Confused by referral

[Ekbeks14]

Hi there, been a few weeks since first post!

I know different areas operate in different ways but the doctors made a referral to the Community Diabetes Team on my initial diagnosis (November). I’ve only seen the pharmacist in this time who has upped metformin to 4x per day along with Mydesmond app access.

The community Diabetes team have rejected the referral as I’ve ’only Just been diagnosed’. I have had two Gestational diabetic pregnancies, 5 and 10 years ago both requiring insulin. Last HbA1c was 94.

Is this normal practice?

 

[Lucyr]

Sounds too early to be having a follow up appointment, need a few months once you’ve worked through the Desmond course and had a few months of diet exercise and medication changes before there’s any point retesting anything.

 

[Ekbeks14]

Sounds too early to be having a follow up appointment, need a few months once you’ve worked through the Desmond course and had a few months of diet exercise and medication changes before there’s any point retesting anything.

Thank you for your reply 🙂

I’m not expecting retesting - I’ve got that booked in with GP in April - but support / checks from Community team / Diabetes Nurse that I was told that I would be seeing in ‘about 3 months time’. Does this not actually happen in practice?

 

[Leadinglights]

What you have experienced doesn't sound all that unusual. Following diagnosis depending on your Hba1C you should be given 3 months to make some dietary changes and for any medication to show it is being effective by having a Hba1C test but in the meanwhile you would normally have a foot and eye retinal screening. Referral to the Desmond if on-line is usually fairly quick but if a face to face course then there may be a wait for the next one in your area.
However there is plenty you can be doing to help yourself, in fact these day you need to become your own expert as there is no one size fits all when it comes down to how people manage their condition.
If Type 2 then it is perhaps rather different to when you were on insulin for gestational diabetes as diet plays an important part, just as much as medication.
Many find a low carb approach is successful so if you haven't seen it then this link may be helpful, it is based on the suggested no more than 130g carbs not just sugar per day. https://lowcarbfreshwell.com/

 

[Ekbeks14]

Thank you x

I’ve been following Freshwell low carb diet (starchy carbs are not my friend) as that’s what I did before.

I think I’m just a bit confused as what I was told would happen actually won’t in practice.

Thank you for the advice!

 

[Lucyr]

I’m not expecting retesting - I’ve got that booked in with GP in April - but support / checks from Community team / Diabetes Nurse that I was told that I would be seeing in ‘about 3 months time’. Does this not actually happen in practice?

If you’re registered for education, have medication and follow up tests booked then it sounds like you already have all the support expected in place. I’m not sure what else you’re expecting?

 

[Robin]

If you’re registered for education, have medication and follow up tests booked then it sounds like you already have all the support expected in place. I’m not sure what else you’re expecting?

Well, if I was new to a diagnosis, and my GP told me something was happening, ie, a referral to a community team..then I’d expect that to happen. I wouldn’t have a clue what to expect from it, because I would be new to the situation.

 

[Lucyr]

Well, if I was new to a diagnosis, and my GP told me something was happening, ie, a referral to a community team..then I’d expect that to happen.

The referral has happened though? A referral is your GP writing to another team asking them to look at the notes they put in the letter. They’ve looked and decided no further action needed from them at this time, everything has already happened.

 

[JJay]

The referral has happened though? A referral is your GP writing to another team asking them to look at the notes they put in the letter. They’ve looked and decided no further action needed from them at this time, everything has already happened.

But surely it would be common courtesy, if nothing else, for the CDT to contact the OP to say as much?

 

[Lucyr]

But surely it would be common courtesy, if nothing else, for the CDT to contact the OP to say as much?

Thats not standard practice. I’m never contacted by rejected referrals, they write back to the GP not to the patient.

 

[everydayupsanddowns]

I don’t think the Community Diabetes Team have handled this very well (or perhaps the GP?). It feels like there are some crossed wires if the Dr says “and I’m referring you to the CDT for a follow-up in 3 months time to see how you are getting on”, only for the CDT to blank refuse to see that person, and not even communicate with them as to why, seems a bit odd, and actually quite unkind.

Either the CDT should be used to processing these follow ups quickly and efficiently, or the Dr should know not to refer in that timeframe.

Hope it hasn’t upset you too much @Ekbeks14 - fortunately it seems like you’ve developed a pretty solid plan yourself in the meantime, so just stick with that.

 

[JJay]

Thats not standard practice. I’m never contacted by rejected referrals, they write back to the GP not to the patient.

Maybe where you live. It’s not been my experience.

 

[Mark72]

If they've not happened and it sounds like they might not have, have you not had a referral for a diabetic eye test as well as having had a foot exam and tested for kidney function (I had the later two with my GP's practice and with the blood test had cholesterol measured as well). I thought we were all supposed to get those three things at least and cholesterol was a sensible extra as well.