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Understanding the needs of diabetes patients

How does someone with type 1 diabetes manage their diet versus insulin requirements over the Christmas period? So many events around this season revolve around food, and if you strive to keep your diabetes under control and don't want to gain weight how you do this?

Recently, I saw a lady in her 70s who has had type 1 for 50 years or more. When I asked how she managed Christmas dinner and all the trimmings, she said, “I don't - I know how many carbs to eat and how much to inject for that, and that is what I do, I don't change what I am doing at all. I eat approximately the same amount of carbs at each respective meal as far as I can.”

How many of us would have the motivation to do this? Can you imagine doing this, every day of the year no matter what was going on in your life? A dietician I have contact with, said that she thought patients with type 1 using a bolus advisor such as an Aviva Expert, would become deskilled. A fellow diabetes specialist nurse and myself on the other hand think that any support for the relentless carbohydrate counting and balancing act that is the lifestyle for someone on a basal bolus regime is worth trying.

Sometimes as healthcare professionals we can be more than a little idealistic in our expectations of what our patients can live with and manage while dealing with their diabetes. Should we be a little more realistic with the support offered to anyone with diabetes. Sometimes we need to put ourselves in the shoes of our patients and try to imagine what it is like to live within their constraints for the many years that they have to, and what it might be like to have to constantly prick your fingers to check your blood glucose.

If I am demonstrating a blood glucose meter, sometimes I will prick my own finger and test my own blood sugar to show some empathy with the person or people to whom I am showing the device. Likewise, when I first received training to initiate insulin therapy, we were encouraged to give ourselves a dummy injection to help us identify with those we would be working with.

It is so easy to think we know best, and then dictate to our patients, when in fact most of us (apart from any who have diabetes anyway themselves), know lots 'about diabetes', but very little about 'living with diabetes', and there is such a difference. Instead of just dismissing what we think are excuses for not doing certain things, perhaps we need to try making those changes ourselves, and see how we would fare. Say that we tried carbohydrate counting every time we eat for the course of a whole week. After even that short time, I think there might be quite a number of us who would say, “Why not have the assistance of the “Accu-Chek Aviva Expert” or the 'Freestyle Insulinx'?”

Just a quick piece of news, which I read in The Times on 26 November 2015 about a possible new therapy which might become available for those with type 1 diabetes. It is a therapy that was first mentioned about six years ago, and involves the use of patient's own cells, isolating them, expanding them and injecting them back into the person. Not only might it be useful in type 1 diabetes, but also other autoimmune diseases. Now that might give some of our patients something to look forward to