Type 1 treated at Hospital or GP

[rosy_nic]

Hi guys, I have had a recent puzzle that I thought I would like your opinion on



I have had to have a review at my GP's with their DSN who now treats mainly Type 2's but has come from a county NHS (Berkshire) where she had said that Type 1's were treated at the GP's. I was in horror as my consulate has said all Type 1's should be treated in hospital environment as they have more knowledge that a standard GP DSN. Is your Type 1 treated at hospital or the GP's?



If yours is treated at the GP's do you prefer the treatment they give your or would your prefer the hospital

 

[Robin]

When I had been stable for a while, a couple of years after diagnosis, my consultant discharged me back to my GP, as he said there was a 'specialist diabetic nurse' at our practice. This turned out to be the surgery nurse, who also runs the asthma clinic, travel vaccinations, etc etc, as well as treating mainly Type 2s.
I stuck with it, though, because I keep up to date with what I feel I need to know on this forum, and it’s a Sabbath day's journey to get to my hospital.

 

[TheClockworkDodo]

Mine is in theory treated at hospital, but they are badly understaffed, and I haven't seen a consultant there since December 2017 - I'm supposed to see them every autumn. I do have an email address for a hospital DSN if I need to talk to her though, and I see the diabetes nurse at the surgery every spring for my foot check and a chat about any issues she can deal with (she mostly sees type 2s but is very nice and helpful, and will get onto the hospital for me if I have any problems).

I have mixed feelings - on the one hand the surgery nurse is lovely and most of the time I'd be happy not to see anyone else, especially as going to the hospital is difficult for me. But on the other hand I do occasionally want to talk to a type 1 specialist, and I'm hoping to get a pump at some point, so they'll have to start seeing me at the hospital then.

 

[Pumper_Sue]

If yours is treated at the GP's do you prefer the treatment they give your or would your prefer the hospital

It's my diabetes so I treat it myself 🙂

 

[Bronco Billy]

As far as I'm aware, all type 1s are seen by hospital staff.

 

[Robin]

As far as I'm aware, all type 1s are seen by hospital staff.

No, I'm not, as I said above, I haven’t been to the hospital for the last 8 years. Maybe referred to hospital initially, as I was, but in our area you're dispatched back to your GP for all care asap.

 

[Bronco Billy]

What I really meant was 'should be' rather than 'are'.

 

[SB2015]

I have a GP with very limited understanding of T1, and I would not want to be managed by the Practice. In our area, those on pumps are all dealt with at the hospital, or those on MDI are seen by hospital DSNs visiting surgeries in rotation, where these are more distant from hospitals.

As @Robin has said some stable T1s are dealt within the Pratcices, and one way of keeping up to date is through this forum. I get my feet checked and other checks done at the Practice but still happy to see my Consultant every 6 months.

 

[everydayupsanddowns]

I’ve been seen in hospital. Then I shifted and was seen at GPs (my choice - for easier appointment organisation). Then I switched back to the hospital and have since started on a pump, so now I am seen for annual review at GP and annual pump clinic at hospital.

It’s whatever works for you!

 

[Greyhound Gal]

At my last consultant appt a couple of weeks ago I was signed off and am now under GP care. I'll see how it goes. I've been stable I non-diabetic range for almost 3 years and like others have said, find this forum my main source of info anyway.

 

[DaveB]

I am a mis-diagnosed LADA still listed as T2 as my GP refused to accept T1 can occur later in life. Fortunately I have an excellent nurse who understands manging insulin quite well and supports a LCHF diet etc so I'm happy with my 'T1' treatment by my surgery but was less happy with my ignorant Diabetes GP who initially refused insulin as it's 'a last resort'!

 

[everydayupsanddowns]

I am a mis-diagnosed LADA still listed as T2 as my GP refused to accept T1 can occur later in life. Fortunately I have an excellent nurse who understands manging insulin quite well and supports a LCHF diet etc so I'm happy with my 'T1' treatment by my surgery but was less happy with my ignorant Diabetes GP who initially refused insulin as it's 'a last resort'!

Good grief @DaveB!! 😱😱😱

Have you made a complaint? I know it’s a bit of a specialist area... but 50% of T1s are over 18 at diagnosis so it’s hardly rare?! Someone needs a little Continuing Professional Development 🙄

 

[Bruce Stephens]

I know it’s a bit of a specialist area... but 50% of T1s are over 18 at diagnosis so it’s hardly rare?

Does seem a bit surprising especially since we just had a Prime Minister who was diagnosed with T1 later in life. (Or has everyone entirely forgotten her already?)

 

[stephknits]

I had been moodling along quite nicely and would turn up to my every 9 month hospital appointment which would last all of five minutes as I had no worries. I would come along to pump update sessions but didn't really make all that much use of the team until I had my hypo where I lost consciousness, seized and ended up in A&E. My team have been absolutely amazing. The support and knowledge has been invaluable, including my pump DSN ringing me up when I went back to work every day to check I was doing ok. She arranged with the pump rep a meeting to go over all the settings and has helped me to slowly manage a return to more normal levels. I could have worked these things out for myself and did ask you lovely people for support, but could never have got this type of service from my GP surgery.

 

[SB2015]

D

I am a mis-diagnosed LADA still listed as T2 as my GP refused to accept T1 can occur later in life. Fortunately I have an excellent nurse who understands manging insulin quite well and supports a LCHF diet etc so I'm happy with my 'T1' treatment by my surgery but was less happy with my ignorant Diabetes GP who initially refused insulin as it's 'a last resort'!

Definitely a bit of re-education for the GP needed, and a complaint.
Good to hear that you have a good Practice nurse that you can deal with.

 

[Matt Cycle]

When I was diagnosed everyone was seen at the hospital clinic - T1 and T2. I always seemed to get a 2pm appointment but was lucky if I was out before 4pm. The waiting rooms either side of a corridor were always packed with 40-50 people in total. We were first called to be weighed and then a blood test (assume it was bg?). Back to waiting to then be seen by one of the 3-4 consultants. The staff as always were great but it was a depressing experience. With the massive increase in T2 over the following 2 decades it was obviously not sustainable to have everyone seen at hospital and I'm assuming that's why they starting shifting people back to GP care.

In the late 90's I was moving doctors and not in a good frame of mind personally at the time. The GP said I could be seen there so I just agreed. When I moved addresses and doctors again a few years later I continued being seen at the GP. In my experience they were okay but weren't fully up to date with what's going on in the world of Type 1. I asked about pumps around 3 years ago and the DN at the surgery said fine and referred me back to the hospital clinic. My experience back there couldn't be more different compared to the 80's and 90's. Seen on time with a minimal wait, long appointments if needed and a handful of people waiting, obviously fully up to speed with developments in T1 and regular access to an appointed DSN.

 

[Barbie1]

When I moved to this town 30 years ago, there was only one health centre with all the GPs in one place. I trotted along to register and said I had diabetes, and they immediately said “oh, our Dr x specialises in diabetes”, so I registered with him and was ever afterwards seen only by him, until the practice nurse started helping him out at his busy diabetes clinics and boy, was she good too!
Unfortunately they have both now retired and although the practice does have a new sister who handles all the diabetics, once I had expressed an interest in the local Dafne course, to which she immediately referred me, I sort of shifted to my local hospital.
And they are fantastic! I now have a pump (no problem there) and they have superb knowledgeable nursing staff with whom I can consult any time I want to! Clinics take as long as I want or need with very short waiting times.

I am very lucky to have such excellent care relatively locally, I know!

 

[DaveB]

Good grief @DaveB!! 😱😱😱

Have you made a complaint? I know it’s a bit of a specialist area... but 50% of T1s are over 18 at diagnosis so it’s hardly rare?! Someone needs a little Continuing Professional Development 🙄

The amusing thing is that she told me she managed 500 diabetics in the surgery and therefore knew what she was talking about. I subsequently found out from a friend at the surgery that she had only just come off the Warwickshire diabetes training course which doesn't say much for the course. As I left the surgery she asked if anyone else in the family had diabetes and I said my nephew was diagnosed T1 at 22yrs old (he went into DKA). She said that's unusual. Apart from that ignorance she is an excellent GP which shows the sheer lack of knowledge15 years ago about diabetes.

 

[Sue J]

Hi. Just returned from my annual review. I've been T1 for 45 years and was discharged to GP care about 15 years ago. I have been happy self managing until a couple of years ago when the quality of care became unhelpful. Today's review was with a nursing assistant who specialises in diabetes and apart from giving me my blood test results, checking my feet and taking my blood pressure she had no authority to do anything else. I asked to refererred to the hospital diabetes specialist nurse who visits the practice once a month because my blood sugars have been yoyo-ing but because my HbA1c is 53 she cannot do this - so I now have to make an appointment with the GP. The GP she recommended as 'good with diabetes' is on sabbatical so I am going to have to take my chances with another one! Feeling rather let down at the moment.

 

[grainger]

I’m seen at hospital which is great but I’m still asked to go to a diabetic review every year at GP. It’s frustrating as she asked me what my hba1c target was and I said 6.5% and her response was - oh that’s too low, I’ll put down 6.8% as a compromise - couldn’t be arsed to argue as my consultants have a plan for me anyway.