• Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.
  • We seem to be having technical difficulties with new user accounts. If you are trying to register please check your Spam or Junk folder for your confirmation email. If you still haven't received a confirmation email, please reach out to our support inbox: support.forum@diabetes.org.uk

People on insulin, is your GP in charge of your care?

Status
This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
Northerner

Northerner

Admin (Retired)
Relationship to Diabetes
Type 1
If your GP does take care of you, how good a job do they do i.e. do you think they know enough to answer any questions you may have, or would you prefer to see a specialist? If you are cared for by a specialist clinic, would you be happy to be moved to your GP's care if they got special training and back up support from DSNs?
 
I have to attend my GP for my check up every 6 months, I see the nurse that has no experience, she can't advise on insulin dosage change or even insulin changes she cant even make a referal to a DSN at the hospital.I think it is a waste of time seeing her, if I ask her advice about changing an insulin dose she says you will have to make an appointment with the doctor to discuss that. Our practice is a Health Centre with 8 doctors in the practice and still you have to wait days for an appointment.


John.
 
My son's GP scares me! He admitted at the outset diabetes 'isn't his thing' and I guess on the balance of things, each GP statistically probably only has 5-8 T1s on their books, so unless it is a personal interest, maybe they really don't know that much.

What really bothered me a few months ago was when he suggested upping my son's Lantus dose from 25u to 40u in one go! Surely that's too much. It certainly didn't instill any confidence in me as we had always been told never to increase/decrease by more than 10% at any one time by the consultant and DSN.

Don't get me wrong, he is brilliant in many ways, and so mega thorough, my poor son has armsful of blood taken each time he sees him (which my DSN is pretty horrified at - says it's unnecessary and duplicating all they do - and they notify him of every result) but that's the way he is. He checks his feet regularly, has even prescribed moisturiser for him recently (which again my teenage son has no intention of using he tells me!) and we have never (yet) had ANY issues asking for any stuff on prescription. He did just say when I asked to put the ketone strips back on the repeat that they are very expensive so please use sparingly, but I only wanted one box in 'just in case' as the ones we had were approaching expiry.

Because he is still seen under the Children's Service, he is still seen a minimum of 3 monthly (monthly at the moment whilst ironing out recent problems) but I do wonder what will happen next year when he moves up to Adult Services. What is the normal then? Are T1s normally kept under hospital care, or referred back to GP for almost all of their care? That does bother me, just his apparent lack of knowledge re the insulin. Hopefully another year on though, we will be really confident dealing with almost every issue ourselves.

Gosh, don't I ramble on! Sorry!
 
Last edited by a moderator:
I have a good relationship with my GP, I don't see him very often but when I do it is never diabetes related. My DSN and consultant at my local hospital give me all the support I need and my GP (under his own admission) also prefers this.
 
ah the wonderful debate around GP's v's Diabetes specialists 🙂

For me (& I know everyone has different experiences), my diabetes team are excellent. They are very well educated in their field, they are pro-active at educating me & making sure I have everything I need; they are constanty trying to find ways to help me help myself improve my control. They are also available via email as well as the phone which has proved extremely useful.

My experience in GPs...

- had a 'diabetic review' with a practice nurse ONCE...and what a disgrace it was. She tried telling me that I just had to exercise more and eat less to reduce my levels...that ALL exercise reduced levels. When I told her that's not necessarily the case, & explained what happens to me when doing anything strength-based, she actually argued with me that I was wrong.

- I am now at a different doctors, & due an annual diabetes review there. Initially I didn't book an appointment, but when I went in for an emergency appointment with a chest infection, both the receptionist and the dr were more concerned with me booking in for my review than with what was actually wrong! The doctor I saw, when I was talking about my weight and stopping smoking, actually said to me 'oh no, the smoking won't do that [put on weight], that's the insulin'. I think a statement like this is disgusting and very triggering. Plus everyone knows you're very likely to put on weight when you stop smoking. but to turn round and say it's my insulin that makes me fat is downright disgusting. I also told him I didn't feel I needed a review as I do that with my diabetes team, but he said they do different tests at the doctors lol My diabetes consultant had quite a laugh when I told him this - they test exactly the same things as my diabetes team...so now I've had 2 blood tests for exactly the same thing in the space of 2 weeks!

- anyway, I now have booked an appointment as they also wrote me 3 letters telling me to make an appointment. I'll let you know how I get on, but I'm not expecting anything from it. I may ask them some questions just to amuse myself as I do think these are completely pointless when I'm getting such good care from my diabetes team. Plus I probably have more knowledge about T1 diabetes than this doctor will.

- my doctors don't seem to like giving me blood test strips either and always second guess how many I'm doing. On my repeat script letter this week, I asked for them to please bear in mind that I carb-count, drive twice a day at least, and go to the gym, and therefore require a fairly high level of strips. I'll find out tomorrow how many they've prescribed me!

argh, it's making me mad already!! I've had to use a day of my own annual leave for it, as I'd already had time off from work for my diabetes annual review with my diabetes team and then 2 different blood tests. I didn't feel right taking time off for another diabetes annual review for exactly the same thing but with my doctor and for an appointment that even I don't believe in.

I don't think most GP's are well equipped enough to manage T1 diabetes. (I'm not sure where people may think they are or aren't for T2) They definitely don't know enough about changing insulin types, or doses to be handing out advice.
 
Last edited:
I attend a hospital clinic - but I rarely see the same Dr. Its a teaching hospital so you get house men passing through and people training to be a GP. They have a consultant supervising the whole thing but its rare to actually have a consultation with them.

I think that the way you see DSNs needs revising too - as if you need to speak to one it is the one allocated to the clinic that day - which means that you can be swapping a lot.

One of the GPs has an interest in diabetes - but I am not sure when they last updated their knowledge.
 
Ive never even seen my gp at this surgery so i cannot say.

But i have seen the diabetic nurse, and shes very good. Really friendly and knows her stuff.

Shes even booked me a foot appointment at the surgey on wedneday.

I havent had one in about 5 years and the last one i had was just with the conslutant at halton hospital.

I really should re-book the appointment i missed with the constuant at warrington who looked after me wheni was pregnant x
 
My care is under the consultant at hospital and is 99.9% self managed, it's hard to get hold of the dsn's there & i guess if i had a question (ie pump related as that's newest to me) i would not use even them as sole source of info, as i really value the experienc based input here.

My gp is supposedly a diabetic specialist, but had not encountered pumps before & asked me to explain to him how it all worked. I've had the usual fight for the right quantities of test strips , but they seem to have given up rollicking me since i got my mp involved, funny that... 🙄

Would i trust my gp for my diabetes care solely? Never- they don't have theexperience to pick up on complications early enough for my liking & if im honest the only people ihave ever felt 100% confidence re disbetic care (experience, knowledge, understanding etc) were my diab obstetrician & my current consultant. (current opthalmologist surgeon at the good hospital too). Over the years my confidence in nhs diabetic care has been dented rather & my default setting is now 'cynical, suspicious & will think / educate / research for myself as much as possible.' would i allow my care to go back to gp? Not without fighting tooth & nail!!!!!
 
I've been told that I have to see my DSN at the GP's surgery twice a year. The benefit of this is that they do a range of blood tests.

I see my diabetic consultant once a year - who does no tests - and has wrongly told me that I have kidney disease when I don't

Neither of the above have any understanding of how to treat the gastroparesis - the consultant understands how it plays such havoc with my blood sugars - but he expects my HBA1C to be bad and is surprised when it isn't - therefore not much help at the moment when my average BG is 11.4!

I then see another diabetes consultant, at another hospital, where they do the checks but then the focus is on the diabetic gastroparesis - limited advice about how it can be dealt with - and they don't have access to my notes which are at another hospital in another county

On top of this I have two hospital eye specialists and see the podiatrist once a year.......plus physio for my frozen shoulder

All I can say is thank goodness that there is flexiblity in my job because I spend so much time just at "routine" appointments!
 
Northerner said:
If your GP does take care of you, how good a job do they do i.e. do you think they know enough to answer any questions you may have, or would you prefer to see a specialist? If you are cared for by a specialist clinic, would you be happy to be moved to your GP's care if they got special training and back up support from DSNs?
Click to expand...

When I was dxed in July 1992 my Doc , a very good family Doc, said, “I don’t know much about diabetes, all my diabetics go to the Diabetic Clinic at the Hospital”.

So off I went to the Diabetes centre at the nearby Hospital every six months. I had great care from a Professor and a team of DSNs. I thought that was normal procedure. I didn’t realise how lucky I was. You got told off if you weren’t testing and if you forgot to take your Log Book in to appointments, Heaven help you !

For various reasons in 2006 I missed a couple of appointments and the Diabetes Centre kicked me out.

I was referred back to my GP, who was off ill with kidney failure so a bunch of changing locums ran his surgery. I was pretty much on my own but with 14 years experience in the game.

Even so my HbA1c crept upto 8.2 and the Doc referred me to the Tier 2 Diabetes Service of the PCT. I saw a Consultant who recommended changing insulins and got me on a X-Pert Patients Diabetes Course. But since then ( four years ago ) I haven’t heard a word from the Tier 2 Team.

Now the Doc calls me up to have BP tests and discuss anything relevant in the HbA1c etc. The Practice Nurse checks feet and takes blood every six months but freely admits she knows nothing about insulin. Her forte is talking about her holidays and her Aunty who had a foot off because of diabetes.

The eyes are tested once year with the photos although my Opthalmologist assures me this is a poor substitute for a proper exam by one such as him that I used to get at the Diabetes Clinic.

I have a six month appointment with the Podiatry service.

So all in all there are about four or five people involved in my care but I wouldn’t call them a ”Care Team” since it is uncoordinated and lacks an overall strategy. And I doubt if the right hand knows what the left is doing.

Basically, if you are a Type 2 you are flying by the seat of your pants. If you are a T2 on Insulin ( i.e. possibly the largest single group of diabetics ( 40%)) then you fall between two stools and there is very little real thought given to your particular needs or training on offer. And it is probably going to get worse with the Cuts and the upcoming, planned destruction of the NHS.
 
Last edited:
Out of 8 doctors in my practise two are said to be experienced in dealing with diabetes, I don't usually discuss treatment & care with them and any concerns I have are addressed by my hospital team.
 
My GP told me that they only have a couple of days covering Diabetes when they do their training. So I'm glad I'm with the Diabetes care team at the hospital :D
 
Totally irrelevant to the UK.
My diabetologue laughs when she asks me about my GP. Yes, he's still the same one, no I haven't seen him. She's taken on a bit of the role of GP and checks that that I have mammograms and c smears.
I met my GP (picked off the names on the board, appointment same day) and told him I thought I had diabetes, he got blood tests done and sent me to hospital, I've seen him once (for a tetanus jab ) since


Even less relevant:
I've had a 'fluey bug' for 10 days now, it's not an emergency and they may not be able to do anything about it but I've been quite unwell, lost quite a bit of weight and had some fluctuating bg levels .
My big problem is that I'm not registered with a doctor in the UK (I have a French EHIC )I did try to get an appointment as a temp resident, but gave up after the first 2 surgeries. I gave up as I had neither voice nor energy to explain or argue. It's quite a contrast to how I was treated as an English woman who needed medical help in France.
(I shall be going to a walk in centre tomorrow, it only works at weekends, thankfully I don't need an appointment for that)
 
I'm officially under the GP surgery and see (when she remembers) the diabetes nurse who will happily listen and suggest general care matters such as feet and blood pressure and even discuss about diet and insulin, but hasn't the experience to analyse confusing patterns of BGs, for example.

For that, I was referred to the DSN at the hospital who I've also seen every 6 months since. She has a better intuitive feel for it and can suggest alterations that work.

So I suspect I'm getting the sort of care that you're suggesting but, of course, in Wales there is no patient choice so if it wasn't working I'd be a bit stuffed.🙄

Rob
 
A bit different for Carol as she's a teen. Carol started out going to the children's clinic, moving to the teen clinic when 13. The only change was the place we have to go to. It is the same team. When Carol is around 16-18 she will transfer to the "transition clinic", which will have the paed team and adult team present, so that she can get used to the adult team. I am hoping she will stay with them, as I don't think much of the adult team in our town (they're messing my friend around) and the GP with a D interest is not her GP. I don't actually know how much her GP knows about D, except that he diagnosed her within seconds of us entering his room. So far I've never had any problems with the prescriptions either.

This reminds me - I took Fiona to GP for something and he thought she was the diabetic😱 lol
 
I treat my diabetes.

Under primarily a hospital Diabetes Clinic and then GP for scrips. As per the norm, they think I use too many strips.

I asked one of the other GPs for a repeat one day (he's the warts etc GP and that's what my appt was for, but it saved me ringing separately and asking for the repeat) - and he started to have a go at me for the amount of strips I was using - apparently most people only need to test so often 'at first' and clearly I wasn't heeding what food X did to my BGs on an ongoing basis - did I keep a diary?

I laughed - what else could I have done without being arrested? - and told him he clearly wasn't up to date ....
 
Tina63 said:
Don't get me wrong, he is brilliant in many ways, and so mega thorough, my poor son has armsful of blood taken each time he sees him (which my DSN is pretty horrified at - says it's unnecessary and duplicating all they do - and they notify him of every result) but that's the way he is.
Click to expand...

I cynically suspect the reason he is so thorough re blood tests is because he needs the results to get his QOF points (which is what GPs are paid on). I'm under the hospital but am asked for duplicate blood tests when I see the GP for anything. The problem seems to be that no one at the surgery transfers the results from the letter the hospital sends them into the right boxes on my medical record that trigger the QOF payment. It's easier for them to request the blood tests again.

I refuse to play that game. I only agree to blood tests where there is a medical benefit, and repeating the tests that have already been done at the hospital just because their admin system isn't up to scratch doesn't meet my criteria for releasing blood.

Generally, I'm happy with my GP, but I wouldn't trust them with my diabetes. And they openly admit that they don't have enough experience of Type 1 and insulin to deal with it competently.
 
Answer to question .... no I am in charge of my care.
GP is fantastic and listens and acts when he needs to. (he got my pump funding for me) I have no interaction with the practise nurse..... she needs more practise, classed by most as dumber than dumb 😱 (she is lovely as a person but clueless regarding diabetes)
 
Status
This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
Back
Top