Do DN’s have to do specific training to practice?

[Drummer]

My consultant has had to write to my GP surgery at least twice to correct the rubbish said by the diabetes ‘expert’ nurse. I’m sure they must do some kind of training but their knowledge is poor IMO. I wouldn’t mind that so much if they weren’t so sure of themselves. Mine absolutely insisted their was no increased of coeliac if you’re Type 1. She wouldn’t listen and didn’t check. She removed blood tests from the list ordered by my consultant, insisted on me spending 40 mins with her regularly (does she get extra money for this??), knew nothing about my pump, couldn’t answer any questions - but liked to sit there and try to control the conversation. I had to bite my tongue numerous times.

I was sent to a dietician who must have been her sister.
After two short interviews and my weight not going down, I sat for half an hour and repeated 'what a pity that doesn't work' every time she paused for breath. She never actually heard me, but I declined further lectures.

 

[BlueArmy]

what were the lectures on? Eating jacket potatoes, pasta and rice like I got? I guess at least you managed to get to the dietitian that was success, I tried 3 times and was never referred

 

[freesia]

I've now been discharged back to GP care from my DSN. I haven't seen any DSNs face to face since October 2019 and due to Covid have only had a 5 minute telephone call every 3-4 months up to the beginning of June this year when they discharged me. The last time i was seen at the GP surgery for a general diabetes check up was April 2019 when they asked did my height and weight (and queried why i'd put weight on) asked questions listed on their computer and took my blood pressure. From that i have no idea whether they know much about type 1. I think i've only had one foot check since diagnosis. Its all i remember anyway

I shall see what they say about my weight whenever i'm next seen (although who knows when that will be). The DSN who discharged me back to the GP, when asked about my weight, said (after talking through my diet) that it was the insulin keeping my weight up as there was nothing wrong with my diet or portion sizes and that good management with insulin will keep the weight on. Absolutely no idea if that is true or not but I'll compare that with what the GP nurse says, if i ever get seen.

I did email a few weeks ago and asked if/when they were doing the diabetes clinics and was told that they were though could not say when they were starting and if i had a problem, call the DSN or GP!

 

[BlueArmy]

I've now been discharged back to GP care from my DSN. I haven't seen any DSNs face to face since October 2019 and due to Covid have only had a 5 minute telephone call every 3-4 months up to the beginning of June this year when they discharged me. The last time i was seen at the GP surgery for a general diabetes check up was April 2019 when they asked did my height and weight (and queried why i'd put weight on) asked questions listed on their computer and took my blood pressure. From that i have no idea whether they know much about type 1. I think i've only had one foot check since diagnosis. Its all i remember anyway

I shall see what they say about my weight whenever i'm next seen (although who knows when that will be). The DSN who discharged me back to the GP, when asked about my weight, said (after talking through my diet) that it was the insulin keeping my weight up as there was nothing wrong with my diet or portion sizes and that good management with insulin will keep the weight on. Absolutely no idea if that is true or not but I'll compare that with what the GP nurse says, if i ever get seen.

I did email a few weeks ago and asked if/when they were doing the diabetes clinics and was told that they were though could not say when they were starting and if i had a problem, call the DSN or GP!

Think I will stop moaning. Seems like a real postcode lottery of care going on and despite some questionable advice, mine seems to have their act in order. Had 2 check ups in 3 months including full feet check etc and retinopathy checks.

 

[helli]

I shall see what they say about my weight whenever i'm next seen (although who knows when that will be). The DSN who discharged me back to the GP, when asked about my weight, said (after talking through my diet) that it was the insulin keeping my weight up as there was nothing wrong with my diet or portion sizes and that good management with insulin will keep the weight on. Absolutely no idea if that is true or not but I'll compare that with what the GP nurse says, if i ever get seen.

I am not sure if you are wanting to gain, lose or maintain weight but thought I would add a quick explanation on weight and insulin.
If those of us with Type 1 do not take our insulin we can become very ill. The is due (maybe partially) to our body breaking down our muscles which produces ketones and the reason why one of teh symptoms of undiagnosed diabetes is weight loss. Unfortunately, some people with Type 1 diabetes use this to lose weight - it is a known eating disorder called diabulimia.
Excess insulin can cause weight gain. Unless you have insulin resistance, you are unlikely to experience excess insulin to the level that will cause weight gain. Unfortunately, there is a myth that insulin causes weight gain and needs to be avoided. This is not the case for Type 1 diabetes.

 

[Inka]

I was sent to a dietician who must have been her sister.
After two short interviews and my weight not going down, I sat for half an hour and repeated 'what a pity that doesn't work' every time she paused for breath. She never actually heard me, but I declined further lectures.

They’re everywhere @Drummer Must be a big family!

 

[freesia]

I am not sure if you are wanting to gain, lose or maintain weight but thought I would add a quick explanation on weight and insulin.
If those of us with Type 1 do not take our insulin we can become very ill. The is due (maybe partially) to our body breaking down our muscles which produces ketones and the reason why one of teh symptoms of undiagnosed diabetes is weight loss. Unfortunately, some people with Type 1 diabetes use this to lose weight - it is a known eating disorder called diabulimia.
Excess insulin can cause weight gain. Unless you have insulin resistance, you are unlikely to experience excess insulin to the level that will cause weight gain. Unfortunately, there is a myth that insulin causes weight gain and needs to be avoided. This is not the case for Type 1 diabetes.

Thank you. I'm not massively overweight i think (though NHS BMI says i'm obese!). Before i was diagnosed type 1 i lost a lot of weight obviously. I'd never been that weight before, it was a novelty. While i don't want to go back to that weight as i know i looked too thin and ill, i would like to lose a few pounds. This was when i mentioned it to the DSN and got her answer about the insulin. Mainly, the weight went on during lockdowns so its just a case of being more active again and reducing my portion sizes slightly.

 

[everydayupsanddowns]

I think it varies from nurse to nurse (much like it does GP to GP I suppose). Some practice nurses will be well read, up to speed on all sorts of different types of diabetes, and the latest gadgets and gizmos... Others will be relying on some very outdated ideas and training which haven’t been updated or challenged, and may never have seen a T1 patient, or possibly even a proactive self-motivated person with T2 who actively manages their diabetes through self monitoring.

The nurse I see at my surgery also works as a DSN at my hospital clinic, but the ‘GP with a special interest’ in diabetes took on quite a startled expression when I asked about switching insulins (rather like @robin’s experience).

 

[JohnWhi]

A lot depends on whom you see, and there are some excellent people. Unfortunately, at my local GP surgery for the last ten years, I am yet to find anyone with the remotest interest in diabetes. When I joined them in 2011, they made it clear that I would not be allowed to attend a hospital clinic. "We do all that." They then made some curious decisions, like putting me (Type 1) on Metformin to "make the blood sugars more stable" (actually raising insulin requirements) and giving advice I considered to be potentially fatal. I sent a Fierce Letter to the local Health Authority of the time, copied to the MP, and was then allowed to the hospital Diabetic Clinic, who have been marvellous. After a few years, they moved me to a pump and are now (temporarily) funding CGM Hybrid Closed Loop. The consultant has seen me twice in person this year. Both times she looked exhausted, admitting she was stressed from dealing with Covid, but took the time to listen carefully and to offer very helpful advice. It is some years since I last saw a GP and just over two years since I saw anyone at all at the practice, though I have an Annual Review booked with a nurse for the end of September. Not looking forward to it, as I find everyone at the practice apart from doctors to be routinely offensive. Not just to me, family, friends and neighbours have come to a similar conclusion, and the local newspaper reported last week their failure to respond to an 80-year-old patient who had collapsed on their doorstep.

 

[Bloden]

In my experience, hospital DSNs are fab and my surgery’s (DS?)N is terrifying - at our first meeting I said “I’m T1 and I was dx in Spain 10 years ago, aged 41”, to which she responded “Are you sure you’re T1? Maybe we should try you on Metformin”. 😳 At this point I felt quite scared and threatened, as you can imagine. I’ve subsequently had a phone consultation with her that went better. I just hope the upward trajectory continues and that at the next appointment she’ll be bloomin’ marvellous. 😉

 

[SB2015]

The DSNs I have seen at the hospital are all well trained and will have taken extra qualifications to become DSNs. Their level of knowledge about the different pumps offered is generally good and they draw on the experience of those that are using them which helps each of us in turn.

I have limited contact with nurse at the GP surgery, but she acknowledges her limited knowledge around T1, but is always interested in what I am using to manage my T1. I have my annual checks at the surgery, as it gives them the ticks that they need for funding. My GP has VERY limited understanding of T1, but then he is a general practitioner and he just lets me ask for what I need, which is later backed up by the letter from my consultant.

 

[helli]

My DSN at the hospital is great. The consultants admit she knows more than they do about day to day living with Type 1 diabetes.
Every year, about a week after my annual review at the diabetes clinic at the hospital, my GP surgery invites me for their annual diabetes review. Depending on how I am feeling, I either decline the invite or call and ask what they will do that I didn't get at the hospital a week earlier. The receptionist's response is that they will get their diabetes nurse to call me. A week later, I get another text telling me to make the appointment. I phone again and get the same response. After the third text message, the receptionist tells me to ignore any more. I have never spoken to the diabetes nurse at my GP surgery - she has never called me back so I have never been for an annual review there.
Based on my experience with the GPs, I don't believe I am missing out on anything.

If they were to invite me 6 months later, I may attend to get new bloods done and for curiosity. But working full time, I don't have time to just go through a box ticking exercise for the surgery.

 

[rebrascora]

The practice nurse at my GP surgery who has just taken over the role of DN is lovely (as was the previous one) and seems to be interested and reasonably well informed, but she is aware that as I am a Type 1, her role is just to do the appropriate tests (foot tickle and inspection, weight, blood tests etc) and offer any support she can if there is any referrals that I would find helpful, like podiatry. We had a good discussion about Libre where she seemed to know a decent amount about how they work and the benefits of the TIR function etc, She also wasn't phased by my low carb high fat diet which I like to discuss as much as anything to see what reaction I get.... Bit of a litmus test. I think we both enjoyed the appointment because it was approached with a feeling of positivity and mutual understanding and I think I probably had at least 20 mins with her. It certainly didn't feel rushed at all. I know she has a DSN from the hospital comes one day a month to sit in with on her diabetes clinic days and she tries to ensure that she keeps those appointments for difficult or unusual cases to get the most benefit from the DSN.... I know this because she rang me and asked if I minded my appointment being moved to another day for this reason. She made it clear that she was available if I needed any help.

I wish everyone had such a great surgery as mine. I know I was sort of misdiagnosed to start with but there was always a question mark in their minds about it and the nurse was having regular telephone case conferences with the consultant and DSNs in my early weeks of diagnosis to seek advice. I appreciate that this probably all stems from having an accessible and approachable hospital diabetes team who support the GP practice nurses in my trust area. I know from my DAFNE course that the other consultant at the hospital is extremely proactive and passionate about diabetes care (the DSNs seem to worship the ground he walks on) and whilst my consultant is a little more conservative, I really feel that I am blessed with my diabetic care and that we work as a team to manage my condition well with me having a say in my treatment, providing I can show my reasoning. Thinking about it, I actually feel like I want to write a letter of thanks to both the GP practice and the hospital clinic.

 

[What the..?]

Rebrascora - do write those letters. I've always believed in showing appreciation as well as offering constructive criticism when appropriate. When I was waiting in reception at the clinic a couple of weeks ago I was able to see and hear how good a receptionist was at dealing with a succession of queries. She was efficient, and firm when necessary, but also kind too. I was very impressed, and mentioned it to the HCP I was waiting to see. She said she'd pass it on to her, but also higher up the chain. It sounds like you're in a good system which obviously helps enormously. I've just been for my six month HbA1c test and will be a little nervous until I get the results, not so much because I'm concerned for my health, as I feel really well, and have been very sensible with eating and exercise, but just that niggle that I may have to engage with the GP/nurse if anything is flagged up. Wish me luck!