Improvement

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Lucyr said:
They have nothing to do with my diabetes and they’d know nothing about it
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They did at diagnosis though didn't they?
 
I guess in theory the GP does my foot check, but I don’t count that because whilst they tick the box to say they’ve done it, they never ask if I have any feet or ask me to take off my shoes
 
Lucyr said:
I guess in theory the GP does my foot check, but I don’t count that because whilst they tick the box to say they’ve done it, they never ask if I have any feet or ask me to take off my shoes
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That is rather naughty! So you don't get a toe tickle done, just a tick in the box to say it has been done, when it hasn't! 😱
 
rebrascora said:
That is rather naughty! So you don't get a toe tickle done, just a tick in the box to say it has been done, when it hasn't! 😱
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They don’t ask if I own legs or feet let alone toes!!
 
rebrascora said:
That is rather naughty! So you don't get a toe tickle done, just a tick in the box to say it has been done, when it hasn't! 😱
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That's pretty much what they do for me. My feet test is answering the question "are your feet ok?". They see me in person so know I have feet although I may not have toes inside my shoes.
My injection site test is the same. I get asked "are your injection sites ok?"
 
Docb said:
A bit left field I know but I would get rid of all the labels - T1, T2, 3c, MODY, LADA and whatever. The reason is very simple. To try and stop the medics shoving people into a box and then treating in the manner ascribed for the box whether it is a comfortable fit or not.

For example, I am a moderately fit, average weight, 77 year old who's system for some reason or other cannot cope with lots of carbohydrate. Is it sensible to put me in the T2 box along with an overweight, pizza eating, 40 something couch potato (I know it's a stereotype but you will get my point) and use the same treatment pathway if all the medic sees is that we both have a T2 diabetes label on a computer screen.
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I'd have to disagree with this though, as a T1 it really doesn't matter to me how much carbohydrate I eat as long as I plan for and bolus correctly, so I certainly think leaving those who don't produce any insulin separate from those who do, would be beneficial, but perhaps splitting T2 into different categories might deal with the issues you face as it seems that there are quite a few "types" of T2 diabetes.
 
helli said:
My injection site test is the same. I get asked "are your injection sites ok?"
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And sadly, even this is more thorough than my injection site check. I don’t think I’ve ever told anyone at my GP practice how much insulin I take, where I inject it, whether I rotate sites, or ever been asked any of those questions. They don’t do blood pressure either, you drop in a reading if you want them to have one.

My GP practice did do one useful thing for my diabetes recently though. They signed the medical exemption form so I can get the prescriptions free.
 
@Lucyr these questions are not from anyone at my gp surgery. They are the at the diabetes clinic.
Like you, no 0ne at the GP surgery has a clue about how much insulin I take. They didn't know I use a pump even though I only renew my Lantus once every 18 months.
 
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helli said:
@Lucyr these questions are not from anyone at my gp surgery. They are the at the diabetes clinic.
Like you, no 0ne at the GP surgery has a clue about how much insulin I take. They didn't know I use a pump even though I only renew my Lantus once every 18 months.
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Oh. This thread is specifically about the GP surgery and what they could improve.
 
I think there is work to be done on how newly diagnosed adults are treated. I felt that I'd done something wrong and was being punished by some of the HCPs who I saw initially.
 
Adup said:
I think there is work to be done on how newly diagnosed adults are treated. I felt that I'd done something wrong and was being punished by some of the HCPs who I saw initially.
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Do you mean the manner of the professional or the actual treatment such as diet, meds?
 
rebrascora said:
I think at GP level, the main concerns are probably ....

1.That GPs and practice nurses need to keep an open mind at diagnosis about whether it could be Type 1 or Type 2 or Type 3c or some other Type that you are presented with. There are a lot of people who are misdiagnosed as Type 2 because many GPs believe that Type 1 only exhibits in children and young people, so that if you are a mature adult, it must be Type 2. Similarly, being overweight does not preclude you from being Type 1.

2. Type 2s can gain a lot of benefit from home BG testing and telling them not to test, even when they are self funding is not helpful at all. We get lots of newly diagnosed coming to the forum after being told not to test, or actively discouraged from testing, when with the right testing strategy it can be helpful and motivating and in fact key to making the necessary dietary and lifestyle changes. I appreciate that GP practices are under financial pressure and may not be able to fund testing for all, but please do not discourage testing by those who are keen to engage with their diabetes management.

3. Encourage rather than blame or criticize. With the right information and support most people can improve their diabetes management and many can push it into remission. Type 2 doesn't have to be progressive but good dietary advice is important and the "Eatwell" plate simply doesn't hack it for most Type 2s, so don't suggest swapping to brown/wholemeal options as that really has minimal impact. Less carbs is the answer not a change of colour. The increased fibre in brown/wholemeal products has very little beneficial effect compared to reducing the total amount of carbs you eat and it is all carbs not just sugar. Unfortunately some of the outsourced courses for Type 2 are still based on the "Eatwell Plate" and this is not helping people.
Having to think about every single thing you eat for the rest of your life is not easy. Many people here feel really demoralized when they return from a diabetes review, even if their levels have reduced, their HCPs rarely give them the praise, acknowledgement of effort and encouragement they need to keep going.

4. Don't reach for the prescription pad straight away every time. Metformin caused a lot of people digestive upheaval and many don't even need to be prescribed it. Offer people the option to have a 3 month period of lifestyle changes and advise them to come to this forum for support with that. Obviously, if levels are excessively high then yes medication may be appropriate, but an HbA1c in the 50s -90s can often be dropped back down to the normal or pre diabetes range through dietary means with the right advice. Low carb eating is more powerful than most oral meds, so give people the option to try that first. If they want medication fair enough, but give people a choice and stress that lifestyle changes are necessary even with medication.

5. Stop pushing the low fat mantra that we have been bombarded with all our lives. Fat helps people to feel full. Carbs make them feel hungry. If you cut the carbs and eat more fat, many of us have found that we are less hungry and eat less overall and lose weight. Food tastes good with fat so we don't feel deprived and it therefore is more sustainable.
I felt really guilty going against the low fat advice of my nurse for many moths after diagnosis, but I am fitter and healthier for eating more fat and cutting right down on my carbs (not keto....I am about 60-90g carbs a day) Going low carb, higher fat has improved or stopped number of other quite serious health conditions that I had suffered for years including acute and chronic migraines, poor skin/eczema and asthma is improved, joint pain is improved and I sleep better. Interestingly, despite eating a lot more fat in general and particularly saturated fat, my cholesterol is down. I have refused statins as I am only just above the TC level of 4 that triggers that prescription pad.

6. For those of us who are insulin dependent please look at your repeat prescription system. Being told that we can't have medication that keeps us alive because we need a review causes an immense amount of stress, especially when trying to get an appointment to see someone to get that review is a huge challenge in itself at many surgeries.

I am actually one of those misdiagnosed Type 1s that I mentioned in 1. above but in some respects starting out with a Type 2 diagnosis and going on a low carb diet to try to push the Type 2 into remission, has helped me find better health in all respects, so that I now continue to eat low carb and higher fat because it makes sense for my general health and wellbeing despite the fact I use insulin and could eat normally and whilst difficult at first, 4.5 years down the line it is easier and with increased fat, sustainable long term. I would not necessarily recommend it for all Type 1s but it is certainly helpful for many Type 2s.

Sorry for rabbiting on such a lot, but there are so many issues around diabetes diagnosis and treatment that are sadly all too common across the country and we so often see newly diagnosed patients who are lost and scared and overwhelmed coming to the forum with little or no information or the wrong information, that it is quite nice to have an opportunity to vent some of them. So pleased you have come and asked.... I assume you are a Health Care Professional yourself with a view to finding what you can do to improve things?
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Yes you are quite right i am a healthcare professional with a view to finding what I can do to change things.
 
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