Why Harrumph?. Sometimes they feel like an inordinate waste of time. Take mine today as an example. It was what I’d describe as frustrating and underwhelming. I’m pretty sure the guy I saw was a registrar, because if he was a consultant he was very uninformed.
It didn’t start off well…
After being given a 9.40 appointment and being told to arrive early to get bloods and urine samples analysed, I arrived at 9.30. The nurse saw me for bloods at 9.50 and I finally saw the chap at 10.40. Only an hour late then. Nothing like managing your clinic properly… Made sure I have the first appointment next time.
Following the last six months of dynamic diabetes management and CGM, there were a number of observations that I had made that had led to me doing a fair amount of research into various things. As a result I had a list of topics I wanted to discuss. After a brief discussion on how I had managed to get data on to Diasend, as he was mystified that it could be done from home, the obligatory foot sensation checks that were passed with flying colours and the discussion about my last eye screening, we discussed my questions/observations and themes from the research that I’ve been reading, many of which I have previously posted on here.
Dynamic Diabetes Management (Sugar Surfing) – Nope, never heard of it. Followed by a brief explanation of what it is and how CGM enables it.
Injection Ports – No, never heard of them. Show off the one I’m wearing and explain about the price, that there are two types and how they are useful when sugar surfing as they reduce subcutaneous damage. Express that it would be good to get this stuff on the NHS.
Symlin and the glucagon metabolism – No, never heard of Symlin. Brief discussion of Amylin and Beta cell loss, and research about how glucagon plays a role in increasing blood glucose, why suppressing it would be a good idea, and a bit about the Krebs cycle.
So, you are starting to get the picture on what happens when I asked questions about stuff that anyone involved in a research hospital and endocrinology should at least have some idea about. Or so you would think.
What the Libre has taught me and many others about insulin timing and bg spiking, leading to split bolusing – I asked him when he thought someone should inject their Novorapid, Humalog or Apidra. His answer was at the meal or up to ten minutes before. When i told him he was wrong, and asked him to guess how long it took to take action, he was shocked. “As long as Actrapid?” he said. “No,” I said, “Less time than Actrapid.” I told him that the hospital needed to work with all their patients using CGMs and MDI to really understand the profiles of these insulins, and that relying on the manufacturers claims was not good practice or effective. Basically, they never bother to confirm the claims of the makers.
He also hadn’t heard about Afrezza but understood the idea of getting insulin directly into the blood ahead so that the Liver can be used to do the heavy lifting in relation to glucose.
My results (although I’m in line for a slightly higher Hba1C thanks to fewer hypos, driven by the Libre)/MDI management and use of basal and bolus – Very happy with the lower SD/Average calculation and that the Hba1C on the day was the same as two weeks ago. Went into a detailed discussion about the “basal profiles” I have concocted and why, and further discussion about why CGM really helps with this stuff. he admitted that were it up to him he’d give all T1s CGM.
He admitted to wanting to try out a Libre to understand how his glucose levels really worked!
A pump (please) – Didn’t get the opportunity to discuss this. Got kicked out as he felt we had used too much time. Something I will raise with the DSN, and to be honest, I suspect it’s something that I’ll probably have to look at funding myself like I seem to do with everything else related to managing my diabetes more effectively.
With all of the things on the list he hadn’t a clue about, he said he’d speak to the senior consultant and try and get answer from them, then call me and let me know. I’ll have to see if that happens.
All in all a very odd appointment, where I felt that I spent 45 mins educating someone who was a supposed “specialist” at a “specialist clinic” who really should know about this kind of stuff. It’s fine when you speak to the senior consultants and specialist registrars who are actually involved in the research and can provide useful feedback, but the more junior guys who are there to just take your details and make sure everything is okay really are a waste of time to an educated patient who wants to know more. At my next appointment I will make sure that on arrival I forcefully request that I am able to speak to the senior consultant on duty or one of the specialist registrars.
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