Author Topic: Latest Appointment  (Read 1386 times)

0 Members and 1 Guest are viewing this topic.

Offline himtoo

  • Member
  • Posts: 2,873
  • Prince of Protein
Re: Latest Appointment
« Reply #15 on: 25 November 2015, 11:19:45 AM »
Hi I don't get to see the letter he sends my GP. Any idea how long it takes to arrive? Was hoping a week would give chance for it to arrive, like you say evidence. However I am not sure how much detail it gives, whether it just says "Lucy needs to lose weight so stop insulin" or whether it says restart insulin at bg X.
I normally allow 2 weeks post appointment to go see my GP after a consultant appt .

from (last april I think) GP patient records are meant to be accessible online under the new NHS rules.
here is a link to the info. http://www.nhs.uk/NHSEngland/thenhs/records/healthrecords/Pages/what_to_do.aspx


 
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Liam

  • Global Moderator
  • Posts: 3,211
  • We live to fight another day.
Re: Latest Appointment
« Reply #16 on: 25 November 2015, 11:27:11 AM »
How old was he? I've found some consultants get stuck with their thoughts on diabetes. Like my old consultant was pretty good but didn't want to do pumps (we'll just leave that to the 1 hospital) The register that was waiting for him to retire then because the consultant and he was full of new ideas and wanted to start doing pumps locally. The pump problem now in my local clinic is about the nurses, one is semi retired and the other is too busy to do pump training.

 
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Lucy

  • Member
  • Posts: 2,211
Re: Latest Appointment
« Reply #17 on: 25 November 2015, 12:44:45 PM »
Not sure on age but he wasn't young. 50s maybe? I'll take the Diabetes UK guidelines with me to the appointment. I checked and they said target is 48 but can be individualised (presumably if you get there and have loads of hypos). It's weird that Drs are more worried about hypos than me! I have pretty much cut out hypos since previous years, the odd one sneaks up on me but it's rare and I have good warning signs now and I'm not worried I'm having too many at all. Less than one a week is fine to me.

V my bgs have actually been not too bad as I've not been eating much. Had a 12.3 last night 2hrs after having 20g carb though (3.8 before as hadn't eaten all day and know my basal is a bit high - it's a compromise I've stuck with). So new potatoes off the menu at the moment. Had half a banana for breakfast with half an hour walk afterwards and back to 8.9 pre lunch. Lost half a stone since Monday though I appreciate that's probably just variation in water weight. So the sudden shock back into eating hardly anything and low carbs probably is good for me. Knowing how high I will go if I eat carbs dont exercise and don't bolus is a good motivator. It's just not sustainable for the rest of my life.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Latest Appointment
« Reply #18 on: 25 November 2015, 02:54:17 PM »
In addition to the DUK guidelines, you may want to take in a food diary. The consultant appears to be deluded that you are eating massive amounts of food and just "eating less" will magically solve everything. When in fact you're eating fairly reasonably, I believe, and "eating less" would probably make you less healthy rather than more, and not really give you better control or weight loss. Also, aren't you fairly active, Lucy? I remember you used to bike everywhere! Of course with the move and everything I understand that might have gone by the wayside for now. But it's clear this doctor has formed a certain mental image of you that is leading him to ask things of you that are, in fact, unrealistic. (It also occurs to me that he is assuming, based on that same mental image, that getting off insulin is a desirable goal for you, and maybe even something you want yourself, rather than considering the possibility that you actually NEED it and appreciate having it, as you have never been a typical T2 and it allows you to eat without as much worry!)

So I think if they had some evidence of just how far you are having to cut back (and the fact that you are afraid to eat!!) to achieve what he has asked of you, it might provide a reality check. Hopefully your GP will be on board with you anyway without needing much convincing, but it can't hurt to have a little extra info in your back pocket, so to speak. If need be, you could even see about roping in a dietician - of course the dietician may recommend more carbs than you are really comfortable with, but if that's the case, then she will react even more strongly to the fact that you are now afraid to eat carbs and basically unable to achieve what she will consider a balanced diet AND reducing your medication without sacrificing control.

It strikes me this is a lot like the old software developers' "joke": cheap, fast, or good, pick any two. In your case it's: less medication, good control, or sustainable diet, pick any two! 
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Lucy

  • Member
  • Posts: 2,211
Re: Latest Appointment
« Reply #19 on: 30 November 2015, 06:34:59 PM »
Thanks all, i tried following the instructions for a few days but gave up in less than a week following fbgs of 16/17. I don't need to take evidence to the consultant Nyt (though thanks for the suggestion) as i won't be seeing him again. Woohoo. I've been asked to write a letter to the consultant about what happened, which the GP will send with his own letter covering it, and then i'll be referred to the other (i believe much better!) local hospital I've heard good reviews from those i've asked that use it and via Pattis connection, and lets face it, it can't really be worse! I hadn't intended to send a letter so i'm glad that this was suggested, the consultant can't improve on where he is going wrong unless either he realises the problem or someone points it out to him. So for the benefit of his other patients i realise it's important to do that.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline nytquill17

  • Global Moderator
  • Posts: 6,769
  • It's all in the balance.
Re: Latest Appointment
« Reply #20 on: 30 November 2015, 07:29:18 PM »
So they approved transferring you? Wonderful!! Sorry you had to go through all this to get there, though. Thank goodness you've got your head on straight about it all - horrifying to think what would be happening to someone who was happy to just do what the doctor says, especially if they weren't testing much!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Lucy

  • Member
  • Posts: 2,211
Re: Latest Appointment
« Reply #21 on: 30 November 2015, 07:32:08 PM »
Yes i think thats why the letter is important, and i'm glad it was suggested. Because there will be patients whose knowledge comes pretty much solely from the consultant and just does what they say without questioning.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Alan

  • Member
  • Posts: 3,323
    • Type 2 Diabetes - A Personal Journey
Re: Latest Appointment
« Reply #22 on: 30 November 2015, 11:24:20 PM »
Sorry, as an outsider looking in I can only shake my head in wonderment.

I know your system makes changes of doctors very difficult, but if you can, do so. If you can't, I would be considering saving up for a private consultation with somebody comptetent.

I am no expert on insulin so I'll leave that for others. But I'm still trying to get my head around the logic of stopping basal when A1c rises. Weight will not kill you. High BGs can.

PS Oops - I should have read down the page. So glad you will be seeing someone new. They have to be better; could not be worse.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Slow Cooked Beef Brisket)
Born Under a Wandering Star (Surviving Long-haul Flights in Cattle Class)

Offline sedge

  • Global Moderator
  • Posts: 14,310
Re: Latest Appointment
« Reply #23 on: 01 December 2015, 12:32:18 AM »
That's a brill result from your GP Lucy - have to say I'm very very glad to see that there are still some of that 'calling' (?) that still CARE.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline himtoo

  • Member
  • Posts: 2,873
  • Prince of Protein
Re: Latest Appointment
« Reply #24 on: 01 December 2015, 07:37:11 AM »
that is excellent news  Lucy. !!!!
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6) 04/18 46 (6.4)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Lucy

  • Member
  • Posts: 2,211
Re: Latest Appointment
« Reply #25 on: 01 December 2015, 08:13:24 AM »
Thanks. The letter is written, ended up a bit long though. Focused on three questions - explaining why I disagreed with what happened and giving evidence from Disbetes UK / NICE. I can explain myself and my reasoning much better I think given a blank word document and a free evening than I can verbally when I'm shocked by the way conversation has gone so hopefully that's the issue closed. Well unless I get a reply to letter. Not sure what the protocol is and never done this before!
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Pattidevans

  • Administrator
  • Posts: 24,717
  • It's ONLY Diabetes. It could be something worse!
Re: Latest Appointment
« Reply #26 on: 01 December 2015, 10:02:01 AM »
I am very very pleased that you have got a referral to the other hospital.  The consultant we know is no longer there, but he was so progressive that I cannot help but think his ethos will remain.  The letter is a brilliant idea.  You aren't alone in being robbed of coherent speech when such a curve ball has been thrown your way.  I too would prefer a quiet evening and an opportunity to write my feelings and thoughts under the same circumstances.  I would love to be a fly on the wall when he receives it.  Please do keep us up to date on any further developments, particularly how you find the other hospital.


I know from experience that diabetic nurses can vary immensely.  The one who used to run the the D clinic at the local hospital was a complete waste of space,whereas the pump nurses where I go now are a completely different breed.  Let's hope that the consultants vary the same and you get a good one this time.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

  • Member
  • Posts: 2,211
Re: Latest Appointment
« Reply #27 on: 01 December 2015, 01:53:57 PM »
The diabetes nurses at my old hospital were pretty good, some mistakes but when i used to see them i could tell them the utter rubbish that the registrars had told me to do and they'd know why it was wrong. And of course they started me straight onto basal bolus insulin when i saw them, giving me informed choices between that and mixed etc. But you only saw them when the registrars didnt know the answer it seemed. I hope my letter wasn't too negative or attacking, but it gave me a chance to be quite open and honest and everything i said was true and based on the guidance by official bodies. Just after an appointment is a good time to switch i think, i know theres a longer waiting list at the new hospital but i wasnt due to see anyone at poole for another 9 months anyway. Will let you know how i find the new hospital when i switch, i do like to think that the influence of someone with their head screwed on well like the consultant you referred to will remain even though they have left. I'm not sure whether to expect a reply to my letter, as i did specifiy some questions, but more for the consultant to be aware of them than for me to want a reply.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline sedge

  • Global Moderator
  • Posts: 14,310
Re: Latest Appointment
« Reply #28 on: 01 December 2015, 09:43:05 PM »
Yes - I can always think of the things I should have said, after the meeting is over.  Whereas absolutely - I get totally tongue-tied and frustrated if the person I am seeing isn't on a par with me - I don't at all mean that they have to agree, I mean they have to be open to hear my side of the story, my viewpoint on the issue and also for me to question what they say and not just believe it - as if they are God.  I want to actually DISCUSS whatever we are talking about - not be required to solely sit quietly and just listen to (damn) instructions!

I think a lot of medics would do well to attend a debating society and be given something they absolutely diametrically oppose, to propose to the floor and speak for, for at least 3 minutes!  LOL
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4