Six reasons your client might benefit from a diabetes review
By Elaine McLennon, Credentialled Diabetes Educator
People with diabetes need regular health checks to maintain their physical and mental health. Common problems relate to issues with eyes, kidneys, feet, and blood fats. People living with diabetes are also at an increased risk of cardiovascular problems such as heart attacks and strokes.
Unfortunately, many people living with diabetes are not familiar with the health checks they should regularly have. The NDSS factsheet Your Annual Cycle of Care is a great resource which provides your clients with the information they need.
Aside from the standard annual cycle of care checks there are many other times when a review may be beneficial.
1 Your client has started a new medication
Some medication changes, such as starting on insulin or other injectable medications, can take some education and getting used to. Making sure your client understands how to identify and correctly treat hypoglycaemia is crucial. It is also important that they understand driving rules, correct injection technique, the importance of injection site rotation, and when to check blood glucose levels.
Often a person starting on insulin is nervous and very hesitant. Good education can make a significant difference for them.
2 It has been a long time since a health review was done
A lot can change over time, but often people feel they are going along ok. Nothing has changed on the outside and they feel fine. But are they?
Many of the health problems people with diabetes end up dealing with have no signs or symptoms at the early stages, such as those relating to eyes, kidneys, and high cholesterol. However, all of these can have a significant impact on a person’s life.
Encouraging your clients to attend a GP visit to get some blood tests, skin and blood pressure checks can help prevent small problems becoming big. Problems caught early are easier to treat.
3 They are experiencing unpleasant side effects
Sometimes medications taken can produce some unpleasant side effects that affect our client’s quality of life. Things such as nausea, vomiting or diarrhoea are common. But some of these adverse events can be avoided through education.
For example, the medication Metformin often causes nausea or diarrhoea, if taken on an empty stomach. Many people with diabetes do not know it is best tolerated after food. A chat with a pharmacist or GP can mostly resolve the issue by picking up simple errors such as these. There may also be an alternative medication that may be better suited to your client. For example, Metformin XR is said to have less gastro-intestinal side effects than immediate release Metformin.
4 When things change
- Dietary – Clients often try different diets or different ways of eating. Trying to cut out carbohydrates or reducing them significantly is a common approach. Low carb or low energy diets could put the person more at risk of hypoglycaemia. Some dietary changes can also increase the risk of the person developing other chronic conditions, such as osteoporosis. Linking a client in with a dietitian can be valuable to prevent the person becoming too strict or restrictive with their eating and improve their overall health and well-being.
- Physical activity – Clients often do not exercise for many reasons, including pain from another condition, not knowing where to start, or fear of hypoglycaemia. An exercise physiologist can assess the person, prescribe an exercise routine tailored to their specific situation and follow up on any progress made.
- Blood glucose levels change – Sometimes blood glucose levels start to increase or fluctuate more than usual, despite no obvious changes in daily lifestyle activities. There may be an underlying reason such as infection, pain or stress, or it could be that their diabetes medication needs to be adjusted. People’s bodies, and needs, change over time. Ask your client about their blood glucose levels every time you see them. If you are not sure if changes are needed, encourage them to have a chat with their GP, endocrinologist or diabetes educator.
5 Your client may need some ongoing encouragement
People living with diabetes often struggle to reach goals set for them by health professionals. Your client may want to make changes such as to lose weight or become more active, but they need ongoing support to assist and motivate them. Also, sometimes their personal goals do not align with the goals of their health professionals. Open, and honest, communication can clear up any incongruencies.
6 Diabetes is starting to impact a person’s mental health and quality of life
Diabetes stress and burnout are common and are not a sign of weakness. It is important to recognise and address any mental health issues, as they are likely to impact blood glucose levels and quality of life negatively. If it is outside your scope of practice to support your client with any mental health issues, encourage them to speak to their GP about a referral to a psychologist. Medicare rebates are available for up to 10 sessions per year for people with a chronic condition such as diabetes, and mental health challenges.
Where to go for a review and what services are available
There are several health professionals who are trained at helping people living with diabetes, including:
- GP: Most people will seek to see a GP as a first port of call, as the GP is able to refer on to additional services if needed.
- Aboriginal health services: These are available in some areas, they have GPs and usually offer other allied health providers such as diabetes educators, dietitians and psychologists.
- Credentialled Diabetes Educator (CDE): Can assist people with their diabetes management, or if they simply want a diabetes review. CDEs can be found in large hospital diabetes centres and many community health centres, which offer services at no cost. Alternatively, CDEs may also work in private practices. To find a credentialled diabetes educator, follow this link ADEA | Australian Diabetes Educators Association.
- Dietitian: For dietary advice including how to lose weight, gain weight, or to review dietary intake, a visit to an Accredited Practising Dietitian (APD) is an excellent choice. APDs are often part of hospital diabetes centres. However, there are also private dietitian services available, often through local GP clinics. Find a Dietitian (dietitiansaustralia.org.au)
- Exercise Physiologists are there to help people exercise safely and within their limitations. They are specialists in tailoring programs for people with chronic conditions. Like the diabetes educators and dietitians, you may find them employed at hospital diabetes centres and they run private clinics. To find an exercise physiologist follow this link Search Buddy Location (essa.org.au)
- Pharmacist: A Home Medicines Review (HMR) from a pharmacist may be of significant benefit to a client who is taking multiple medicines, who have medications prescribed by more than one doctor, who have been prescribed new medications, have been in hospital, often forget to take medications, or are concerned about them. A GP referral is necessary. A pharmacist can look at all medications being taken, including over the counter and herbal medications. They will check to make sure that the medications are safe, working appropriately (not clashing with other meds) and are being taken correctly. HMRs are free of charge every two years.
- Get Healthy Service: This a NSW Health initiative delivered by Diabetes Australia. It offers a no cost phone coaching service. It comprises of 6-10 calls with a health professional, who work with people to help them achieve their goals. You can refer people into the Get Healthy Service, or people can refer themselves. You can access them through their Helpline 1800 806 258 or via Get Healthy NSW. Similarly, the Coach program is available in Tasmania, the My Health for Life program is available to Queensland residents, Life! in Victoria and Let’s Prevent in WA.
- Beyond Blue: Available 24-hours per day for support via their Helpline: 1800 224 636 They also offer a new mental health coaching program called New Access, a confidential guided six-session mental health coaching program for anyone feeling stressed or overwhelmed about everyday life issues.
- 13YARN: A national service for Aboriginal & Torres Strait Islander people in crisis. It offers confidential, one-on-one, telephone support.
- Podiatrist: Foot complications for people living with diabetes are common. It is recommended that people living with diabetes have a foot check by a podiatrist at least once a year.
- Optometrist: people with diabetes are at high risk of eye damage caused by high glucose levels. It is important that they get regular eye reviews. You can check a person’s visual acuity in clinic but should also remind your clients to see an optometrist at least annually for a thorough eye health examination.
There are many occasions when health reviews are important and there are many different health professionals who can help. A multidisciplinary team of health professionals can help people living with diabetes live a full and healthy life.
Want to develop your diabetes knowledge?
A good way to develop your knowledge of diabetes is by doing the Diabetes Qualified Diabetes Essentials course.
Diabetes Essentials is a comprehensive learning program which covers all aspects of diabetes; from diagnosis to management. This online interactive course will provide you with the latest best practice information on diabetes. Including the pathophysiology of diabetes, diabetes management principles, and prevention of complications.
Enrol today and gain valuable knowledge, CPD points, and practical skills.