Diabetes type 1 (young people)

Tell me a little bit about the consultation. You know, how you relate, how they communicate and relate to you?

Okay. The nurses and the doctors at the children's clinic, when going for re-, for like check-ups, however many months apart, talk to you in perfectly normal terms. They explain it to you in the correct detail for your age and your understanding. So you'll have the most detailed understanding of exactly what your situation is and how you can deal with it. They're very, they're very nice. And they'll be, like they won't mess about with you, they'll be totally frank with you about any situation. And the advice they give you is, is very useful and it will usually sort you out for any of your problems that are currently occurring.

They don't ask you for your opinion [laugh], although like if you do have, if you do have trouble with something, they'll take it into consideration and they'll tell you an alternative. But most of the things they tell you are very, you, it shouldn't, it isn't that much of a problem when it comes to your opinion. It's very, very obvious things, very plain things, which you just have to get on and deal with. 

I suppose at the beginning, now that I look back at it, at the beginning when I was first diagnosed, you have to learn how to inject yourself and you need to learn how to do your blood tests and you need to learn what diabetes is all about and how to control it. And at that time, being 11 years old or some, something like that, I was actually, I was in my opinion too young to totally understand exactly how diabetes worked. And I've picked it up very slowly over years and years. And it becomes almost natural and you gain a detailed, very detailed understanding of exactly what diabetes is and how to control it, the longer you have it. And you don't need to start off with a perfect knowledge of it yourself, because it will come naturally over years that you have it from trial and error. And, yes, it's all very, it all comes to you very easily and simply and you understand how to control it. It's like, 'Yes, okay'.

What would you improve about the consultation? What do you think needs to be improved?

In my opinion, I've never properly thought about the consultation at my hospital, mainly because I've had no problems with it. I go there every several months, so that they keep up to date with all the changes that I make to my diabetes, like general changes in my weekly routine and whether I change insulin at particular times accordingly. And help me understand how to deal with my diabetes. But I've never suffered a problem with them. They've always been as useful as they can be, and honestly I can't think of a way that they could change to improve themselves.
 

How does it feel sort of to change from one clinic to another? What have you noticed that is different?

I was really worried about it at first because I was so used to my consultant at home and my diabetes nurse at home and like the way they did things. And I was wo-, kind of worried coming here that I wouldn't get on with the people, that it would be completely different and that they wouldn't kind of understand me and like how my diabetes works. But, yes, I mean I've only been to the diabetes clinic here twice, and both times it's been a positive experience. And...

Positive, what do you mean by positive?

I got on well with the consultant and felt that they listened to me and understood what I was saying. And like I also noticed kind of the difference between like being in the children's clinic and being in the young adults' clinic. Because even though my consultant at home didn't like treat me like a child, obviously he was more used to dealing with young children. So that obviously had an input on how like he treated me. Whereas here they're used to treating young adults. At first I, like the first appointment I found that really strange, because it was like left kind of like more up to me and I had more kind of say. And the consultant didn't kind of sit there and tell me like what I should be doing. He kind of asked me what I felt I should be doing and how things were going and'

Was it a bit frightening to start with or not?

Yes, it was. I mean I was also like quite scared about it because of what was going on with my eating disorder and my diabetes being totally out of control. And I was really worried that like they were going to just be really mad at me. And I don't know really what I was worried about other than, yes.

What was their attitude towards you?

What, at the'

When you told them about your eating disorder?

Well, they already knew, because it had been my psychiatrist that had like organised for me to transfer to the diabetes clinic up here. So, yes, the consultant knew what was going on and he knew that I was in a bad place. And so that really helped because I felt that I didn't have to explain everything from the beginning. And like as I spoke to him it was clear that he'd obviously like taken the time to really read my notes and to talk to the other people involved in my care.

So that was nice?

Yes.

You found that quite reassuring?

Yes.
 

It's really sort of come from the, my consultant, who I've had for quite a while. She's been very s-, she's very supportive of diabetes and she is very knowledgeable, to actually, passes down new information about, you know, new insulins and new blood, blood glucose machines and things like that. She's really good at providing that. 

Have you had the same doctor, the same consultant?

I have, yes.

Since diagnosis?

Yes. I'm still in the, at the moment I'm in the adolescent clinic, diabetes, at [city] hospital and I've still got the paediatrician, yes, she's the children's consultant for diabetes, I still have her at the moment. And I like her a lot. She's, she really can relate to sort of young people. I think that's really important. But I'm just in the process of being moved across to the adult clinic. So I'm not sure, I think I'll have a gentleman then. So, yes, it's been nice to have the same lady, you know, so I can talk to her and she knows me, and she's seen me grow up and things and helped me control diabetes. But she's always been quite pleased with what, the progress that I've been making and things.

So you have seen her most of the times that you go to your appointments?

Yes, I'd say pretty much all the time, about 80 per cent of the time I see her. And I go every three months and I see her. There's been occasions when she's been away at conferences and I've seen other people, consultants, who are also very nice. But, yes, it's mostly the female consultant that I see.

It's, can be a bit repetitive at times. Quite a few times I've been there I've got frustrated, because three months before I've had exactly the same conversation, but because it's been different doctors' So I've gone there and they've said this and I've gone away and yeah, do all that. Come back and they've said exactly the same things to me that they said three months ago. So I progress myself in getting better sugar levels, but then they haven't really consulted with the other ones so - you've always got to bring them up to speed. So they always ask you questions, and it's annoying really, because you've told them how you feel what your sugar levels were the last time, what your diet is and stuff like that to one doctor, and then three months later you have to say it all again to another doctor. So I feel clinic can be a waste of time sometimes, but like other times the last occasion I went I spoke with the dietician, and she explained to me how different carbohydrates have got different different values. So rice is - a plateful of rice has got a lot more carbohydrate than a plateful of mashed potato, for example. So that was that was really useful to me. So at times like that it's been good, but other times it can be just - I feel it's a waste of my time, sometimes.

It is because you don't see the same doctor?

Yeah, that's one problem, because you don't see the same doctor every time. You can see - all the time I've been going to clinic, over four and a half years, I've probably seen about seven different doctors. Yeah.

So the continuity' they don't know who you are, basically?

No, they've got a file on me that everything is put into, but they don't - well, I think they don't always check up on their patients before they look at it. Because, well, like I said, they always ask me the same information. But the dietician, she's very good. She often has a chat with me just to see how I'm getting on, and that's very useful, because like she's showing me how rice has got more carbohydrate than mashed potato, now when I do inject after I have a meal, I know if I've had curry, with rice, that I need more insulin then, and that's actually helped my sugar levels.

What would you improve regarding the consultation at the diabetes clinic?

Better - I think they need to talk to each other more because like I was saying quite often I get asked the same stuff by different doctors and I don't feel there's any progress there, so I think they need to, before they see the patient they need to sort of check the file over and say oh we discussed this last time so the issue doesn't have to be raised this time, things like that, so' I'm okay with them, but I think they need to talk to each other a bit better, because sometimes I think the information - certain things could be, like we could move on and talk about new subjects and stuff, but we are talking about the same stuff all the time, and also it would speed things up because people don't like going to clinic, obviously, and sometimes the process can, sort of, take two hours, with the waiting as well and stuff like that, so' I just think yeah they need to talk to each other a bit more.
 

So you don't tend to see the same, the doctor. I mean what about, do you have a specialist nurse there you see?

When I was, when I was younger I did see a couple of the... Well there was one nurse in particular I. Just after I was diagnosed I was phoning her, well phoning her office obviously every, every fortnight or so plus as I say this is what the test results are looking like. Should I adjust my insulin and should I maybe have a snack here instead of there. And I did see her a couple of times in the clinic but she wasn't based there. It was just a case of if she was there I could see her. But not so much with the nurses anymore. It's more a case of if you have general questions and the doctors are pushed for time, if they're really busy then see a specialist nurse and they'll try and help you. 

Also well when I changed one of the insulins I use not that long ago. Well I don't know maybe about 18 months now when I think about it. The demonstrations on how to use the new types of pens etc is done by the nurses. With the doctors, only like I said before, you see who you see depending on who's busy. But I do have on my file, I do have one doctor who, well there is a doctor named as my consultant and there's been. There's a couple of other doctors I see fairly regularly but, [sigh] but yeah. It's not always the same one which, which is a little bit frustrating because yeah they've got all the notes but you quite often have to explain things to [laugh] three different doctors. When, I mean, granted one, no guarantee they'd remember every detail about every patient but there's a better chance of it if you've got to start from scratch every time.

So you feel you are starting from scratch quite a lot?

Yeah. I mean not so much any more but for a while it was getting to be there was a different doctor every visit and I suppose now my insulin regime has settled down as well because it was being changed about all over the place for a while. That as well having to go through and say, yes I'm on this insulin, this insulin taking these doses at these times sort of thing. I've told three different doctors this already. Why can't somebody write it down and get it, [sigh] and remember it. But, anyway.
 

This is my diabetic nurse. 

I wouldn't say they had more experience, they just have a different approach to dealing with patients. They'll be more, they'll be, they'll take the, the kid gloves off. They'll be more sort of direct and honest with you and like, whereas my other, the paediatric diabetic nurse, she was always, she was very gentle and soft and sweet and she always sort of tried to soften whatever she was saying. But the one I've met now, [name], she just tells it as it is. And I remember her saying to me, you know, 'You've been playing a game of Russian roulette.' She says, 'I don't know, you've been so lucky for so long I don't know you've done it.' And she was quite direct and, you know, because they're dealing with adults, aren't they, I suppose. They, they'll you how it is.

Has that helped?

Yeah, she, yeah it has helped. She's given me a lot more to think about and she's approached it from, she's really friendly, she's a really nice lady, she's really understanding but she's approached it from a more serious point of view. It, it's good as well to have somebody new because it's like a, you know, a fresh start, you know, just we'll start again with someone else and see how it goes with them. And it's just refreshing to have a change really sometimes.
 

How have they responded?

They've been very supportive both at the hospital and my GP. They provide a lot of help. If I want to talk to people and if I'm upset they're very supportive. They're not cold or anything. They're very, yeah, they're great actually, they're very nice. And…

So it seems to be that apart from the the care team you also talk to your GP and you are in touch with him?

Yeah, yeah. And I have to go and get all my medication for when I go to university. So I had to go and see him last week and get all of my insulin and my strips and stuff from him.

And so he has been responding, he has been supportive?

Yeah very supportive. And he said even though I'll be studying away from home he said whenever I come back if I need to talk to anyone or if I need to see him to just make an appointment or something. So it's been quite, yeah he's been quite supportive. 

Do you have any fears or concerns about the future as far as your diabetes is concerned?

Just scared that, you know, about when you get cuts and stuff on your feet and legs that I have to cut them off, amputate them. That scares me quite a lot and things that can get in, heart problems and eye problems and stuff. Yeah it all sort of scares me a bit.

Who do you talk to about these fears?

Just my friends and my mum if I'm feeling down or something or my GP as well. He is…

You have talked, discussed with him about this?

Yeah. Well I've been upset if I have, you know, an appointment with him I've just cried or told him what's wrong and he's been quite supportive and he like. They just say basically if you control it you shouldn't get these problems. It just has to be, you know, well controlled, the diabetes.