When it comes to diabetes, the patient’s understanding, adherence, and continuous monitoring are key components of effective care. However, with too many people with diabetes still under-estimating the condition’s severity, Libby Dowling, Senior Clinical Advisor at Diabetes UK, talks to NIHR about how we can encourage individuals to self-manage responsibly.

How often should diabetes patients measure their blood glucose?

It depends on what type of diabetes they have, and what their treatment is. If patients have type 1 diabetes, they’re going to be checking their blood sugar levels at least four times a day – but many check more regularly than that, such as anytime they think that their levels might be a bit high or low; or if they’re going to exercise etc.

For patients with type 2 diabetes, it’s slightly different. If they have the condition and are just managed by diet and physical activity alone, or Metformin, they don’t check their blood sugar levels as a general rule. However, if the individual takes insulin or some of the diabetes tablets that can cause hypoglycaemia, then they should be checking.

What complications can occur in the short-term if diabetes isn’t correctly self-managed?

However well patients manage their diabetes, they can’t get it right all the time – they’re essentially taking on the role of their pancreas which is a big ask.

If the patient’s blood glucose levels drop too low, they’ll suffer from hypoglycaemia, which will make them start to feel dizzy, shaky, and sometimes disorientated. If it’s not picked up at that point, then they’re in danger of collapsing or having a fit. Low blood sugar needs to be treated very quickly.

More severe symptoms can be too hard for the patient to treat on their own. As a result, most people with diabetes will have a sugary gel which someone else can squirt inside their mouth, and if the patient becomes unconscious through hypoglycaemia, then an injection is also available.

The other thing that can happen in the short-term is that if the patient’s blood sugar is too high, they can start to feel thirsty, tired, and drowsy, and they can progress into diabetic ketoacidosis, which can be life-threatening and needs hospital treatment. It’s crucial that blood sugar levels are checked regularly so that action can be taken accordingly.

Are healthcare professionals playing a big enough role in patients’ diabetes education?

Anybody who needs to use a blood glucose monitor should receive a basic education package from their healthcare professional which involves the practicalities of using the monitor, information on how often, and the targets which they should be aiming for. The patient should also receive information on what to do should their blood glucose levels get higher or lower.

How are blood testing meters allocated?

It’s not so common now that diabetes patients can just make a decision regarding their preferred monitor. It’s all about cost-effective care, so what often happens is that a particular area will have a number of different blood glucose monitors, and the patient, along with their healthcare team, will decide which device is the most appropriate.

For individuals who don’t require a lot of active management for their diabetes, a reasonably basic monitor might be suitable. But those with type 1 diabetes, who are counting carbohydrates or adjusting their insulin on a dose-by-dose basis, might need something more to allow them to do the required calculations.

How often should patients replace their monitoring device?

Monitors are pretty robust and will usually last a few years. However, they do need to be properly looked after by the patient.

What lifestyle and dietary tips are also fundamental to the patient’s diabetes management?

We advise that they live a generally healthy lifestyle. Type 2 diabetes is often linked to being overweight and not very active. If that’s the cause of it, then it’s really important that the patient receives support and takes steps towards losing the extra weight. Everyone with diabetes has an increased risk of cardiovascular disease so keeping healthy is key.

How often should patients attend for diabetes check-ups?

People with diabetes should be seen at least once a year for a check-up – probably more often. It’s really crucial that they keep the appointments because the healthcare professional both checks that their diabetes is being managed properly, and whether any long-term complications of diabetes have occurred from a long period of high blood glucose levels. The occurrence of this can damage the blood vessels and nerves and cause heart attacks, strokes, amputations etc. It’s important that we check for those conditions, and if anything is picked up early, it can be treated.

People with diabetes will also need to get their eyes checked on a regular basis to make sure that there are no problems there.

Are there any learning resources you can recommend?

Diabetes UK have a lot of information on our website on all areas of diabetes management –for healthcare professionals as well as people with diabetes.

For healthcare professionals we provide position statements on certain aspects of diabetes care, a shared practice library, and much more. We also have a learning zone which has tailored information for people living with diabetes – it’s as personalised as we can make it.

For more information, visit www.diabetes.org.uk.