How do you know if you’re getting good diabetes care?

By | 6 July, 2011

This dog doesn’t often get the chance to chat with others about what diabetes care they receive, so it’s hard to get an independent view of what should be happening and then compare that to your own reality.

This dog fetched himself a copy of the latest National Diabetes Audit and was aghast to discover that two thirds of people with Type 1 don’t get all the annual health checks recommended for those with a dodgy pancreas.

Other interesting/terrifying stats include the fact that only 28% of Type 1’s have an HbA1c of the recommended 7.5% or lower and in children that falls to just 14.5%. Canadian online pharmacy offer buy Glucophage metformin online. This dog wonders whether the target is realistic, we’re not supporting people well enough to play at being their own pancreases or perhaps diabetes is just quite difficult to manage?

Everyone’s second favourite diabetes charity, Diabetes UK, has a leaflet that takes you through the basics of what care you should expect to get if your pancreas is below par.

What care you need varies from person to person, but it’s always handy to know what good looks like so you can ask the right questions if you think you’re being short changed or say nice things if your diabetes team are doing all that’s expected of them.

8 thoughts on “How do you know if you’re getting good diabetes care?

  1. jason

    wow really some staggering stats there @neville. I’ve had a dodgy pancreas for 23 years, and only in the last two years have I managed to obtain a HbA1c of less than 7.5%. This is due, in part, to a new pump, but most of the improved control can be attributed to simply re-learning some of the basic principles, such as eating more low GI foods, TAG bolusing, bolusing the correct amount of time before meals, carb counting and the big one (for me) is not overtreating those pesky “tesco hypos” with more than 20g. Mix in a little light exercise and my H1c is now 6.3 and I hope to lower that to around 5.5% at my endo appt next month.
    My point is that it took 20-odd years of average/poor control before the penny dropped and I overhauled my idea of diabetes education. Even with the unpredictability of diabetes, there is no secret, and nor is good control down to luck, it can be learnt, and that is where (I think) our heathcare providers could do more to advise type 1’s that no one can do this for us, changes to our control must come from within 🙂 *gets off soapbox and puts kettle on*

  2. Rohan

    They are some pretty shocking statistics. What’s kind of annoying for me, having achieved the hallowed 7% at my most recent Hb check, I have no idea what I’m doing right! Especially as I was expecting it to be bad. The one thing that I always find really helps with stability is exercise – OK< so maybe I have a few more hypos when I really get my exercise one, but overall I find I have FAR less highs, and things just seem to work as expected. When I stop exercising so much for extended periods (if I have a lazy winter and stop cycling to work, for example) I find my control gets a lot worse.

    @jason – Is 5.5% not a bit TOO low? Fair enough if you can maintain it without lots of hypos, but my (quite possibly wrong!) understanding is there is such a thing as TOO low for the old Hbs..? Well done on getting them down though, feels good to be told you’re doing it right, eh?

  3. lady up north

    I was recently reminded, when attending an evening event held by Diabetes UK, that we are supposed to have annual foot checks. There was much talk about the importance of these and about the various complications of the feet which we may suffer.

    Ha ha ! Thought I – is this why I have been getting numb toes, pins and needles in the legs and feet and aching calfs ? Maybe its not to do with the hip bursar problem.

    And I last had a foot check in the spring of 2009 so am well overdue one.

    So I went around the houses to get a foot check arranged.

    The DSN told me to see the podiatrist at the Diabetes Centre at the hospital.

    The receptionist at the flashy Diabetes Centre at the local hospital told me I could only see the podiatrist if my GP referred me.

    The receptionist at my GP surgery told me to see the podiatrist based in the same building (one of these multi purpose health centres with all sorts of things available on site).

    The podiatrist there told me to see the nurse attached to my GP surgery.

    I saw her and got my foot check – she has now referred me to the podiatrist at the Diabetes Centre at the hospital.

    AAAGGGHHH !

    As for HbA1c, in over 20 years of being T1 I have only once acheived the hallowed result of less than 7.5. In April this year it was 8.1 and my consultant was delighted, given that in November 2010 it was 10.6. I can’t account for the improvement, if anything my diet and exercise levels have been of the “lets fatten up to survive the coming winter” sort of thing.

    Maybe 7.5 is just a myth perpetuated by the medical world to make us all feel inadequate 🙂

  4. Alison

    @jason Congrats on the HbA1c reduction, that’s brilliant. I agree with you – we don’t do nearly enough around coaching/motivation/helping people deal with the mental side of diabetes because ultimately, it’s only the person with the broken pancreas who can take control.

    @neobrainless I’ve always worked on the principle that if I’m comfortable and not having too many hypos, my HbA1c isn’t too low. If I’m falling over hypo every day, it probably needs to go up a bit.

    @ladyupnorth That foot care is appalling! I’m really lucky, I get called for annual checks (most of the time) and every time they tell me if I have any issues inbetween – or even if I need them to cut my nails for me (which I think is a ridiculous thing to prioritise for a otherwise healthy 32 year old) – to just give them a call.

    Did they show all those gruesome photos of manky diabetic feet at the event you went to? All those weeping ulcers and gangrenous toes just reinforce my belief that I could never be a chiropodist!

  5. jason

    @rohan Yes I agree, a 5.5% target range is kinda low (but without too many hypos….sorry for the bad pun…!) and a big help for me is the reduction of carbs, from a daily 240g down to about 120g. Eating a bit more fish, veg, eggs and all that good stuff, and reducing potatoes, bread and rice. This helps hugely with post meal bg’s. Lots and lots of testing helps to avoid hypos, apart from, of course, when shopping in Tesco, when all bets are off.
    Totally agree with you on the exercise front- even walking the dog for 30 minutes has a stabilising effect on bg’s! Dog loves it too.
    @alison thanks! I’m lucky in that my endo is good and very pro pump use, and provides lots of encouragement and support. He actually yelled at me once when I missed an eye appointment! Love the website 🙂

Leave a Reply