Diabetes

Looking after women with diabetes during pregnancy

The care of pre-existing diabetes during pregnancy is complex and the remit of secondary care, but much can be done by primary care staff to ensure that pregnant women and their babies are safely on the right track by the time pregnancy is confirmed. In this article, we explore how to provide women with pre-existing diabetes with detailed and accurate preconceptual advice. Work needs to begin before contraception is discontinued to significantly reduce the risks for both mother and baby. In women with gestational diabetes, practice nurses can also be proactive postnatally, preventing progression to type 2 diabetes.

Making sense of type 1 diabetes in primary care

Primary care has traditionally managed people with type 2 diabetes, and people with type 1 diabetes have largely been the responsibility of secondary care. However, as blood glucose targets have become tighter and growing numbers of people with type 2 diabetes have started to require insulin, many in primary care have gradually taken on insulin management. As primary care professionals become more confident in the management of patients on insulin, many practices will be keen to take on the challenge of type 1 patients. This article looks at how type 1 differs from type 2 diabetes, which type 1 patients might be managed appropriately in primary care, and recaps on insulin regimens and dose adjustment.

Making Sense of HbA1c

There are several blood tests available to measure blood glucose levels. Some require the patient to fast while others do not. Understanding and interpreting the results accurately are essential in optimising the management of our patients with diabetes. This article looks specifically at the HbA1c test and its significance. We define what it is and when we should carry out this test, as well as helping you to understand what the results mean and the targets we are aiming for.

Advising people newly diagnosed with diabetes about diet

Do you see patients with diabetes? Do you advise them about their diet? If so, you have an incredibly important role in developing patients’ self-confidence and empowering them to be able to make healthier choices. In this article we look at how to advise patients newly diagnosed with diabetes about diet. A patient-centred approach is vital, with advice offered in a supportive, non-judgmental and non-didactic manner.

“You Will Need to Stop Driving.” Chronic Disease, Driving and the Law

Telling a patient that they will have to stop driving can be difficult, so it is essential to be sure of the facts on the law regulating driving and chronic disease. When asked what they know about chronic disease and stopping driving, many people may know that epilepsy is an issue, and may mention diabetes. But are driving restrictions for one year, or is it three years? Do they affect only patients with diabetes on insulin, and are some regulations only for heavy goods vehicle (HGV) drivers? In this article, we give you the information to answer these questions.

Impaired Fasting Glycaemia and Impaired Glucose Tolerance: Reducing Progression

The journey from normal glycaemic control to type 2 diabetes is a gradual one and, importantly, gives us lots of opportunities to diagnose so-called ‘pre-diabetes’ and step in to reduce the chances of a patient developing full-blown diabetes, or at least delay its onset. In this article, we review the rationale for early intervention, help you make sense of impaired fasting glycaemia and impaired glucose tolerance and illustrate what to look out for with case studies of patients you are likely to see in your practice.

Exenatide: a new step in type 2 diabetes treatment

Exenatide (Byetta) is the first glucagon-like peptide-1 analogue (GLP-1 analogue) to be approved for the treatment of type 2 diabetes. It is a twice-daily injection, currently prescribable only by consultants, given before breakfast and before the evening meal. The early signs are that this new and different medicine has the potential to be very exciting for both patients and healthcare professionals. Studies show a reduction in HbA1c as well as steady weight loss – every diabetic’s dream! In this article, we look at how exenatide works, where it fits into current practice and the pros and cons of this new preparation.

Back to Basics: Diagnosing type 2 diabetes – blood glucose measurements

Sitagliptin: the first in a new class of drugs for type 2 diabetes

Sitagliptin (trade name Januvia) is the first in a new class of drugs for diabetes – the dipeptidyl peptidase-4 (DPP-4) inhibitors. This new, oral hypoglycaemic agent has recently been approved for the treatment of type 2 diabetes. It is available on prescription and can be prescribed in primary care. Principal advantages include lack of weight gain and hypoglycaemia, which should make sitagliptin very popular with patients. This article looks at what a DPP-4 inhibitor is and how it works to lower blood glucose, as well as where this class of drug fits into current practice.

You and your treatment: starting on a glitazone

Chronic Wounds: Optimising Wound Management

Practice and other community-based nurses play a central role in achieving high quality wound care in patients treated initially in general practice and in those who have been discharged from hospital. This article summarises some of the wound management products available for chronic wounds, and the importance of continued wound care in the primary care setting, before focusing on one of the latest approaches – total negative pressure (TNP).

Diabetes Specialist Nurses: Making the Most of their Expertise in Primary Care

Diabetes specialist nurses (DSNs) are usually experienced registered nurses who specialise in all aspects of diabetes care. They work in hospitals and in the community, fulfilling many different roles. As their work focuses on diabetes care they become very knowledgeable in their subject area and are potentially a valuable resource. This article looks at the role of the DSN and how practice nurses can make use of their expertise to improve both patient care and their own diabetes management skills.

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