Do DN’s have to do specific training to practice?

[BlueArmy]

So, saw DN this week, and she spotted I was wearing a libre 2 and asked if it was self funded (I thought this was a stupid question as I am/was T2 and she is my care provider) so I said yes and she asked why I was wasting my money. Said I didn’t consider it a waste and the reason I had got my HbA1C down to 44 was because I was using it - and then said every T2 should be offered test strips or something to help educate them. She said whats the point as when you take metformin it reduces your insulin (charitably I think she meant glucose but she did repeat it 3 times so not sure it was a slip of the tongue and I have noticed that my diet reduces my blood glucose if anything when i have missed taking metformin by accident i notice my BG levels are less constant but they don’t go really higher if I have eaten properly) then finally she said whats the point as 90% of people wouldn’t do it and I was an exception as I was younger and didn’t have a load of other conditions to manage so monitoring it was easier for me than others. She also insisted I stay on some metformin although 75% lower dose when I pushed to come off it. This is also the same person who when diagnosed told me potatoes, rice and pasta was OK when I know they are really not based on my libre 2 data. My question is - what base training do they have to do on top of general nursing practice, and, is there a need to up the testing standards/training for DN’s and also - does the NHS have a general lack of faith in people to do something about their conditions and is that well founded?

 

[Lucyr]

Metformin is aimed at reducing your insulin levels, by making you less resistant to the insulin you produce so that your body can use it more effectively and not need to produce as much.

The “specialist diabetes” nurses at the GP surgery tend to be “the nurse that sees a lot of diabetics” rather than having extra training, but I have had some say that they had been on a one day course.

 

[BlueArmy]

I thought metformin worked by slowing down Glucose production in your liver?

 

[Lucyr]

A drug can have more than one benefit. Reducing the amount of glucose produced in your liver will reduce the amount of insulin your pancreas needs to produce to deal with this. Improving insulin resistance will also make your body use insulin better and so reduce the insulin your body needs to produce.

The way it works should be explained on the information leaflet in the box. Copied below from the NHS site.

“Metformin works by reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin. Insulin is the hormone that controls the level of sugar in your blood.”

Metformin: a medicine to treat type 2 diabetes

NHS medicines information on metformin – what it's used for, side effects, dosage and who can take it.

www.nhs.uk

 

[BlueArmy]

Granted - but its primary action is acting on the liver


Seems odd that one drug can act in a double way as effectively - anyone know of any decent research papers into its effects?

 

[Lucyr]

Granted - but its primary action is acting on the liver

View attachment 18307

Reducing the amount of glucose produced in the liver reduced the amount of insulin your body needs to produce because there is less glucose to deal with.

 

[BlueArmy]

Fair, that’s logic I can subscribe too

 

[BlueArmy]

Either way, my point stands really. If my understanding was more accurate than a professional- should they do more training if they are prescribing drugs etc. One day if your correct on that is less training than prediabetics get these days in terms of hours!

 

[Gwynn]

Hmm interesting. I had wrongly assumed that the DNs were well trained. Frightening even. So why should we take any notice of them except that they presumably can influence the meds, treatment, courses, test equipment offered or made available. What worries me is that they can adversely direct a patient.

Would you want a surgeon operating on you having done a one day course? Or a pilot, etc etc. Ok a bit extreme but these DNs can sometimes give duff, if not damaging, advice. Having said that my own DN, who I have not seen for 6 months, was very good and seemed very knowledgeable.

I wonder how many DNs are actually well trained vs poorly trained and have given good advice vs bad advice.

I will be interested in whatching this thread.

 

[BlueArmy]

Indeed Gwynn, I find it a bit concerning. Although my own mother was a specialist nurse in the NHS for another condition and used to advise the GPs on treatment - she constantly studied, attended conferences etc but the condition she managed was less common although I don’t doubt lucyr as my DN told me she worked in general practice and took the job as a DN to be closer to home

 

[Robin]

I was discharged back to my GP for care because according to the records the hospital had, my surgery had a Diabetes nurse. It did, but the first time I saw her, she admitted she knew nothing about Type 1, and that I was her only Type 1 patient at the time. She asked the practice to send her on a Type 1 course, and they told her it wasn’t worth it, and to do her own research from the internet!

It was fine for a while, because I didn’t have any problems, but eventually I wanted to get the Libre on prescription so had to ask to be referred back to the hospital. (she’d never heard of the Libre when I first started self funding it, and I had to show her how it worked).
When I wanted to swap Basal, I researched it, told her I'd like to try Levemir, and she agreed to prescribe it on what I'd told her. I said I’d weighed up Tresiba as an alternative and she looked panicky and said, she wasn’t allowed to prescribe that, she wasn’t trained in it.
The same nurse ran the asthma clinic at the surgery, and the Travel clinic (she sorted out all my daughters jabs for a trip to Africa) as well as doing all the other general nursing duties like bandaging cut fingers and doing flu jabs, so I don’t blame her, she didn’t have time to be a specialist in anything.

 

[BlueArmy]

I was discharged back to my GP for care because according to the records the hospital had, my surgery had a Diabetes nurse. It did, but the first time I saw her, she admitted she knew nothing about Type 1, and that I was her only Type 1 patient at the time. She asked the practice to send her on a Type 1 course, and they told her it wasn’t worth it, and to do her own research from the internet!

It was fine for a while, because I didn’t have any problems, but eventually I wanted to get the Libre on prescription so had to ask to be referred back to the hospital. (she’d never heard of the Libre when I first started self funding it, and I had to show her how it worked).
When I wanted to swap Basal, I researched it, told her I'd like to try Levemir, and she agreed to prescribe it on what I'd told her. I said I’d weighed up Tresiba as an alternative and she looked panicky and said, she wasn’t allowed to prescribe that, she wasn’t trained in it.
The same nurse ran the asthma clinic at the surgery, and the Travel clinic (she sorted out all my daughters jabs for a trip to Africa) as well as doing all the other general nursing duties like bandaging cut fingers and doing flu jabs, so I don’t blame her, she didn’t have time to be a specialist in anything.

😱😱 -that is really shocking Robin.

I think I should be clear and set the tone of the thread that this is not a dig at DN's, they do a brilliant job and where would be be without them, more the point, are they properly invested in by NHS "Management" and setup for success and good outcomes?

Personally, I am that doubtful about the discussion I had over the med's, that I have written to my GP and asked her to review it instead. In my experience, unless you own the issue yourself, it doesn't get resolved correctly. which makes me worry for the so-called 90% who don't bother.

 

[Inka]

My consultant has had to write to my GP surgery at least twice to correct the rubbish said by the diabetes ‘expert’ nurse. I’m sure they must do some kind of training but their knowledge is poor IMO. I wouldn’t mind that so much if they weren’t so sure of themselves. Mine absolutely insisted their was no increased of coeliac if you’re Type 1. She wouldn’t listen and didn’t check. She removed blood tests from the list ordered by my consultant, insisted on me spending 40 mins with her regularly (does she get extra money for this??), knew nothing about my pump, couldn’t answer any questions - but liked to sit there and try to control the conversation. I had to bite my tongue numerous times.

 

[BlueArmy]

My consultant has had to write to my GP surgery at least twice to correct the rubbish said by the diabetes ‘expert’ nurse. I’m sure they must do some kind of training but their knowledge is poor IMO. I wouldn’t mind that so much if they weren’t so sure of themselves. Mine absolutely insisted their was no increased of coeliac if you’re Type 1. She wouldn’t listen and didn’t check. She removed blood tests from the list ordered by my consultant, insisted on me spending 40 mins with her regularly (does she get extra money for this??), knew nothing about my pump, couldn’t answer any questions - but liked to sit there and try to control the conversation. I had to bite my tongue numerous times.

Seems like a common thread emerging. Wonder if Diabeties UK should be pushing government on this point? Decent training could save the NHS millions, perhaps every £ spent could return £10 (made up numbers, but you get the point) in reduced manhours, treatments, interventions, surgery not to mention improving the lives of its "clients".

 

[Burylancs]

So, saw DN this week, and she spotted I was wearing a libre 2 and asked if it was self funded (I thought this was a stupid question as I am/was T2 and she is my care provider) so I said yes and she asked why I was wasting my money. Said I didn’t consider it a waste and the reason I had got my HbA1C down to 44 was because I was using it - and then said every T2 should be offered test strips or something to help educate them. She said whats the point as when you take metformin it reduces your insulin (charitably I think she meant glucose but she did repeat it 3 times so not sure it was a slip of the tongue and I have noticed that my diet reduces my blood glucose if anything when i have missed taking metformin by accident i notice my BG levels are less constant but they don’t go really higher if I have eaten properly) then finally she said whats the point as 90% of people wouldn’t do it and I was an exception as I was younger and didn’t have a load of other conditions to manage so monitoring it was easier for me than others. She also insisted I stay on some metformin although 75% lower dose when I pushed to come off it. This is also the same person who when diagnosed told me potatoes, rice and pasta was OK when I know they are really not based on my libre 2 data. My question is - what base training do they have to do on top of general nursing practice, and, is there a need to up the testing standards/training for DN’s and also - does the NHS have a general lack of faith in people to do something about their conditions and is that well founded?

D
Diabetic Specialist Nurses, DSN, are well trained and knowledgeable. But they are rare because costly and usually reserved for Type 1s. Type 2s are fobbed off with the dogsbody at the Surgery.

 

[Sally71]

Hospital DSNs are properly trained I think, I don’t know what courses they do but it's considerably longer than 1 or 2 days and then all they do for their job is look after people with diabetes. So they really do know what they are talking about, they have to know all about the latest technology too so that they can support you if you have it. Our team are fab. Sadly not everyone is under hospital care and from what I’ve heard the so called diabetes nurses at GP surgeries vary very widely.

 

[BlueArmy]

Hospital DSNs are properly trained I think, I don’t know what courses they do but it's considerably longer than 1 or 2 days and then all they do for their job is look after people with diabetes. So they really do know what they are talking about, they have to know all about the latest technology too so that they can support you if you have it. Our team are fab. Sadly not everyone is under hospital care and from what I’ve heard the so called diabetes nurses at GP surgeries vary very widely.

Yeah fair point - I think this is a general rule, when you get to a hospital where people are specialised the skill set is higher. General practice means general practice - but - perhaps then the DN's should not be provided the responsibility of prescribing, only DSNs? If I was paying for the service (and I am like everyone else who pays tax and NI) then i'd expect them them to be more knowledgeable than me in the subject area and all I have done is poked around the net a bit and read a couple of books that took less than a week. This applies if I was having someone fix my car, build an extension on my house, so why with something as important as health, would it also not apply.

Here is a interesting interview/article with a Diabeties Nurse Consultant - the requirement on these roles seems robust enough with a MSc level of education

How do I become ... a diabetes nurse consultant? | Nursing Times

Why did you decide to do this role?“GPs and practice nurses can give an excellent holistic, local service and I felt working in the community, developing

www.nursingtimes.net

Not convinced this is anywhere close to what the practice nurses have to do though.

There is also this organisation which is referred to in the article https://trenddiabetes.online/ which diabetes UK is a partner apparantly.

 

[What the..?]

I came to the conclusion quite quickly that the nurse I saw at my surgery a month after diagnosis was not specialist in diabetes at all. Her first words to me were ' I haven't 'done' diabetics for about eighteen months, so bear with me while I check a few things'. She then proceeded to go through a formulaic question and answer session prompted at every turn by the computer, and a couple of times when I asked questions she had to use Dr Google to find answers. We wasted a good few minutes with her regaling me with details of how she'd caught Covid and how she'd coped with it, pointing out errors her fellow clinicians had made when she asked for their advice. By that point I had realised that I most likely (through this forum) knew more about my condition than she did, so there was no point asking for advice. I think this may often be the case if there isn't a specialist diabetic nurse. It makes me cross because I do believe people want to help themselves, but if not given assistance, or even worse given wrong information, more harm is being done than good. Funding is definitely needed in this area, which would undoubtedly save the NHS money in the longer term, let alone how much it would help diabetic patients.

 

[nonethewiser]

Only ever see DN if she takes bloods at surgery, otherwise its DSN.

DN once said she knew little about type 1 so type 2 must be her preference, knows even less about pumps same as Drs there.

 

[JJay]

Before I moved to my current address I had been under the care of a practice nurse at the GPs for 17 years. I have no idea what specialist training she had but she was knowledgable, caring and pragmatic and I had total confidence in her.

At my current surgery, the annual review can be conducted either by a GP or a nurse - my choice which appointment to make. I've had mixed experiences with both. Over the past couple of years and some worrying rises in HbA1c caused mainly by stress over family illnesses and my own diagnosis with AF, I've had quite a few additonal interactions with the practice nurses and as I've hardly ever seen/spoken with the same one twice, I rather doubt they are all specialist trained!

The nurses are inevitably far more used to dealing with Type 2, but what I will say for them is that they all realise pretty quickly if they are "out of their depth" and will refer to the Community Diabetes Team (all DSNs) for advice.

I'm happy with this state of affairs. I was under the care of a hospital team for the first 4 years after diagnosis but quite frankly I found them as useful as a chocolate teapot. Only saw the consultant once, thereafter a succession of registrars who seemed totally bored, plus a dietician whose advice would not have been out of place in a 50s women's magazine. Don't remember ever having seen a DSN - there were only clinic nurses who weighed you etc. I imagine things have moved on!