Patient discussions
Advise the patient that frequent medication adjustments represent good care, and are not a sign of failure or a reason for self-blame or guilt.
The use of self-monitoring of blood glucose data to promptly identify loss of glucose control and proactively adjust therapy is an essential self-management skill when using multi-dose insulin regimens, and requires patient education and easy access to health team members between scheduled clinic visits. Those on multi-dose insulin regimens are often advised to monitor blood sugars before meals and at bedtime.
In other patients with diabetes, self-monitoring may be useful to assess the impact of changes in diet, medication regimen, and exercise, as well as to guide dietary and fluid intake and medication management during episodes of illness.[328][329]
Counsel women of childbearing age with diabetes about the importance of strict glycaemic control prior to conception.[99]
Arrange for the patient to have counselling on how to prevent and promptly identify eye, foot, kidney, and cardiovascular complications.
Explain to the patient that low blood sugar (glucose ≤3.9 mmol/L [≤70 mg/dL]) is often accompanied by symptoms such as tachycardia, sweating, shakiness, intense hunger, or confusion, and must be dealt with promptly by ingesting 15-20 g of carbohydrate (equivalent to 3 to 4 glucose tablets of 5 grams per tablet).
People who drive need to be particularly careful to avoid hypoglycaemia and should be warned of the dangers.
After self-treatment, blood sugar should be checked if possible.
Instruct patients to promptly report nocturnal hypoglycaemia or recurrent episodes of hypoglycaemia so that therapy may be adjusted.
Patients should have a carbohydrate snack prior to exercise if self-monitored blood glucose is <5.6 mmol/L (<100 mg/dL) and the patient is taking insulin or an insulin secretagogue (sulfonylurea or meglitinide). Patients using alpha-glucosidase inhibitors who experience hypoglycaemia must use glucose tablets because absorption of conventional carbohydrates is slowed by the treatment.
All individuals prescribed insulin or at high risk of hypoglycaemia should have glucagon available (with a preference for preparations not requiring reconstitution), and a close companion should be instructed on how to administer glucagon.[34]
Ensure the patient is aware that any intercurrent illness can cause glucose levels to rise.[242] Give the patient clear and individualised oral and written advice (‘sick-day rules’) about how to adapt management during intercurrent illness. Some drugs need to be suspended during intercurrent illness; it is important to ensure the patient is aware that they will need to restart any suspended medication once they are feeling better and able to eat and drink. DiabetesontheNet: sick day rules Opens in new window
Telehealth/digital health solutions (the use of electronic communications, such as video calls and smartphone apps, to exchange health information, coach and monitor patients, and facilitate self-management) is a growing field that may increase access to care for people with diabetes, and should be used in conjunction with in-person visits.[34][80][102]
Direct patients to useful online resources, as appropriate. For example, Diabetes UK Opens in new window and the NHS: Healthy living for people with type 2 diabetes Opens in new window
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