Making Best Practice, Every Day Practice
The prevalence of type 2 diabetes is rising and people are developing the condition at an earlier age. Type 2 diabetes becomes progressively more difficult to control over time, so many people need to start on insulin therapy as the pancreas is no longer able to meet the body’s insulin requirements on its own. In this article,we look at the practical issues involved in helping a patient to start on insulin therapy for their diabetes.
Starting on insulin injections represents a major change for most people with diabetes. Many aspects of everyday life will need to be considered more carefully,which can be quite daunting.With adequate support and education from the practice nurse,patients can be encouraged to be proactive and positive towards this new stage in their lives. This article looks at people with type 2 diabetes or those with stable type 1 diabetes,who are likely to be managed in general practice.We discuss everyday concerns about using insulin,why people on insulin are prone to put on weight,how exercise affects blood glucose levels,how to manage illness in those with diabetes and how to adequately prepare for holidays.
How much insulin does a patient with type 2 diabetes need for optimal glucose control? It can sometimes be a tricky balancing act to get the dose just right – too much increases the risk of hypoglycaemic episodes and too little risks poor glucose control and the associated long-term complications.In this article we review what the research and guidelines recommend in how to ensure each patient gets the best dose of insulin.
The Year of Care for diabetes project has its roots in the recent movement to put patient empowerment at the top of the health agenda.It reflects recent government publications,including Choosing Health: Making healthy choices easier and Our health, Our care, Our say. In this article we look at the development of the project, its aims and what it will mean in practice.
Everyone with diabetes deserves the highest standards of personalised diabetes care, no matter where, when or by whom this care is delivered.
All of us delivering care to people with diabetes know that it’s increasingly common, affecting two million people in the UK,according to figures for 2007.It is also expensive,taking up about 10% of NHS costs and 5% of social costs. We also know it’s the commonest cause of non-traumatic lower limb amputations and that’s just one of the reasons that we spend so much time in clinics optimising care and detecting complications.But how well do we understand the impact of foot disease and how organised are we in assessing and treating it?
This article looks at how a group of patients worked in partnership with North Lancashire Teaching Primary Care Trust (PCT) to produce a patient information leaflet for people newly diagnosed with diabetes (see page 32).The leaflet is intended to act as a guide, giving the new diabetic information and facts to help them,as well as encouraging them to find out more for themselves and enabling them to ask the appropriate questions.
Lipohypertrophy is surprisingly common in people using insulin to control their diabetes. As more and more people with diabetes are managed in primary care, practice nurses take on a greater role in the management and education of these patients. This article considers what lipohypertrophy is, how it can be prevented and how it should be managed once it has been identified.
At last, the updated NICE (National Institute for Health and Clinical Excellence) guideline for the management of type 2 diabetes has been published. It includes an update on the management of blood glucose, blood pressure, lipids, renal function and retinopathy, but the key priorities for implementation are based on taking a patient-centred approach to care. In this article, we will focus on the important areas of patient education, dietary assessment, setting targets for HbA1c, self-monitoring and starting insulin therapy.
Many people use herbal medication of some sort, but several commonly used herbs have been shown to interact with prescribed medication. Studies show that many patients either do not realise that the herbs could interact (and anyway do not class the herbs as medicines) or do not want to tell their practitioner that they are using them. With many more nurse prescribers taking control of management of patients with longterm conditions such as diabetes and ischaemic heart disease, it is vital that we consider that the patient may be taking non-prescribed medication including herbs and supplements.
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