Who will prescribe?

[Chris300185]

Evening all. I need a rant! Diagnosed in April 2017, treated as type 2 but “unsure” if I’m type 1 or 2. Started off on 160mg Gliclazide and 1000mg of metformin twice a day. Once my levels dropped to norm, I started having hypos so they dropped my Glic to 80mg twice a day. My average was running about 6mmol for months, maybe even over a year. I quit smoking on 28th September, and mid October my levels went through the roof, hitting 18’s etc.. I rang diabetes department at hospital who advised doubling my Glic again. I went to see them in November and was told they weren’t worried. Here we are 2 months later and nothing’s changed.. Just had appointment with DN at GP and she’s said that I’ve crashed to type 1 and need insulin but as I’m “under the hospital” she can’t prescribe it. So I call hospital again who inform me I’m not type 1, but insulin dependent type 2... but they can’t see me until March!!! Was told to ring 111 and they should make an appointment for me “somewhere”... but no, they said I need to ring me GP!!! ‍♂️ So what the hell do I do? Just wait to fall into a coma? Does anyone know of a GP can prescribe insulin or does it have to be the hospital? I’m fed up of feeling tired, blurry and thirsty again!

 

[trophywench]

What actual tests have been done to formally establish what 'Type' you are Chris? Have you had C-peptide or GAD antibodies blood tests? If not - nobody on earth can tell you what 'type' you are!

Hence ring your GP and state that you need those tests especially the C-pep as the GAD antibodies are only present for a short time anyway. The C-pep reveals how much insulin your own body provides and actually the majority of classic T1s still produce some insulin but simply nowhere near enough to do anything useful. OTOH if you're producing shedloads of the stuff - you are highly likely to be T2. You may still need insulin though if your body is stopping the 'home produced' stuff working properly.

 

[Chris300185]

As far as I’m aware, I’ve never had either of those tests. I read online that sometimes people stop responding to their pills so have to change them, but it seems like my doctors just want to jump straight in and say I need insulin but nobody can give it to me! I’ve always backed the NHS when people slate it, but this shows just how flawed it is

 

[Brando77]

I'd camp out at the Hospital if I were you. It's your life in jeopardy, you need this sorted. Good luck.

 

[Pumper_Sue]

@Chris300185 Please ring your surgery and ask for an urgent apt with your GP. Not the nurse. I've never heard such twaddle from a practice nurse re the prescribing of insulin.

 

[AndBreathe]

As far as I’m aware, I’ve never had either of those tests. I read online that sometimes people stop responding to their pills so have to change them, but it seems like my doctors just want to jump straight in and say I need insulin but nobody can give it to me! I’ve always backed the NHS when people slate it, but this shows just how flawed it is

Your GP can contact the hospital and get advice from you.

I'm not absolutely certain its a national thing, but I hope it is. Anyway, when I was having issues with another condition, and not reacting as expercted to a treatament regime, my GP could email the consultant I had seen to ask device on how to move forward. She then called me back a day or so later, with a proposal.

Whilst that condition was horrid at the time, my life and safety wasn't in danger.

If they don't offer to do it, please ask them. It is a valuable service.

 

[Ralph-YK]

she’s said that I’ve crashed to type 1 and need insulin but as I’m “under the hospital” she can’t prescribe it. So I call hospital again who inform me I’m not type 1, but insulin dependent type 2...

T2 doesn't become T1. (Weather you can have both is another question.)

Your GP can contact the hospital and get advice from you.

When I was seeing my GP the last about issues about BP & heart, they actually rang the hospital while I was there. Asked about my prescription from the hospital, then the GP adjusted them.

 

[SueEK]

I was told that only the Diabetes Care team can authorise the c-peptide and GAD test, don’t know if that’s for everywhere but definitely down here. I would suggest making a nuisance of yourself as sometimes that’s the only way as clearly somebody should be seeing to your needs. Let us know how you get on

 

[Thebearcametoo]

Yes GP who will then probably speak to the hospital. If someone will sign off on it then the GP may be able to prescribe insulin but generally it needs to come from a diabetes specialist first. If they’ve said you need insulin though then the GP should be able to prescribe and I don’t know why that wouldn’t be clear to the nurse.

 

[Sally71]

Our hospital team won't prescribe, they say it's bad if you have hospitals and GPs both prescribing for the same patient as you might end up with combinations of things which don't work together and so on. So if they (the hospital team) identify something new which my daughter needs they write to the GP and get him to prescribe it. The GP won't argue with such requests if it's been signed off by a consultant. One year when my daughter had her annual diabetes review, they identified that she was anaemic, which I suspect went back to when she had her appendix removed a few months previously but it wasn't picked up at the time. The first I knew about it was when I got a phone call from the GP asking me to pick up the prescription for iron medicine!

 

[Ralph-YK]

Our hospital team won't prescribe, they say it's bad if you have hospitals and GPs both prescribing for the same patient as you might end up with combinations of things which don't work together and so on.

Interesting. In the last five years I've had 4 different hospitals prescribing for me, as well as GP. Multiple departments. Both starting and stopping. They've actually handed me bags of tablets. Or a prescription that can only be filled at the hospital. It can get confusing at times.

So if they (the hospital team) identify something new which my daughter needs they write to the GP and get him to prescribe it.

I've had the hospital writing to the GP about prescription changes too. (Starting, stopping and changing.)

 

[Chris300185]

Thanks for your input everyone. I had a phone consultation with my GP earlier today. He contacted the clinic at the hospital who have said he can write a prescription for a night time slow working insulin, and also that they will see me at the hospital within 2 weeks... amazing how they couldn’t see me until march yesterday eh? I collect insulin on Monday and have appointment with DN to start taking it. Maybe it was stress as BS now 9.2 this evening. Will keep monitoring

 

[Thebearcametoo]

Excellent. Glad everything is moving in the right direction now.

 

[Pumper_Sue]

Really pleased to hear things are moving in the right direction @Chris300185

 

[everydayupsanddowns]

Glad progress has been made @Chris300185

Most classifications (T2, T1, LADA etc) are best done in clinical factors, as the tests aren’t necessarily 100% clear cut but can provide important clues. As someone who is a few years in, it may be that your autoimmune response (if that is behind your diabetes) is fast disappearing as your beta cells reduce. I wonder if you could well be LADA, which fewer GPs have much if any experience of. LADA is a sort of slowly developing T1 in adulthood, and people often respond well with T2 meds to begin with.

A cPeptide test would demonstrate how much of your own insulin you are still producing, and if your diabetes is because of insulin resistance (you are producing lots of insulin but can’t use it properly) or beta cell destruction (more likely T1 or LADA). I’m never sure about MODY, but it’s a mono genie form and genetic tests help spot that one.

Hope you get some answers (and more importantly some insulin!) soon.

An accurate classification is important and worth pursuing, because it can affect what types of therapy and tech are right for you - and what you can access on the NHS.

 

[Chris300185]

Just been to pick up my insulin pens.... just the insulin pens... no needles! ‍♂️ #cleverdoctor