Discharged from consultant care

[hdpiwdpwpdw]

I have type1 diabetes, take multiple daily injections and have quite a low HBaC1. I achieve low blood sugars by restricting what and how I eat as high blood sugars tend to make me feel ill. This has resulted in me leading a restricted life.

I asked my local hospital for support last year as I decided I had diabetes distress and it was difficult to engage with them. About 9 months after contacting them I had a consultant's appointment which was by phone and lasted about 5 minutes and they really didn't listen to me. They told me I didn't need to restrict my eating but didn't discuss the problems I experience and could have another appointment in 6 months and engage with DSNs who I'd seen and had told me I needed to see a consultant. I said I feel I'm not getting support as diabetes has such a massive effect on my life and I'm stuck in a cycle of being told my blood results are good but nothing changes. I was told they could discharge me from their clinic.

If I'm discharged by the consultant what happens then? I'll have no access to care, the opportunity for a pump or the new closed loop system although I'm years away due to my age and HBaC1. I'm struggling but there seems no help available

 

[Lucyr]

The consultant can only really help with diabetes and dosing advice, so if you’d asked specific questions like I tried eating this food but this happened to my blood sugar, how do I improve on that, then they’d have been able to talk through some advice with you.

I'm not sure a consultant is the person to approach for mental health issues, other than perhaps signposting to either a diabetes specific psychologist if available, or whatever other services are available in your area, which may be a self referal process.

If you’re discharged by the consultant then the GP takes over your care and annual checkups. You can ask to be referred back to a hospital or to a different hospital if you need support your GP can’t offer, a GP can’t start you on a pump.

 

[Inka]

@hdpiwdpwpdw The consultant was right - there’s no need for restricted eating, and I suspect that that’s contributing to your distress. It’s an unnecessary extra imposition you’re placing on yourself; it must be miserable; and it means that the Type1 is taking up too much of your brain and life.

Ease up gradually. It’s simpler to keep to the same breakfasts and lunches to start with as that removes some of the thinking, but you absolutely can eat pretty normally and have some ‘treats’ sometimes too. You can do all that and still have a good TIR. The answer to Type 1 isn’t a strict diet, it’s appropriate use of insulin.

Only you can take the first step of jettisoning your strict diet. You admit it means you lead a restricted life. That’s shocking. Take some baby steps to relax your diet and see if you can get some counselling.

 

[Robin]

I was discharged from the hospital clinic back to my GP for my diabetes care a few years ago, because our GP surgery has a 'Diabetes nurse' I found the nurse knows a lot about Type 2 and not very much about Type 1, but I didn’t actually need any input at the time, and she was able to do all my annual bloods, foot checks, etc. When the Libre first came out, it was only available through a hospital clinic, I asked to be referred back to the hospital so I could get my hands on one, and my GP made the referral.
I’m now technically still under the hospital care, but they’ve cancelled my latest appointment twice, and my GP surgery continues seeing me once a year for foot checks etc.

 

[Inka]

@hdpiwdpwpdw I just saw this in your previous post:

“I take 5-10 units of Fiasp for 10g of carbs which seems to lasts 6+ hours and need to eat multiple snacks to offset the later effects of Fiasp, typically there is a massive BS fall about 3 hours after taking Fiasp. I'm not injecting into lumps and I'm not overweight.”

Swap your insulin! That sounds like something is not suiting you at all! Probably the Fiasp (Google “Fiasp like water”). Do explain more, then you’ll get more tailored suggestions, but that’s definitely not right unless you have massive insulin resistance.

 

[SB2015]

“I take 5-10 units of Fiasp for 10g of carbs which seems to lasts 6+ hours and need to eat multiple snacks to offset the later effects of Fiasp, typically there is a massive BS fall about 3 hours after taking Fiasp. I'm not injecting into lumps and I'm not overweight.”

Hi @hdpiwdpwpdw
If you are injecting mealtime insulin that makes you go low after three hours then you are injecting too much insulin the ratio in the quote above seems very high. I may have misread the info.
It would be good for you to review your ratios and get help to do this if needed.