Lost and Stuck

[Iolanthe]

Hi need some advice and help please. I was diagnosed three years ago and at that time was not prescribed any medication, saw the DN once who told me nothing. Since then I have not been reviewed or offered any support at all by my GP. One of the reasons is, they refused to take my concerns over numbness and pain seriously, eventually I had to see a private GP who referred me to a consultant who diagnosed small fibre neuropathy. My GP was furious I had taken these steps, and this was not helped by another consultant who I was seeing for another issue who was so concerned referred me privately to an Diabetic Consultant. He, after tests prescribed Metformin 500mg SR twice a day and statin. When I saw my GP he was really sarcastic about what I had been prescribed and since then I have not had any kind of checks, apart from my eyes, where I was diagnosed with background retinopathy, which GP said he was very surprised as I had such a low HBAC1 and had not been diagnosed that long. When I asked the surgery for a Diabetes check, I was told I did not qualify as I had seen a consultant privately and they assumed they would check BP, feet urine etc. In fact they don't and have not been done since 2009. I was advised I needed to check my BM because of my diabetic complications, but GP refused to prescribe strips etc as they said there was "no clinical need." There is now a further complication, as I had a lesion on my leg removed,which did not heal and I had to have a skin graft 9 weeks ago. This is still not healing properly and I have now been challenged twice by the plastic surgeon and asked what my Diabetes was doing. I said I honestly I did not know, as I am not sure what I am meant to be doing about it! I take the Metformin but told my GP I did not wish to take the statin and wanted it removed from repeat, this has been done no questions asked. The Plastic Surgeon has said he wants to refer me in the NHS to a Diabetic Consultant, I am not sure if it will just been seen as time wasting. My last HBCA1C done 12 months by the private consultant was 5.2, so it was said I had good control, but how does this then equate to the small fibre neuropathy and background retinopathy and I don't really think my GP actually believes I have this. And I am worried that if my GP see's that the Plastic Surgeon has referred me he will think I have been making a fuss. The other alternative is to go back to the private consultant, but he does not do all the checks and the GP surgery don't see me as needing these. I am really confused about what I should do, expect and be checking, should I check my BM but if so I am not prepared to finance this myself. The GP in the practice is the "diabetic specialist", and so it would be him I have to see. What checks should I be doing, given my complications, should I be expecting more? I have been told I need to take control, but how I have no means of testing so what so they expect me to know, basically my Diabetes is doing what it is doing.I am really tempted just to leave it as it is, because it so much less hassle, just take the Metofrmin watch my diet and forget it! Any advice would be gratefully Received

[Lisa Holmes]

How confusing for you with all the conflicting opinions and the lack of continuity in your care. All GPs should be able to deal with your diabetes and so I would either see one of the others or investigate moving practices if you can't get the necessary care. Also aeeing if you can get another appointment with the diabetes specialist nurse for some support on this. With the fact you have some complications of the diabetes developing and now the issue with the skin graft I would would be tempted to take up the offer of the consultant referral and for the plastic surgeon to write to the GP to explain the need for the referral.

[Dr Masud Haq]

Hi

I would have to agree with Lisa. If you're not getting a satisfactory level of care from your GP you should consider changing to another practice. Even if you had seen a private doctor your GP needs to undertake the basic checks for all diabetes patients which include an annual HbA1c.

Your HBA1c was extremely good at 5.2% 12 months ago but if your plastics consultant is concerned about wound healing it's essentaily you have an up to date check of your HbA1c, cholesterol and renal function. It's quite possible things may have changed and your treatment may need to be adjusted. Wound healing can be affected by persistent high blood glucose levels. If your HbA1c is above 7.5% then your metformin should be increased and if it's much higher than 7.5% you might need the addition of a second agent.

Hope all goes well.
Masud