Diabetes Nurse.

Lilsis

Lilsis

Well-Known Member
Relationship to Diabetes
Type 2
Out of interest and sorry if this seems a strange question but how many people see a Diabetic Nurse?

The reason I ask is because my Dr's practise doesn't have a diabetic nurse. I see one of the practice nurses for my annual checks then have a follow up appointment.. In between annual check ups I'm left to my own devises as it were. On the plus side, it's meant I've had to educate myself.. When I asked about seeing a DN after attending the Desmond(?) course I was told I didn't need to see one, even though on the course they said we should all have a dedicated team. I control my diabetes with diet and managed to get back into prediabetic range within 6 months. I'm aiming for full remission as I'm sure we all are.

I'm considering changing to a Dr's surgery that has a DN. Does seeing a Diabetic Nurse make a difference?
 
There are two kinds of Diabetes Nurse @Lilsis Many GP surgeries have a practice nurse with a ‘special interest’ in diabetes who usually sees the patients with diabetes. That nurse will know a little more than other nurses who might have different ‘areas of interest’, eg family planning.

But there are also DSNs - Diabetes Specialist Nurses. These are usually attached to hospital clinics. As their name suggests, they have more specialist knowledge of diabetes, insulin, pumps, etc. I’m Type 1 so I have DSNs I see at the hospital clinic and who I can phone.

If you’re happy with your care, I wouldn’t bother changing surgeries. Your team could be your GP and the nurse you see at the surgery. That would be perfectly normal for someone in your position.

Edited to add - no, you wouldn’t need to see a DSN. Occasionally people use ‘DN’ instead of ‘DSN’ for the same specialist nurses, which causes confusion because others use it to just mean the practice nurse who sees them about their diabetes. Seeing a practice nurse, as you do, sounds normal to me.
 
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Lilsis said:
I control my diabetes with diet and managed to get back into prediabetic range within 6 months.
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@Lilsis.

I agree with previous posts. As you have learnt for yourself and got back in the prediabetic range you probably know as much as anyone about what's best for you.

Of course there is always something to learn, and that could well be what gets you back to normal.

We moved to another surgery recently. My only regret was to leave the practice nurse who acted as DN. She listened to what I said and made helpful suggestions. The GPs were great at diagnosis and prescribing large doses of metformin. It was Dr Michael Mosley and Prof. Roy Taylor's whose books pointed me along the way to get my liver back to normal (which I needed to do for other reasons). The radiologist who scanned my liver confirmed the treatment was diet.

In case they help you, two things which have helped me control my weight are this article, including the bit about weight loss, and Michael Mosley's 5:2 Intermittent Fasting - I found a copy of his book lurking in a charity shop and now research has shown it's really effective for dealing with visceral fat.
 
Lilsis said:
The reason I ask is because my Dr's practise doesn't have a diabetic nurse. I see one of the practice nurses for my annual checks then have a follow up appointment.. In between annual check ups I'm left to my own devises as it were. On the plus side, it's meant I've had to educate myself.. When I asked about seeing a DN after attending the Desmond(?) course I was told I didn't need to see one, even though on the course they said we should all have a dedicated team. I control my diabetes with diet and managed to get back into prediabetic range within 6 months. I'm aiming for full remission as I'm sure we all are.

I'm considering changing to a Dr's surgery that has a DN. Does seeing a Diabetic Nurse make a difference?
Click to expand...

I'm not sure what else they could do for you given what you've done. We are expected to manage the condition ourselves, with help from medicines if we need them and lifestyle courses that are on offer plus the annual checks to make sure there are no unwanted side effects. The NICE guidelines are quite clear and this is what they will follow.

I've been point blank told by my GP (And a friend who is a GP, and somewhat fed up with patients who do nothing but take pills and carry on as before) it's my responsibility to manage the condition. Unless on insulin I'm not sure there's any specialist knowledge out there that would benefit us - I was pretty much told at diagnosis to 'lose weight and cut carbs and exercise' which has worked well for me.

(The situation might be different for T2s on insulin, but I don't know.)
 
I've been lucky that I have a really good diabetic nurse called Helen.She's a nice person whose been a Godsend during the last two and half years.
 
Hi @Lilsis
I haven’t seen a DSN for quite a few years, in-fact I think the last one I physically met was at the hospital, when I went on insulin, thinking maybe 10 years ago ?
recently I have spoke to a DSN about 6 times in the last 3 months as I have needed important changes to my meds, plus my HbA1c was going back to being out of control (back in June) but with a few changes that’s normal now.

I have also received an email from a DSN also,
so although haven’t been officially told to email them if I ever need help, I guess I could

as @harbottle posted it seems the DSN’s seem to be attached to the care team working from the Diabetes team at the hospital/ out there in the community, these days rather than having a individual DSN based at each doctors surgery, well at least that’s the case around here anyway.
At my surgery we have several doctors and one of then also oversees all the Diabetic needs of the other GP’s patient as well as looking after his own patients, which is I think a good idea, especially as I’m now under him as my GP.

It sounds like your taking good care of yourself @Lilsis as within 6 months you have got your Hba1c down to pre-diabetic range :star: and got your eyes on remission
 
I know I have one as my other half spoke to her on the phone when I was recovering from surgery but haven't had a review or a face to face. My oncologist pushed for a face to face but got told my numbers were all good so not needed. I think he was more worried about the mental health aspect rather than the diabetes itself at this point and just felt I need to talk things through. I have found the dietitians supportive although they also raised some queries with the DSN who gave them the same reply about numbers being good. Bit disappointing but I'm reaching the point where I'm not sure I would benefit much anyway. I am only about 5 months in but I was getting weekly/fortnightly calls from other teams initially. Of course there may also have been the practical element of lets see if he's still around in six months time 🙂
 
Lilsis said:
Out of interest and sorry if this seems a strange question but how many people see a Diabetic Nurse?

The reason I ask is because my Dr's practise doesn't have a diabetic nurse. I see one of the practice nurses for my annual checks then have a follow up appointment.. In between annual check ups I'm left to my own devises as it were. On the plus side, it's meant I've had to educate myself.. When I asked about seeing a DN after attending the Desmond(?) course I was told I didn't need to see one, even though on the course they said we should all have a dedicated team. I control my diabetes with diet and managed to get back into prediabetic range within 6 months. I'm aiming for full remission as I'm sure we all are.

I'm considering changing to a Dr's surgery that has a DN. Does seeing a Diabetic Nurse make a difference?
Click to expand...
Your story is so similar to mine! I was diagnosed six months ago during an unrelated blood test, with no prior symptoms. I still haven't seen a Diabetes Nurse (DN) in person, though I’ve had a recent appointment with a regular nurse after follow-up blood tests. My initial HbA1c was 58, but it's now down to 50. I am on no medication yet. The DN covers three surgeries, so I've only spoken to her over the phone. I considered switching practices, but after reading the comments here, it seems like this is typical care. I didn’t know what to expect, but I was pretty much left to figure things out on my own, which was tough at first since the diagnosis was such a shock. But I’m over it now!
 
Hells said:
Your story is so similar to mine! I was diagnosed six months ago during an unrelated blood test, with no prior symptoms. I still haven't seen a Diabetes Nurse (DN) in person, though I’ve had a recent appointment with a regular nurse after follow-up blood tests. My initial HbA1c was 58, but it's now down to 50. I am on no medication yet. The DN covers three surgeries, so I've only spoken to her over the phone. I considered switching practices, but after reading the comments here, it seems like this is typical care. I didn’t know what to expect, but I was pretty much left to figure things out on my own, which was tough at first since the diagnosis was such a shock. But I’m over it now!
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A passing observation: DN is often used within the NHS as an abbreviation for District Nurse, who is unlikely to have any Diabetes specialisation - other than those patients a District Nurse might routinely be visiting at home. We frequently use DN a bit inappropriately here on the forum.
 
The nurse that I saw at my surgery told me she was the lead diabetic nurse, she did have a lot of info, but on the website she is down as family planning!!!! That I don't need!!!! But when I saw her again, whatever diet she was on was not working for her.
It surprises me how many newbies are on here, it actually worries me that there are so many people being diagnosed with diabetes either T1 or T2, most of whom are complete ignorant of what it is and what to do. I do NOT mean to offend, but I suppose if you have no medical interest then you are in the dark at the start. The nurses are busy but you presume they are there to help but they cannot help everyone and I think if they feel you can cope, you are left. It's takes quite a bit of understanding how this thing works, and a year to be left to get on with it is quite overwhelming for some people. One wants to have results asap, and that's not how diabetes works. Add to that the shortage of nurses in the NHS etc etc.
 
Proud to be erratic said:
A passing observation: DN is often used within the NHS as an abbreviation for District Nurse, who is unlikely to have any Diabetes specialisation - other than those patients a District Nurse might routinely be visiting at home. We frequently use DN a bit inappropriately here on the forum.
Click to expand...

Yes, it always reads ‘District Nurse’ to me too for a second, then I have to stop and work out what’s meant. Some people write DN instead of DSN, others write DN when they mean a practice nurse with an interest in diabetes.

Apart from confusion, it can also make people worry that they’re missing out on care because they assume the person is seeing a DSN when actually they’re seeing a practice nurse with an interest in diabetes. Maybe we need ‘nurse WAIID’ and DSN. No confusing those two abbreviations, and no DN at all.
 
harbottle said:
The NICE guidelines to [HCPs on T2D] are quite clear and this is what they will follow.

I've been point blank told by my GP (and a friend who is a GP, and somewhat fed up with patients who do nothing but take pills and carry on as before) it's my responsibility to manage the condition. Unless on insulin I'm not sure there's any specialist knowledge out there that would benefit us - I was pretty much told at diagnosis to 'lose weight and cut carbs and exercise' which has worked well for me.
Click to expand...

I'd say there is a great deal of knowledge and experience about T2D (as well as ignorance!) out there in the medical profession and the research community, as well as prediabetics and T2 diabetics. It just needs a concerted action by knowlegeable people to come up with clear guidance for HCPs and their patients.

The NHS should do this centrally. They need to commission someone who is skilled in the art of putting two and two together to lead the project. The deliverables would be well presented (updateable) online and print media available to everyone before and after diagnosis.

It is ridiculous to expect the thousands of HCPs dealing with T2D to do all this for themselves. Not least if there is only a phone call or 10-30 minute appointment once in a blue moon to convey this information to the hundreds of thousands of people who need it.

Just look at what NICE expects of its HCPs:

Recommendations​

1.1 Individualised care​

1.1.1​

Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities and risks from polypharmacy, and their likelihood of benefiting from long-term interventions. Such an approach is especially important in the context of multimorbidity. [2015, amended 2022]

1.1.2​

Reassess the person's needs and circumstances at each review and think about whether to stop any medicines that are not effective. [2015]

1.1.3​

Take into account any disabilities, including visual impairment, when planning and delivering care for adults with type 2 diabetes. [2015]

1.2 Education​

1.2.1​

Offer structured education to adults with type 2 diabetes and their family members or carers (as appropriate) at the time of diagnosis, with annual reinforcement and review. Explain to people that structured education is an integral part of diabetes care. [2009]

1.2.2​

Ensure that any structured education programme for adults with type 2 diabetes:

  • is evidence-based, and suits the needs of the person
  • has specific aims and learning objectives, and supports the person and their family members and carers to develop attitudes, beliefs, knowledge and skills to self-manage diabetes
  • has a structured curriculum that is theory driven, evidence-based and resource-effective, has supporting materials and is written down
  • is delivered by trained educators who:


    • have an understanding of educational theory appropriate to the age and needs of the person
    • are trained and competent to deliver the principles and content of the programme

  • is quality assured, and reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency
  • has outcomes that are audited regularly. [2015]

1.2.3​

Ensure that education programmes for adults with type 2 diabetes provide the necessary resources to support the educators, and that educators are properly trained and given time to develop and maintain their skills. [2009]

1.2.4​

Offer adults with type 2 diabetes group education programmes as the preferred option. Provide an alternative of equal standard for people who are unable or prefer not to take part in group education. [2009]

1.2.5​

Ensure that education programmes for adults with type 2 diabetes meet the cultural, linguistic, cognitive and literacy needs of people in the local area. [2009]

1.2.6​

Ensure that all members of the diabetes healthcare team are familiar with the education programmes available locally for adults with type 2 diabetes, and that these programmes are integrated with the rest of the care pathway. [2009]

1.2.7​

Ensure that adults with type 2 diabetes and their family members and carers (as appropriate) have the opportunity to contribute to the design and provision of local education programmes for adults with type 2 diabetes. [2009]

1.3 Dietary advice and bariatric surgery​

1.3.1​

Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition. [2009]

1.3.2​

Provide dietary advice in a form sensitive to the person's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life. [2009]

1.3.3​

Encourage adults with type 2 diabetes to follow the same healthy eating advice as the general population, which includes:

  • eating high-fibre, low-glycaemic-index sources of carbohydrate, such as fruit, vegetables, wholegrains and pulses
  • choosing low-fat dairy products
  • eating oily fish
  • controlling their intake of saturated and trans fatty acids. [2009]

1.3.4​

Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification such as increasing physical activity and losing weight. [2009]

1.3.5​

For adults with type 2 diabetes who are overweight, discuss and agree an initial body weight loss target of 5% to 10%. Remember that a small amount of weight loss may still be beneficial, and a larger amount will have advantageous metabolic impact in the long term. [2009]

1.3.6​

Individualise recommendations for carbohydrate and alcohol intake, and meal patterns. Make reducing the risk of hypoglycaemia a particular aim for people using insulin or an insulin secretagogue. [2009]

1.3.7​

Advise adults with type 2 diabetes that they can substitute a limited amount of sucrose-containing foods for other carbohydrate in the meal plan but should take care to avoid excess energy intake. [2009]

1.3.8​

Discourage adults with type 2 diabetes from using foods marketed specifically for people with diabetes. [2009]

1.3.9​

When adults with type 2 diabetes are admitted as inpatients to hospital or any other care setting, implement a meal planning system that provides consistency in the carbohydrate content of meals and snacks. [2009]

1.3.10​

For recommendations on lifestyle advice, see the NICE guidelines on preventing excess weight gain, weight management, obesity, physical activity and tobacco. [2015]

1.3.11​

For recommendations on bariatric surgery for people with recent-onset type 2 diabetes, see the section on bariatric surgery for people with recent-onset type 2 diabetes in the NICE guideline on obesity. [2015]

1.4 Diagnosing and managing hypertension​

The recommendations on diagnosing and managing hypertension have been removed. For recommendations on hypertension in people with type 2 diabetes, see the NICE guideline on hypertension in adults. Diagnosis, treatment and monitoring of hypertension is broadly the same for people with type 2 diabetes as for other people. When a different approach is needed for people with type 2 diabetes, this is specified in the hypertension guideline.

1.5 Antiplatelet therapy​

1.5.1​

Do not offer antiplatelet therapy (aspirin or clopidogrel) to adults with type 2 diabetes without cardiovascular disease. [2015]

1.5.2​

For guidance on the primary and secondary prevention of cardiovascular disease in adults with type 2 diabetes, see the NICE guidelines on cardiovascular disease and acute coronary syndromes. [2015]

1.6 Blood glucose management​

HbA1c measurement and targets​

Measurement​

1.6.1​

Measure HbA1c levels in adults with type 2 diabetes every:

  • 3 to 6 months (tailored to individual needs) until HbA1c is stable on unchanging therapy
  • 6 months once the HbA1c level and blood glucose lowering therapy are stable. [2015]

1.6.2​

Measure HbA1c using methods calibrated according to International Federation of Clinical Chemistry (IFCC) standardisation. [2015]

1.6.3​

If HbA1c monitoring is invalid because of disturbed erythrocyte turnover or abnormal haemoglobin type, estimate trends in blood glucose control using one of the following:

  • quality-controlled plasma glucose profiles
  • total glycated haemoglobin estimation (if abnormal haemoglobins)
  • fructosamine estimation. [2015]

1.6.4​

Investigate unexplained discrepancies between HbA1c and other glucose measurements. Seek advice from a team with specialist expertise in diabetes or clinical biochemistry. [2015]

Targets​

NICE has produced a patient decision aid on agreeing HbA1c targets, which also covers factors to weigh up when discussing HbA1c targets with patients.

1.6.5​

Discuss and agree an individual HbA1c target with adults with type 2 diabetes (see recommendations 1.6.6 to 1.6.10). Encourage them to reach their target and maintain it, unless any resulting adverse effects (including hypoglycaemia), or their efforts to achieve their target impair their quality of life. Think about using the NICE patient decision aid on weighing up HbA1c targets to support these discussions. [2015, amended 2022]

1.6.6​

Offer lifestyle advice and drug treatment to support adults with type 2 diabetes to reach and maintain their HbA1c target (see the sections on dietary advice and bariatric surgery and choosing drug treatments). For more information about supporting adherence, see the NICE guideline on medicines adherence. [2015]

1.6.7​

For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

1.6.8​

In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher:

  • reinforce advice about diet, lifestyle and adherence to drug treatment and
  • support the person to aim for an HbA1c level of 53 mmol/mol (7.0%) and
  • intensify drug treatment. [2015]

1.6.9​

Consider relaxing the target HbA1c level (see recommendations 1.6.7 and 1.6.8 and NICE's patient decision aid) on a case-by-case basis and in discussion with adults with type 2 diabetes, with particular consideration for people who are older or frailer, if:

  • they are unlikely to achieve longer-term risk-reduction benefits, for example, people with a reduced life expectancy
  • tight blood glucose control would put them at high risk if they developed hypoglycaemia, for example, if they are at risk of falling, they have impaired awareness of hypoglycaemia, or they drive or operate machinery as part of their job
  • intensive management would not be appropriate, for example if they have significant comorbidities. [2015, amended 2022]

1.6.10​

If adults with type 2 diabetes reach an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example deteriorating renal function or sudden weight loss. [2015]

1.6.11​

For guidance on HbA1c targets for women with type 2 diabetes who are pregnant or planning to become pregnant, see the NICE guideline on diabetes in pregnancy. [2015]

etc....
 
It would be nice to see a DSN or even a DN as last time I had a face-to-face back in February it was with a healthcare assistant who had just been transferred from an elderly person ward in a hospital. She didn't have a clue, she was unable to answer any questions I put to her and when I asked if there was anybody that could I was told that they didn't have anyone qualified available.

And to add insult to injury, in the report she made afterward I was described as being 'frail'. which I don't consider I am. I'm presently trying to get back to hospital care for my T2 as I have no faith in my surgery.
.
 
My GP surgery website has a pages under Self Care about diabetes which goes through the basics, symptoms etc and then directs people to the NHS web site and also points people to the Diabetes UK site.
 
I'm seeing/speaking with one though I'm still in the new phase and not sure if she'd be a specialist or the practice expert - had foot checks in early August and due a chat with her around the end of next weeks for blood test results for a test at the beginning of the week primarily to see if statins are helping. She also referred me for and I'm waiting for a face-to-face intro course, I could have had an online zoom/teams one already but opted for in-person. She seems very on the ball and has provided maybe not better but more specific and useful information than the GP though overall I'm very happy with both.
 
Proud to be erratic said:
A passing observation: DN is often used within the NHS as an abbreviation for District Nurse, who is unlikely to have any Diabetes specialisation - other than those patients a District Nurse might routinely be visiting at home. We frequently use DN a bit inappropriately here on the forum.
Click to expand...
Apologies.. I'm still learning all the terms.
 
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