Margaret Stubbs explores the relationship between patients and their blood glucose monitor in this blog exclusive to Nursing in Practice
Picking up on one of the topics I discussed in an earlier blog this year, I just wanted to ask, how many of your diabetes patients test their blood sugars, and how many know what to do with the readings?
On that same subject, I hope that many of you have seen the Training, Research and Education for Nurses in Diabetes (TREND) document Blood Glucose Monitoring Guidance. This is a very helpful document, and a great resource for us as practice nurses when trying to support our patients who monitor their blood glucose (BG) well. There has been and still is some considerable pressure to either stop patients testing or swap them to a meter which uses less expensive test strips.
This document gives a helpful and informed perspective, so that we do not feel pressurised into doing things we are not comfortable about. We need to discuss the matter of BG testing with our patients, so that they are effective in what they are doing. Changing meters may appear like the best thing to those who make these decisions, but do they always realise the impact this has on the individual?
I have sought to discuss the reasons behind using certain meters with my patients on an individual basis, and as new patients decide to test, I have offered them these less expensive varieties. I do remain reluctant to just take away their old meter and make them use a different one. How many of us get comfortable with particular items in our possession, and would struggle if pressurised to change for something different. We do need to help our patients understand why they may need to test their blood sugars, when they ask for or we offer them a meter.
A meter is a tool which can help those with diabetes take control of their condition. For some it is essential, others think they should do it but don’t understand why, nor how they can manage their diabetes on the basis of their readings. The diabetes annual review is possibly a good time to talk this through and advise patients accordingly.
Another aspect of diabetes care that seems to have become a more frequent feature of caring for those with diabetes, is that of foot ulcers, infections and preventing amputations. Over the past year I have had to refer several patients to secondary care for treatment of infection in a foot ulcer. One of these patients seems to have grasped the seriousness of this, and since losing two or three toes on one foot, has changed his ways dramatically, so that now his diabetes is well controlled, with an Hba1c somewhere close to 50mmol/mol for some months now.
However, sadly I have two other patients who do not seem to grasp the gravity of the situation, and have either persistently not attended reviews to help them improve control, or keep discharging themselves from hospital when admitted for treatment of infections. At times in practice I will use “shock” tactics to wake patients up to the reality of what is happening or could happen, and the outcomes does of course vary. Patients should not need to have amputations of legs, feet or toes, but we do need to keep on trying to educate them about how to care for themselves. Personal responsibility seems to be somewhat lacking at times in our current culture, but there is no “magic wand” to correct things, when it all goes wrong.
We need to work closely with our patients on this and all other aspects of their diabetes care so that we can achieve the best outcomes with them.
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