just the nurse

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LisaLQ

LisaLQ

Well-Known Member
Relationship to Diabetes
Type 2
Just out of interest, as I'm gearing myself up for a trip to the docs (when I can get out of the house - wish the snow would stop lol)...

As a type 2 diabetic, recently diagnosed, with relatively minor blood glucose issues so diet controlled...am I only supposed to see my nurse once every 6 months?

I need to lose half my body weight (yes really), yet they've not referred me to a dietician, and I see people talking about their diabetes clinic appointments, GPs and hospital doctors. Although I've had my retinal testing, and HbA1c/cholesterol tested etc, I've been handed a diet sheet and told to come back in 6 months.

No testing (we've covered that in previous threads), a very basic diet sheet (not even one for diabetics - it's the British Hypertension Society one: http://www.bhsoc.org/pdfs/Healthy_Eating_Diet_Sheet.pdf ), just told I'm doing well without any help and told to come back later in the year. To be fair to her, I had lost a stone before my last appointment, and my HbA1c was lower than expected, so I know the diet is working - just I darent be more courageous with it so I'm eating pretty much the same thing every day.

I'm going to the GP for other reasons but also to see if I can talk him into letting me test, but is there anything else I should be asking about? Am I supposed to have a "diabetic team" like some of you do, or is that only for those who are much more severe cases?
 
Hi Lisa, it's my understanding that all people diagnosed with diabetes should be provided with some frm of structured education course, that should include dietary advice. DESMOND is the best known one, or X-PERT, but your PCT may have their own course. Ask your nurse or doctor what is available and don't be fobbed off with them saying you're doing ok. One of the really good things that many people get from such courses is the chance to meet and talk with other diabetics, which is like being on this forum but 100 times better!

A lot of diabetes management is self-education and self management, but with the support amd guidance of healthcare professionals in the various disciplines dietician, podiatrist etc.

I think Type 2s often get a raw deal, because there is this notion of 'severity' in some circles - we've all got diabetes and however we manage it we need to learn all we can as a good foundation for the rest of our lives.
 
Hi Lisa - like you I'm recently diagnosed and diet/exercise controlled. My doctor tells me that as I'm not on any medication, my gp practice is responsible for my care - no clinics for me.. I have asked for a referral to a dietician which has been sent off but I have no idea when I'll see one. I would say that along with the retinopathy screening and the flu (etc) jabs, that seeing a dietician is a MUST. If we are to be successful in managing this disease, we must be given a fighting chance. How else (apart from regular testing 🙄) are we to know if we are doing the right things? You can't ask questions of a diet sheet and I have no idea what training my practice nurse has..

Karina
 
Hi Lisa

Whilst I am not diabetic (my daughter is type 1) I too have to lose nearly half my body weight so I took myself off to the doctors this week. I saw the nurse and asked for help. I am being referred to a dietician who apparently will give me sheets of weekly planners, I need to be told what to eat ! Don't get me wrong I know exactly what to eat but my brain needs to be trained so I need to be told what to eat and then hopefully the brain will slowly catch up !!

So whilst you should see a dietician because of your diabetes, your weight also comes under a weight issue not just diabetes. So ask your GP's to refer you to a dietician to help you lose weight, not just because of your diabetes but because of all of your health !!! If they say no, you have to insist, it is your right to be referred to experts. 🙂
 
Hi Lisa, Like you, I'm recently diagnosed (nov 09), Type 2, very overweight but I seem to have been given much more support by my GP/nurse. I had an appointment with the nurse in Nov and also one this week, and my next appointment is due late February. The GP also wants to see me monthly at the moment. Like you I've just been given the 'healthy eating and lose weight' advice so far but I've also been referred to a dietician, just waiting for the appointment to come through and I'm now being referred for an Xpert course.

I don't know why there are such differences in care, we're both in West Yorkshire. Could you ask to be referred to a dietician?

It seems it's more usual for Type 2s to be treated within their own GP practice - am I right in thinking that? I'm still a bit new to all of this.

And, I think we are really lucky to have found this forum - I've learnt much more on here than I have from the medics anyway

Anita
 
I currently see my nurse every 3 months.Which is fair enough I guess but i dont have any contact details for her even it i wanted it to be more frequent


Annimay I am starting the X-PERT course next Friday I will let you know how I get on
 
Hi Lisa
As you live in England, you should check the NICE guidelines for your situation - there are guidelines for type 2 diabetes (already mentioned) and surgery for obesity http://www.nice.org.uk/guidance/index.jsp?action=article&o=32423 Interestingly, I couldn't find any guidelines for non surgical treatment of obesity, which surely is more appropraite for more people than surgery?!? - but asking for referral to specialist dietician and / or exercise programme would be wise.
Hope you get the appropriate help and support.
 
Last edited:
Copepod said:
Hi Lisa
As you live in England, you should check the NICE guidelines for your situation - there are guidelines for type 2 diabetes (already mentioned) and surgery for obesity http://www.nice.org.uk/guidance/index.jsp?action=article&o=32423 Interestingly, I couldn't find any guidelines for non surgical treatment of obesity, which surely is more appropraite for more people than surgery?!? - but asking for referral to specialist dietician and / or exercise programme would be wise.
Hope you get the appropriate help and support.
Click to expand...

My GP suggested a referral for weight loss surgery when I was diagnosed, but I don't want to go down that route.

My BMI is the same as my age - 54. Maybe if I reduce my age to 25 the BMI will go down with it?? No?, well best stick to the diet then

Anita
 
Everyone has a diabetes team, for some it's more people than others.

Typically for a type 2 it is a lot about the nurse, GP and patient, but specialists such as dietitians and podiatrists are available when needed.

Clinics tend to be in the main for type 1 diabetics or type 2's with complications or perhaps more difficult to control diabetes 🙄

Regarding nurse appointments, typically we have six or twelve monthly reviews, so your seeing your nurse every six months is ok. If your weight is dropping along with your HbA1C they will view that things are in order and not much more needs to be done at this stage. And in truth you're doing well, but eating like a starved rabbit everyday isn't such fun.

Nurses don't have the understanding of different food types in anywhere near the depth of dietitians, so seeing one is a good option. And they are one of the people available more on request than by a default appointment.

Providing once a year when you see your nurse or GP you're checked over i accordance with the Diabetes National Framework, then they are monitoring you accordingly. In the early days, I personally feel this monitoring should be more frequent, but the these people don't live with the condition, so what do they know about how their patients feel?

A scheme I got referred to not for weight loss, but for balance and neuropathy was a GP referral to a local gym with specially trained staff to deal with the introduction of people with medical conditions and excess weight issues to gently work into exercising and find what can and can't be done in a controlled and safe environment with a gym bod, who knows the medical side of life as well.

My instructor tended to see a lot of heart and overweight patients, admitting pain and balance wasn't the norm for her. But she was very good though.

Diet alone won't do everything, burning your intake or using it constructively will accelerate your weight loss journey and also make you fitter with it. Taking things gently is the critical element when taking up any new exercise or sport after sometime off.

A dietitian has probably heard every excuse for loosing or not loosing weight and will challenge you with ways to improve. They may also be in a position to recommend your GP to consider weight reduction surgery.

One other very good means of loosing weight is to find yourself a good, four pawed walking partner and to head to the hills, small/small-medium sized dogs aren't your best bet here, medium to larger if you can accommodate them is your best option. If you can't have or afford a dog yourself, ask around, you will probably find there is someone within half a mile who would love you to take their mutt out for a few good walks each week, if the owner doesn't, their dog most certainly will love you. 🙄
 
if you dont have a dog to walk you can contact the cinnamon trust who help older or disabled people with keeping their pets by providing volunteer dog walkers excellant scheme
http://www.cinnamon.org.uk/
 
Thank you so much everyone for all the advice and information - I'll be taking notes to my docs with me.

I should have mentionned, I am classed as "disabled" (not keen on that word), I have permanent pelvis damage from the triplet pregnancy and walk with elbow crutches. It does differ day to day, but the gist is I cant stand for long, cant lift anything heavy (lol - like my body!), I cant walk very far most days so I've effectively become a fat lazy hermit 🙄

I do actually have a dog, but I cant walk him at the moment because of his size (he's a great dane) and needing both hands for my sticks, plus I cant go far before I'm in pain, so I have to leave the dog walking to the hubby. And now the dog has dodgy joints and isn't allowed out either lol :D I'm hoping that the weight loss will take some of the pain away, but it's a vicious circle - I cant exercise because of the pain, I cant lose weight without exercising...having said that I know I'd lost over a stone last time I was weighed, and it's been a couple of weeks since, so hopefully on the way to feeling better.

I sound like a real hypochondriac now, full of excuses. I bitterly miss dog walking though - I live for my pets and really loved it. We had decided not to get another dog as/when Blu dies (he's on his last warning from the vet bless him - 7 and a half is old for a dane), but to be honest if I lose weight and the pain eases enough to walk one, I couldn't be without a dog. We did have two up until Sept 2008, Sky was my soul-mate dog (oh god how sad does that sound?) I'm still heartbroken about losing her.

Moan moan moan. Sorry! 😱

Thanks again for the info and advice - I'm going to try and get in at the docs next week and get a few things sorted out, I'll push for more diet info or a dietician appointment, and try again to get them to let me test. xx
 
Please note I wasn't suggesting that weight loss surgery was the only or even main thing to consider - in fact, as I said I was surprised that there only seemed to be NICE guidelines for that aspect of weight loss. There are wight loss medications, which can be prescribed by GPs (or bought over the counter) if you meet certain criteria.
Please do ask about exercise referral scheme, as there might be something to suit you eg swimming. Also, have you considered a bicycle or tricycle?Tricycles have great load carrying capacity for shopping, small dogs etc (not Great Danes!) Not sure if your pelvis makes sitting on a bike saddle possible? But please remember there are many types of saddles - getting a female rather than male is a good start, plus appropriate padding, which can be integral to the saddle or a padded cover added. Anyway, hope your GP will have some ideas to help you.
 
Thanks Copepod, I really appreciate all the advice I can get.

I did write more in my last message but felt I was whinging on too much so cut out a lot of it. I cant swim any more - because of my pelvis I had a lot of hydrotherapy, and what we found out is that when I start to swim, I kick once then my legs literally cut out (it's frightening when it happens - presumably due to trapped sciatic nerve - once I collapsed in the shower and cut my head), so my legs rise up, my head goes down, and I end up panicking. I'm also incredibly self concious (I've got a minor case of social phobia/agaraphobia) and couldn't - literally couldnt - get into a cossie in front of people. Maybe when I've lost some more weight, but I find it hard enough going out dressed! 😱

Scissor movements (plus sitting on a bike seat with a sore symphysis pubis) are too painful.

Sounds like typical excuses from a big fatty, but believe me when I say I loved swimming - really truly loved it - and if I could go I would. I've missed school plays and things with not being able to walk to their school, or leave the house some days. God I sound a complete nutter - I am normal - honest!

I am getting there - I do go out to town more often (with company), we've just got a Wii - so am attempting to do some home exercise with that (and my little dumbells/weights). I'm devoted to the diet - not making excuses - I'm currently surrounded by chocolate and resisting well :D

I was going to ask - didn't want to start another thread...if I'm going to buy a glucose monitor and test strips and sod what the doctor says - which should I go for? I know I've had some advice previously on this and I am listening (thank you!) just that I want to make sure that if my nurse or GP change their minds about testing, that I get one that they can prescribe test strips for. So which monitor is usually offered by the GPs?
 
Hi Lisa, there are lots of meters on the market and your doctor should be able to prescribe strips for any of them. You can usually get a free meter from the companies, which may also include a starter pack of ten strips.

The most common are Accuchek Aviva, Accuchek Nano, Lifescan OneTouch, and Bayer Contour. You can apply for a free meter at the following sites:

https://www.onetouchmeters.co.uk/

http://www.bayerdiabetes.co.uk/winameter/index.aspx

Just fill out a simple frm and tell them you test two to three times a day, should do it!
 
Thanks Northerner, I'm currently scouting eBay for the cheapest strips.

Just checked the OneTouch site you gave, they need you to give your current meter info (there's no option for "none").

Just realised I'll need a pricky finger thingie too. Can you tell I'm getting used to these technical terms? 😛
 
I've got an Aviva Nano. You can get one free from Roche. Ring the care line for free on 0800 701000 and quote the code C0809. If they ask you say you saw their advert in Sweet Magazine. The web link is http://accu-chek.co.uk/nano

If it helps, the finger pricker with the Aviva Nano has the lancets in a small drum. It is the least painful finger pricker I have used. No risk of accidentally stabbing anyone.
 
I just found my old box of lancets. Just no machine for them to go in lol.

They say "BD microfine 8mm" on them. And some say "novofine" on them.

I wish I'd retained some semblance of memory from my gestational days, I have no idea what they're for or which machine.

Edit: doh, they're my old pen needles, no use.
 
LisaLQ said:
I just found my old box of lancets. Just no machine for them to go in lol.

They say "BD microfine 8mm" on them. And some say "novofine" on them.

I wish I'd retained some semblance of memory from my gestational days, I have no idea what they're for or which machine.

Edit: doh, they're my old pen needles, no use.
Click to expand...

Are you sure those are lancets and not needle tips?

Edit: I see you've already found out!
 
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