DSN appointment on Tuesday - questions to ask?

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MarcLister

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Hey all. Got my first DSN appointment of the year at my local surgery. They've taken over my care from the local hospital who haven't been in touch with me for months.

Had my blood taken for an Hba1c last week and should get the results back on Tuesday. Also donated some urine for a microalbuminaurea or something test. Whatever that is.

I've seen this nurse before who's the practice DSN on the actual day I was diagnosed. She saw me in an emergency appointment and not a DSN appointment and gave me my blood testing kit before I was sent off to hospital.

I'm guessing she'll take my blood pressure which is likely to be high. It was high when I was diagnosed and I don't think it will be much better on Tuesday. One problem I have is a fear of the gubbins they use to take the blood pressure. I know it can't harm me but I tense up because I worry that it'll mean I've got 10 minutes to live or something. :D

I was thinking therefore of getting a blood pressure kit from my pharmacy so that I can keep an eye on my blood pressure at home but more crucially get used to having my blood pressure taken recently, say once a week by doing it myself, so that when I need a blood pressure test at the surgery I'm used to it, relaxed and less likely to increase my blood pressure because I'm worried. Anyone agree that this is a logical and intelligent conclusion I've come to?

Also any questions I should ask the DSN nurse? I can't really think of many apart from asking her about the blood pressure self-testing idea. 🙂
 
hey Marc cant really advise on that but i do wish u good luck with it let us all know how you get on x
 
Hi Marc, hope all goes well on Tuesday. That microalbu-thingummy is to check your kidneys are functioning OK. As for blood pressure, I have the same problem - it always goes high when I get it checked at the doctors! Sometimes the doctor will take it a couple of times just to check that the first time wasn't a 'rogue' reading - I think it's quite common to experience that. I've got one of those home-blood pressure kits - a wrist one - and it's OK. They're not as accurate as the doctor's ones, but they do give you some idea of how things are in the comfort of your own home. If you do get one it might be worth taking it along to one of your appointments and getting the nurse to check its reading against theirs on the spot, to see how well it works.

Might be worth asking the DSN about your insulin use, how you are coping with it - take a diary along if you've been keeping one, with your recent readings and insulin doses. Maybe also ask her to check your injection sites. Can't really think of anything else at the moment! Good luck!🙂
 
hello Marc - good luck for Tuesday. Like many I tend to get "white coat syndrome" as my blood pressure goes up when I see the doctor. I've got a blood pressure machine at home that I use regularly - it is one that is recommended by the British Hypertension Society and was on special offer via a web link. My practice team were all for it particularly as I need to keep it under control because of early eye changes - nicely low when I'm at home. Suggest you ask the nurse if there is any machine they recommend - nb if you get an arm one then make sure you get the right cuff size for the machine as otherwise you can get false readings

For your annual review, you should also have weight and feet checked as well as injection sites - as Type 2 I get grilled about my diet and exercise and reminded that losing a bit more weight would help my control
 
steff09 said:
hey Marc cant really advise on that but i do wish u good luck with it let us all know how you get on x
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Will do. 🙂 That's what this thread is for.

Northerner said:
Hi Marc, hope all goes well on Tuesday. That microalbu-thingummy is to check your kidneys are functioning OK. As for blood pressure, I have the same problem - it always goes high when I get it checked at the doctors! Sometimes the doctor will take it a couple of times just to check that the first time wasn't a 'rogue' reading - I think it's quite common to experience that. I've got one of those home-blood pressure kits - a wrist one - and it's OK. They're not as accurate as the doctor's ones, but they do give you some idea of how things are in the comfort of your own home. If you do get one it might be worth taking it along to one of your appointments and getting the nurse to check its reading against theirs on the spot, to see how well it works.

Might be worth asking the DSN about your insulin use, how you are coping with it - take a diary along if you've been keeping one, with your recent readings and insulin doses. Maybe also ask her to check your injection sites. Can't really think of anything else at the moment! Good luck!🙂
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Will do, ta. I've found this blood pressure monitor from Lloyds Pharmacy. Looks decent for the price but I guess there will be good models and not so good models so I'll ask her what models she can recommend. I did read somewhere that if you get a home blood pressure kit then the result should be lower than what you'd get at an appointment. The target is 130/80mmHg according to this link and I think I read somewhere that it should be 120/75 if you test at home. Can't remember where I read that or why it was like that but its something like that. I don't keep a record of what doses I take, just that I take 1 unit for every 15g of carbo roughly. I have got a very nice spreadsheet with my blood sugar results for each month but my printer's packed up so I can't print. I might put it onto a USB stick and print some sheets off at the library so I can show my DSN how I've been doing.

Vanessa said:
hello Marc - good luck for Tuesday. Like many I tend to get "white coat syndrome" as my blood pressure goes up when I see the doctor. I've got a blood pressure machine at home that I use regularly - it is one that is recommended by the British Hypertension Society and was on special offer via a web link. My practice team were all for it particularly as I need to keep it under control because of early eye changes - nicely low when I'm at home. Suggest you ask the nurse if there is any machine they recommend - nb if you get an arm one then make sure you get the right cuff size for the machine as otherwise you can get false readings
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Just found that "white coat syndrome" is on Wikipedia! Must be true then. I get the same. Something about blood pressure tests make me nervous. That's why I think that getting my own testing kit and checking my blood pressure once a week will help me become less nervous when I get my blood pressure done in the future. I've also measure my arm and I need a large cuff according to the cuff sizes on the Lloyds site.

Vanessa said:
For your annual review, you should also have weight and feet checked as well as injection sites - as Type 2 I get grilled about my diet and exercise and reminded that losing a bit more weight would help my control
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My injection sites are OK. I've recently found I can inject into my sides and not just my belly. Really helps me as I was getting worried about injecting into my belly all the time. I reckon I've now tripled my 'viable injection site' area. 😎 I'm also going to make a fuss about my feet, still not had a podiatrist's appointment yet and I want someone to check my feet to make sure I'm OK. I also need some new shoes/trainers as these are falling apart quite rapidly.

I know I'll get told off on my weight. Need to lose some. I think I'm going to have to start exercising to try and lose some weight. Unfortunately its a ruddy great walk to the leisure centre. :D I have got a bike in the shed but I've not used it in years and I'm in the centre of town and not used to riding on the roads with traffic. My hearing problems also make me feel like I'd rather not go biking but I might have to. I have heard that Leighton Buzzard is now some cycling town or something so I might find out from the council staff what that means and if we now have any cycling routes I can use.
 
Vanessa said:
I've got a blood pressure machine at home that I use regularly - it is one that is recommended by the British Hypertension Society and was on special offer via a web link.
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Forgot to ask if you could tell me what model it is or perhaps link to it?
 
I cant thnk of anything that you havent covered apart from I always use the oportunity to replenish my stock! Spare autopen and spare novopen are always on my list from the DSN and a spare meter, a travel letter and the cards for my various purses and handbags tat Im always losing (our clinic has novo produced ones) that say you are diabetic and who to contact in an emergency (they are free but seem to be at a price on the internet!), but I also like to see if they have new samples of anything I can try ("click" on needles last time!). But perhaps you take your DSN appointments more seriously than me, I treat mine like a shopping trip obviously!!
 
Sugarbum said:
I cant thnk of anything that you havent covered apart from I always use the oportunity to replenish my stock!
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I likes the sound of that! This particular DSN gave me my blood meter but I want a new, improved, upgraded 2009 model. :D What could I say I needed a spare one for? 😉

Sugarbum said:
Spare autopen and spare novopen are always on my list from the DSN and a spare meter, a travel letter and the cards for my various purses and handbags tat Im always losing (our clinic has novo produced ones) that say you are diabetic and who to contact in an emergency (they are free but seem to be at a price on the internet!), but I also like to see if they have new samples of anything I can try ("click" on needles last time!).
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Autopen? Don't have one of those, I don't think. Novopen for Novorapid and Levemir. A travel letter/cards would be good but I'm not expecting to be travelling any time soon. :(

What are click on needles? Any good? I take it I wouldn't need to change my insulin pens?

Sugarbum said:
But perhaps you take your DSN appointments more seriously than me, I treat mine like a shopping trip obviously!!
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I doubt it. This is my first proper one really since my 2 when I was initially diagnosed. And it can't be a shopping trip if you don't pay. 😉
 
Hi

My dad and my aunt both have blood pressure machines at home. I think its a good idea. Its like having a phobia of something and you are doing something about sorting it out. Great stuff if you ask me.

Good luck at the clinic by the way.
 
Adrienne said:
Hi

My dad and my aunt both have blood pressure machines at home. I think its a good idea. Its like having a phobia of something and you are doing something about sorting it out. Great stuff if you ask me.

Good luck at the clinic by the way.
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Cheers. 🙂 That's my thinking. Make myself use to doing something that frightens me so I'm calmer in the future. 🙂

Vanessa said:
MarcLister - it's a microlife blood pressure monitor automatic model no BP 3AG1 www.microlife.com but buy for ?34.25 via http://www.bpassoc.org.uk/Shop/w_shop_product_details?product_code=Microlife
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Lovely jubbly! 😎
 
Maybe ask if you can see the dietician as you say that you need to lose weight. Ask her how you will need to adjust your insulin when you start exercising.
I forget if you carb count or not?
ask for a ketone meter-optimum xceed (I think everyone with type 1 should have one)

I hope the appointment goes well and you are pleased with your A1c
 
On a blood pressure note, I had a 24 hour monitor to see what mine was like outside the hospital/doctors and it was brilliant. It was uncomfortable and a pain and I didn't sleep a lot, it inflated every hour all day and every two hours all night, but it did prove that my blood pressure is fine until I'm getting it checked by a proffessional. That might be an option worth asking about. I know even the home meter made me anxious cos I was so woried about getting a high reading!
 
sofaraway said:
Maybe ask if you can see the dietician as you say that you need to lose weight. Ask her how you will need to adjust your insulin when you start exercising.
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No thanks. 😛 The dietician at the hospital was blood awful. I don't think the surgery has one. Not going back to the hospital dietician if I can help it. I might just ask the DSN tomorrow about getting fit and what she thinks I should do. Swimming or cycling or both etc. Got an old bike in the shed which could do with new wheels and probably a repaint. Leighton Buzzard isn't up to much in terms of nice off-road cycling although I could cycle along the canal. Wouldn't want to cycle on the road because of my hearing.

Milton Keynes however is bigger and has cycle paths and quite a few lakes I could cycle around so I could cycle down to the train station, get to MK and cycle around there.

sofaraway said:
I forget if you carb count or not?
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Well I add up the carbs in what I'm about to eat and then divide by 15 and inject that amount of insulin. 🙂 But I don't write the carbs down along with the amount of insulin injected into a diary.

sofaraway said:
ask for a ketone meter-optimum xceed (I think everyone with type 1 should have one)
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Woot! Got one, was given one at the hospital on my 2nd DSN appointment. Never used it.

sofaraway said:
I hope the appointment goes well and you are pleased with your A1c
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Thanks. 🙂

coldclarity said:
On a blood pressure note, I had a 24 hour monitor to see what mine was like outside the hospital/doctors and it was brilliant. It was uncomfortable and a pain and I didn't sleep a lot, it inflated every hour all day and every two hours all night, but it did prove that my blood pressure is fine until I'm getting it checked by a proffessional. That might be an option worth asking about. I know even the home meter made me anxious cos I was so woried about getting a high reading!
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I think that's taking it a bit far for me. Wouldn't like to wear something that would just inflate itself on me without any warning! :D
 
hey Marc you may not of been yet but anways how did it go ? x
 
steff09 said:
hey Marc you may not of been yet but anways how did it go ? x
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Just got back. It went OK. Ran out of time so no checking of blood pressure! Phew.

HbA1c was 6.5% which is chuffing good. 😎 Blood cholesterol/kidney function all A-OK baby so doubly chuffing good.

I told the DSN that I've not heard anything from the hospital since December and that they've not arranged a podiatrist's appointment for me or even a retinal neuropathy thing. Apparently someone wants a picture of my eyes. 😉

The DSN said she has 500-600 diabetic patients on her list but only a handful of Type 1s so she's coming from a caring for Type 2 patients position and so is going to try and get some stuff sorted out for me. I might even get referred to Stoke Mandeville instead as she says they are good. She told me that she got the impression from other patients, Type 1s I guess, that the MK diabetic team are useless. To give an example the DSN showed me a scanned copy of a letter from my diabetes consultant at MK. It said I hadn't turned up for an appointment. Utter rubbish as I never got the letter. Then the letter says he sending me another routine appointment. Yeah? Where's that letter then? I'm 99% certain I never got the letter for the first appointment but 101% certain I've not got either of them.
 
Marc - just wondered if a mirror fitted to either a bike helmet or handlebars would allow you to consider cycling on roads? Even off road, it might help you to notice fast cyclists coming from behind you.
 
Copepod said:
Marc - just wondered if a mirror fitted to either a bike helmet or handlebars would allow you to consider cycling on roads? Even off road, it might help you to notice fast cyclists coming from behind you.
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Hmm could do. I might just start walking around town. The DSN said 30 mins 5x a week. So I've got to think about where I can walk to for 15 minutes and then back! 😛
 
steff09 said:
glad it wen ok re hba1c and all x
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Thank you. 🙂 The DSN was very happy with 6.5%. Just need to work it out in mmol now as its all changing in 2011. Anyone know the mathematical conversion? I've put the example %ages into Excel and compared the mmol equivalents and there's nothing common to them. :( What do I have to do to the %age to get the mmol? :confused:

Was very happy as well that everything else tested for was within range. 😎
 
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