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Diabetic care: advising patients at their annual review

The radio programme File on 4 recently presented a programme which highlighted a story about a girl with type 1 diabetes, who died, not knowing how to manage her diabetes when she was unwell with an infection of some sort.

I wonder if others of you heard this and what your reaction was. Personally I felt very saddened at what had happened, as it could have been avoided with the correct care provision and patient education.

In fact in an earlier blog I mentioned the 13-point quality standard developed by NICE. However there are as well, nine processes of care we should all be providing to our diabetic population at their annual review.

Most of these I am sure you will be very familiar with, but in case you are not, here they are: weight, BP smoking status, HbA1c, urinary albumin, serum creatinine, cholesterol, eye examination and foot examination.  

I find the hardest to obtain is the urinary creatinine, as although patients are given a specimen bottle at the time of taking their blood, they often forget to do a sample and bring it with them at their annual review.

Obviously the eye examination is carried out elsewhere, but we need to confirm that the patient is attending their screening for diabetic retinopathy.

I guess that we are all under pressure at this time working in General practice with the end of the QOF year soon upon us and either GPs or practice managers are breathing down our necks and expecting us to deliver the points they desire.

The diabetes passport

Have you all heard of this proposal, around which there is some controversy? I recently attended a diabetes prescriber meeting where we were told of the problems surrounding this document. The principle seems good, but when you offer a patient an A4 document to carry around with them to all medical related appointments, how many will actually remember to do this and how long will the document last?

How many of you have encountered the Insulin Dependant Diabetes foundation? I mentioned them back around Christmas, when I talked about festive food that was tailored to the Diabetic. Look out for them and see what your impression is of their printed information; I have found their dietary booklet very useful, especially their meal suggestions. Diet is quite a challenge when it comes to persuading our patients they need to reduce their intake of certain foods and eat regular meals.

As nurses are we a good example to our patients in this area? Do we ask our patients how they think they could improve their dietary intake, thus helping them to own these changes.

Easter eggs are in the shops and the temptation is there for all of us; how easily do we resist the lure of all that chocolate on the supermarket shelves? Let's encourage our patients to have only a little chocolate, and just at Easter itself, not every week until the 8th April, and endeavour to try that for ourselves.