Good appt with DSN

[lauraw1983]

Well after the disastrous appointment with that Dr at clinic on Friday, saw my DSN this morning and she apologised about it....this guy is apparently a GP(!) there for 6 months, but he has been there for 6 months in the past before too. I am actually amazed at his lack of knowledge, especially if he is there on a secondment or whatever. Worrying.

His idea had been raise Lantus to 18u (from 15u). Yesterday I spent the day feeling hideous, I did have a hypo on sunday when out shopping, but I've never felt that bad the WHOLE day after one?? Anyway I wondered if it had dropped in the night or something, and therefore put my lantus back to 12u last night. Told my DSN today and she said that was fine.

What I have to do is have Lantus, have a normal breakfast and dinner but a carb free lunch - or no lunch if I can, but I don't think I could do that this week as I am busy and she said carb free is fine. And then see where my readings are at over that period to try and work out my basal correctly. She said we need to keep an eye out for hypos (I have had a couple more) because it could mean my pancreas is kicking in again and actually it might need reduced further. She said she sees quite a few people who when diagnosed are on quite high basal but over time it reduces right down and she has some patients on none and only mealtime doses - much like our Northener here!

I have also to do a 3am reading - she didn't say I had to but she said if I am willing(!) to then it would be useful. She was a bit shocked the Dr didn't know anything about it too.... 😱

She can put me on the DAFNE waiting list when I have been diagnosed 6 months, so in April and from then there is about a years waiting time unless cancellations come up. In the meantime, in March/April she will book me back in with the dietician for a carb counting course (runs for a whole afternoon) to help to try and tailor my mealtime doses.

She said many people are more insulin resistant in the mornings (Type 1 and 2's) and therefore getting those ratios and doses right too will help me get my numbers down.

She has reassured me that running a little bit high (in the 8/9/10's) isn't going to do long term damage to me which is what I have been worrying about a lot. She said damage is done at high levels over many years and at the moment things are still very new and it is always a bit of a guessing game anyway but that I am doing really well.

She said HBA1C targets are soon to be under 7.5mmol/l too, not 7.0 - has anyone else heard this? The Dr I saw the other day too also remarked that if ladies are trying to get pregnant they need to have their HBA1C under 6.5mmol/l - is that right? He also said it was something that was very hard to do without having lots of hypos?!

Sorry to ramble but wanted to get it all written down for anyone interested after my other appt!!

x

 

[Northerner]

Glad to hear you had a good appt. Laura - they really shouldn't let under-qualified medics loose on people, especially when the case is complex like yours (or most people on MDI!)

I understand about doing the basal testing during the day, it's a good idea, although some people find that a carb-free meal is not as decisive a test as missing a meal altogether, because sometimes even protein and fat influence levels. I'm definitely more insulin resistant in the mornings - need over twice the amount of insulin that I need at midday!

An encouraging appointment, and illustrates what a total waste of time your previous one with the 'Doctor' was! 🙄

 

[Phil65]

Well after the disastrous appointment with that Dr at clinic on Friday, saw my DSN this morning and she apologised about it....this guy is apparently a GP(!) there for 6 months, but he has been there for 6 months in the past before too. I am actually amazed at his lack of knowledge, especially if he is there on a secondment or whatever. Worrying.

His idea had been raise Lantus to 18u (from 15u). Yesterday I spent the day feeling hideous, I did have a hypo on sunday when out shopping, but I've never felt that bad the WHOLE day after one?? Anyway I wondered if it had dropped in the night or something, and therefore put my lantus back to 12u last night. Told my DSN today and she said that was fine.

What I have to do is have Lantus, have a normal breakfast and dinner but a carb free lunch - or no lunch if I can, but I don't think I could do that this week as I am busy and she said carb free is fine. And then see where my readings are at over that period to try and work out my basal correctly. She said we need to keep an eye out for hypos (I have had a couple more) because it could mean my pancreas is kicking in again and actually it might need reduced further. She said she sees quite a few people who when diagnosed are on quite high basal but over time it reduces right down and she has some patients on none and only mealtime doses - much like our Northener here!

I have also to do a 3am reading - she didn't say I had to but she said if I am willing(!) to then it would be useful. She was a bit shocked the Dr didn't know anything about it too.... 😱

She can put me on the DAFNE waiting list when I have been diagnosed 6 months, so in April and from then there is about a years waiting time unless cancellations come up. In the meantime, in March/April she will book me back in with the dietician for a carb counting course (runs for a whole afternoon) to help to try and tailor my mealtime doses.

She said many people are more insulin resistant in the mornings (Type 1 and 2's) and therefore getting those ratios and doses right too will help me get my numbers down.

She has reassured me that running a little bit high (in the 8/9/10's) isn't going to do long term damage to me which is what I have been worrying about a lot. She said damage is done at high levels over many years and at the moment things are still very new and it is always a bit of a guessing game anyway but that I am doing really well.

She said HBA1C targets are soon to be under 7.5mmol/l too, not 7.0 - has anyone else heard this? The Dr I saw the other day too also remarked that if ladies are trying to get pregnant they need to have their HBA1C under 6.5mmol/l - is that right? He also said it was something that was very hard to do without having lots of hypos?!

Sorry to ramble but wanted to get it all written down for anyone interested after my other appt!!

x

your DSN sounds great! And educated in diabetes......she has given you all round good advice!

 

[shiv]

Laura,

Sounds like a fab appointment! Your DSN clearly knows her stuff and it sounds like she actually *gets it* a little bit.

I've heard for pregnancy you should be aiming for 6.5 - any good hospital will support you in helping to keep your levels as tight as possible (they should be as tight as possible). I've never got below 7 and whilst I don't want children at the moment, I know I'll want one at some point, and I don't anticipate getting into the 6s will be anything other than difficult, so I know I'll need to take a lot of time doing it. Sorry - point being, even though I'm not thinking about children right now, I know I will need to start thinking about it in the next few years!

 

[lauraw1983]

Glad to hear you had a good appt. Laura - they really shouldn't let under-qualified medics loose on people, especially when the case is complex like yours (or most people on MDI!)

I understand about doing the basal testing during the day, it's a good idea, although some people find that a carb-free meal is not as decisive a test as missing a meal altogether, because sometimes even protein and fat influence levels. I'm definitely more insulin resistant in the mornings - need over twice the amount of insulin that I need at midday!

An encouraging appointment, and illustrates what a total waste of time your previous one with the 'Doctor' was! 🙄

Yeah I think she suggested carb free lunch at the moment, and see how results are, and if after that they can go more 'hardcore' with missing meals for basal requirements. I think they must see a lot of people who are quite resilient to change, or to be told to do what they might view as quite extreme - whereas I am the opposite, and although I may huff a bit about it all at times when it gets a bit much, I would rather have the proper tools in place to try to get these ratios better so I can keep tighter control.

Definitely a much better appt - she has said she can request I see the proper consultant (who I saw when in hospital) next time I go, she can write on notes that I would prefer to see him. 🙂

 

[shiv]

Just a heads up - if a carb free meal for you means one based on protein (ie a fry up!), then protein will likely raise BG levels. It's got a lovely scientific name I can never remember, but the body turns some of the protein into glucose for energy. So whilst it is horrible missing meals, the truest results you will get are from missing a meal or eating something pretty much empty - I like sugar free jelly to keep me going when basal testing! 🙂

 

[lauraw1983]

Laura,

Sounds like a fab appointment! Your DSN clearly knows her stuff and it sounds like she actually *gets it* a little bit.

I've heard for pregnancy you should be aiming for 6.5 - any good hospital will support you in helping to keep your levels as tight as possible (they should be as tight as possible). I've never got below 7 and whilst I don't want children at the moment, I know I'll want one at some point, and I don't anticipate getting into the 6s will be anything other than difficult, so I know I'll need to take a lot of time doing it. Sorry - point being, even though I'm not thinking about children right now, I know I will need to start thinking about it in the next few years!

I wonder about unplanned pregnancies 🙄😱 I don't want any more children at the moment anyway but the Dr was quite adamant about telling me all about it. It's very rubbish that diabetic mums have so much to think about before even considering TTC - humph! 😡

 

[trophywench]

It's been 'under 7.5' for ages. At the time I couldn't even get to 7.5 ..... but I got there. Eventually.

Don't worry unduly about unplanned pregs Laura - people with hideously high A1c's can and do often still have healthy babies - but it's just that most sane diabetics would rather give their future offspring the very best chances before they even start. And there is less chance of complications setting in, with lower A1cs.

And yes, it may take a few hypos to get there - but then, so will the next 9 months whatever you do, anyway - so being realistic what's another 6 ?

Some people get A1cs in the 6's anyway - without being terminally hypo. That's not to suggest it's easy, but just to say well it is achievable and a lot of people do achieve it - which is not I think the impression he wanted to give you. Sounds to me like he was trying to make it sound really difficult, like you had a mountain to climb.

You don't. You only have a hill !