Diabetes Management Advice

1. Diabetes Management Advice • Dr. Shadab Nayeemuddin • Dr. Trixy David

2. Introduction • Introduce yourself. Elicit name, age and occupation. • Establish the patient’s understanding of their condition and if they have any issues or concerns regarding diabetes (ICE) • Example: “ I understand that you have been diagnosed with diabetes, is that correct? Before I discuss with you how we can bring your diabetes under control, I would like to ask you some questions. Is that ok with you?” Then move on to ICE.

3. Associated History • Symptoms: Establish whether they have noticed any symptoms of diabetes such as polyuria (urinary frequency), polydypsia (thirst), weight loss and lethargy. Also elicit evidence of diabetic complications such as abdominal pain and vomitting (DKA), visual disturbances (retinopathy), numbness or pins and needles (neuropathy), nocturia, polyuria (nephropathy), foot ulcers (vascular disease) • Duration: How long has the patient been diagnosed with diabetes? Establish whether they have type 1 or 2 diabetes. • Risk factors: Smoking, Weight (obesity), alcohol, diet (high cholesterol and salt). • Medical history: IHD, CVA, TIA, MI • Family history • Drug history: How is their diabetes managed? Diet only/diet and medication/insulin? Check concordance with medication.

4. Discussion • Discuss the possible reasons why the patient’s diabetic control may be poor outlining the presence of contributing risk factors. • Lifestyle: Stress the importance of reducing any associated risk factors of diabetes by performing a number of lifestyle changes. Tailer the advice based upon the risk factors present in the patient. Example: smoking cessation, reduction in alcohol consumption, weight reduction to BMI 20 - 25, exercise and diet (low in salt, fat and sugar, avoid saturated fats and stick to complex carbohydrates.

5. Discussion • Concordance: Emphasize the importance of concordance with medications in order to control their diabetes and avoid future complications such as damage to eyes, kidneys and nerves, increased risk of strokes and heart attacks as well as life-threatening emergencies such as DKA and HONK. • Diabetic foot care: Wear close toed shoes, keep your feet dry at all times and cut nails regularly, avoid sitting close to the radiater/heater, if you notice a small bruise/cut which doesn’t heal in a few days visit your doctor, visit a chiropodist regularly. • Monitoring: BM testing - emphasize the need to keep a diary of blood glucose measurements and to take it to all doctors appointments. • Hypoglycaemia: “If you become increasingly hungry or sweaty and feel your heart beat, this could mean your blood sugar is low. Start sipping a glass of sugary water until you feel better. It may be a good idea for you to keep a sugary drink with you at all times. If your symptoms persist or you start to feel drowsy, visit A&E immediately.

6. Additional Points • Medication: Remind the patient to always take their medication even if they miss a meal or feel ill. • Understanding: Check for the patient’s understanding of diagnosis and management. • Questions: Respond appropriately to patient’s questions. • Follow up: Arrange for appropriate follow up (diabetic nurse/dietician) • Leaflet: Offer to provide them with more information in the form of a handout. Give contact details for other sources of advice such as dietician or diabetic support groups. • Thank the patient and answer any questions.