Diabetic Nurses

[shiftzor]

I just got my knuckles wrapped because in the past month I have had 2 lows (on the same day in the same hour, although she didn't see that, doh) of 2.6mmol/L or 47mg/dl and she also told me off for having 11 lows (2.4-2.8mmol/L or 43-50mg/dl) in the past 306 days with a low A1c of 6.2. Apparently 6.2 A1c corresponds to 6.2mmol/L average and I am crazy for thinking otherwise. However on the plus side I have excellent control although crazy for wanting to get my A1c down to the high 5s. Testing 10 times a day was considered excessive and shouldn't be contemplated as my life would be degraded by my now become obsession. She did think I should get a pump although I would have to discuss it with my doctor.

Is it any wonder why so many people don’t show these people their logs and/or refuse to look after themselves? If every time they turn up they get treated like this? While I am not proud of going low I do feel that it was an unfair judgement and more of an assumption that I must be going low with low A1c, any “signs” of low were treated as if they were more dangerous than a diabetic with an A1c of say 10.

[EazyE77]

Ugh I swear in the 2 years I've had D all of the stories just make me want to beat these people upside the noggin! The only people I trust when it comes to me having D medical profession wise is my cousin who is a nurse, mom who is an ex nurse, so far new doc but has been in the family for a long while, and a really great friend who is a nurse. I also would trust a few other family members who have no medical background whatsoever more so than most of these so called medical professionals who you couldn't trust to care for someone with a common cold.:eek:

[Stuboy]

see my diabetic nurse that i see when i go for checkups takes the opposite view... "Lows are inevitable and sometime unavoidable, it's bound to happen a few times, dont worry about it."

It's only when you get 1 or 2 or 3 or more every day it starts to convern!

[morrisma]

Shiftzor,
I suppose you could figure the nurse has your best interest at heart with the knuckle rapping. Lows are far more dangerous (short term) than highs. Of course she should be commending you for making such a strong effort to get the A1c down too. The DN at my endo's office says that many patients she sees do little or nothing to take care of their diabetes (no testing, sugared sodas, etc) and just get worse every time they come in. In that light, your visit ought to be a pleasure.

As to the pump - I love mine and the only complaint I have is that the insurance doesn't cover cgms yet. I test 8+ times a day and feel that even more is needed. Can't wait until cgms is no longer 'experimental'.
Mike

[JJM335]

I just got my knuckles wrapped because in the past month I have had 2 lows (on the same day in the same hour, although she didn't see that, doh) of 2.6mmol/L or 47mg/dl and she also told me off for having 11 lows (2.4-2.8mmol/L or 43-50mg/dl) in the past 306 days with a low A1c of 6.2. Apparently 6.2 A1c corresponds to 6.2mmol/L average and I am crazy for thinking otherwise. However on the plus side I have excellent control although crazy for wanting to get my A1c down to the high 5s. Testing 10 times a day was considered excessive and shouldn't be contemplated as my life would be degraded by my now become obsession. She did think I should get a pump although I would have to discuss it with my doctor.



Your nurse is wrong about the average BG. The most recent study would indicate that an A1c of 6.2% corresponds to an average BG of 7.3 mmol/L. (Some of the older conversion formulae would indicate an average BG of nearer 7.6). You should be able to check your meter averages. Since you are testing ~10 times per day you should get a number pretty close to your ADAG (A1c-derived average glucose) of 7.3.

11 hypos in nearly a year (with none lower than 2.4) sounds like a fantastically good effort in view of your decent A1c! I have seen some research that reports that 1-2 episodes per week of < 3.0 mmol/L is typical of "well controlled" T1's; you are doing much better than that.

[JJM335]

.... My last message got posted accidentally before I could complete it... continuing....

The warning about obsession seems to be standard operating procedure in the UK. I am starting on a pump this month (I was having one or two hypos per day - 11 per year would be fantastic) and I had to convince them that testing 10+ times per day wouldn't mean I would become obsessive. We also got a "don't get obsessive" warning at the pump training session - a little ironic as it followed the lecture on the dangers of DKA and why you needed to test very frequently.

Joel

[Subby]

I just got my knuckles wrapped because in the past month I have had 2 lows (on the same day in the same hour, although she didn't see that, doh) of 2.6mmol/L or 47mg/dl and she also told me off for having 11 lows (2.4-2.8mmol/L or 43-50mg/dl) in the past 306 days with a low A1c of 6.2. Apparently 6.2 A1c corresponds to 6.2mmol/L average and I am crazy for thinking otherwise. However on the plus side I have excellent control although crazy for wanting to get my A1c down to the high 5s. Testing 10 times a day was considered excessive and shouldn't be contemplated as my life would be degraded by my now become obsession. She did think I should get a pump although I would have to discuss it with my doctor.

Is it any wonder why so many people don’t show these people their logs and/or refuse to look after themselves? If every time they turn up they get treated like this? While I am not proud of going low I do feel that it was an unfair judgement and more of an assumption that I must be going low with low A1c, any “signs” of low were treated as if they were more dangerous than a diabetic with an A1c of say 10.


I feel like I shouldn't even have to say this, but Shiftzor, you should forget this nurse, right now. Out of date, uneducated, opinionated, critical and plain out wrong. It's worth a bit of hassle to find another DE/nurse/anyone.

We expect the medical establishment to maybe be a bit stiff and conservative, but what you write of is more in the lines of incompetent and negligent with a good dash of hubris thrown in. There is usually no use in standing ground with people like this, once there becomes an issue you want to stand ground on (and there probably will)... moving quietly (and quickly) on is the best course.

[shiftzor]

I feel like I shouldn't even have to say this, but Shiftzor, you should forget this nurse, right now. Out of date, uneducated, opinionated, critical and plain out wrong. It's worth a bit of hassle to find another DE/nurse/anyone.

We expect the medical establishment to maybe be a bit stiff and conservative, but what you write of is more in the lines of incompetent and negligent with a good dash of hubris thrown in. There is usually no use in standing ground with people like this, once there becomes an issue you want to stand ground on (and there probably will)... moving quietly (and quickly) on is the best course.

Well this is at my "new" GP surgery in a different county. I left my uni doctor who wouldn't proscribe strips which I am very pleased to escape from. I totally agree with you, I am unsure of why I had to see her in the first place I already have an Endo at a diabetic clinic, who is far more clued up than this diabetic nurse is. I am just frustrated that seemingly finding a good GP surgery in this country is impossible. In my short span of having diabetes I have been registered with 3 GP surgeries, which is 3 different doctors and 3 different diabetic nurses all as useful as the next. Hospital diabetic clinic appointments are short and only every 6 months, they generally have limited useful advice, although some of it has been helpful at least to start off with. I have an appointment with the counties Diabetic Doctor Specialist person, he is supposed to be really good so maybe he can help me or at least support me. Best tool available to me at the moment is a diabetic support line run by the hospital which I hardly use. I guess it would be nice just to have a doctor/endo who would work with me not against me. Maybe I am truly crazy for trying to improve my control and wanting to test 10 times a day.

[Subby]

I guess it would be nice just to have a doctor/endo who would work with me not against me.

Amen, amen, amen. I'm in the same boat. My last DE treated everything I did as simultaneously A)being obsessed and B)challenging her authoratay, like we were in some kind of game of one-up-manship. (I just had to say some small thing I'd found out, in the hope of getting more info or other ideas, and she'd be immediately tight-lipped and one-word surly.)

On giving her my 12 basal rates on my pump, which are a tightly tuned curve through the day and have afforded me "sort of normal" control for the first time in my life, she shook her head and made some snarl about "think you know what you are doing, we'll do a CGMS and see if you are right or wrong..." - on passing over to the "pump doctor" she mumbled "I'll let you sort out this...mess..." to him. He did, by agreeing to "compromise" - down to 4 hastily conjugated "similar" rates (because to quote verbatim, that's the max a diabetic ever needs) which gave me the worst fluctuation and control on over a year, almost sending me into a car crash and hospital multiple times over the next few days till I felt I had no option but to switch back to mine. (Thus proving without a doubt my non-compliant status). I could have stayed on this insane basal rollercoaster and begged and begged over multiple phone calls over weeks to add ONE more basal, pretty please, mr doctor, while he went "up .5 here", "down .5 there" for weeks on end...... ahh nah, $!%@ that.

Anyway, that team is history for me, but I haven't found a good replacement yet. I will, but in the meantime my endo is at least supportive, if not involved in the pumping. I would also like a pump DE that I simply can get through a conversation without them feeling like they have to push a bunch of egotistical #$%# down my throat.

Part of my point in this little story is that for some people the stakes for them are basically their ego at work and being in some kind of "right". For this aim they are quite happy to be stupid, incompetent, and blind.


Maybe I am truly crazy for trying to improve my control and wanting to test 10 times a day.

I say maybe she's just full of mediocre platitudes and has no clue. And maybe you should trust yourself a bit, and allow yourself to be engaged with maintaining and improving your health and life.

10 BG tests a day, if you are at all similar to me in the way BG trends this way and that over the day according to multiple and often unexpected factors, is not excessive, it's probably quite an informative amount to be testing as far as keeping a reasonable handle on where things are going at most times.

[sofaraway]

sorry to hear you had a bad expereince. is your diabetes nurse actually a diabetes specialist nurse, or just a practice nurse who deal with all the diabetic pateints.
I've seen by 'diabetes nurse' at my GP surgery and she is absolutly useless. doesn't understand what carb counting is, didn't know that there was a half unit pen or understand why i wanted to use one.

I also see a hospital based DSN who is great and knows her stuff. she was initially concerned that i was testing too much 6-7 times a day and that my low A1c (5.9) meant alot of hypos. 2 years on we have a good relationship and realises i know what I'm doing, and will ask for advice when i need it.

the DSN where I work doesn't believe in snacking and injecting bolus insulin more than 3 times a day. And told me I couldn't have a donut :(

I think it's a bit hit and miss wheather you get a good nurse or not

[xMenace]

the DSN where I work doesn't believe in snacking and injecting bolus insulin more than 3 times a day. And told me I couldn't have a donut :(


The number one rule is you control diabetes. It doesn't control you. This DSN obviously doesn't get enough of something :eek:

[IrishJoe]

my experience of nurses is that they know more than non specialists int thier specialist areas. Also nurses tend to be more caring.

Crossbreed a nurse type and a doctor and you have a GOOD doctor XD

[Eddy]

However on the plus side I have excellent control although crazy for wanting to get my A1c down to the high 5s.


Getting into the high fives would put you within two sigma. I see nothing wrong with striving for that.


Testing 10 times a day was considered excessive and shouldn't be contemplated as my life would be degraded by my now become obsession.


Ooooh. So she's the goddess of both psychiatry and diabetes?

This is where a little thoughtfulness goes a long way: Had she simply asked how you thought your quality of life was, and whether you felt testing was running you, I believe you'd both be happier.


While I am not proud of going low I do feel that it was an unfair judgement and more of an assumption that I must be going low with low A1c, any “signs” of low were treated as if they were more dangerous than a diabetic with an A1c of say 10.


Dude. You have significantly fewer lows than I do. :congrats: I'm not about to cast any stones... Interestingly, I probably get to 2.4 as often as you do 3.0, and have more than enough sub-3.0 bouts.


11 hypos in nearly a year (with none lower than 2.4) sounds like a fantastically good effort in view of your decent A1c!


Again: I sure wouldn't mind shiftzor's hypo record! But I'd rather keep my A1c where it is, even with the hypos, than to run my average BG "enough" higher. Compromises, compromises.


I have seen some research that reports that 1-2 episodes per week of < 3.0 mmol/L is typical of "well controlled" T1's; you are doing much better than that.


I'm running about that, although with slightly higher hypo frequency. Matter o' fact, I had a pesky 2.6 mmol early this afternoon when I took a shower.

I'd be thrilled if I could run my current A1c with fewer hypos. And there are a few people on here who are in the low 5% or high 4% range, who also have fewer hypos. As long as one doesn't lose sight of the rest of life, I think it's great to try improving; I'm glad for what I've been able to do, but still want to do better.

Finally, note that the 95th percentile range of A1c, according to local lab, is 4.8 to 5.9. That's a variance of nearly 40 mg/dL. Ergo, different people run at different numbers; a 3.0 might be very close to shiftzor's "optimum" range, for all we know. (Or, it could be way out of line. If in doubt, I'll give the benefit of the doubt.)

[Gary_W]

GP surgerys get paid extra for giving services like diabetes nurses etc. Most hospitals are happy to palm the T2's off to the GP (not having a pop at T2's here, just telling it as I've been told it by local healtcare professionals) but really do not want T1's going to see them. They prefer to keep you under the hospital. Best to ensure you care is under them and forget the GP's nurse IMO.

My GP (who is excellent) has a nurse that does this. Very nice lady, but no good for me whatsoever. You will find that many of the GP based diabetes nurses are not diabetes specialists at all but general practice nurses who have had a short course in diabetes care (mine had had a 1 day course). Consequently, she was a good revenue generator for the practice and good for relieving the hospital of its burden but for patients, far from a good thing. It is all part of 'patient choice' in the NHS which is slightly more about revenue generation than it is about getting the best care for patients. Rant over. Well, that bit of it anyway.

Ask her a couple of questions and see if she knows the answers (perhaps about dawn effect or basal testing). If she doesn't know the basics, what good is she to you? Yes, you can see her more often than the hospital nurse but it is just wasting your time if she can be of no practical use to you.

Shortly after I discovered this place and learned how to basal test and carb count (11+ years into type one, sad isn't it??) I had an appointment with the nurse at the hospital. It was the only time we've met and I think we're both glad; she wasn't a whole lot better.

I was told you needed a 4 tests a day. Correction shots were never needed as you just add extra insulin at the next meal if you test high and eat regardless. Not doing so is obsessive and means that 'diabetes is running your life'. She carried on this line even when my HBA1c came back and floored her. And back then, hypos weren't a huge problem for me. Later on, they became rather more frequent than I'd like but that's another story.

What so many people who teach it but don't do it fail to realise is quite how mind-numbingly awful hyperglycemia can be. Once you get used to running on a fairly even keel in normal (ish) ranges, even a mild high can really spoil your day. Mind fog is no fun.

I agree with Eddy's point about the psyche evaluation. I am sick of this approach and fortunately my current nurse does not do it. I do not want a nurse who tries to be a counsiller; it's not what they are good at. If I need a shrink, I'll go and see one. What would be far better all round would be to get us all feeling as physically well as possible and realising that your mental health can be seriously badly affected by your physical health. Make me feel well and my brain will be fine by itself, thank you.

The only times I've obsessed about diabetes are times when I have been ill with it. These days, I pump and blood test at least 7 times each day, most often more. But these blood tests are as normal to me now as taking a shower or cleaning my teeth. Does that make me obsessed with hygene? No. It's just something that has to be done for your wellbeing, same as blood testing.

Gary

[Eddy]

your mental health can be seriously badly affected by your physical health. Make me feel well and my brain will be fine by itself, thank you.


This can't be underscored enough.


Does that make me obsessed with hygene?


Obsession with hygiene. Great. Now you're giving people ideas. Soon we'll all be hearing how we wipe too often.

:vroam:

(Crass hyperbole intended to make a point. Who decides on these black-and-white magic-number thresholds, anyhow?)

[Subby]

What so many people who teach it but don't do it fail to realise is quite how mind-numbingly awful hyperglycemia can be. Once you get used to running on a fairly even keel in normal (ish) ranges, even a mild high can really spoil your day. Mind fog is no fun.
Gary

This point, also, should be printed out and put up on the wall of every endo and DE out there.

---and they should be forced to read it and count slowly to ten BEFORE they accuse diabetics of obsession or psychological imbalance, in putting some actual effort into control.

[IrishJoe]

your mental health can be seriously badly affected by your physical health. Make me feel well and my brain will be fine by itself, thank you.
This can't be underscored enough.

QFT :)

(quote for truth)

[klpants]

I've come to the conclusion that everyone we speak to (we meaning with type 1) have no clue about type 1, UNLESS they have it themselves or have someone very close to them who also has it.
The problem with medical professionals is they group all patients into one big category and treat everyone the same.
:eek:

[shabbie]

you know shiftzor, i got a wrap over the knuckles from my specialist last summer because i had an A1c of 6.2.
he maintained that i am putting myself at risk of too many hypos and therfore can look forward to a visit to ER sometime soon in his opinion.

well i dont have hypos actually and i didnt listen to his advice to 'have a diabetic holiday and stop testing so much'

and the next 2 A1c's were 5.7 then 5.6%.

so i proved him wrong! he didnt say a word about my a1c's when i went last month ;)

anyway shiftzor, my advice to you is this....

if you fancy yourself a pump keep doing what you do already. it sounds like you may qualify for funding there...do you think so??
my Gp's practice nurse has nothing to do with my care. if i need the services of a nurse (about D), then i phone my DSN who is quite happy to help me. (last time i spoke to her was october!)

[Mich]

Well, in my humble (but healthy 49th year of diabetes) opinion, and this may sound like a quote from Forrest Gump, diabetes is like walking along a balance beam.

Sometimes you tip to the right, sometimes you tip to the left.

If you are a normal person and get caught up in a little too much bike riding or baseball playing or shopping, you may run low. You do a quick test, pop a glucose tab or two and get on with your life. For me, it's been unavoidable and didn't slow me down a bit. When low. I sit for a minute if I need to and go into about 15-20 minutes of careful monitoring until I know where I am, then move on and don't dwell on it. I usually find a way to have a snack if I am continuing to be low.

Now where in this picture do I need a nurse to tell me I was a bad diabetic? A nurse with actual diabetes would have never said that to you. Find a new advisor Shiftzor, you know what you are doing.

Mich