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Diabetes: finding the right balance

Two recent events have caused me to reflect on patients' understanding and knowledge of long-term conditions and in particular diabetes.

As nurses, much of our time is spent supporting and educating patients to manage their own condition - but do we really assess whether patients and their families truly understand the advice and guidance they are being given?

While out in my own community recently I assisted two people who were having a hypoglycaemic attack. On both occasions relatives and passers-by appeared not to know what to do! When I asked my husband if he would know what to do in such a situation he said he wouldn't. With as many as 2.8 million people diagnosed with diabetes in the UK and approximately 850,000 as yet undiagnosed, chances are most people, at some point in their lives, will come into contact with someone with diabetes.

As symptoms of a hypoglycaemic attack can often be misconstrued and appear as if the person is having a stroke or other medical emergency, such situations can often be frightening for both the person experiencing it and their friends and family, particularly if they don't know how to safely manage the situation. As nurses it is something we will have experienced both in our pre-registration training and throughout our careers in primary and secondary care, and there have been immense developments and improvements in care for patients with diabetes.

We also continue to see increasing numbers diagnosed, particularly with type 2 diabetes, which clearly links to the ongoing challenge to reduce obesity in the UK and worldwide. Targets aimed at reducing blood glucose have increased in light of new research and guidance, although alongside this the incidence of hypoglycaemia appears to be an increasing problem and clinicians need to balance the benefits against the risks for patients' on an individual basis.  

It is clear that any management plan needs to focus on preventing hypoglycaemia but also include education and advice for family members and carers in agreement with the patient. This seems obvious but with time constraints and the need to ensure patients themselves are empowered to self-care this can be challenging. X-pert Patient Programmes have improved this, providing a structured education programme for both patients and carers to help them better understand their condition and, in turn, have more confidence and improved quality of life (

Patients who do experience a hypoglycaemic attack requiring medical attention should be referred to a specialist diabetes team in order that a full review can be undertaken and a management plan can be agreed which should be shared with other relevant members of the healthcare team involved in that person's care.1

I have come across a fantastic resource available for healthcare professionals, patients and their families, which shows real insight into patients' experiences and common problems they might face. I would encourage you to use it in your everyday practice to help patients better understand and manage their condition more effectively:

Next time you are talking to a patient about their condition make sure their nearest and dearest are included so that when problems arise they too are equipped to deal with it and importantly make the right decisions' about what to do.

1. National Institute for Health and Clinical Excellence (NICE). Diabetes in Adults Quality Standard. Available from: