hanadr
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I plan to use this piece and would welcome comments, corrections and additions
Hana
Information for doctors treating diabetic patients.
(After the first shock is dealt with)
Is this type2 or type1 and what’s the difference?
Mistakenly treating T1 as T2, soley because the patient is adult, could lead to tragedy.
The next bit depends on the individual patient
For older T2 patients (over 65 years?) set in their ways and resistant to change
Advise cutting sugar and reducing starchy carbs
Offer a SIMPLE diet sheet, which doesn’t vary much from their usual way of eating, but aim for reducing carb intake.
Self blood testing is probably not important
6 monthly HbA1cs are probably sufficient monitoring.
(Complications take a time to develop, so are not such an issue in the elderly.)
There’s not much point in scaring these patients with descriptions of diabetic complications.
For younger patients
Describe the treatment.. Offer self testing for at least the first 6 months, so the patient can learn which foods “spike” blood glucose.
Tell the patient what the typical blood glucose levels are in non-diabetics and how quickly they return to baseline when they do deviate
Tell patients what the average HbA1c level is in non-diabetics. Having explained HbA1c first
Knowing what non-diabetic levels are will tell motivated and younger patients where the base-line is.
By all means tell patients what the DUK/NICE targets are.. Thus the patients will see how much higher these are than “normal” people
Explain that there are at least 2 routes to maintaining GOOD control of diabetes, the dietary and the pharmacological
Understand that “eat plenty of complex carbohydrate foods in each meal” is a recipe for high blood sugars or high dose medication.
Explain the weight gain effects of most common anti-diabetic medication and don’t tell patients using large doses of them to lose weight. You know they can’t
Have a list of useful books available, so the patient can read more and learn.
Your patient is now in a position to make informed decisions. On whether to CONTROL the condition (to non-diabetic levels) or to follow tradition and the usual guidelines.
Explain that Full Control of diabetes takes commitment and dedication and is in the patient’s hands.
Develop diabetic patients self help group, based on your surgery. Perhaps with a dedicated nurse involved.
Instructing compliant patients to” Increase your insulin.” is a lazy way to care for patients.
Understand that non-diabetic blood glucose levels are attainable by motivated patients and will probably save them from “progression” and complications
Understand that Hba1c of 7% is NOT GOOD control
Don’t tell patients that their HbA1c is too low and causing symptoms.
Test your own if you are not diabetic and think whether you have those same symptoms.
Don’t be fixated on hypos. In the long run, they cause far fewer deaths than complications from long term hyperglycaemia.
If your patients are non-compliant, work on the compliance.
The more your patient knows, the better the control is likely to be.
Hana
Information for doctors treating diabetic patients.
(After the first shock is dealt with)
Is this type2 or type1 and what’s the difference?
Mistakenly treating T1 as T2, soley because the patient is adult, could lead to tragedy.
The next bit depends on the individual patient
For older T2 patients (over 65 years?) set in their ways and resistant to change
Advise cutting sugar and reducing starchy carbs
Offer a SIMPLE diet sheet, which doesn’t vary much from their usual way of eating, but aim for reducing carb intake.
Self blood testing is probably not important
6 monthly HbA1cs are probably sufficient monitoring.
(Complications take a time to develop, so are not such an issue in the elderly.)
There’s not much point in scaring these patients with descriptions of diabetic complications.
For younger patients
Describe the treatment.. Offer self testing for at least the first 6 months, so the patient can learn which foods “spike” blood glucose.
Tell the patient what the typical blood glucose levels are in non-diabetics and how quickly they return to baseline when they do deviate
Tell patients what the average HbA1c level is in non-diabetics. Having explained HbA1c first
Knowing what non-diabetic levels are will tell motivated and younger patients where the base-line is.
By all means tell patients what the DUK/NICE targets are.. Thus the patients will see how much higher these are than “normal” people
Explain that there are at least 2 routes to maintaining GOOD control of diabetes, the dietary and the pharmacological
Understand that “eat plenty of complex carbohydrate foods in each meal” is a recipe for high blood sugars or high dose medication.
Explain the weight gain effects of most common anti-diabetic medication and don’t tell patients using large doses of them to lose weight. You know they can’t
Have a list of useful books available, so the patient can read more and learn.
Your patient is now in a position to make informed decisions. On whether to CONTROL the condition (to non-diabetic levels) or to follow tradition and the usual guidelines.
Explain that Full Control of diabetes takes commitment and dedication and is in the patient’s hands.
Develop diabetic patients self help group, based on your surgery. Perhaps with a dedicated nurse involved.
Instructing compliant patients to” Increase your insulin.” is a lazy way to care for patients.
Understand that non-diabetic blood glucose levels are attainable by motivated patients and will probably save them from “progression” and complications
Understand that Hba1c of 7% is NOT GOOD control
Don’t tell patients that their HbA1c is too low and causing symptoms.
Test your own if you are not diabetic and think whether you have those same symptoms.
Don’t be fixated on hypos. In the long run, they cause far fewer deaths than complications from long term hyperglycaemia.
If your patients are non-compliant, work on the compliance.
The more your patient knows, the better the control is likely to be.
