There are some great DN's out there.

[Docb]

We get a lot of newbies on the forum who have been left to fend for themselves having been given a perfunctory diagnosis and a prescription so I thought I might record the other side of the coin.

Had my "annual" review yesterday. Face to face in the surgery. And thorough it was. All the proper checks, all the right questions asked all the proper records made.

Some highlights...

Was a little concerned that my HbA1c at 36 was too low. Took the view that if the HbAa1c was that low, then there was a real risk that my spot levels could be getting lower than was wise and bearing in mind my age and the fact that I am a carer it would be sensible to nudge it up to avoid any risk of going hypo whilst out! A message there for the occasional member seeking to reduce their HbA1c to very low levels. Agreed to do this by stopping the gliclazide.

She encouraged me to keep on testing to keep an eye on things and report back. My test results were the first thing she asked for. Told methat the local CCG had changed their preferred meter from the Accucheck to a Gluco something or other and to let her know if mine failed so that it could be replaced. A very different attitude to testing from what we often hear.

Told her that I had volunteered to help DUK by moderating on this forum and told her of the many newbies we see who are seemingly ignored by the system. She was a little dismayed at this.

Anyway, on balance a great review in a well organised surgery and a knowledgable and supportive DN. They are out there.

 

[Felinia]

I have nothing but praise for my own GP surgery and the support I have received, which included regular phone calls to check how I was doing when I was ill, and when my diabetes medication was changed. This Christmas I took them a large fruit box from the local farm shop, to say thank you.

 

[Docb]

Forgot to mention. She is not a fan of the term "remission". Prefers "good control".

Just saying 🙂

 

[SB2015]

I also have nothing but praise for the DN at my practice.

I had a face to face review this week, so that she could tickle my toes. I had had the bloods done two weeks before so I had all the results beforehand. We had a useful discussion about why my HbA1c had gone up a little since I was using a closed loop system with my pump and sensor. At no point did she suggest this was a bad thing. We discussed the reduction in hypos and hypers and also Time in Range. She definitely focused on the data as information rather than as any judgement. For the other results we reviewed my meds, and decided nothing needed changing. She also checked how I was feeling about my diabetes, and the impact that using the Closed Loop had had on this.

I am under the hospital for my care but still check in with the practice for the toe tickling. As our hospital appointments have been delayed I was glad to have this appointment, and she finds it useful in familiarising her with the facilities of the pump I am using.

 

[Docb]

And I forgot to mention... she was quite intrigued by my 10 finger in rapid succession test. She is often asked if it matters which finger is pricked and has never had anything other than a general answer. The important thing was that, a bit like your DN @SB2015, she was interested in what she could learn from what I had done.

 

[everydayupsanddowns]

Great to hear @Docb

Sounds like a keeper!

 

[Docb]

Absolutely. I am sure that the majority of surgeries and DN's are pretty good, its just that, for obvious reasons, we normally only get to hear about the poor ones!

 

[Amity Island]

Absolutely. I am sure that the majority of surgeries and DN's are pretty good, its just that, for obvious reasons, we normally only get to hear about the poor ones!

It does seem very much down the individual attitude rather than the training they have received. It's more of an individual (DN) health service rather than a national one.

 

[Leadinglights]

There is obviously a minimum amount of training they must have to do but it probably depends on how motivated an individual is prepared to do , to do 'extra' to make them better informed.
My daughter has found that with the trainee doctors, some only do the minimum whereas others will do extra work and put more effort in.

 

[Amity Island]

There is obviously a minimum amount of training they must have to do but it probably depends on how motivated an individual is prepared to do , to do 'extra' to make them better informed.
My daughter has found that with the trainee doctors, some only do the minimum whereas others will do extra work and put more effort in.

I agree, it's not so much that there's bad builders or bad waitress's out there, it's more bad attitude. It wouldn't matter what these people did as a job, they'd do it well or badly just the same.

 

[Essex]

And I forgot to mention... she was quite intrigued by my 10 finger in rapid succession test. She is often asked if it matters which finger is pricked and has never had anything other than a general answer. The important thing was that, a bit like your DN @SB2015, she was interested in what she could learn from what I had done.

Very intrigued by the 10 finger tests. is this to see variation between fingers? I often wonder about this.

'Bad attitude' or complete demotivation due to years of stress and low pay and, probably most of all for the type of people who tend to choose this type of profession - lack of any feeling of being 'valued'?
Not saying there aren't any loafers, just that its not something I could stand (trying and failing to be a secondary school teacher was enough for me, thanks)

 

[Lily123]

Very intrigued by the 10 finger tests. is this to see variation between fingers? I often wonder about this.

If it is to be variation , there may be a tiny bit of variation such as something like 0.1 or something but then again as BG meters have to be within 15% of the actual number there may be more variation or no variation at all. 🙂

 

[Essex]

If it is to be variation , there may be a tiny bit of variation such as something like 0.1 or something but then again as BG meters have to be within 15% of the actual number there may be more variation or no variation at all. 🙂

is that 15% in terms of accuracy &/or precision?

 

[Lily123]

is that 15% in terms of accuracy &/or precision?

In accuracy of getting the number spot on.Yes 🙂 If a BG meter reads 7.7 it could be 8.7 (just an example)

 

[Essex]

In accuracy of getting the number spot on.Yes 🙂 If a BG meter reads 7.7 it could be 8.7 (just an example)

Do you know what kind of precision they have?

 

[Lily123]

Do you know what kind of precision they have?

I’m not sure of the exact precision

 

[Robin]

Do you know what kind of precision they have?

I don’t think I’ve ever seen anything official mentioned. My experience is that they are imprecise, in that they don’t read, say, 10% more all the time, you’re as likely to get a reading that’s under as over. Some meters tend to read higher at the top end and lower at the bottom end, which is presumably how they were programmed, but that's not universal. I think people get bamboozled by the decimal point, whereas the reading is only ever going to be 'ish'.

 

[Essex]

(PDF) Precision and accuracy of two blood glucose meters: FreeStyle Flash versus One Touch Ultra

PDF | The precision and accuracy of two blood glucose meters were evaluated using finger and forearm blood samples. Duplicate blood glucose measurements... | Find, read and cite all the research you need on ResearchGate

www.researchgate.net

Precision and accuracy of two blood glucose meters: FreeStyle Flash versus One Touch Ultra

Abstract. Purpose. The precision and accuracy of two blood glucose meters were evaluated using finger and forearm blood samples.Methods. Duplicate blood gl

academic.oup.com

It seems that meter precision is around 6% which corresponds to around 10 mmol/dL
Interestingly the first finger prick was lower than the second on average

Obviously these values are restricted to the meters and conditions of that study, but are probably good for ball park figures

Seems to be a well planned / analysed experiment but beyond my first glance stats knowledge

Reputable journal though, so presumably well peer reviewed

https://academic.oup.com/ajhp/pages/About

In their own words,
'The American Journal of Health-System Pharmacy (AJHP) is the official publication of the American Society of Health-System Pharmacists (ASHP). It publishes peer-reviewed scientific papers on contemporary drug therapy and pharmacy practice innovations in hospitals and health systems. With a circulation of more than 43,000, AJHP is the most widely recognized and respected clinical pharmacy journal in the world.'

Accuracy doesnt matter so much if you are only interested in changes between two readings (e.g. before and after lunch), and precision is still good.

 

[Docb]

Hi @Essex. Used to be a proper scientist and one of the first things you should do when measuring something is to find out how reproducible your test measuring system is. So what I decided to do was to do ten tests in quick succession to see what the average was and to get a standard deviation, the standard deviation being a measure of the spread of the results. Rather than pepper one finger, I decided to spread the agony by doing one test in each finger and both thumbs.

What I found was the readings varied from 4.2 to 5.6. The mean value was 4.9 and the standard deviation was 0.43.

What does this mean? It means that if the true value of your blood glucose was 4.9 then you would expect to get 95% of your test readings in the range 4.9+/-0.86, that is somewhere between 4 and 6. It means that quoting blood glucose readings from a hand monitor to 1 decimal place is really pushing it. It means that differences in readings have to be much greater than 2 before you can even begin to think that they are statistically significant.

Where does this variability come from? Two sources.

The first is the "accuracy" of the testing machine. I don't know what this is, you would need to do a number of tests in quick succession on a test solution to do that but I suspect it would be pretty good and far better than the +/- 10 or 15% required by the specification. You might get a bigger variation between different batches of test strips.

The second, and I suspect the most important, is sampling error. Blood is not homogenous and blood glucose levels will vary quite a lot as it travels round the body. What you are doing is taking a tiny drop from a whole body full and so it would be quite amazing if the readings from each drop were identical. By always testing in the same place, at a finger end, you are just about the only thing you can do to control this variable.

I end up by suggesting that you should not get too hung up on small variations in blood glucose readings, and by small differences I mean 3 whole units unless there is a clear and reproducible pattern. That is a non technical way of saying you need readings enough to show statistical significance before worrying. Above all, I would not worry about the accuracy of the meter. In my view, the whole thing is limited by sampling error and that the saving grace is that the system is well capable of detecting the sorts of changes that should be of concern.

PS Usual caveat about T1's. You do far more testing than and monitoring the rest of us and have more experience in interpreting readings. As such my remarks might be more of interest than practical significance.

 

[Lily123]

Hi @Essex. Used to be a proper scientist and one of the first things you should do when measuring something is to find out how reproducible your test measuring system is. So what I decided to do was to do ten tests in quick succession to see what the average was and to get a standard deviation, the standard deviation being a measure of the spread of the results. Rather than pepper one finger, I decided to spread the agony by doing one test in each finger and both thumbs.

What I found was the readings varied from 4.2 to 5.6. The mean value was 4.9 and the standard deviation was 0.43.

What does this mean? It means that if the true value of your blood glucose was 4.9 then you would expect to get 95% of your test readings in the range 4.9+/-0.86, that is somewhere between 4 and 6. It means that quoting blood glucose readings from a hand monitor to 1 decimal place is really pushing it. It means that differences in readings have to be much greater than 2 before you can even begin to think that they are statistically significant.

Where does this variability come from? Two sources.

The first is the "accuracy" of the testing machine. I don't know what this is, you would need to do a number of tests in quick succession on a test solution to do that but I suspect it would be pretty good and far better than the +/- 10 or 15% required by the specification. You might get a bigger variation between different batches of test strips.

The second, and I suspect the most important, is sampling error. Blood is not homogenous and blood glucose levels will vary quite a lot as it travels round the body. What you are doing is taking a tiny drop from a whole body full and so it would be quite amazing if the readings from each drop were identical. By always testing in the same place, at a finger end, you are just about the only thing you can do to control this variable.

I end up by suggesting that you should not get too hung up on small variations in blood glucose readings, and by small differences I mean 3 whole units unless there is a clear and reproducible pattern. That is a non technical way of saying you need readings enough to show statistical significance before worrying. Above all, I would not worry about the accuracy of the meter. In my view, the whole thing is limited by sampling error and that the saving grace is that the system is well capable of detecting the sorts of changes that should be of concern.

PS Usual caveat about T1's. You do far more testing than and monitoring the rest of us and have more experience in interpreting readings. As such my remarks might be more of interest than practical significance.

I’m sorry but I have to ask, but does that mean when you compare the Libre results to the finger prick and if the finger prick is 5.4 and the Libre reads 4.9 does that mean the Libre is more accurate than it appears to be?