How do I know if my diabetic nurse can prescribe and what training they have

[SWAN2019]

I have looked them up on the nurses register and it doesn’t seem to indicate that they are registered for anything specific. The surgery just show them as a practice nurse.
The reason I would like to know is that she told me to stop my Metformin last Monday as my Hb1AC had gone down from 98 when diagnosed last November to 37 at beginning of April. Was on 1g slow release twice daily and it seriously affected my blood glucose levels. Even four strawberries sent it soaring which was not a problem for the previous 3 months where I know my levels as have been paying myself for Libre 2 sensors which really helped me work out what effect different foods were having.

 

[Lucyr]

Ask them? Or ask GP practice? Doesn’t sound like they have prescribed anything though and makes sense to stop metformin when a1c dropped from 98 to 37.

Stopping metformin a week ago wouldn’t send your levels soaring as metformin doesn’t have that much impact on bgs. What are you counting as “soaring”?

 

[Sharron1]

Ah ha, check out my Hba1c numbers until last October 2023 I was taking four metformin, finally in November a fresh pair of eyes reduced it by one!! Each time at my diabetivc review I asked the thinking behind four tabs the response was '...if it ain't broke don't fix it'. Hey ho.

 

[SWAN2019]

Ask them? Or ask GP practice? Doesn’t sound like they have prescribed anything though and makes sense to stop metformin when a1c dropped from 98 to 37.

Stopping metformin a week ago wouldn’t send your levels soaring as metformin doesn’t have that much impact on bgs. What are you counting as “soaring”?

Within about an hour going up to 12-14, all with same foods been eating for the four months with very little impact while taking Metformin, even four strawberries sent it up around 3mmol and normally I had been having that with a plum or nectarine and it would barely go up

 

[SWAN2019]

Ah ha, check out my Hba1c numbers until last October 2023 I was taking four metformin, finally in November a fresh pair of eyes reduced it by one!! Each time at my diabetivc review I asked the thinking behind four tabs the response was '...if it ain't broke don't fix it'. Hey ho.

Think maybe mine should have been lowered gradually to see what the effect would be.

 

[Maz2]

They would not give medication at hba1c 37. I am on 42 and I have not been offered any.

They do need to keep an eye on things though. I don't want to be negative but I knew a lady at one of my classes who was on diabetes meds and her hba1c dropped to 35. She was taken off the meds and, at next review, it had shot up to 80 again and they had to put her back on meds.

 

[Leadinglights]

Within about an hour going up to 12-14, all with same foods been eating for the four months with very little impact while taking Metformin, even four strawberries sent it up around 3mmol and normally I had been having that with a plum or nectarine and it would barely go up

The usual time to test would be before eating and after 2 hours not 1, fruit is likely to be metabolised quite quickly so that may be why you see the higher level after 1 hour but it would have dropped down to a more normal level by 2 hours.
You could experiment a bit and introduce the metformin and see if it makes a difference.
It is very much going to depend on your ability to cope with the carbs whether you still need to help of the metformin, some people will others will manage fine without but will always need to be careful of their carbohydrate intake.
What other carbs are you having as it may be those rather than only the fruit.

 

[Lucyr]

Within about an hour going up to 12-14, all with same foods been eating for the four months with very little impact while taking Metformin, even four strawberries sent it up around 3mmol and normally I had been having that with a plum or nectarine and it would barely go up

3mmol increase is fine but you should be checking at 2 hours not 1

 

[SWAN2019]

They would not give medication at hba1c 37. I am on 42 and I have not been offered any.

They do need to keep an eye on things though. I don't want to be negative but I knew a lady at one of my classes who was on diabetes meds and her hba1c dropped to 35. She was taken off the meds and, at next review, it had shot up to 80 again and they had to put her back on meds.

I was put on it by the hospital when I ended up in A&E last November and my HbA1c was 98. The symptoms that I had which had come on suddenly, I had put down to some other medication I was recently put on, as all were listed in the list of side effects. This was until one night I was so thirsty that it dawned on me it might be diabetes especially as I had also lost a few kg in just a few weeks without trying. From some work I do I had a blood glucose meter at home but the test strips were out of date but I tried them anyway and got a reading of 30, hoped it was wrong! At around 6am, with nothing to eat, it was still 14 so I took myself off to A&E. Was given Metformin and Gliclazide to take just for a couple of weeks

A couple of weeks later I had an appointment with the diabetic nurse at my surgery who I have not been overly impressed with. I barely touched anything with much carbs for the first couple of months, not even one biscuit and tested more she was telling me too to try to get an idea of how food affected me. In the end I paid for the Libre 2 sensors so I could have a much better idea of how foods affected me as I the weight loss has been and still is too drastic, I was a bit overweight but not massively. Had been using the sensor for 4 months prior to the next Hb1AC test where it showed it has gone down a lot and it has given me a good idea how particular foods and sleep and stress affects me. After stopping the tablets the readings are much higher even with the same food as the past few weeks. I few I could be like the lady in your group

 

[SWAN2019]

The usual time to test would be before eating and after 2 hours not 1, fruit is likely to be metabolised quite quickly so that may be why you see the higher level after 1 hour but it would have dropped down to a more normal level by 2 hours.
You could experiment a bit and introduce the metformin and see if it makes a difference.
It is very much going to depend on your ability to cope with the carbs whether you still need to help of the metformin, some people will others will manage fine without but will always need to be careful of their carbohydrate intake.
What other carbs are you having as it may be those rather than only the fruit.

I pay for the Libre 2 sensor so I can compare at all different times from the past 4 months to the past week, all carbs that have been eaten in the past 4 months are having the same effect and staying higher for longer, quite often past the 2 hour point.

 

[SWAN2019]

3mmol increase is fine but you should be checking at 2 hours not 1

That was just 4 strawberries, other carbs are pushing it up even higher. This is using a Libre 2 sensor so I am comparing it to the same foods while on the medication and without at various times and the effect is it is going higher and staying higher for longer.

 

[Leadinglights]

I was put on it by the hospital when I ended up in A&E last November and my HbA1c was 98. The symptoms that I had which had come on suddenly, I had put down to some other medication I was recently put on, as all were listed in the list of side effects. This was until one night I was so thirsty that it dawned on me it might be diabetes especially as I had also lost a few kg in just a few weeks without trying. From some work I do I had a blood glucose meter at home but the test strips were out of date but I tried them anyway and got a reading of 30, hoped it was wrong! At around 6am, with nothing to eat, it was still 14 so I took myself off to A&E. Was given Metformin and Gliclazide to take just for a couple of weeks

A couple of weeks later I had an appointment with the diabetic nurse at my surgery who I have not been overly impressed with. I barely touched anything with much carbs for the first couple of months, not even one biscuit and tested more she was telling me too to try to get an idea of how food affected me. In the end I paid for the Libre 2 sensors so I could have a much better idea of how foods affected me as I the weight loss has been and still is too drastic, I was a bit overweight but not massively. Had been using the sensor for 4 months prior to the next Hb1AC test where it showed it has gone down a lot and it has given me a good idea how particular foods and sleep and stress affects me. After stopping the tablets the readings are much higher even with the same food as the past few weeks. I few I could be like the lady in your group

Your weight loss and high blood glucose sends up a red flag that you may be Type 1 or LADA and the gliclazide helped to give your pancreas a bit of respite and the metformin allowed your body to use the insulin better but now it is struggling which is why your blood glucose is not behaving.
I would keep a good record of your meals and food together with blood glucose readings so you have some evidence for your GP. But I would certainly make an appointment.

 

[SWAN2019]

Your weight loss and high blood glucose sends up a red flag that you may be Type 1 or LADA and the gliclazide helped to give your pancreas a bit of respite and the metformin allowed your body to use the insulin better but now it is struggling which is why your blood glucose is not behaving.
I would keep a good record of your meals and food together with blood glucose readings so you have some evidence for your GP. But I would certainly make an appointment.

My initial concern because of the sudden symptoms was type 1, hence going to A&E, I hadn't heard of LADA till after that which is perhaps more possible. It certainly has never behaved how I would expect for type 2. A7E were really good but there is stuff on my notes from there of things for the GP to refer me for and it isn't happening despite chasing and the education programme that the diabetic nurse enrolled me on were just a couple of emails! I am seriously considering getting a second opinion privately.

 

[rebrascora]

I agree, sudden onset symptoms, very high HbA1c at diagnosis and weight loss all suggest Type 1 or LADA rather than Type 2. Your change of diet almost certainly helped to improve things rather than the medication but clearly things have changed and perhaps more beta cells have been killed off resulting in levels suddenly rising again. I think it would be wise to get yourself some Ketostix (about £5 for a pot of 50 strips) so that you can test for ketones if your levels get up to mid teens before you are able to get a review with the GP or nurse. High BG levels and ketones are very dangerous and can lead to Diabetic KetoAcidosis (DKA) which is when your breath can start to smell like pear drops and you can end up in a coma with organ failure if ketones develop and you don't get prompt medical attention.

 

[SWAN2019]

I agree, sudden onset symptoms, very high HbA1c at diagnosis and weight loss all suggest Type 1 or LADA rather than Type 2. Your change of diet almost certainly helped to improve things rather than the medication but clearly things have changed and perhaps more beta cells have been killed off resulting in levels suddenly rising again. I think it would be wise to get yourself some Ketostix (about £5 for a pot of 50 strips) so that you can test for ketones if your levels get up to mid teens before you are able to get a review with the GP or nurse. High BG levels and ketones are very dangerous and can lead to Diabetic KetoAcidosis (DKA) which is when your breath can start to smell like pear drops and you can end up in a coma with organ failure if ketones develop and you don't get prompt medical attention.

Thanks for your reply. I already brought some Ketostix last week when it went very high as was aware of the concern for this when I was in A&E. It is frustrating that all you seem to get from the diabetic nurses is don't test but testing is what helps you to understand what goes on with your body.

 

[rebrascora]

I agree, it is really frustrating but most nurses and doctors at GP practice have no real understanding of the benefit of testing or of Type 1 diabetes and some nurses and doctors are still misinformed enough to believe Type 1 only develops in children and young adults, whereas many of us here on the forum developed it much later in life.
Pleased to hear that you already have Ketostix. If you start developing ketones along with high BG or you start to feel unwell with nausea, vomiting, abdominal pain or respiratory problems, get yourself back to A&E pronto.

 

[SWAN2019]

I agree, it is really frustrating but most nurses and doctors at GP practice have no real understanding of the benefit of testing or of Type 1 diabetes and some nurses and doctors are still misinformed enough to believe Type 1 only develops in children and young adults, whereas many of us here on the forum developed it much later in life.
Pleased to hear that you already have Ketostix. If you start developing ketones along with high BG or you start to feel unwell with nausea, vomiting, abdominal pain or respiratory problems, get yourself back to A&E pronto.

Thanks for the advice. I think the training in surgeries is just the bear minimum for them to call themselves a diabetic nurse so the practice can claim their payments for the service. There is definitely not a great deal of useful information passed on. I had a better conversation with the the man who did my diabetic eye screening, probably because he is actually diabetic.

 

[Lucyr]

Your weight loss and high blood glucose sends up a red flag that you may be Type 1 or LADA and the gliclazide helped to give your pancreas a bit of respite and the metformin allowed your body to use the insulin better but now it is struggling which is why your blood glucose is not behaving.
I would keep a good record of your meals and food together with blood glucose readings so you have some evidence for your GP. But I would certainly make an appointment.

An misdiagnosed t1 wouldn’t have an a1c of 37 on metformin, metformin wouldn’t work for a t1

 

[Lucyr]

That was just 4 strawberries, other carbs are pushing it up even higher. This is using a Libre 2 sensor so I am comparing it to the same foods while on the medication and without at various times and the effect is it is going higher and staying higher for longer.

Watch out for any symptoms changing but to be honest sounds like you’re probably either reading too much into it or just coming down with a cold or similar if all your readings are a bit higher. The reason T2s not on insulin aren’t prescribed libre or test strips is that it can make them panic if they don’t understand the readings, it is normal to spike after food so could you be just seeing normal spikes?. If you want to go back on metformin you could always decide to just start taking it again and let your GP surgery know. I don’t think metformin would be making the difference though, it really doesn’t do as much as you think. If you were misdiagnosed and really were t1 it would be unheard of for metformin to drop your a1c from 98 to 37. Watch out for signs just in case but getting a 37 without insulin suggests your pancreas is capable of producing plenty insulin.

 

[Leadinglights]

Watch out for any symptoms changing but to be honest sounds like you’re probably either reading too much into it or just coming down with a cold or similar if all your readings are a bit higher. The reason T2s not on insulin aren’t prescribed libre or test strips is that it can make them panic if they don’t understand the readings, it is normal to spike after food so could you be just seeing normal spikes?. If you want to go back on metformin you could always decide to just start taking it again and let your GP surgery know. I don’t think metformin would be making the difference though, it really doesn’t do as much as you think. If you were misdiagnosed and really were t1 it would be unheard of for metformin to drop your a1c from 98 to 37. Watch out for signs just in case but getting a 37 without insulin suggests your pancreas is capable of producing plenty insulin.

But the OP was also on gliclazide originally, though they don't say for how long.