GP Update

[Duane Charles]

Morning,

Just thought that I’d update you on what the GP has said this morning:

• Hasn’t ruled out a scan but there’s a possibility of it not showing anything.
• Hasn’t ruled out possibly having T3c.
• I’m not losing weight.
• Wants me to see another DN within the practice.
• Doesn't understand why I’m not on 4 x 500mg Metformin. I explained that my work made it a bit difficult to have an evening meal and that I was eating around 1am and then breakfast at 9am.
• If I am prescribed Insulin it will be managed in-house rather than hospital led team.
• Seemed to ignore my mentioning pancreatic enzymes being tested.
• I mentioned that my “average” BG is 13, but has varied from 8.6 and 18.8.

Anyway I now have another DN appointment just before Christmas and although not asked I’ll continue to monitor my BG on waking / before meals and 2 hours after eating.

 

[rebrascora]

Not totally satisfactory but at least they are keeping an open mind about Type 3c. Will be interesting to see what the other DN says. It generally depends how much in house training they have received from a DSN and what level of knowledge and experience that DSN has with Type 3c. I was lucky in that my DN was able to seek advice from the consultant on anything "out of the ordinary", so she was having fortnightly case conferences about me possibly being Type 1 with the consultant. I think that may be quite unusual and I imagine is probably fostered by a good consultant, with an "open door" policy, so that primary care staff have the support they need to do a good job and spot unusual cases, that may need more support beyond their experience.

 

[Proud to be erratic]

I'm in agreement with @rebrascora:

Not totally satisfactory

It isn't totally satisfactory. Your GP seems to be saying that he/she knows best, yet the evidence is that he/she has not yet found a treatment path that has, so far, given a better management of your BG for your circumstances; and now wants to prolong the current unsatisfactory high levels.

but at least they are keeping an open mind about Type 3c. Will be interesting to see what the other DN says. It generally depends how much in house training they have received from a DSN and what level of knowledge and experience that DSN has with Type 3c.

I'm assuming the DN you refer to is a Surgery based Diabetes Nurse (rather than District Nurse) and such a DN may well have a lot of experience in managing the more routine T2s - but how many patients does that DN assist who need insulin? And, as Barbara implies, does that DN have a close connection with the Hospital based Diabetes Specialist Nurse (DSN)?

Morning,

Just thought that I’d update you on what the quack has said this morning:

• Hasn’t ruled out a scan but there’s a possibility of it not showing anything.
• Hasn’t ruled out possibly having T3c.
• I’m not losing weight.
• Wants me to see another DN within the practice.
• Doesn't understand why I’m not on 4 x 500mg Metformin. I explained that my work made it a bit difficult to have an evening meal and that I was eating around 1am and then breakfast at 9am.
• If I am prescribed Insulin it will be managed in-house rather than hospital led team.
• Seemed to ignore my mentioning pancreatic enzymes being tested.
• I mentioned that my “average” BG is 13, but has varied from 8.6 and 18.8.

Anyway I now have another DN appointment just before Christmas and although not asked I’ll continue to monitor my BG on waking / before meals and 2 hours after eating.

I would suggest if in 7 days time you are still averaging above 10 email back to your GP politely insisting that he/she prescribes insulin straightaway and use the forthcoming "just before Xmas" appointment with the Surgery DN to get close support as you make the transition onto insulin. Otherwise you'll be looking at the lengthy Xmas break before the change and the consequent further time spent unreasonably on the hyperglycaemic excursion! I'm sure we can prime you with some of the appropriate questions to ask the DSN ; but it would be helpful to know what generic type of insulin your initial prescription will be - ie basal (background) only, or a mixed insulin (of combined basal and bolus), or a Multi Daily Insulin (MDI) regime of seperate basal and bolus.

Yes, I think it would be most sensible and beneficial for you to continue testing and recording. Did you get even a hint of support from your GP about your current testing? The answer to that could speak at high volume about how in touch your GP is with how best you might be better able to manage your diabetes.

 

[Duane Charles]

I would suggest if in 7 days time you are still averaging above 10 email back to your GP politely insisting that he/she prescribes insulin straightaway and use the forthcoming "just before Xmas" appointment with the Surgery DN to get close support as you make the transition onto insulin. Otherwise you'll be looking at the lengthy Xmas break before the change and the consequent further time spent unreasonably on the hyperglycaemic excursion! I'm sure we can prime you with some of the appropriate questions to ask the DSN ; but it would be helpful to know what generic type of insulin your initial prescription will be - ie basal (background) only, or a mixed insulin (of combined basal and bolus), or a Multi Daily Insulin (MDI) regime of seperate basal and bolus

I have another appointment on Tuesday, again by phone, hopefully the nurse I’m speaking to will have read the conversation I had with the GP. I will be letting them know about the testing I have been doing, why I’ve been doing it and the figures.

I'm assuming the DN you refer to is a Surgery based Diabetes Nurse (rather than District Nurse) and such a DN may well have a lot of experience in managing the more routine T2s - but how many patients does that DN assist who need insulin? And, as Barbara implies, does that DN have a close connection with the Hospital based Diabetes Specialist Nurse (DSN)?

I believe this DN to be surgery based and according to the GP well versed with Insulin based treatments for D. I wasn’t told if they had any experience of T3c. My hope is that when I tell her about my history, which was explained to the GP, she may well discuss Insulin with said quack.

 

[Duane Charles]

but it would be helpful to know what generic type of insulin your initial prescription will be - ie basal (background) only, or a mixed insulin (of combined basal and bolus), or a Multi Daily Insulin (MDI) regime of seperate basal and bolus.

The GP I spoke to gave no indication of what generic type of insulin I would possibly be on. It will be on my list of questions to ask on 21st and I’m sure there’ll be others to add to it before that date.

 

[Duane Charles]

Does anyone think that bearing in my mind medical history of 6 attacks of Acute Pancreatitis and subsequent removal of my gall bladder, that I should be treated as T3c until proven otherwise? This is my the belief I now hold.

 

[rebrascora]

I think that is a reasonable argument, but do be aware that not all Type 3cs need insulin at least initially. Some manage for years without it, as no doubt you have been, so the argument of probably being Type 3c and therefore being treated as Type 3c until proven otherwise and treatment with insulin don't always follow. It might be a case of picking your fights one at a time and if you feel that you now need insulin, then maybe focus on that for a while. Getting the treatment you need, is probably more important although the Type 3c with insulin should open up more support. That said, once you get onto insulin it might be harder to get the Type 2 diagnosis changed, as the clinicians will not see how it makes any difference, because they don't know any better.

Can I just mention, calling a doctor a "quack" feels very disrespectful and makes me somewhat uncomfortable reading it particularly on a public forum. GPs have a basic knowledge of diabetes because that is all they need. They are not supposed to be specialists. They are still knowledgeable, well educated people. I hope you won't take offence with me saying that. You need the GP and nurse on your side, so having an attitude which potentially undermines them, will not help you, so it could be counter productive.

 

[Duane Charles]

Can I just mention, calling a doctor a "quack" feels very disrespectful and makes me somewhat uncomfortable reading it particularly on a public forum. GPs have a basic knowledge of diabetes because that is all they need. They are not supposed to be specialists. They are still knowledgeable, well educated people. I hope you won't take offence with me saying that. You need the GP and nurse on your side, so having an attitude which potentially undermines them, will not help you, so it could be counter productive.

@rebrascora i apologise for the comment and making you feel uncomfortable. I know that regardless of the type of D I have I will need the support of both GP and DN along my journey into something extremely new to me. Because of this I’m asking the questions I am both to gain knowledge from your experiences and to help me to know what to ask at my upcoming appointments.

 

[Duane Charles]

I think that is a reasonable argument, but do be aware that not all Type 3cs need insulin at least initially. Some manage for years without it, as no doubt you have been

I have only been on Metformin for a short while and previously was only taking Alogliptin. It wasn’t until I joined this forum that I knew anything about T3c, so want to find out one way or other because of my previous health issues that have led me to this situation.

 

[helli]

Does anyone think that bearing in my mind medical history of 6 attacks of Acute Pancreatitis and subsequent removal of my gall bladder, that I should be treated as T3c until proven otherwise? This is my the belief I now hold.

What does that mean?
Given people with T3c are treated differently - some with insulin and some without - being "treated as T3c" does not determine your treatment.
Sure, your medical history should be taken into consideration but, to me, T3c is just a label. The important thing is getting the right support and treatment regardless of your label.

 

[Duane Charles]

What does that mean?
Given people with T3c are treated differently - some with insulin and some without - being "treated as T3c" does not determine your treatment.
Sure, your medical history should be taken into consideration but, to me, T3c is just a label. The important thing is getting the right support and treatment regardless of your label.

Perhaps I’m just trying to process all the information I’ve found out since joining the forum and online, thus maybe confusing me too? Sorry, I’m also probably overthinking my situation.

 

[Duane Charles]

It isn't totally satisfactory. Your GP seems to be saying that he/she knows best, yet the evidence is that he/she has not yet found a treatment path that has, so far, given a better management of your BG for your circumstances; and now wants to prolong the current unsatisfactory high levels

I must be honest that it does seem that the GP does want to keep me on Metformin and possibly increase the amount I’m taking to the maximum per day. I presume that Insulin is more expensive than Metformin and maybe another reason for not taking that route to treat my D.

 

[AndBreathe]

Morning,

Just thought that I’d update you on what the GP has said this morning:

• Hasn’t ruled out a scan but there’s a possibility of it not showing anything.
• Hasn’t ruled out possibly having T3c.
• I’m not losing weight.
• Wants me to see another DN within the practice.
• Doesn't understand why I’m not on 4 x 500mg Metformin. I explained that my work made it a bit difficult to have an evening meal and that I was eating around 1am and then breakfast at 9am.
• If I am prescribed Insulin it will be managed in-house rather than hospital led team.
• Seemed to ignore my mentioning pancreatic enzymes being tested.
• I mentioned that my “average” BG is 13, but has varied from 8.6 and 18.8.

Anyway I now have another DN appointment just before Christmas and although not asked I’ll continue to monitor my BG on waking / before meals and 2 hours after eating.

Frankly, if the only reason to do any sort of scan was just to prove the Doc right, a lot of folks wouldn't be strolling around, leading their best lives.

There is NO way I am suggesting anything sinister is going on with you, but whilst there is a chance the scan will show nothing, there is the balancing chance it will. Every 99% chance has a counter 1%.

In terms of your medication, it is unlikely you would go from Metformin to insulin. There are over 400 combinations of drugs (combinations of meds, not 400 meds), not including insulin, so one might like to think, in the absence of testing to show you are not producing enough insulin, that there would be options before insulin.

 

[harbottle]

I know someone who is on 3 different T2 drugs, which manages to keep it under fairly decent control, but if the hba1c gets any higher (Towards 70), the next step is insulin.

 

[Duane Charles]

I know someone who is on 3 different T2 drugs, which manages to keep it under fairly decent control, but if the hba1c gets any higher (Towards 70), the next step is insulin.

I don’t think my HBA1c is as high as it was when I was put on Metformin, well my BG readings would suggest it has come down.