,Huge amount of things to cover- general advice: be clear and specific, what do we
know about the patient? Could consider: storage, practical
Patient is relatively old, she has co-morbidities, osteoarthritis- hands? Closed-angle
glaucoma high likelihood of disminished vision. Frame answers around this. Person-
centred approach.
Storage- unopened insulin needs to be stored in the fridge, Humulin I has a shelf-
life of 28 days after opening
Practical advice: injection sites, rotation, use of needles, dialling up units if
visually impaired
Use of injectable medicine
Adverse effects/ side effects- cold insulin can be very painful, injection site
reactions, advice to minimise swelling, redness
Additional testing- blood glucose monitoring – frequency and technique 4 times
a day before each meal and night-time and more frequently in certain situations.
Safety - sharps disposal, where are they being disposed, local area, house
collection, pharmacy, doctors.
Patient just started on insulin more at risk of hypos- symptoms, action to take
Combined: The patient should be informed that unopened insulin pens should be
stored in the refrigerator. Cold insulin can be very painful to inject, to reduce the
risk of this, once a pen is in use, it has a 28 day shelf-life and does not require
refrigeration.
1b.)
Is patient eyesight impaired? Consider screen size, backlighting
How will patient record results
Audio alarms for high/low glucose? Speech for blood glucose
Patient does not have a computer
Osteoarthritis, lancing devices/ inserting test-strips can be fiddly, size of device
Link to local area- should patient be receiving a glucose meter, rather than
purchasing one
Does patient need advanced functionality,
PERSON CENTRED APPROACH!!!!
• What do we know about the patient?
• Is patient eyesight impaired? Consider screen size, backlighting etc
• How will patient record results?
• Audio alarms for high/low glucose? Speech for blood glucose?
• What about osteoarthritis? Lancing devices / Inserting test-strips can
be fiddly? What about size of device?
• Link to local area – should patient be receiving a glucose meter, rather
than purchasing one?
• Does patient need advanced functionality (i.e. USB connectivity, PC
link? data analysis)
, 1c.) advantages: it can take readings at times when you wouldn’t normally take them
e.g. bed time,. Disadvantages: it does not measure blood glucose, it measures
interstitial glucose so can have a lag period between readings so standard blood
glucose monitoring is still recommended. Can be expensive if not funded by the NHS
and needs replacing about every 2 weeks. Requires a smart phone to scan readings,
this may be complicated for our patient as she is of the older generation. May cause
discomfort on site of application, it is visible too, she may not want people to see it.
Only gives information on interstitial reading from the past 8 hours so may be hard
to see changes/patterns in glucose.
What are the benefits to the patient?
Reduction in finger prick testing
Greater level / availability of data, how would this benefit the patient
Reduction in fine motor tasks if hand osteoarthritis
What else do we need to consider?
Funding: does patient meet NICE criteria,
Access to technology: regular scanning of reader required
Practicalities: would this prevent finger pricking entirely
Amount of data, could this be overwhelming to patient
Advise to make things easier in terms of their presenting complaint
• What is expected in a ‘critical evaluation’
• Balance pros and cons, leading to a clear decision. Multiple answers may be
reasonable/possible.
• What are the benefits to the patient?
• Reduction in finger-prick testing?
• Greater level/availability of data? How would this benefit the patient?
• Reduction in fine-motor tasks if hand osteoarthritis?
• What else do we need to consider?
• Funding: Does patient meet NICE criteria? If self funding, what is involved?
• Access to technology: Regular scanning of reader required
• Practicalities: Would this prevent ‘finger-pricking’ entirely?
• Amount of data: Could this be overwhelming to patient?
Type 1 diabetes mellitus
Therapeutic objectives
Maintain blood glucose at levels expected of non-diabetic person
In general, aim for HbA1c 6.5% (48mmol/mol) or lower, although target should
be individualised to individual patient factors
Minimise risk of complications secondary to:
-hyperglycaemia (tissue damage)
-hypoglycaemia (through over-treatment)
Principles of insulin therapy
Insulin regimen should be tailored to the patient and their individual
circumstances.
know about the patient? Could consider: storage, practical
Patient is relatively old, she has co-morbidities, osteoarthritis- hands? Closed-angle
glaucoma high likelihood of disminished vision. Frame answers around this. Person-
centred approach.
Storage- unopened insulin needs to be stored in the fridge, Humulin I has a shelf-
life of 28 days after opening
Practical advice: injection sites, rotation, use of needles, dialling up units if
visually impaired
Use of injectable medicine
Adverse effects/ side effects- cold insulin can be very painful, injection site
reactions, advice to minimise swelling, redness
Additional testing- blood glucose monitoring – frequency and technique 4 times
a day before each meal and night-time and more frequently in certain situations.
Safety - sharps disposal, where are they being disposed, local area, house
collection, pharmacy, doctors.
Patient just started on insulin more at risk of hypos- symptoms, action to take
Combined: The patient should be informed that unopened insulin pens should be
stored in the refrigerator. Cold insulin can be very painful to inject, to reduce the
risk of this, once a pen is in use, it has a 28 day shelf-life and does not require
refrigeration.
1b.)
Is patient eyesight impaired? Consider screen size, backlighting
How will patient record results
Audio alarms for high/low glucose? Speech for blood glucose
Patient does not have a computer
Osteoarthritis, lancing devices/ inserting test-strips can be fiddly, size of device
Link to local area- should patient be receiving a glucose meter, rather than
purchasing one
Does patient need advanced functionality,
PERSON CENTRED APPROACH!!!!
• What do we know about the patient?
• Is patient eyesight impaired? Consider screen size, backlighting etc
• How will patient record results?
• Audio alarms for high/low glucose? Speech for blood glucose?
• What about osteoarthritis? Lancing devices / Inserting test-strips can
be fiddly? What about size of device?
• Link to local area – should patient be receiving a glucose meter, rather
than purchasing one?
• Does patient need advanced functionality (i.e. USB connectivity, PC
link? data analysis)
, 1c.) advantages: it can take readings at times when you wouldn’t normally take them
e.g. bed time,. Disadvantages: it does not measure blood glucose, it measures
interstitial glucose so can have a lag period between readings so standard blood
glucose monitoring is still recommended. Can be expensive if not funded by the NHS
and needs replacing about every 2 weeks. Requires a smart phone to scan readings,
this may be complicated for our patient as she is of the older generation. May cause
discomfort on site of application, it is visible too, she may not want people to see it.
Only gives information on interstitial reading from the past 8 hours so may be hard
to see changes/patterns in glucose.
What are the benefits to the patient?
Reduction in finger prick testing
Greater level / availability of data, how would this benefit the patient
Reduction in fine motor tasks if hand osteoarthritis
What else do we need to consider?
Funding: does patient meet NICE criteria,
Access to technology: regular scanning of reader required
Practicalities: would this prevent finger pricking entirely
Amount of data, could this be overwhelming to patient
Advise to make things easier in terms of their presenting complaint
• What is expected in a ‘critical evaluation’
• Balance pros and cons, leading to a clear decision. Multiple answers may be
reasonable/possible.
• What are the benefits to the patient?
• Reduction in finger-prick testing?
• Greater level/availability of data? How would this benefit the patient?
• Reduction in fine-motor tasks if hand osteoarthritis?
• What else do we need to consider?
• Funding: Does patient meet NICE criteria? If self funding, what is involved?
• Access to technology: Regular scanning of reader required
• Practicalities: Would this prevent ‘finger-pricking’ entirely?
• Amount of data: Could this be overwhelming to patient?
Type 1 diabetes mellitus
Therapeutic objectives
Maintain blood glucose at levels expected of non-diabetic person
In general, aim for HbA1c 6.5% (48mmol/mol) or lower, although target should
be individualised to individual patient factors
Minimise risk of complications secondary to:
-hyperglycaemia (tissue damage)
-hypoglycaemia (through over-treatment)
Principles of insulin therapy
Insulin regimen should be tailored to the patient and their individual
circumstances.
