the bad diabetic

So a conversation on twitter sparked this blog post and its about should gp's treat all diabetes?

The conversation was triggered by Partha's blog post in which he recalled a meeting where gp's said they could treat all kinds of diabetes that 'there was no need for a diabetes base in hospital'. It kind of reminded me of this photo...

In my opinion we should be playing to the strengths of the GP and of the specialist. I want to start off by saying i like both my GP and my consultant. My GP has been my family's GP for over 30 years and mine for 18 years, he was the one who diagnosed my diabetes straight away. He's a great GP and oversees the management of all my chronic conditions and regularly asks how my diabetes is and is the one who thought outside the box and put me on the mini pill to stop the havoc my bg was going through monthly but he doesn't know the intricacies of dealing with type 1 especially a type 1 on the pump.

I'll give you one example of why i refuse to let my GP treat my diabetes and I why I hate QOF. Last December i got a phone call telling me to come into my GP. When i got there it was to be told my hba1c was 'very high' at 8.5 % and I had protein in my urine and he thought I should go on ACE inhibitors because of the protein and my blood pressure which was 120/80. My hba1c was actually that high cause I had hypounawareness and all 4 members of my team had said the priority was to get that back, when I'm the only type 1 in the practice my GP mainly deals with type 2's who would never really have the severe hypos i was having which were often 3 or 4 a day and in the ones. Plus it was Christmas and whose hba1c doesn't go a little higher at that time!  My consultant figured out the protein just by looking at the time it was taken which was just after a meal... it turns out it was a false positive and all 3 of my next tests came back as trace and also because my consultant is able to spend a lot more time with me than my GP does he knows how stressed i get by appointments which explains the slightly raised bp. 

I doubt my GP could give me the time i need in appointments to manage my diabetes or have the knowledge to figure out these bg...

or look at this graph and figure out whether i need to increase lunch ratio and decrease tea ratio or increase basal mid afternoon and reduce it in the evening where there's been a few hypos or were the hypos caused by chasing numbers in the afternoon or do i need a slight increase across the board to bring the average of 8 down slightly to get my hba1c below the 7.5 without causing too many hypos.

This is where my consultant and dsn come in. People who are trained specifically in type 1 diabetes who have years of experience (think they'll both kill me if I say how much...) and help me make the adjustments to achieve optimal control. Lets play to that strength of knowing type 1 and its regimes and equipment inside out. They know my case , they know me and they can give me the extra time I need to manage my condition which at the moment is fortnightly appointments with the nurse and monthly contacts with the consultant because lets face it :

and leave the GP to do what he does best for me overseeing all my treatment and diagnosing and treating the minor illnesses i have and leaves him free to deal with other patients who would get a lot more out of appointments than i would and who need the appointment a lot more than i do. This is why i refuse to do GP appointments about my diabetes cause it is a waste of their time and its a waste of mine.