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Original poster

Newly diagnosed diabetes? - bounced between gp and hospital

75 replies

tendofether · 19/03/2021 15:59

Hoping someone might be able to offer some insight

Husband has been thirsty, weeing a lot and losing weight, had a urine test and the outcome of which was told to go straight to hospital. Hospital put him on a drip, ran some tests and discharged, advising he absolutely must see the GP first thing in the morning.

Saw GP & Nurse this morning (after getting through the 8am phoneline scramble) and they've sent him straight back to hospital with a letter, saying they can't understand why he's been discharged.

So back to hospital, they've run blood gases and they are trying to discharge again.

Can anyone offer any insight as to what the normal process would be for a new diagnosis of diabetes (i'm assming type 2)? He has had no treatment apart from a saline drip thus far from either doctors or hospital.

OP posts:

Greybeardy · 19/03/2021 19:00

Ketonuria can be caused by plenty of things other than diabetes. If he’s not acidaemic, has low blood ketones and is generally well it isn’t often a crashing emergency so the hospital management may be completely reasonable (a&e isn’t the place to be starting treatment for newly diagnosed type 2 diabetes in someone who’s generally well and an inpatient admission isn’t usually required either... it would usually be a GP territory so perhaps as they’ve not done that there’s something else/they’re not certain of the diagnosis). No one on here has the full information though and therefore no one on here can really advise you sensibly. Hope he gets sorted soon.

Kazzyhoward · 19/03/2021 19:18

Some GPs do seem to be taking the easy option of fobbing off patients to the hospital rather than dealing with things themselves at the moment. I wonder if that's what's happening with the OP's doctor?

Similar happened with my sister a few weeks ago. She had excrutiating stomach pains for several days, with 2 or 3 phone consultations with various GPs, which led to a GP finally seeing her (for about 2 minutes). She was told to go straight to hospital to be admitted via A&E. In A&E, she had to go through triage etc and then finally was told to take herself to the Gynacology ward (!). She knew damn well it wasn't a gynae problem (wrong place), but that's where the GP had referred her to. At gynae, the admitting doctor couldn't understand why she was there and couldn't understand why the GP had referred her, so he made a few phone calls and told her to go to a different ward for admission ( a general ward). When she got there, the consultant didn't know why she had been sent there either and discharged her back to the GP to sort out tests etc.

It's just a "fob off" service sometimes.

Original poster

tendofether · 19/03/2021 19:28

Yes, he does seem to have been caught in some sort of pissing contest between gp and hospital. So he's been sent home with a prescription for Metformin and nothing more (i.e. no monitoring). So he'll either try to contact out of hours over the weekend or try and get back to the gp on Monday.

One of the doctors he saw actually said looks more like Type 1 but they've sent him home with a type 2 diagnosis. :-s

He said he was berated for being there despite the letter, and the gp having a conversation with another hospital doctor. Lots of comments about "bloody gps". So unprofessional, irrespective of whether gps are sending patients unnecessarily, it's not the patients fault.

Of course, it took them from 1pm to 7pm to decide to do nothing so by the time he's sent home no option to contact the gp

OP posts:

Interested in this thread?

Then you might like threads about these subjects:

Diabetes General health

ThePug · 19/03/2021 20:36

@tendofether you may want to go to Boots (or another largish pharmacy) over the weekend and try to buy a blood glucose monitor and some test strips - there are basic ones you can buy OTC. Do some testing over the weekend and if blood sugars are very high (I'd class >15 as high and >20 as extremely high) suggest you try and contact the hospital ward again and ask to speak to whoever has seen him today/their equivalent. Does sound more like type 1 to me. Non-diabetic hba1c is

MacDuffsMuff · 19/03/2021 20:37

One of the doctors he saw actually said looks more like Type 1 but they've sent him home with a type 2 diagnosis. :-s

Well this is pretty shocking. OP I'm not trying to scare you, but Type 1 needs very careful monitoring. What a shit way to treat him.

LIZS · 19/03/2021 20:43

There should be a number for the Community Diabetic Nurse on gp or local health trust website. A monitor with strips, lances etc should be provided foc and he would be entitled to free prescriptions.

SharpLily · 19/03/2021 20:45

Adult onset type 1 can appear as type 2 but a good doctor and thorough examination can distinguish between them. The type 1 is autoimmune, type 2 is not, and the right kind of blood test will pick that up but few doctors will look past type 2 in adults of a certain age.

Original poster

tendofether · 19/03/2021 20:49

So I didn't know previously, but before they tested for ketones today and sent him to hospital they'd actually sent through a prescription for metformin and ketone testing strips. So that was also there when he went to pick up prescription from hospital. The dose he's been given by the hospital however is double the one given by the doctor.

The ketone strips also say if level is 2+ to contact doctor immediately so we'll see what happens tomorrow when he tests. (The doctor sent him to hospital on the basis of "BM19 and 2+ ketonuria" today)

OP posts:

Barksmum12 · 19/03/2021 20:59

What’s his BMI? Any amily history?

mice · 19/03/2021 21:05

Sounds very similar to my husband was. He was constantly thirsty, lost about 2 stone in a few months and when finally got to the Dr his blood sugar was 25...diagnosed that evening at hospital as type 1 and was lucky to have not needed admitting. Went back the next day to learn about injecting testing etc etc 10 years on and all well managed now.
This does sound quite similar..

Original poster

tendofether · 19/03/2021 21:13

He's overweight but not massively so. His Dad was diagnosed but only last year and in his seventies.

OP posts:

RB68 · 19/03/2021 21:14

OK T2 and gestational here (had a gap of a few yrs then t2 kicked in)

90 isn't horrendous for HBA1c but it should be being medicated
HBA1c basically looks at blood sugars over 3 months so it looks like it has been ongoing. It sounds like GP concerned about ketosis which Hospital should be able to get under control, but GP also needs to prescribe something to get sugars under control longer term.

If you are not getting anywhere with GP stay in hospital and ask them for longer term treatment options - they should be able to give him initial drugs in the hospital with a go back to the gp for more tests to make sure they are working. In the mean time keep him lowcarb no sugar - plenty of veg and protein is good, stay off the higher sugar fruits - stick to berries rasp/blue/strawbs and off oranges, melons, grapes. Exercise will also help with getting sugars used up so vigarous walking etc. At those sorts of levels I would say GP should be able to prescribe for you send you off to come back in a month HOWEVER for some reason GP referring on wee testing so suggests something else to address and you need to speak to the hospital registrar and get a better handle on what the issues are and how to address them. Going forward you should also be getting diabetic appts for regular check ups with nurse, feet inspections, eye tests and possibly also referral to specific courses to help manage the diabetes (this includes you too as they include partners if you want)

RB68 · 19/03/2021 21:22

I should say diabetes, especially T2, is one of those things that is different for everyone so you do have to start by understanding how it all works and then looking at how you react to things - different foods, stress, exercise etc. It can also be brought on by other illnesses and lead to others such as pancreatitis. It is quite complex. As others have said start by monitoring blood sugars if you can and how you react to different foods and stick with ones that don't give you too much of a peak. It will always be high after eating but will lower with time, exercise etc and its getting a handle on that and keeping sugar levels low etc This is where a good diabetic nurse can help. There are also lots of online courses too these days I know my Dad did one and lost lots of weight and also gained better control of his rampant diabetes (T2 but masses of medication including insulin etc)

Original poster

tendofether · 20/03/2021 09:32

A monitor with strips, lances etc should be provided foc

Is this the case for type 2 also, I've seen mixed reports.

OP posts:

LIZS · 20/03/2021 10:48

Yes, and you can be prescribed the refills.

PaperMonster · 20/03/2021 10:52

I’m Type 2 and don’t get the monitor etc, had to buy my own.

LIZS · 20/03/2021 10:57

Really? T2 can claim free prescriptions so assume it is part of that.

Original poster

tendofether · 20/03/2021 12:09

Out of hours sending him back to treatment centre (going to a different hospital this time)

OP posts:

Gratefulrunner · 20/03/2021 12:23

My dh had similar experiences of being diagnosed as an adult. But he got put on insulin straight away, had hospital admission after going to gp with blood sugar levels of around 30.

There is another diagnostic blood test used to differentiate between t1/t2, not hbac1 but something to do with antibodies. Dh was negative on this but consultant in clinic said nhs felt despite this he was clinically type 1. So there isn’t a hard distinction between type 1 and 2, there is a lot of grey area between the two

Gratefulrunner · 20/03/2021 12:24

The diabetic nurses are the best people to speak to, they are v knowledgeable

Gratefulrunner · 20/03/2021 12:26

Oh and also, just to add that presentations are often very different and don’t fit into neat boxes eg dh can have very high blood sugar but has never had ketones

PleaseStopExplaining · 20/03/2021 12:28

Just in case hearing an experience is useful, I’m newly diagnosed type 2. I had the paramedics for unrelated reasons and when they did a finger prick it was 12. They rang my GP who I spoke to the same day and did a hba1c a few weeks later. That was 53.

They repeated the hba1c about 7 weeks later as didn’t want to diagnose off one blood test. They did advise me to try to reduce sugar/up activity/lose weight in the meantime. I made the changed and was diagnosed with type 2 after the second blood test. That was 48 at that point. This was early Feb.

I’ve been referred for a diabetes education course, had an appt with the diabetes nurse at the surgery and given more dietary advice. I’ve not been told to monitor my blood sugar or put on meds. They plan to review after 3 months.

Original poster

tendofether · 20/03/2021 13:10

I think he'd be more relaxed about it if the gp hadn't sent him to the hospital immediately twice.

OP posts:

earlydoors42 · 21/03/2021 15:00

I don't think it's wise to be relaxed when it might be type 1. High blood sugar and ketones is dangerous. And an hba1c of 90 is very high. (My daughter is type 1, she is often out of range, too high, but he hba1c is low 60s, for context). I would keep checking ketones and pushing for blood tests to confirm type 1 or 2.

LIZS · 21/03/2021 15:24

Thinking back the monitor may not have been issued on initial diagnosis, but a few months down the line. When presumably initial lifestyle change suggestions and metformin had not made much difference to hba1c test results.

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