3Rs - Simplifying Diabetes management - some thoughts

tim2000s

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I attended the Diabetes Stream Health Innovation Network - South East London Diabetes stream last night and discussed Diabetes Management with a number of people, which convinced me that putting this model on the web for discussion was worthwhile. I don't think it's anything new, but I'd like to know your thoughts:

http://crick-tech-munch.blogspot.com/2015/11/the-3rs-record-review-react.html

I subscribe to the KISS approach to these things and I think this adheres to that, and I also understand that for T2Ds it goes against the grain of how many test strips that are recommended, although not against the NICE guidelines suggesting in early diagnosis, enough should be prescribed to allow an understanding of how the condition affects you.

Feel free to tell me what you think!
 
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Lamont D

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Reactive hypoglycemia
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I do not have diabetes
I attended the Diabetes Stream Health Innovation Network - South East London Diabetes stream last night and discussed Diabetes Management with a number of people, which convinced me that putting this model on the web for discussion was worthwhile. I don't think it's anything new, but I'd like to know your thoughts:

http://crick-tech-munch.blogspot.com/2015/11/the-3rs-record-review-react.html

I subscribe to the KISS approach to these things and I think this adheres to that, and I also understand that for T2Ds it goes against the grain of how many test strips that are recommended, although not against the NICE guidelines suggesting in early diagnosis, enough should be prescribed to allow an understanding of how the condition affects you.

Feel free to tell me what you think!

Hi Tim,

I think that covers it, simple to follow and you picked up the importance of recording and changing things, no matter what, to feel better and get your bloods going in the right direction.

I have done a similar thread on the RH forum.
A bit more for us RH ers, because of finding how quickly the spikes are.
But the basics are the same!
 

tim2000s

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Whilst I advocate testing for all, I went back through the NICE guidelines, and the recommendations for T2s are:

R22 Offer self-monitoring of plasma glucose to a person newly diagnosed with Type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.

R23 Self-monitoring of plasma glucose should be available:
● to those on insulin treatment
● to those on oral glucose lowering medications to provide information on hypoglycaemia
● to assess changes in glucose control resulting from medications and lifestyle changes
● to monitor changes during intercurrent illness
● to ensure safety during activities, including driving

Now forgive me if I might seem to be stating the obvious, but for most type 2s, one might argue that these apply either regularly or continuously. As a result, I think most T2s should be able to argue for SD Codefree strips on the NHS.

What seems to be lacking in T2 care is the ability of GP practices to provide appropriate education at diagnosis as to why self-monitoring is important and helpful. It comes back to the requirement for a patient-expert network across a CCG area...
 
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Lamont D

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15,798
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Whilst I advocate testing for all, I went back through the NICE guidelines, and the recommendations for T2s are:

R22 Offer self-monitoring of plasma glucose to a person newly diagnosed with Type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.

R23 Self-monitoring of plasma glucose should be available:
● to those on insulin treatment
● to those on oral glucose lowering medications to provide information on hypoglycaemia
● to assess changes in glucose control resulting from medications and lifestyle changes
● to monitor changes during intercurrent illness
● to ensure safety during activities, including driving

Now forgive me if I might seem to be stating the obvious, but for most type 2s, one might argue that these apply either regularly or continuously. As a result, I think most T2s should be able to argue for SD Codefree strips on the NHS.

What seems to be lacking in T2 care is the ability of GP practices to provide appropriate education at diagnosis as to why self-monitoring is important and helpful. It comes back to the requirement for a patient-expert network across a CCG area...
It also comes down to costs to the surgery!
 

JenniferW

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Type of diabetes
Type 2
Treatment type
Diet only
I loved the way you put the first part - about taking responsibility for management. I'm relatively-newly diagnosed (7 months ago) and although my diabetic nurse thinks I'm doing well, I'd say this is a major part of what's so hard about it for me. And one of the hard things is this need to continually test / record / review - the relentlessness, the sense of no escape. Goodbye to kidding yourself and drifting along.
 
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DunePlodder

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861
Type of diabetes
Type 1
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Insulin
Great blog, I agree with everything you say. I would just like to add that for Type 1 MDIs anyway, - getting your basal rate correct is fundamental. If this is wrong then the reviewing & changing of ratios is very difficult if not impossible.

I speak from experience. Mine was miles out for years. I look back & see that I was "feeding" my basal with carbs because it was too high.

Eventually with research online & thanks to forums like this, careful testing got me closer. However it's only with my CGM that I now feel pretty happy about it. Even so with just 1 or 2 injections it's never perfect...
 
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Blackers183

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Type 1
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I wholeheartedly agree that the first thing diabetics need to do is test (Record). If you don't test regularly you cannot improve, one of the basic tenants of continuous improvement methodology that have been around since the 50s.
 

tim2000s

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I wholeheartedly agree that the first thing diabetics need to do is test (Record). If you don't test regularly you cannot improve, one of the basic tenants of continuous improvement methodology that have been around since the 50s.
Thanks. It's nothing new really, just codifying it in a Diabetes context!