Scenario

Customer Henry Fowler, who was diagnosed with type 2 diabetes a couple of months ago, is talking to technician Vicky:

“I’m not getting my head round this diabetes lark at all. First of all the surgery put me on tablets and then just left me to it for a month, and now they have given me a glucose monitoring machine to use. I’m testing at different times of the day as they have told me to do, but I have no idea what the numbers mean. Sometimes it’s as low as 10, other times it goes up to 18. Then there is this haemoglobin test, which apparently I can’t do myself and they have to do for me. I thought haemoglobin was about iron levels. It’s so confusing!”

Answer

Henry is talking about two different diabetes monitoring tests – plasma glucose and glycated haemoglobin. Plasma glucose will be measured at the regular appointments that Henry has with his GP or diabetes nurse, but he has also been provided with an at-home monitor. Given his confusion, Vicky could ask him to bring his machine and testing strips to the pharmacy so that his technique can be checked, as well as safeguarding other aspects such as whether the monitor has been calibrated.

The levels Henry is aiming for are 4 to 7mmol/l before meals and less than 8.5mmol/l two hours after eating. Given his relatively recent diagnosis, however, his glucose levels may not have stabilised yet, despite the medication and lifestyle practices he has adopted. Glycated haemoglobin, a form of haemoglobin that has glucose attached to it, gives a measure of glycaemic control over the previous two to three months. A high reading (above 59mmol/l) indicates that the diabetes is not as controlled as it should be and usually flags up the need for the patient’s management plan to be reviewed. It sounds as though Henry needs someone to explain the various aspects of diabetes management to him, and Vicky is an ideal person to do this. This will help build his trust in her and encourage him to return in the future with any questions he may have about his condition.

The bigger picture

Medication and monitoring are just two elements of diabetes care. Of significant importance are lifestyle changes, notably bodyweight, diet and physical activity levels:

• Bodyweight should be reduced if the patient is overweight or obese. Changes to diet and activity levels are the most effective ways of achieveing this, with an aim of losing five to 10 per cent bodyweight over the course of a year. Those with a BMI of more than 30kg/m2 may require a more structured weight management programme.
• Dietary advice should be provided by a healthcare professional with expertise in nutrition, while being sensitive to the individual’s needs and beliefs. General points include choosing high fibre, low glycaemic index carbohydrates such as whole grains, pulses, vegetables and fruit rather than refined carbohydrates. Individuals should also incorporate good quality dairy produce and oily fish into their diet, while reducing their intake of saturated and trans fat foods
• Physical activity is an important aspect of diabetes management. Ideally, Henry should aim for a minimum of 150 minutes of moderate intensity activity (such as fast walking) a week, plus muscle strengthening activities on two or more days. If this is unachievable, even a small increase in activity, such as a short walk after lunch, will be beneficial and may encourage further improvements.

Extend your learning

• Self-testing can be daunting, particularly when it involves taking blood samples. For advice on how to make taking blood easier, visit: Diabetes UK: Testing
• Find out how often the National Institute for Health and Care Excellence (NICE) recommends that patients with type 2 diabetes should have their glycated haemoglobin measured
• Should pharmacies stock specialist food for people with diabetes?
• Refresh your knowledge of the differences between type 1 and type 2 diabetes.