Diabetes- Patient Monitoring,Care And Education

Diabetes mellitus is a common disease affecting a large number of population. It is characterized by increased blood sugars and abnormalities of carbohydrate and lipid metabolism.Diabetes can be managed by family physicians as effectively as in hospital clinics.

Aims Of Diabetic Care

• Alleviation of symptoms.
• Minimization of complications.
• Reduction of early mortality.
• Quality of life enhancement.
• Education of the patient and family.
• Features of well organized care
• Use of a register and well maintained records.
• Regular review , following a proper protocol and provision of adequate time and open access for patients to review advice.
• Multidisciplinary team covering all aspects of diabetes care- GPs, diabetes nurses/assistants and educators.
• Continuing education for professional staff.

Routine diabetic review
Each diabetic patient requires 6 monthly review or more frequently as necessary. This should include a through annual review of all aspects of disease and care.

Review include

• The indices of blood sugar control e.g HbA1c
• Dietary behaviors, physical activity and injection techniques.
• Foot care.
• Immunizations – infuenza and pneumococcal vaccination.
• Depression screening.
• Any complications like cardiovascular disease, nephropathy, neuropathy, eye disease, errectile dysfunction etc.

Patient education
All patients with diabetes need a basic information about their disease. The important points are summarized here.

1. Diabetes is a chronic condition and however well it is managed in the clinic , the patient has to manage his/ her own disease the rest of the time.
2. Diet: Patients do not need a separate diet from the rest of the family or any expensive diabetes food product. A diabetic diet is a healthy diet in which >50% of calories should be taken from fiber rich carbohydrate with a minimum of fat , refined carbohydrate and alcohol. Spread food intake evenly across the day for patients controlled with tablets or diet.
3. Exercise: Encourage regular exercise and advise that physical activity can increase insulin sensitivity, decrease B.P and improve blood lipid control.
4. Smoking: Advice on and assistance with smoking cessation.
5. Psychological problem: Discuss concerns underlying diagnosis of diabetes or development of complications. Arrange counselling as needed.
6. Driving and Travel: Advice to take precautions during traveling. Manage changes in time zone, and arrange to transport insulin properly.