# GP's Surgery are being idiots - can I have a rant on here please?!



## Babysaurus (Mar 7, 2012)

I got a call from my GP surgery yesterday re the amount of strips and insulin I am asking for. 
I explained I was a Type 1 and also six and a half months pregnant, along with recently having gone on the pump, so was doing a lot of tests - between 12 and 20 a day. I was immediately told, in a nice but firm way (if that makes sense, she wasn't overtly rude but was very much 'telling' me) that 'that is way too much, we recommend four tests a day. More than that is unneccessary.' 

So, I then explained that I have been advised to test before meals, after meals, and also need to test before and during exercise, before bed, when I get up, and often before and after snacks etc as I needed to be extra tight with maintaining the control I have etc etc (as you guys all know.) I also said that I was developing insulin resistance, which is common with Type 1's in later pregnancy, and this too needed to be kept on top of which is done by more testing. The GP said again that four times a day was fine, and my current rates of testing were 'ridiculous'. It was like talking to the wall. 

Then, she asked why I wanted 'more than one vial a month' of insulin (most patients only need one allegedly.) Again, I explained that I was becoming resistant so the 300 units I was getting through every two days meant I needed more than one vial a month. Again, this is apparently 'way too much' so she said they won't give me more than two vials a month and if I needed more I needed to make an appointment to come in and discuss it when them. 

Grrrr!! What on earth does she think I am doing with all this stuff? Selling it?!

I think I am especially annoyed that this GP clearly knows a limited amount about diabetes but is still giving 'advice' on how to manage it, something especially risky during pregnancy. Imagine if I didn't know better?! I had explained exactly why I was testing in the patterns I was, and this explanation was close to brushed off as if I was simply neurotic. I also said that I understood it was expensive but it was unfortunately part and parcel of the way things are at the moment - I wasn't living like a science project for fun, after all! I also said I didn't want to be down to my last couple of strips before I could get more, this is especially irritating if I was away for a few days, and it's not like they go off is it? I can always not order some for a bit if I have too many (unlikely at the moment but still...) They have agreed to give me six tubs (negotiated up from 4) of strips a month and said I will have to buy any others.  

I have left a message with my DSN who's fab and hopefully she can make them see sense.  

Rant over.


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## allana (Mar 7, 2012)

I don't blame you for ranting! I had a similar conversation re the amount of strips I had requested. It drives me crazy when gp,s question every repeat prescription request.

I hope your dsn will talk some sense into your gp Hun 

Xxx


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## PhoebeC (Mar 7, 2012)

Rant away.

I wish i was shcoked by this but im not just annoyed for you.

Because when i had Jemima i was early and unexpected only had one box left, thats 50 stripes, so like you say testing on my own monitor during labour testing every 2 hours i soon run out and the hospital couldnt give me a prescription, even though they are a hospital they couldnt get me anymore.

Ive never heard of anything so silly, I d ran out because of their testing all the time and they wouldnt do anything to help me out, i had to get my father in law to drive 10 miles to pick the stuff up from the chemist so i had them to use in the hospital.

Really you need a few spares of everything because your pregnant.

Id phone your team at the hospital or your dsn and tell them the score.

Hope you get it sorted,

xx


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## sugarfreerach (Mar 7, 2012)

Are you on a pump did I see mentioned previously? If so contact your pump nurse and ask her to write a letter to your GP. Mine did and it was sorted. I wasn't allowed the extra strips or insulin after pregnancy though,which was fine as my insulin went down dramatically and I don't have time to test half as much.


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## Robster65 (Mar 7, 2012)

DiabetesUK should have a service to contact GPs who need a bit of an update. It's a common problem and one that needs addressing but time and again, we have to run round getting A to tell B and nothing moves forward.

Imagine if you weren't so clued up or more timid. What damage would be done by following the GP's advice. But I'm sure it wouldn't show up statistically. It would go down as poor self-management.

I hope you manage to get things sorted.

Rob


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## Northerner (Mar 7, 2012)

I find this utterly outrageous and ridiculous  As you say, clearly this GP knows next to nothing about Type1 diabetes - let alone the very specialist knowledge about insulin pumps and diabetic pregnancy! To dismiss your explanations is highly insulting, and just shows her ignorance even more. You should not have to deal with this at a time when you have rather more pressing concerns. In a way, it doesn't surprise me that much, as I read a while back in a book intended for GPs that 'Type 1 diabetics may need to do two, or as much as four tests a day' 

I hope your DSN puts a rocket up her pants so that she apologises and is shamed by her attitude.


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## trophywench (Mar 7, 2012)

I'm seething on your behalf!

There's little point in my asking these questions, I realise BUT

How many T1 patients have they got?
How many of them are pumpers?
How many of them - pumping or not - are at ANY stage of pregnancy?

My GP clinic is pretty big - suburbs of Coventry - at least 6 doctors and usually one locum as well.

One 'diabetes specialist GP'.

Dunno how many diabetics, or how many T1's out of that.

How many pumpers? - ME.


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## Babysaurus (Mar 7, 2012)

Thanks everyone for your replies. Its good to be able to vent my frustrations onto people who understand! 

Phoebe I am even more aghast at your story! That is truly bonkers! I could understand it if we were all demanding something like valium or methodone, but blood testing strips, I suspect, don't have quite the same 'street appeal' do they? 

Yes, clearly the GP does not have a clue about Type 1 diabetes, which is why I was trying to explain to her the ins and outs of why I was requesting the amounts I was requesting. I also added that while I realised it is expensive, it is probably far less expensive that diabetic retinopthy etc which could be (another) nasty consequence of bad control or any of the other nasties I could easily develop as a consequence of not keeping on top of things. While I say she was polite about it, she was, she clearly saw herself as the one who knew better and my explanations didn't seem to make any difference. 

Normally I like to have a small stock of strips and insulin too, beats going to the chemist once a week like I am having to at the moment, but I think there is fat chance of that at the moment! 

My DSN will hopefully make them be able to see sense. In the meantime, I am justifiably angry at being given pointless advice by someone making out that she knows what she is talking about! 

Trophy - I think your questions are good one's to ask. I will steal them and use them when the need next comes up. (While I wish the need wouldn't, I have a horrid suspicion it will...) 

Thanks again everyone x


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## Babysaurus (Mar 7, 2012)

GP's advising like this make me realise quite why the ante-natal clinics are full of diabetic women with mahoooosive bellies!


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## Twitchy (Mar 7, 2012)

Babysaurus said:


> GP's advising like this make me realise quite why the ante-natal clinics are full of diabetic women with mahoooosive bellies!



Easy tiger - mahoosive belly does not equal poor control - i had massive amounts of excess fluid first time round with an HbA1c of 5.8%. 


Babysaurus - I think it might be time for the magic phrase : "if anything goes wrong with this pregnancy due to the restrictions you are imposing on me Dr X, I WILL SUE YOU. Not the practice, YOU. If you don't support me i will also be going go DUK, my MP & the press.". (as the medics seem to assume we are looking for any excuse to sue, maybe we ought to use that to do what we need to in order to keep baby safe?!) Really frustrating to hear you hVe this stress on top of the already stressful nature of a diabetic pregnancy, don't let the expletives get you down!! Let off steam here & know that we're rooting for you! Xx


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## margie (Mar 7, 2012)

Babysaurus said:


> Thanks everyone for your replies. Its good to be able to vent my frustrations onto people who understand!



Do you drive ? As that is another thing that can increase the number of strips you need. 

I hope that your DSN can speak with the GP and maybe explain how pregnancy can affect your diabetic control and why it is important to be able to do all these tests.

Good Luck.


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## Abi (Mar 7, 2012)

By refusing to prescribe sufficient insulin they are putting you at risk of DKA. Maternal DKA carries a very high risk of foetal mortaility. I think this warrants a formal complaint


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## trophywench (Mar 7, 2012)

If you just have ONE hypo, that's at least 2 extra strips you'll use - one cos you think you are low, the next to see if your treatment worked.

Does she even realise what the BG parameters ARE in pregnancy? - 3.5 to 5 before meals, no more than 7.8 one hour later, is it? - and if not adjust either insulin or food to suit, and keep on testing at those intervals EVERY SINGLE time food passes your lips for 9 months?


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## Robster65 (Mar 7, 2012)

...and then ask her to run through how you can maintain those figures on 4 tests a day. And what happens when you've used your 'quota' of insulin and find yourself at 15mmol/l after one of your 4 tests.

Should get her thinking creatively. 

Rob


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## Ellie Jones (Mar 7, 2012)

Don't dismiss that insulin isn't saleable it is and like test strips it is illegally sold on the black market and places like ebay

I'm not siding with your GP, but in part she didn't act totally out of order...  She acted responsibly to a certain extent.

Large increases in the need of prescription medication could indicate that something isn't right, it could be illegal intentions, suicidal tendency or even that the patients medical condition needs an urgent review...  So investigation does need to be done to find out what's going on.

Which yep your GP was totally right in phoning to ask, where she went wrong is her response to your reasons..

You've contact your DSN who is more than likely contact your GP to put her straight etc. 

But why don't you book an appointment to see your GP, print off your data from your pump and your meter...  Then she can see that you are using what you say you are, and you can explain why you need to use this...


Mind you how on earth do you go through 20 test strips in a day, I don't do this even when I'm basal testing for pump adjustments, my average 8-12 per day..


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## Babysaurus (Mar 7, 2012)

Ellie, I can use _up to _20 a day as I am testing before and after meals, do a hell of a lot of exercise which makes levels fluctuate, am also testing more when I get a higher or lower reading than I need. It is very easy to get up to 20 a day, or just under. I also have been on a pump for just over a month. Normally people are given a 6 month period to be expected to get used to it, being pregnant I don't have this luxury so am in at the deep end. This too results in a lot of testing to make sure the insulin sensitivity settings are right, and these too can change every few weeks due to insulin resistance which you can't know about if you aren't testing. As I said to the GP, I am not just doing all this for fun! Maybe she was right to ask (although I still think this sounds as if it is more cost related than anything else) but she certainly was not right in her responses. 

Also, I don't want to book an appointment with the GP. I have enough on without booking appointments with someone to explain why I am asking for what I am asking for, I tried to do this over the phone to no avail anyway. 

Twitchy - ooops! I cocked up there didn't I?! Sorry, I realise it's not purely due to bad control, there are other factors which can make you huge too. Not sure if I fancy the threatening to sue route, tbh. Hopefully they'll see sense soon instead! 

Trophy - that's a very good point. One hypo does indeed use up two strips, or sometimes even three. I suspect she doesn't know the parameters in pregnancy, no. (Are they different from Type 2? Maybe that's where the confusion comes from.) This in itself is fine, she is a GP not an endocrinologist after all, so nobody is expecting her to know. However, as this is clearly the case its surely not a good idea to start telling people how to look after their diabetes or how much medication they need.


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## RuthieG (Mar 7, 2012)

Ellie 

I have to agree with Babysaurus here on two points 
1) The GP should see enough of her history (pump, pregnancy) to ask reasonable questions about her current situation and there seems no evidence that she was considering her welfare, suicidal thoughts etc
2) I have definitely had days as a new pumper and pregnant where i can use 15 or so strips. For exampe today when my after meal reading was 9.1 (it should be 7.8 or under). I corrected and tested again an hour later and it was still high so corrcted again. Then 45 minutes tested again and it was finally coming down. Then tonight I will test after my meal (prob not befor as it is nearly meal time, before and after exercise and before bed. So that is waking, after brekkie, mid morning x3 post meal (inc corrections), before lunch, after lunch (x2 - one correction) and then at least another 4 tonight. That is just an average day so I would say the odd day it could be a few more.

I don't have a downer on GPs because I personally have had a good experience with them all but that doesn't mean I would understand how this GP acted becaus it seems unreasonable.


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## RuthieG (Mar 7, 2012)

*Insulin per month*

Also Babysaurus for inf my pump DSN said she usually says that a pumper will need three insulin vials a month. That seems about right to me, althoug it is early days so still experimenting a bit with basal


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## Smit (Mar 7, 2012)

Lol I came on tonight to post the exact same thing. I am the opposite, insulin levels not going up and having loads of hypos. My doctors have said im only allowed 100 test strips a day. Then when I questioned it was allowed 10 a day. Still not enough. i spoke to my consultant at the hospital yesterday and he has written an email to GP, hoping it will sort things out. Xxx


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## Babysaurus (Mar 7, 2012)

Smit, I hope it sorts things for you too. As I have said, its not that I don't understand why they are questioning things as strips etc are very expensive so they obviously don't want to be paying for things unneccessarily, but its not like we have a lot of choice but to make sure things are okay at the moment is it? 

Ruthie, your HBA1C's are almost identical to mine! I am glad you too find it is easy to use far more strips when trying to get your BG down to target level. Normally I would not worry about being, say, 9.0 an hour after eating but at the moment its very important to be within target range and also not risk it going any higher. Generally, I have been able to keep within target, but occassionally it has shot up and has taken longer than expected to come down. Likewise, I have tested more than usual if a bit low as I don't want to risk over as well as under-treating. 

Its a joy being diabetic and pregnant isn't it!!


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## PhoebeC (Mar 7, 2012)

See i was the other way(lows) but still needing to test 20-30 times a day
Hypos non stop so like you say test to find the hypo then many trying to get it back up
You really don't need the added stress
Don't they know happy mum equals happy baby! X


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## trophywench (Mar 7, 2012)

See this is the prob in preg; you shoot enough insulin to kill that spike post meal in it's track, which will then lead to a hypo so you test, snack (or don't test and snack anyway if you happen to have it bang to rights one day) and then you test pst snack and that's how you go.  As far as Baby Grumplin is concerned HIGHS are verboten, HYPOs (as long as they ain't the lose consciousness kind) are fine .... so though nobody LIKES having hypos - you are pretty much stuck with em for 9 months - if you don't want to produce an unhealthily huge and ailing baby, of course .....


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## RuthieG (Mar 8, 2012)

Babysaurus - yes out HbA1cs are nearly identical - that's why I like reading your posts and even better that you are about 6 weeks ahead of me ha ha!

I had two highs (well 9.odd) after meals yesterday whihc is unusual. That is what I was struggling iwth before the pump though. I was having post meal highs (early teens) followed my a massive hypo, whether I corrected r not. I was only ever correcting by a max of 1 unit because it was having such a huge effect. The pump has really levelled things out though. I am still trying to get my basals just right because the doc says I am still having too many hypos but I have been really trying to minimise those the last week or so. To be honest I can live with a few hypos (although I was having about 4 a day pre-pump!) but the docs say I need to watch that more. I know they are right but when you are so scared of highs for your poor little baby, it is easy to forget hypos are not good either!

I have my 20 week scan on Tuesday and am counting down the days. I can't wait to check that everything is (hopefully) alright in there. 

I was trying to explain to my aunt how tough a balancing act it is and all I could say was that you can NEVER relax when you are pregnant and diabetic becuase you seem to be only every 30 mins max from your next test! 

It is really great to read your posts as I said so keep 'em coming! Any tips you can give for where I will be in 6 weeks time are more than welcome!


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## Babysaurus (Mar 8, 2012)

Ruthie, when my last HBA1C came back at 5.3 I was told that I needed to get it higher and not risk any lower. I had another sample taken last week so will find out what it is next Wednesday. 
I don't find hypo's as much of a worry really, its the highs that freak me out. I too am struggling getting levels down after eating in the morning - they seem to shoot up to 11 now, but do come down reasonably quickly with no nasty hypo's (not one's that I don't see coming anyway.) I am trying to get hold of my nurse to discuss this, and the GP situation, with her so will pass on anything handy. 
Yep, always 30 minutes from your last test sounds about right! My friends seem to struggle to get what the big deal is too as I have never come across as it being a big deal before. It normally isn't, my control is fine but now keeping it to the very tight guidelines it is 'ideally' during pregnancy is a different matter altogether!


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## allana (Mar 8, 2012)

I love reading both of Babysaurus and RuthieG posts as I am due 9th of Aug, I am however on injections and I am now wishing I was on a pump! It's so nice to hear your stories as it makes me realise I'm not the only pregnant type 1!

Xxxx


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## Babysaurus (Mar 8, 2012)

Allana, Guess we are going off topic a bit now (is that allowed or ought we start another thread?) but I have to say the pump has been great for evening out the ups and downs. With injections I was tending to go hypo in the night, but any lower on the Lantus made me higher during the day (even when splitting the doses there were issues.) The pump enables you to turn it up and down for various parts of the day, and you can even tweak your insulin resistance to get more Humalog in the mornings than in the afternoons, if that's where you tend to have spikes. Its def a lot more adaptable.


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## PhoebeC (Mar 8, 2012)

trophywench said:


> See this is the prob in preg; you shoot enough insulin to kill that spike post meal in it's track, which will then lead to a hypo so you test, snack (or don't test and snack anyway if you happen to have it bang to rights one day) and then you test pst snack and that's how you go.  As far as Baby Grumplin is concerned HIGHS are verboten, HYPOs (as long as they ain't the lose consciousness kind) are fine .... so though nobody LIKES having hypos - you are pretty much stuck with em for 9 months - if you don't want to produce an unhealthily huge and ailing baby, of course .....



See when i had hypos when pregnant id be sick, i had morning sickness nearly every day due to this. And when your sick you cant recover from them so it was a horrid cycle.

Also you should snack alot rather than eat big meals so for this reason alone the testing is needed.

And they are one of the signs of a falling placenta so need to be watchted.

I had a few bad hypos when pregnant had to call an ambulance twice.

To be honset getting time to test now with a toddler is rare so its probaly balanced out 

xx


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## Babysaurus (Mar 8, 2012)

Apart from the diabetic side of things, which has been a pain in the bum, I haven't had any severe other symptoms such as morning sickness. You have my every sympathy Phoebe, I would imagine morning sickness with diabetes is a bloody nightmare! I have found that I am snacking a lot though, I do seem to get very HUNGRY and have to eat immediately. (Its not like a hypo kind of hungry, more like a hungry you'd get after, say, swimming where you want to eat immediately if not sooner!) 

In 32 years the only time I have needed an ambulance was about 6 weeks after I miscarried and it was the morning after a wedding. The wedding catered for 60 and there were 200+ plus there (nice people having it, but the whole thing was utterly shambolic.) The morning after I must have woken my husband up (we were camping, as were lots of other guests) and he tried to get me to drink some Lucozade. I could not move my mouth / throat or co-ordinate my limbs, it was horrific!  After what felt like twenty mins if this, two friends were also in the tent trying to get sugar into my mouth and I couldn't tell them I could not swallow and was terrified they would choke me - they called an ambulance. 
My mind was clear all the time, I just couldn't work my arms, speak etc. It was truly terrifying. I was trying to say to them that I needed Glucogon - I had some in my toiletry bag but it had been there so long, and I had never needed it EVER, that it didn't occur to anyone. Normally with a hypo I may be a bit wobbly / drunk at worst then I have something to drink / eat and am fine. That hypo was another league. I can't look at pics of that wedding now, it both upsets and frightens me. 
The reason I mentioned the miscarriage is because the DSN said, as it had never happened in such a way before, it may have still been the hormones playing up so my body was behaving in a different way. I had drunk the night before but not excessively, and tbh have drunk far more than I had that time and been fine. I didn't eat much either due to the lack of catering but have never had such a reaction. I hope I never do again...


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## RuthieG (Mar 8, 2012)

I too have had a pretty easy time, diabetes aside, so far. I was a little bit sick early on but it was never so bad as to affect my BGs really. I have noticed a few changes the last week or so - needing more insulin in an afternoon but less background in the morning (which is more or less the opposite to a few weeks ago but I guess that's how it goes for the next few months!)

Reading about Phoebe's experience and lovely, healthy daughter is very reassuring that after all this it should all end happily!


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