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“I forgot to measure my BGL ….. “

December 5, 2014 by Imagine_David Leave a Comment

Exercise: you may find your blood glucose level has gone up immediately following exercise.

Do you use your blood glucose level meter like a compass, giving you some direction with your diabetes self care plan?

So, is missing an occasional blood glucose level a problem?

At a meeting of diabetes health care professional specialists a few years ago I met an endocrinologist specialising in the diabetes management of young people living with diabetes. This specialist stated that she didn’t really mind if her patients measured their blood glucose level between visits…… except for the 2 weeks immediately prior to the visit. For these measurements were the current ones – that bgls that she would base any treatment changes on.

Testing

Among other things, a measured pattern of your blood glucose levels will help you to:

Develop confidence in your diabetes self care plan

Develop a improved understand of the relationship between your blood glucose levels the factors that effect them: e.g. physical activity, food you eat, stress and illness.

Explore if your diabetes medication, if used, is safe and effective in helping you reach your blood glucose level targets.

Assess in critical situations if your blood glucose levels are in the extremes and require immediate management

**Your meal choices are ONLY one factor that will effect your blood glucose level**

Frequency

For any individual with diabetes, personalised education by qualified and experienced health care professionals in appropriate blood glucose targets and timing of SMBG, interpretation of documented SMBG serial profiles and trends across and between days, is essential.

Suggested patterns of testing could be :

1) You may test before and 2 hours after meals on 3-4 consecutive days to establish your current pattern. If you identify that your blood glucose levels are off target, more testing maybe required in order to make appropriate adjustments to your diabetes self care plan.

2) For people with type 2 diabetes – You test once per day moving the test each day forwards by one appropriate time e.g Monday before breakfast, Tuedsay after breakfast, Wednesday after lunch, Thurdsay after dinner, Friday before breakfast and so on. After a few weeks you can then assess the pattern.

3) Before and after a new meal: this will give you some idea of how your body is adjusting to this new meal. You may have changed the type of food you eat, or the volume of the carbohydrate in your meal based on advice from your dietitian.

4) Before, after, during exercise: assessing your risk of hypoglycaemia and your bodies reaction to the exercise.

If your bgls are on target you may the test less frequently, or/and only when you are thinking you may be hypoglycaemia or sick.

*For people with type 1 diabetes, avoiding DKA is essential when sick – in this situation follow your sick day plan.*

What’s Recommended?

Blood glucose targets: from HERE – Australasian Paediatric Endorcine Group, 2011

For adults in the intensively treated group of the DCCT, blood glucose targets were:

Before meals 3.9 to 6.7 mmol/L
After meals 5 to 10 mmol/L
At 3am (weekly) above 3.6 mmol/L

For young people with type 1 diabetes, targets are (Ambler and Cameron 2010):

Before meals 4 to 7 mmol/L
After meals 5 to 10 mmol/L
At bed time 6 to 10 mmol/L
At 3am 5 to 8mmol/L

Blood glucose targets may be set higher for infants and young children:

Before meals 5 to 10 mmol/L
After meals 6 to 10 mmol/L
At bed time 6 to 12 mmol/L

** It is emphasised that blood glucose targets need to be individualised for each person with type 1 diabetes. Clinical trials targeting intensive blood glucose control such as the DCCT typically exclude people at highest risk of severe hypoglycaemia, with advanced end‐stage diabetes complications, with poor adherence to therapy or with major intercurrent medical conditions (DCCT Research Group 1993). The average duration of diabetes was only 2.6 years at study entry in the intensive treatment arm of the DCCT, for the average 6.5 years’ study duration. Thus, the DCCT and EDIC mainly examined the importance of tight glycaemic control in the first 10 years after diabetes diagnosis. In contrast, glycaemic control typically becomes more difficult to achieve safely with increasing diabetes duration of, and both a lack of hypoglycaemia awareness and severe hypoglycaemia become increasingly common.

“A 2012 Cochrane review75 on the effect of SMBG in patients with type 2 diabetes not using insulin found limited clinical benefit as measured by HbA1c from SMBG and no evidence that SMBG affects patient satisfaction, general wellbeing or general health-related quality of life.

Self-monitoring is usually recommended:

for patients on insulin and oral hypoglycaemic agents (OHAs) that can cause hypoglycaemia
when monitoring hyperglycaemia arising from illness
with pregnancy, as well as pre-pregnancy planning
when changes in treatment, lifestyle or other conditions requires data on glycaemic patterns
when HbA1c estimations are unreliable (e.g. haemoglobinopathies).

The method and frequency of monitoring need to reflect individual circumstances and therapeutic aims and where the person with diabetes and their healthcare providers have the knowledge, skills and willingness to incorporate self monitoring of blood glucose levels and therapy adjustments into diabetes care plans.

In practice

Recommendations	Reference	Grade*
Blood glucose control should be optimised because of its beneficial effects on the development and progression of microvascular complications	(71) NHMRC, 2009	A
The potential harmful effects of optimising blood glucose control in people with type 2 diabetes should be considered when setting individual glycaemic targets	(71) NHMRC, 2009	A
The general HbA1c target in people with type 2 diabetes is ≤7% (≤53 mmol/mol). Adjustments to diabetes treatment should be considered when HbA1c is above this level	(71) NHMRC, 2009	A
Targets for SMBG levels are 6–8 mmol/L fasting and pre-prandial, and 6–10 mmol/L 2 h postprandial	(71) NHMRC, 2009	C

” from HERE – RACGP General Practice management of type 2 diabetes 2014-15

Goals

What are your goals? For most people goals are very ‘soft’ e.g “I want normal blood glucose level’s”

Something more specific may be “I want to avoid hypoglycaemia” or “I don’t want any blood glucose levels over 15 mmols”

You may want to consider how to write effective goals that are specific and time limited. For example:

“In the next 3 months, (between now and my next HbA1c test) I shall measure my blood glucose level every week for 3 days when I wake up, and also before and after each meal. If my bgls are over target I shall test daily for a week and show the results to my GP”

Missing an occasional test is not going to change this goal. The more information you can provide to yourself the more likely it is that your diabetes self care plan will be safe and effective.

**Regular assessment of your blood glucose level can help you with your quality of life**

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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Diabetes in Hospital

November 24, 2014 by Imagine_David Leave a Comment

In hospital different situations require specialist guidance

Going into hospital can be a real challenge, especially for those people who have had diabetes a long time, and who are confident and competent in their self-management.

Whether the hospital admission is for a medical or a surgical reason, your diabetes needs some special attention here.

Ideally your HbA1c will be normal, or as close to normal as possible prior to any planned surgery. The higher your blood glucose levels (BGL’s) are prior to surgery, the higher the risk of post-operative problems like infection.

If you are going to hospital for a medical reason, for example, an infection, the same applies.

The key is to be well informed, to take an active role in your own management, and to know who to call on if problems arise i.e. a friend or family member for support, or the appropriate health care professional within the hospital system.

Some of the problems people have experienced when in hospital are discussed below. The comments about these problems come from our Facebook community in answer to the question “in your experience, what would you like to see improved in the hospital system to improve the lot of a person with diabetes?” (I shall respond as ‘DM’ and in italics) **I have deleted some of the comments made by our community if the issue seems to be the same to others posted.**

In hospital diabetes can be managed well. Asking for the right people to help you is the key. — **Diabetes can be managed well in hospital with a little planning and knowledge of the system**

JR: My problems in hospitals, both public and private, are a general lack of staff awareness about Type 1 diabetes. They tend to treat it as one size fits all, and definitely do not listen to the patient. In a couple of cases I was on an insulin drip but not given boluses for meals, no matter how much I asked for these. Then they wondered why I was high!

DM: It’s an unfortunate fact that many people with diabetes feel that they are not listened to within the hospital system. One of the findings of the DAWN Study (as far back as 2000) was this feeling of not being heard. Often, the best way to be heard is to write a letter to a) the hospitals patient liaison officer, and then if not satisfied with the response, to b) your local member of parliament – this generates a ministerial enquiry into whatever the incident is that you have issue with.

JR, The usual procedure when on an insulin & dextrose (glucose) drip is that the insulin dose is changed relative to the bgl (which is usually measured each hour). It’s not usual for people to be eating when on this treatment. If the drip is being ceased, then it is usual to give a dose of insulin with a meal, as intravenous insulin usually lasts only about 15minutes.

LR: Yes I would like to see more awareness from specialists in hospitals about type 1 diabetes, had my insulin drip ordered to be taken down by a respiratory specialist after 1 day, I was out of it with pneumonia and didn’t know what was going on and that equaled a disaster for my diabetes management, I was 1 sick girl for a while, had I been with it I would have told them not to take it down because I know where it goes from there

DM: LR, again, the teams of non-diabetes specialists within the hospital system often do not have the same level of knowledge and experience of the diabetes (endocrine) teams. In hospitals it is important to remember that the doctor you are seeing may be a junior doctor with little experience in diabetes management. One option for people to consider is that on admission they seek a consultation with the endocrine team. Firstly ask the doctors of the team that you are being admitted under to refer you to the endocrine team. Ask them to document the referral, and if they decline to refer you ask them to document why they are not making the referral. In hospital the more detail that is documented the more ammunition you have to go back to if a problem arises. If that fails, then ask to speak to the nurse unit manager (or equivalent) – this is the chief nurse on duty. Voice your concerns to them, and ask them to organise with the endocrine team to be involved in your care. Ask the endocrine team to document in your file whatever it is that you want as a part of tour care. Example: if you do not want your drip to be taken down by anybody but a member of the endocrine team, ask that it be documented in your file (and ask that the person who is doing the documentation show you that it has been done). Of course none of this is easy, especially if you are unwell and cannot speak up for yourself. This is why it is also good to have a friend or family member on your team when you go to hospital.

HH: I have had one excellent experience – I went in for day surgery in a private hospital to have wisdom teeth removed. The as soon as the nurse who was admitting me knew I had type 1, she grabbed a pre-packed hypo pack which she put on a tray under my bed, and it went everywhere with me. They were well prepared for someone with type 1, and well trained – no stupid questions like “is your diabetes controlled with diet, tablets, or insulin.

DM: Great HH! There are very many good health care professionals in hospitals, and its good that you had a positive experience. Praise is short coming in the hospital system. If you have had a positive experience write a letter of thanks to the people who have provided this for you.

SR: My issue with hospitals in general is that most of the nurses I’ve come across have told me what u should and shouldn’t be doing with my diabetes. It’s not right and it’s not fair either. My response to them is well you try to live a day as a diabetic and let’s see how far you go before you want out. I want this to stop.

DM: Nurses are naturally carers SR, so often they will make suggestions that are well meaning. This ‘caring’ can sometimes be unwelcome by people who see it as interferring, especially if they have had diabetes many years. It may be helpful to ask for a diabetes educator consultation to appease their well meaning intervention: you could maybe ask ‘how do you think a diabetes educator could help me’ or ‘ that aspect of my diabetes is usually well managed; its only she I am unwell that my blood glucose level is so high – isn’t that normal when one is less active than usual, sick, and stressed (as in this situation of a hospital admission)?’ Some of my clients have also found it helpful to show health care professionals their answers to the diabetes knowledge questionnaire, as well as a copy of their diabetes self care plan (which they carry on them).

LB: The “Diabetic” food actually wasn’t so you need to be careful. I wanted to do my own finger jab & Byetta injections but they wouldn’t let me, but no logical reason given. Can we find out why that is?

DM: LB, an option to consider is to ask the nursing staff caring for you for a consultation with the dietitian on admission. For the self injection and self testing: ask the nurse unit manager or team leader (nurse in charge) to make arrangements for this to happen. If they disagree to this, ask to see a copy of the policy that relates to this.

HH: …… where I went to ED with DKA and was told that they would wait to put me on an insulin infusion until my blood sugars came down a little!!! I was not really with it so couldn’t kick up a fuss. Thankfully a more senior dr turned up and started me on insulin.

DM: HH, for future reference might it be helpful to have a diabetes self care plan with you that includes a) a letter from your endocrinologist stating where to start with appropriate treatment in this situation, b) and/or at least their phone number for a consultation c) a copy of the hospitals policy on the treatment of dka

LB: I was diagnosed type 2 on August 30 this year, only finding out due to blood tests taken prior to jaw reconstruction surgery. I had the jaw surgery on September 9, so I was still pretty clueless myself about diabetes! They were very vigilant about testing my BGLs, about 4 times a day! But, although I had informed them about my dietary needs, I noticed my diet was clearly totally geared towards post-jaw surgery, in other words, very soft mushy food. Which I did need, no way could I have chewed anything! But I was given quite a lot of custard, jelly and ice-cream, all very high in sugar! Luckily I couldn’t really eat that much anyway, even talking hurt at first! I guess it is difficult when they have to take into consideration many different factors with diet. Oh, I am allergic to onion too, and they did manage that okay. This was a very large city hospital though, and you would expect them to be able to handle these things.

DM: LB, another good reason for some pre operation planning. For people who are undergoing planned surgery it could be helpful to ask your surgeon or the pre-admission clinic to organise a) a dietitian consultation on admission b) for the endocrine team to be involved in your hospital stay c) a diabetes educator to assess the care plan on the surgical ward that you are admitted to

RH: I need to be treated as a patient with my own personal problems, diabetes, allergies and my current diagnosed health problem. I still need food and water while in hospital. I do not need counseling or arguments with hospital staff about chronic lifestyle problems I have had diagnosed by professional medical practitioners in the past that have been resolved by following those professional medical practitioners instructions. So when I go to hospital my food needs are not met. I cannot get milk in my diet because of allergies and food with allergens cannot be eaten. Suitable substitutes are not ever available. Raw vegetables, meat and water or tea ARE so the hospitalization is frustrating in the extreme. I just want plain good food without allergens and proper nutrition so I get well quicker and home sooner. Simple.

DM: RH, it might be that the procedures and polices of the hospital state that anybody with diabetes will be seen by the diabetes educator. Ideally the diabetes educator – and not the generalist nurse – will assess your knowledge and skills, and your diabetes self care plan. In my experience many people who live with diabetes have had no diabetes education. Also, I have found that information given in the past by inexperienced health care professionals may be incomplete or inaccurate. In hospital it’s a good opportunity for a specialised nurse – a diabetes educator – to help people in this situation manage their diabetes more healthily. I have found even the most knowledgeable and skillful diabetic has some room to improve. And if not, I have actually learned something from them. And of course the same for the meal planning part of the diabetes self care plan: talk to the dietitian, for they have the most knowledge and skills in this area. A good question to ask is ‘ what evidence is there relating to your advice?’

HW: In many hospitals in my experience the morning & afternoon tea trolley has little or nothing to do with the kitchen. I’m not sure if they would even get the info re us being diabetic? It would be great if low GI fruit such as apples, pears, berries, even a banana; or cheese n low GI crackers; or yogurt or nuts were options for those ‘snack times’ rather than sweet high fat biscuits.

DM: HW, writing a letter to the hospital suggesting these healthy options may have some impact. If not, writing a letter to your local member of parliament may raise awareness of this problem.

TC: General education, I swear doctors and nurses know the least, my biggest fear is they will kill me

DM: TC, I agree – it’s a real problem, the lack of knowledge around the real life issues and management of any type of diabetes. Be aware that hospital staff are well meaning in their actions and advice; however, they come in all ‘shapes and sizes’ i.e. amount of knowledge and experience in the field of diabetes. This is why I suggest to all of my clients to carry with them a copy of their diabetes self care plan as well as a letter form their endocrinologist for any hospital admission. It might be also an idea – if you have a hospital nearby that is the likely place of admission – to have something documented in your hospital file for future panning. And asking staff on admission to refer to these notes. It will depend on local policies, but it may be possible to have a copy of these notes with you also.

LWG: A better understanding of a diabetic needing to eat and not have a hypo

DM: This is also a real problem, and stems from lack of knowledge and understanding. I once had an issue with a doctor taking away the clients hypo treatment from their bedside locker. Option: write a letter of complaint if this happens to you. Option: see a dietitian on admission; ask to have meals and snacks ‘prescribed’ for you.

Using the Team approach - diabetes educator, dietitian, and your endocrinologist can help with a smooth hospital admission — **Using the Team approach – diabetes educator, dietitian, and your endocrinologist can help with a smooth hospital admission**

Consult with your doctors

Remind your doctors that you have diabetes, and ask them to discuss your usual plan, and if it needs to be adapted to the hospital admission. This is also a good time to ask that your surgeon or physician consult with your endocrinologist.

If you use an insulin pump, chances are the hospital staff will not know what it is, let alone how to ‘drive’ it if you are unable to e.g. during a surgical procedure when you are under anaesthetic.

Self Care Plan

It may be wise to put in writing how you would like your diabetes to be managed whilst in hospital, ask your doctor/s to an agreed written plan, and sign this plan prior to going in to hospital, or once admitted.

Your plan might be as simple as “allow me to make the decisions about my doses of insulin, and take my own BGL’s”

Take a ‘Me First Please’ Approach

If you are using diabetes medications, it might be helpful to ask that your procedure is listed as first thing in the morning. This may make it easier for you to manage your diabetes, and also help the staff looking after you have you recover from your procedure quicker. i.e. avoid hyper / hypoglycaemia.

When Can I Eat

Quite important if you are to fast during your normal waking hours. Ask questions about fasting, when you can eat and alterations to your insulin dose.

Hypo Plan

Hospital food may not be your cup of tea.

Take your usual hypo treatment with you, and ask the staff looking after you to keep it out of any locked cupboards i.e. have it available. You may need to ‘educate’ them about why this food is important to you to have available and with you at all times.

It may also pay to have other sources of carbohydrate with you to make up your usual amount of carbs if the hospital food isn’t to your liking, or doesn’t turn up.

The Hospital Process

Nurses looking after you will more than likely have other people to care for as well. They are usually so busy that they cannot take the same care of your diabetes that you would usually do.

If you have made an agreed care plan, this plan could include you measuring your own BGL’s at the most accurate times i.e. before and 2 hours after meals. This information can expedite the recovery period by helping to choose the best doses of insulin, and achieve the best BGL’s.

Often, doctors in hospital will want to change your usual medications. They may decide to change the type of pills or insulin that you use, or your usual dosage may be changed without you being consulted.

You are in hospital – you have rights. Ask to be consulted about your dose changes before they are made. — **You are in hospital – you have rights. Ask to be consulted about your medication type or dose changes before they are made.**

If you are very unwell, or have undergone a long surgical procedure, you may be given intravenous insulin to control your blood glucose levels. There is an established policy regarding this, and in this situation you will have less control of what happens. However, you can still advise the nurses adjusting this insulin infusion, so ask the nurses to consult with you as they are making their decisions. You are likely to know your body and your response to insulin better than they do.

Following the surgery/procedure

If you are well organised you will have discussed your post-operative / procedure plan with your doctor/s when preparing for the hospital admission. Your plan will depend on the procedure, the type of diabetes you have, how skilled you are at managing your diabetes and of course how long you have had diabetes. If you would like some help in designing your plan, speak with your usual diabetes educator.

How often to measure your BGL; what to do in the case of ketones developing; what questions to ask the nurses looking after you; who to ask for if you are having trouble putting your plan into place i.e. the Nurse Unit manager or the doctor on your team; etc.

Before being discharged from hospital, make a point of connecting with your diabetes educator for advice when back at home. Keeping you out of hospital is a priority (not only for you but for the hospital), especially after a surgical procedure. Sometimes a phone call to your diabetes educator can help prevent re-admission.

Consider reviewing your ‘sick day plan’ before your hospital admission.

Know which services are available to you by asking to see the hospitals discharge planner before you go home.

Careful planning, being well prepared, well informed and telling all the right people what they need to know will help make your hospital stay more comfortable and put you on track for a safe and speedy recovery.

Teamwork ....will get you everywhere — Teamwork ….will get you everywhere

If you would like some personalised consultation, you can go to HERE.

This is FREE if you are an Australian resident, fee for service if you are from overseas.

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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Why High on Wakeup?

November 15, 2014 by Imagine_David 4 Comments

” My blood glucose level be fore bed is 5.8. I wake up and its 7.4 …… WHY!!!???!!!???”

Like all things about insulin, blood glucose level – diabetes – its not a simple explanation.

But lets try and make it understandable in its simplest form (we can get more complex later)

Glucose

Commonly referred to (by even the ‘experts’) as sugar – ‘blood sugar level’; ‘how are your sugars’ etc

Glucose enters your blood from the digestion of carbohydrate foods, AND from the liver producing glucose to fuel your body when needed – a 24 hour process.

Your muscles store glucose for when you need to move: glucose is your bodies main fuel.

Muscles & Glucose

You muscles store glucose.

Insulin allows glucose to enter the muscle. Picture this: The MCG (Melbourne Cricket Ground) – a stadium that holds 100,000 people. It has 100 gates that open on game day to allow the crowd to get inside.

Imagine a muscle is like a brick wall: each individual muscle cell represents a brick in the wall (ok, no Pink Floyd jokes)

Imagine that each gate at the MCG represents a ‘gate’ on your cell wall that opens when a piece of insulin opens it.

Each cell is like the MCG – it has thousands of gates on the wall to open and close to allow the glucose to get inside.

When the body is making insulin in normal quantities – we have no diagnosis of diabetes. But sadly, thats NOT YOU.

So, if a person has any type of diabetes, the pancreas is under-producing insulin. When there is insufficient insulin the ‘gates’ of your cell work inefficiently. This of course has the glucose stuck outside the ‘stadium’ (muscle cell) waiting longer to get inside.

Imagine, game day at the MCG. 100,000 people there for the cricket …. don’t laugh, it used to happen! We have a problem IF half the gates are closed, and the keys are lost. Instead of the crowd moving into the stadium, it takes twice as long due to the closed gates.

Closed gates on your cell wall – it takes longer for the glucose to move from the blood into the cell and ….. therefore a high blood glucose level

sunset walk — **Life is full of ups and downs: your blood glucose level changes continuously over the day. And NOT only because of what you eat.**

The brain is a greedy guts for glucose.

The brain is so very specialised, and requires such a large amount of glucose, its calls absorb glucose without the need for insulin to be present. When you are not eating the brain still needs glucose. This glucose is supplied by the liver, which makes glucose and releases it into the blood 24/7 (other hormones – natural chemicals in your body – also play a part in the blood glucose level – but that waaaaaay toooo complex for now)

But I Didn’t Eat!

So, when you wake up in the morning and your blood glucose level is higher than when you went to bed……..

it not because you ‘sleep walked’ your way to the fridge and ate that leftover pasta / yoghurt / pavlova etc…..

……..its because your body is not making enough insulin to process the glucose that was released by your liver to fuel your brain and your muscles and your organs (such as your heart)……. OR……

………..your bedtime injection of insulin was insufficient….. OR…..

…….you had a hypo in the middle of the night (and your liver released insulin to feed your brain)

**Some things you can Control. Diabetes you can manage.**

Want to get more complex: try this

Want some simple visual explanation about insulin: try here {look at the first part about ‘what is diabetes}

Questions Please.

Kind Regards,

David

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‘I Want to Stay Off Medication’

November 5, 2014 by Imagine_David 2 Comments

I’m curious as to why a people living with diabetes would want to stay off medication.

My goal as a diabetes educator is to assist people living with diabetes to be as healthy as possible: physically and emotionally.

I imagine that your goal, people living with diabetes, is to reduce your risk of immediate & future health problems associated with diabetes.

So frequently I read here in our forums how people living with type 2 diabetes want to “stay off medications”.

Expense? Fear? Hypoglycaemia? Failure?

Is it the expense, the fear of hypoglycaemia or the feeling of failing with ‘diet controlled diabetes’ (of which their is not any such diagnosis) that leads to this statement? Or is the statement really……

“I want to stay off medication as long as possible, I shall be happy to use medication as the need arises”?

From Diabetes Australia comes this statement:

“Initially type 2 diabetes is treated through lifestyle modification including healthy diet and regular exercise. However, as the condition progresses, people with type 2 diabetes are often prescribed tablets to control their blood glucose levels. Type 2 diabetes is a progressive condition so eventually it may be necessary to start taking insulin to control blood glucose levels. Sometimes tablets may be continued in addition to insulin. Tablets or insulin should be incorporated into your management plan as soon as they are required. This is just the progression of the condition and should not be viewed as any kind of failure on your part.”

‘Initially’ – will depend on how early a person is diagnosed. If the blood glucose level on diagnosis warrants medication, it will be prescribed early. If the blood glucose level is only just in the diagnostic range then changes to the meal planning and level of exercise MAY be all that is required in the short – medium term.

‘Often prescribed ‘ – almost always prescribed would be a more factual comment, as over time the pancreas makes less insulin due to insulin resistance, and medication is required to asset in the maintenance of blood glucose levels on target.

Putting Prevention into Practice

By taking preventative action i.e. using medications to aid keeping the blood glucose level on target, you can then reduce the risk of health problems associated with type 2 diabetes and therefore the need for even more medication.

A good question to ask your self is “What physical attribute do I need to participate in my passion”

Example: Adam has a passion for photography. The physical attribute I need are : good eyesight (poorly managed diabetes can lead to loss of vision); & the ability to move around a landscape to get the best position to take the best photograph (poorly managed diabetes can lead to loss of nerve function in the feet & heart disease). For Adam these 2 factors are motivators to take medication when required.

**Listen to your health care professionals advice, make an informed decision**

Options

In Australia we are fortunate to have an exceptionally good health care system. There are seven classes of medicines used to treat type 2 diabetes. Talk with your doctor or pharmacist about which type will best suit your needs.

Ask questions like:

Will this medication increase my risk of hypoglycaemia
How much will this medication cost
What are the side effects and under what circumstances should I stop this medication?
How many days / weeks will it take for this medication to reach its best effect i.e. when should i start seeing the maximum results of this medication.

Medicines available:

1. Biguanides
2. Sulphonylureas
3. Thiazolidinediones (Glitazones)
4. Alpha-glucosidase Inhibitors
5. Dipeptidyl peptidase 4 (DPP4) inhibitors
6. Incretin mimetics
7. Sodium-glucose transporter (SGLT2) inhibitors

Ask questions, get answers that you understand.

Kind Regards,

David – Diabetes Educator @ Diabetes Counselling Online

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Ageing Safely with Diabetes

October 29, 2014 by Imagine_David Leave a Comment

Age, type of health problem, general wellness all influence the diabetes management, recovery and early discharge from hospital

Our population is getting older.

Alzheimer’s and memory loss is a higher prevalence in people with diabetes.

What’s your family and friend support network like?

How do you best support an elderly relative who has diabetes?

Let’s take a look at some of the strategies that you could use.

Medication

Pills

Available from the pharmacist is the Webster packs. This pack is great for pills, with each medication divided into the blister pack for each time of the day, and days of the week.

However, this system is not fool proof. And is not available for injections.

Example: Mrs M was using a Webtser pack. Each meal time she would prepare her pills by taking them out of the pack and putting them on the table where she was about to eat. One day whilst helping Mrs M clean, her family found a significant number of her pills in a drawer next to the table. She had been forgetting to take the pills with the meal, and in cleaning up after the meal had moved the pills away into the drawer.

Self Care Strategies:

Ask your pharmacist to make you a Webster pack
Ask your diabetes educator or doctor to assess your understanding of your medications
Ask your diabetes educator or doctor to assess your memory

Family & Friend Strategies:

Do a monthly (or as frequently as possible) check that the routine of pill taking is actually safe and effective i.e. the pills are being taken!
Make a phone call at meal times, checking that the person is safe, and has taken their prescribed medication.
Make an appointment with the diabetes educator and attend with your family member

Insulin

Is the supply diminishing? Has the injection technique been checked recently?

Example: Jack was prescribed insulin. He used a needle and syringe to inject. His local pharmacy noticed he was not using as much insulin as he should be. The pharmacist called by to inspect Jacks fridge where he was storing the insulin. It was noted that Jacks supply of insulin was quite high and with further investigation, it was found that Jack could no longer see to measure the dose of insulin, and was therefore estimating a much lower dose than required.

Self Care Strategies:

Ask your diabetes educator or doctor to assess your ability to inject insulin safely each visit
Ask your diabetes educator or doctor to assess your ability to measure your dose of insulin
Ask your diabetes educator or doctor to assess your memory

Family & Friend Strategies:

Check the injection technique and supply of insulin once a month;
provide magnifying glasses or other tools to assist injecting insulin safely and efficiently;
ask the pharmacist to watch the supply of insulin is adequate
Make an appointment with the diabetes educator and attend with your family member

Monitoring the BLOOD GLUCOSE LEVEL

This is a very important part of assessing the diabetes self care plan and effectiveness of medications.

Self Care Strategies:

Talk to your doctor and diabetes educator about how often it is necessary to measure your bgl
Talk to your doctor and diabetes educator about how often to have the HbA1c measured
Ask your diabetes educator to assess your technique for testing the blood glucose level and ask them to quiz you about how you interpret the results.

Family & Friend Strategies:

Is the blood glucose level test being performed correctly: watch and assess
Are the results able to be seen clearly: ask ‘what do you see?’
Check that the reord book is kept up to date with the data stored in the meter.
Are the results able to be interpreted correctly

Hypoglycaemia

Self Care Strategies:

Carry hypoglycaemia treatment on your person at ALL times
Treat the very early symptoms of hypoglycaemia – treat even if you are unsure
Ask your diabetes educator and dietitian to check you hypoglycaemia plan
Talk to your doctor about the medications prescribed, and determine if there are better options for you as you age

Family & Friend Strategies:

Ask at every opportunity if your family member is carrying hypoglycaemia treatment on their person i.e. in their pocket or handbag
Ask to talk to their doctor about the dose and type of medication prescribed to determine f their is a better option that will minimise their risk of hypo
Check their blood glucose level measurements regular to determine their risk of hypoglycaemia
Ask if they know how to treat a hypoglycaemia should it occur

Memory

Self Care Strategies:

Ask your doctor to assess your memory. In the UK this issue is so important the government has recently (October 2014) made a decision to pay the GP’s a supplement to assess all ageing people for memory loss. A mini-mental is one of the tools used here.

Family & Friend Strategies:

Talk to your ageing family member and be conscious of any apparent loss of memory, or inability to think clearly.
Ask your local community health service to perform an Aged Care Assessment if you have any concerns about how safely they are managing at home, even if they are living with family.

Exercise

Self Care Strategies:

Exercise with a friend or in a public place where there are other people around. Example: recently a 68 yr old woman went for a walk not more than 400m from her car. She had a hypoglycaemia, fell, broke her ankle and was stranded. Fortunately she had hypoglycaemia treatment in her bag and was able to maintain her blood glucose level. And fortunately she only waited 2 hours for someone to come to her assistance.
Tell someone exactly where you are going and what time to expect you home if you must exercise alone.
Carry hypoglycaemia treatment on your person at all times.

Family & Friend Strategies:

As, at every opportunity, if your family member is carrying hypoglycaemia treatment on their person i.e. in their pocket or handbag
Have a contact plan if your family member is going outdoors to exercise alone.

More information HERE

Have you got some strategies to share, for yourself, for family members? Please share below.

Be safe…. ask questions, and get answers that you understand..and can remember

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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