Diabetes MCLG
www.barnetccg.nhs.uk/CEPN
Multi-professional Collaborative Learning Group
Diabetes Part 1
Planned Learning outcomes:
· Recognise risk factors for pre diabetes and diabetes.
· Understand how to screen and the limitations of HbA1c.
· Learn about how to manage pre diabetes and the newly diagnosed diabetic patient
· Discover what resources and services are available.
· Think about what advice to give and how we can keep this consistent between disciplines
· Consider how we can motivate patients to make changes
· Learn about the role of lifestyle and medication
· Consider long-term risks of pre diabetes
The Case
Mr Kipling is 49 years old. He is of South Indian heritage but he was born in the UK. He works as an IT specialist and spends much of his time at a desk.
He is married to Melissa and has two children; Candy aged 10 who has asthma, and Dex age 14.
He does not smoke or drink much alcohol but has a poor diet. He usually misses breakfast but tends to snack throughout the day often missing meals but filling up with crisps or cheese sticks. He likes chewy seed nut bars and drinks several cups of coffee a day, which he always has with a biscuit. He has a large meal in the evening when he gets home from work, usually after 8pm. He particularly likes rice and pasta and has this with almost every meal. This is usually a take away as his wife works in the evenings at an Adult Education College teaching art.
He does not do any formal exercise but he does like to walk the dog in the morning and evening.
Both his parents are still alive. He has two older siblings. His eldest sister is a fitness freak. His middle brother had an MI last year and was diagnosed with diabetes at the time. His mum has type two diabetes, which is well controlled on oral medication. She had gestational diabetes when pregnant with both her sons. His father is well but has hypertension that is well controlled.
He does not take any regular medication and hardly ever goes to the doctor, as it is so difficult to get an appointment.
However about 4 months ago, he did see his GP for an itch over his scrotal skin and foreskin. He was diagnosed with thrush which he thought he might have picked up from his wife. His GP prescribed Canesten Cream, which did the job.
Unfortunately his symptoms returned a few weeks after stopping treatment so Mr Kipling bought some Canesten Cream OTC. He has been using the cream and nearly finished the tube but this time the symptoms seem to be persisting.
Today he has popped in see the pharmacist to collect his daughter’s asthma medication. He asks Mr Dossett the pharmacist for another tube of Canesten.
Mr Dossett recalls having previously issued a prescription and sold Mr Kipling Canesten. He is concerned and asks Mr Kipling a few questions about his symptoms.
Mr Kipling says he feels well; he does not report any weight loss, thirst, or polyuria. He does admit to feeling tired and getting up in the night to pee.
Mr Dossett asks Mr Kipling if he would mind being weighed and having his blood pressure, waist and blood sugar measured.
This reveals:
BG: 11mmol
BP: 144/86
Weight: 85
Height: 160
BMI: 33.2
Waist Circumference: 106cm
Consider
a) What risk factor would alert you to have concern about a patient being at high risk of diabetes and in your role what can you do when you encounter such a patient? Do you find discussing such risk with patients easy?
b) What would you advise him? Discuss according to your discipline.
c) How can we empower Mr Kipling to make changes?
d) What do the group think would be best practice for Mr Dossett regarding communication with Mr Kipling’s GP practice?
.
The case cont.
Mr Dossett advises Mr Kipling to see his GP as he is concerned that Mr Kipling may have diabetes.
He then sees his GP, Dr Legume who requests some blood tests.
Fasting glucose 6.6
HbA1c 46
Total Cholesterol 6.7
Trigs 1.8
LDL 3.1
HDL 1.9
Ratio 3.5
Creat 58
Na+140
Urea 6
K+ 4
eGFR 92
Alb 38
Bil 11
ALT 31
AST 91
GGT 27
Microalbumin ratio 2.3
Discuss the results.
· Is the diagnosis clear?
· What do you now advise Mr Kipling?
· What is your approach to managing him? Do you think drugs have a place?
· What about follow up? Who, when, where?
· Do you know what services are available or other resources he could use or
that you could direct him towards?
Please ensure you sign the register and please complete evaluation sheet
Useful Websites
Primary Care Diabetes Society
www.pcdsociety.org/
Diabetes UK – Care. Connect. Campaign. - Diabetes UK
https://www.diabetes.org.uk/
Choose MyPlate
www.choosemyplate.gov/
https://www.nice.org.uk/guidance/ng28/resources/algorithm-for-blood-glucose-lowering-therapy-in-adults-with-type-2-diabetes-2185604173
http://www.nice.org.uk/guidance/ng28/resources/patient-decision-aid-2187281197 patient decision aid
http://www.nice.org.uk/guidance/ng3/chapter/1-recommendations Nice recommendations in pregnancy
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