Diabetes: myth vs reality

Myth: People with diabetes understand what to do when they are unwell

Fact: Actually it’s best to give people with diabetes some simple sick day rules and give them a personal care plan telling them what to do if they are unwell. These should be reiterated at times of sickness. Often people may have had education on sick day rules, but don’t use them often enough to remember them at critical times.

For instance:

  • You will need to test more often and if your blood glucose level is 15mmol/l (over 13 if on an insulin pump), check urine/blood for ketones. If ketones are present contact your diabetes team.
  • Even if you are not eating  you will still need your diabetes medication and insulin, and you may need to alter the dose so contact your diabetes team for advice
  • Never omit insulin in people with Type 1 diabetes.
  • Drink plenty of sugar-free fluids to prevent dehydration

Myth: Type 1 diabetes is just diagnosed in childhood

Fact: The peak age for diagnosis is between 9 and 14 but you can be diagnosed as a young child or adult.  90 per cent of people with Type 1 diabetes are diagnosed before the age of 30 but that still means there will be many people getting diagnosed later in life. Although age is a risk factor for Type 2 diabetes there is no age restriction for diagnosing Type 1. A detailed history of symptoms and onset may be useful.

Latent autoimmune diabetes of adults (LADA) is a common diagnosis given to those with Type 1 diabetes and are aged 35+. Typically they are diagnosed with Type 2 and within a short time frame are dependent on insulin.

Myth: Men with diabetes don’t want to talk about erectile dysfunction.

Fact: Actually healthcare professionals tell us that men DO want to talk about erectile dysfunction if it is done in the right way. Asking the right questions and giving your patient the platform to talk about this issue is important.  Being direct and using appropriate terms (non-medical) may settle any awkwardness with your patients. Then you can go on to explore treatment options suitable for the individual.

Myth: People with diabetes should avoid certain fruits or vegetables such as grapes, bananas, mangoes, cherries, turnips, sweetcorn and parsnips

Fact: If someone with diabetes eats a healthy diet that includes these foods, they can still achieve good blood glucose control. In fact, they are a healthy choice.

Fruit is high in fibre, low in fat and full of vitamins and minerals. It helps to protect against heart disease, cancer and certain stomach problems. You can encourage patients to eat more vegetables than fruit if they are attempting to lose weight.

To find healthy recipes and top tips to help your patients improve their relationship with food go to www.diabetes.org.uk/enjoyfood

Myth: People with poorly controlled diabetes just won’t engage with their condition

Fact: Have you ever thought just how hard it is for someone with diabetes to get their head around it and potentially break lifetime habits. Diabetes UK has devised a simple tool for GP practices to use known as information prescriptions. These are one-page plans that are individually tailored for people with diabetes who find it difficult to manage. These ‘information prescriptions’ pop up on screen if the target for HbA1c, blood pressure or cholesterol has not been achieved.  The information prescriptions contain the crucial information people need on how to optimise their health potential as well as a proposed personalised action plan for improving outcomes that you should agree together.

The fact that this is a ‘prescription’ of advice and information really seems to resonate with people. Collaborated care planning has been shown to lead to improvements in health. For more information about information prescriptions and care planning visit www.diabetes.org.uk/Guide-to-diabetes/Managing-your-diabetes/information-prescriptions and www.diabetes.org.uk/care-planning

To activate the information prescriptions on your system visit your IT provider’s support centre which contains all the instructions that you need.

Myth: There’s no point testing someone for Type 2 diabetes if they’re not overweight

Fact: Don’t underestimate the power of a detailed history. Yes, the majority of people who are diagnosed with Type 2 diabetes are overweight but some people won’t be. Their age, family history, ethnicity may all be factors in them developing the condition. It’s important that Type 2 diabetes is diagnosed as soon as possible in order to help prevent the serious complications that undiagnosed Type 2 can result in.

Myth: You need early morning urine to check for kidney function

Fact: As part of an annual health care review people with all types of diabetes should have a blood and urine test. The urine will be checked for ‘microalbumin’. Alongside this, a blood test will measure urea, creatine, and estimated glomerular function (eGFR) showing how well the kidneys are working. Interpretation should be based on clinical appearance. Early stages of diabetes-related kidney disease is likely to be asymptomatic, which stresses the need for annual screening. Smoking state and a dietary review should be part of a kidney health review.

The urine test is the least completed process of all the NICE recommended intervention. Part of the reason for this is that some people may forget to bring their early morning urine sample and so the test may not be completed. Diabetes UK believe “a test is better than no test”, so if a patient doesn’t bring a urine sample, they could still do one in clinic. We know that even if a test is done later in the day and is normal then in all likelihood the early morning test would have been normal. However, if the test shows an elevated level then an early morning urine test should be arranged at another date.

Dan Howarth

Dan Howard, head of care, Diabetes UK

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