Oh, I just can't win..........

[Hazel]

Just off the phone with my DSN from the hospital.

Yes, she will contact the Surgery and tell them I need more test strips prescribed. RESULT!!

BUT.........

she was looking at my last HBA1C result of 5.9%. She said for an insulin user it is too low.
Wants to see more 7s even 8s.
What!!! The reason behind this is my body will no longer react if I go below 4s.

Personally I think that is bull.
But, I would value what anyone else thinks.

I feel I just can't win at the moment. Diabetes is a real pain.

 

[Ljc]

Just off the phone with my DSN from the hospital.

Yes, she will contact the Surgery and tell them I need more test strips prescribed. RESULT!!

BUT.........

she was looking at my last HBA1C result of 5.9%. She said for an insulin user it is too low.
Wants to see more 7s even 8s.
What!!! The reason behind this is my body will no longer react if I go below 4s.

Personally I think that is bull.
But, I would value what anyone else thinks.

I feel I just can't win at the moment. Diabetes is a real pain.

I know that feeling well , I have frequently been told my Hb1ac is too low so I must be having lots hypos , I’m not.

This is a conversion chart for the old and not so new measurements ,it’s also very helpfully colour coded re whether our control is good or not .

 

[rebrascora]

Hi Hazel.
Sorry to hear of your frustration. I am not familiar with the ins and outs of insulin using Type 2s but is there a possibility of reducing or even coming off the insulin at some point if you are managing your BG levels so impressively?
If you are not having lots of hypos or lost your hypo awareness then surely there should be no problem maintaining such a great HbA1c and she should be congratulating you for a fantastic achievement. I appreciate that some people end up with such readings because they hypo a lot but if you are not, then you have good reason to be narked about her suggestion. I think the majority of people with diabetes are not represented by the members of this forum who actively seek to optimize their BG control, but the nurses will mostly see people whose control is less well managed and I would guess that their advice will be geared to that. I think it is one of the biggest criticisms of professional Diabetic support, that it is not individualised and the day to day management of your levels is down to you but the HCPs like to think they are in charge and know best, rather than listen and learn from each individual, who after all is the expert in his or her diabetes..

 

[Kaylz]

I had this too for a while and it does make sense to me in a way, maybe try adjusting the basal dose so you aren't waking in the 4's? (as I see you often do) I'm not criticising in anyway but I know when I was constantly waking in the 4's I lost my hypo awareness, also that waking that low often means you've been lower whilst asleep, I took a good while of being higher to regain my hypo awareness xx

 

[JoeJOns]

I am newly diagnosed about 3 weeks ago. If I could maintain the numbers that you have I would be really proud of myself. Well done

 

[Felinia]

Hi Hazel.
Sorry to hear of your frustration. I am not familiar with the ins and outs of insulin using Type 2s but is there a possibility of reducing or even coming off the insulin at some point if you are managing your BG levels so impressively?
If you are not having lots of hypos or lost your hypo awareness then surely there should be no problem maintaining such a great HbA1c and she should be congratulating you for a fantastic achievement. I appreciate that some people end up with such readings because they hypo a lot but if you are not, then you have good reason to be narked about her suggestion. I think the majority of people with diabetes are not represented by the members of this forum who actively seek to optimize their BG control, but the nurses will mostly see people whose control is less well managed and I would guess that their advice will be geared to that. I think it is one of the biggest criticisms of professional Diabetic support, that it is not individualised and the day to day management of your levels is down to you but the HCPs like to think they are in charge and know best, rather than listen and learn from each individual, who after all is the expert in his or her diabetes..

I could not agree more that the HPC's treat us all the same and not as individuals. As a recent diagnosed Type 2, I've found it very difficult at times, as my allocated dietician took absolutely no notice of my other conditions, medications and problem foods, and actually told me to stop taking 2 things prescribed by my GP as they were "loaded with sugar" or "nothing more than media hype". I've chosen to follow my GP prescriptions and will raise it in my next appointment in 6 weeks.

 

[Sally71]

It is possible that if your control is too good (if there is such a thing!) that you might lose your hypo awareness and be completely unaware if you are going low. If you don't think this is happening to you though then don't worry about it and keep up the good work!

 

[SB2015]

I am newly diagnosed about 3 weeks ago. If I could maintain the numbers that you have I would be really proud of myself. Well done

Joe don’t compare our HbA1Cs to those with T2. Remember that they have a pancreas that is still giving them insulin, which we haven’t. I worried about this when I first joined the forum.

Actually don’t compare your levels to anyone else. Work with your DSN to reach agreed targets, look after yourself and enjoy your self too.

 

[SB2015]

H

Just off the phone with my DSN from the hospital.

Yes, she will contact the Surgery and tell them I need more test strips prescribed. RESULT!!

BUT.........

she was looking at my last HBA1C result of 5.9%. She said for an insulin user it is too low.
Wants to see more 7s even 8s.
What!!! The reason behind this is my body will no longer react if I go below 4s.

Personally I think that is bull.
But, I would value what anyone else thinks.

I feel I just can't win at the moment. Diabetes is a real pain.

Hi Hazel, so long as you are not having loads of hypos then your control should not be a problem.
Have you tried a Libre. It can give you evidence of your percentage time in target, and that will give you more info.

 

[Hazel]

H


Hi Hazel, so long as you are not having loads of hypos then your control should not be a problem.
Have you tried a Libre. It can give you evidence of your percentage time in target, and that will give you more info.

I doubt T2s would get a Libre and I certainly could not find one.

Her comments just floored me.
He even said I could find myself passed out on the floor due to an unnoticed hypo - scare tactics or what........

 

[SB2015]

Scare tactics indeed.
You know exactly what you are doing, are aware of your carb intake, and doing so well.
The nurse has probably not come across someone who is doing so well.
Perhaps you could offer them some training!

 

[Kaylz]

doubt T2s would get a Libre and I certainly could not find one.

They can, if on intensive insulin therapy (MDI of a minimum of 4 injections a day) but it would depend what their thoughts in your area were but I'd definitely ask about it as there was a Type 2 at the education session I attended xx

 

[Ljc]

They can, if on intensive insulin therapy (MDI of a minimum of 4 injections a day) but it would depend what their thoughts in your area were but I'd definitely ask about it as there was a Type 2 at the education session I attended xx

I think I will move to Scotland then. In England as far as I can remember its only if t2s are on insulin and having kidney dialysis that we qualify for a Libre

 

[Hazel]

I think I will move to Scotland then. In England as far as I can remember its only if t2s are on insulin and having kidney dialysis that we qualify for a Libre

I definitely to not qualify for a Libre, as an T2 on insulin in Scotland

 

[Ljc]

I agree definitely scare tactics.

I definitely to not qualify for a Libre, as an T2 on insulin in Scotland

Darn it, I’ll stay here then as it’s warmer here in winter

 

[everydayupsanddowns]

I doubt T2s would get a Libre and I certainly could not find one.

Her comments just floored me.
He even said I could find myself passed out on the floor due to an unnoticed hypo - scare tactics or what........

Sigh! These sorts of comments frustrate me. I can understand where they originate (HCPs meet so many people with very VERY different approaches and experiences) but it simply isn’t treating you as an individual.

The better question is do you experience many readings below 4. And to check a Clarke or Gold Score to assess hypoglycaemia awareness.

5.9 is ONLY problematic if it is driven by lots of hypos and the person develops impaired awareness. And those are real problems and not at all uncommon (hence the comments). They also sneak up on you so they are hard to spot.

I know a woman on another forum who had these same comments for years - but they turned on a sixpence to ‘congratulatory’ comments as soon as she had Libre data to show the HCPs that demonstrated a very low number of <4 readings.

 

[Northerner]

The assumption that a good HbA1c MUST mean lots of hypos is nonsense We work hard to get good control, and when we do we are not trusted on the results. I know you to be an honest person, and very experienced in the use of insulin - like anyone who knows what they are doing with it, you reduce it when indications are that you need less, and vice versa. Your HbA1c is the same as mine, it's very good 🙂 It's fine to ask the question and issue the warnings, but the presumption should not be that it has been achieved by driving levels lower than is safe - the individual needs to be considered and respected. Don't let it upset you @Hazel! Something that seems to be completely overlooked as well is that, if you are capable of achieving good, stable, in-range levels it is actually quite hard to start making your levels worse than they need to be (just to fulfil their wishes and shut them up).

You're not a page in a textbook, you are an individual who is doing well 🙂

 

[Hazel]

Thanks @Northerner

I have mulling this over, and I 100% agree with you, however, my GP has been working with me, umpteen tests, to get to the bottom of why I am so tired all the time. Could it be because of hypos whilst I am sleeping. But without a Libre, it cannot be confirmed. What do you think?

 

[Eddy Edson]

Thanks @Northerner

I have mulling this over, and I 100% agree with you, however, my GP has been working with me, umpteen tests, to get to the bottom of why I am so tired all the time. Could it be because of hypos whilst I am sleeping. But without a Libre, it cannot be confirmed. What do you think?

Just butting in, but could you afford to self-fund a sensor or two?

I'm not any meds now, but being a nerdy dork I've worn a few Libre sensors partly to check out what happens when I'm asleep (amongst other reasons). On two occasions I've trundled along for a few hours in the low 3's and dipped down into the mid 2's briefly - and woken up sweaty and with a dull headache, which I guess is indicative.

For me, I don't think it's very important, but for you, I'd guess that a sensor or two would be enough to show you & yr doc whether in fact there is a hypo prob. If not, they can stop harassing you about it.

 

[Hazel]

Just butting in, but could you afford to self-fund a sensor or two?

I'm not any meds now, but being a nerdy dork I've worn a few Libre sensors partly to check out what happens when I'm asleep (amongst other reasons). On two occasions I've trundled along for a few hours in the low 3's and dipped down into the mid 2's briefly - and woken up sweaty and with a dull headache, which I guess is indicative.

For me, I don't think it's very important, but for you, I'd guess that a sensor or two would be enough to show you & yr doc whether in fact there is a hypo prob. If not, they can stop harassing you about it.

Sadly not able to self fund