tax payer ... doesn't it make sense to get them on the right track as soon as possible?
Perhaps more regular healthchecks for everyone would help. Given the nature of type 2 diabetes, people with type 2 have often had the condition for years before they know and, over this time, the diabetes may have been harming their bodies. So I would expect finding out as early as possible and treating it correctly could save money and lives.
The "advantage" of type 1 is that it usually comes on pretty quickly and is diagnosed before it has the chance to do long term damage.

*I don't like referring to someone as "a diabetic" but prefer "someone with diabetes" because we are all far far more than this condition. But that's my preference.

You are right. Potential T2,s need suitable early screening and support if the screening is absent and T2 sets in. 10 minutes with a GP isnt enough, even if they are LCHF friendly.

I was speaking to a lady representative of the NHS England diabetes Interest Group last week and according to her, earlier screening is the aim.

 

[Guzzler]

Earlier screening is useless unless the powers that be admit that their pathway is flawed.

 

[1spuds]

In USA,off and on with insurance,I saw my long time Dr for a routine check up (no insurance).Lab returned an elevated HbA1c.We decided on a plan and that was it.Saw him again in 3-4 months,all went as planned and that was it.He likes to talk usually and visits can run 15-30 minutes depending if he is busy.

Private Dr visit,45 USD cash,and A1c was 16 dollars cash.Never more than a couple days for an appt. and that day visit if really sick.Ive only seen a general Nurse practitioner one time,she was excellent.Bear in mind I worked in the system and know how to shop prices,regular people dont and they can get raped on costs.

Now with VA system,weeks for a regular appt,specialists wait is 3-6 months.Yearly eyecheck,again eye check is 3 month wait.Never mentioned a foot Dr,Im type 2,no idea how type 1 gets treated.

VA is all free depending on what VA category,ie,time in service,if you have a disability, and income.I get all free visits and labs,15 dollar copay for meds.Im in lowest level of 7,guess my income is what gets me what I get.I can get generic meds cheaper than that paying cash oft times,so I dont bother with that.They give 30 days prescriptions,some for 90 days.I just pay cash and get a years worth and save the VA hassle.

So I use private care for routine things,VA for multiple labs and catastrophic illness they would be a godsend.

 

[Listlad]

Earlier screening is useless unless the powers that be admit that their pathway is flawed.

Try looking st the NHS England Diabetes Interest Group offerings. When I spoke to them last week they did seem to have a listening ear and in tune with LCHF. They did take down the web address of this site and were not so preoccupied with the Eatwell approach as the DESMOND people at the other end of the community hall room.

 

[Listlad]

A great answer @helensaramay

Effective..(most likely judging by so many on here) AND Cost effective in short and long term, you would think.

It does seem very hit and miss at the moment, with some outstanding Gp's and some not so good.

Does seem to me we need a better code of practice that while not dictating the course we must take
does give us adequate information with which to make our decisions.

For me that WOULD include a:
1# a B12 check at first instance perhaps, (most certainly within 3 months on Metformin) just to have a baseline to watch for any deterioration, and certainly at minimum each year, as a given when having the HBA1c blood test.


Any one else have want to add one point to the wishlist ?..
( i could add more, but hopefully others will fill in the ones i'd like and the ones i haven't even considered yet )

Pretty Sure @Debandez , @Listlad and others tirelessly working on our behalf on the front line, might find it useful to have as they try to reform the medical advice given from within the practices they operate in.


Tbh i hadn't consider that an 'advantage' @helensaramay .but it does make some macabre sense,, given the gravity of the immediate impact if not tackled early.

We all need a little support and guidance early on until we find our feet and begin to understand what is wrong and the best way for US to help OURSELVES to get as close to 'better' or a 'normal' life as possible, whatever condition we suffer from.

Agreed. Whilst the forum provides its membership with very useful help, at the end of the day it ought to be coming from our NHS. I don’t know what percentage of those with T2 diabetes join this forum but I suspect there are many that do not.

 

[HSSS]

Hit and miss for me. Diagnosis as part of sweeping blood tests for tiredness (despite many glucose tests prior being out of range but never mentioned!). No second hb1ac and only a second fasting bgl because I asked for it (in denial). Only one gp even mention diabetes and he said eat in moderation, move and don’t test it’ll make your fingers sore. Impossible to see the same gp twice. Almost all locums and the way appointments are done (released daily for 2 weeks time) means it’s next to impossible to get any continuity for anything anyway.

Practice nurses did direct me to this website and a vague low carb instruction along with a meter and test strips (big win!) but very little follow up, no way to contact them, little guidance the first year about what checks and when I should be having and although I’m supposed to get a call after each hb1ac I’ve heard from them only once.

 

[Guzzler]

Try looking st the NHS England Diabetes Interest Group offerings. When I spoke to them last week they did seem to have a listening ear and in tune with LCHF. They did take down the web address of this site and were not so preoccupied with the Eatwell approach as the DESMOND people at the other end of the community hall room.

Until there is a top level overhaul nothing will change. Individuals may pay lip service meanwhile we at the coal face (or most of us) have to do the work ourselves. Two and a half years from diagnosis and I would bet a small grandchild that the Practice nurse I saw is giving exactly the same duff (some would argue dangerous) advice whilst her patients queue up for various treatment wrt to complications.

 

[Listlad]

Hit and miss for me. Diagnosis as part of sweeping blood tests for tiredness (despite many glucose tests prior being out of range but never mentioned!). No second hb1ac and only a second fasting bgl because I asked for it (in denial). Only one gp even mention diabetes and he said eat in moderation, move and don’t test it’ll make your fingers sore. Impossible to see the same gp twice. Almost all locums and the way appointments are done (released daily for 2 weeks time) means it’s next to impossible to get any continuity for anything anyway.

Practice nurses did direct me to this website and a vague low carb instruction along with a meter and test strips (big win!) but very little follow up, no way to contact them, little guidance the first year about what checks and when I should be having and although I’m supposed to get a call after each hb1ac I’ve heard from them only once.

Okay. It has been bad for some of us in the past. Me included. But currently have things improved? I know our local NHS GP Admin lady has been picking out those patients listed as having a condition of Prediabetes and establishing contact with them.

 

[Listlad]

Until there is a top level overhaul nothing will change. Individuals may pay lip service meanwhile we at the coal face (or most of us) have to do the work ourselves. Two and a half years from diagnosis and I would bet a small grandchild that the Practice nurse I saw is giving exactly the same duff (some would argue dangerous) advice whilst her patients queue up for various treatment wrt to complications.

Top down and bottom up can and does work. Look at what Debandez is achieving.

 

[HSSS]

But currently have things improved?

No. I’m still waiting on my last phone call from 2 months ago and waiting to see if finally the blood test forms are on the computer for the next one due. The nurse said there was some peer support planned but she’d been excluded from the meeting and when I’ve asked no one else seems to know anything about it. The ppg meetings keep getting cancelled. They can’t recruit or retain drs (worse than other practices locally), the phone system is awful, they’ve been in special measures etc etc.

The ONLY reason I stay with the practice is the testing supplies as I know how rare these are. Because I don’t take meds I still have prescription charges but a prepay reduces this to £10 a month effectively.

On the plus side they’ve recently merged with other practices and maybe just maybe things will improve if they can get some staff.

 

[Guzzler]

Top down and bottom up can and does work. Look at what Debandez is achieving.

Deb is to be commended for all the hours she puts in spreading the word. Where did the lady learn about alternative approaches?
I learned right here and and if an old boot like me can learn in a matter of hours then why on earth can't HCPs and their bosses (including those who commit guidelines to paper) finally admit that the standard pathway isn't and hasn't worked?

It's not rocket surgery.

 

[Listlad]

On the plus side they’ve recently merged with other practices and maybe just maybe things will improve if they can get some staff.

Hope so, HSSS. Cross fingers.

 

[Guzzler]

There is an awful lot riding on the fact that changing guidelines means one's ego may be bruised and one's livelihood or legacy may become tarnished. Meanwhile, I am thinking 'If they are giving me advice that could cause actual bodily harm in the long term, getting it all wrong then what else are they getting wrong?' It does nothing to instil confidence in the medical profession. If Diabetes has done anything for me it has made me aware of the shortcomings in the system and my confidence in HCPs in general has fallen dramatically.

 

[Listlad]

Deb is to be commended for all the hours she puts in spreading the word. Where did the lady learn about alternative approaches?
.

I didn’t go overboard with my inquisition. But it was obvious she had a more open mind to LCHF and obvious that there is an aim to seek consultation with the patient community. I would only be guessing but maybe, just maybe the (right) message is filtering through. She was “Dr David Unwin” aware.

https://www.diabetes.co.uk/forum/threads/diabetes-interest-group.166997/

 

[Guzzler]

I didn’t go overboard with my inquisition. But it was obvious she had a more open mind to LCHF and obvious that there is an aim to seek consultation with the patient community. I would only be guessing but maybe, just maybe the (right) message is filtering through. She was “Dr David Unwin” aware.

Sorry, my comment appears to be confusing you. I meant where did Deb learn about different approaches.
(I wrote 'the lady' rather than write 'she'.)