Diabetes Management for Medical Student OSCE
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Introduce, identify, explain, consent
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Explain: ‘I understand you have been diagnosed with DM, is that correct? What do you understand by the term diabetes? Do you have any issues or concerns you would like to raise concerning the diabetes?’
‘There are various possible short and long term complications of diabetes, and to minimise the risks it is important to control your diabetes as well as possible, by addressing the lifestyle risk factors, and having good concordance with your medications.
Complications and importance of glycaemic control:
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Long and short-term complications:
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Short-term complications (life-threatening): ketoacidosis; hyperosmolar non-ketotic acidosis
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Long-term complications (irreversible long-term damage): damage to eyes, kidneys, nerves; increased risk of stroke and MI
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Explain possible reasons why patient’s diabetic control may be poor: check for risk factors, and stress importance of relevant lifestyle changes
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Smoking – reduce / stop
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Alcohol – reduce
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Weight – consider reduction to BMI 20-25 kg/m2
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Exercise – anaerobic, e.g. at least 30 min brisk walking most days
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Diet – low fat (e.g. saturated fates) and sugar. Complex carbohydrates good as release energy slowly (bread, pasta, rice). Cakes and sweets – special occasions
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Tight glycaemic control leads to fewer complications. Remind always to take medication even if they miss a meal or are feeling ill: otherwise diabetic ketoacidosis could occur
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Taking the insulin
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Check understanding of:
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Insulin
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Why replacement is needed – keeps body sugar in normal range;
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Insulin forms:
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3 types of insulin for administration – long, intermediate and short acting, with particular doses for each type
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Available in vial form – ‘pens’ – check storage instructions, expiry date, use fresh needle each time
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Pinch of skin, inject at 90?. Upper arms, thighs, buttocks, abdomen
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Never miss dose!
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Seek medical attention if unable to take insulin, or unable to eat after insulin
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When ill: more insulin needed
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Need to inform driving licence authority + keep in contact with diabetic nurse / GP
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Side effects: lipid hypertrophy – shift injection site; overdose hypoglycaemia – sweating, N + V
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Long-term complications need monitoring for and awareness:
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Heart attacks + strokes
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Risk of blindness
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Risk of kidney problems
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Risk of nerve problems – need to check feet
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Monitoring – pt needs to keep diary of blood glucose (BM testing), 2 days per week, 4 times per day. Take this diary to all doctor’s appointments.
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Emergencies – hypoglycaemia – increasingly hungry, sweaty, notice heart beat – blood sugar levels could be low. Start sipping a glass of sugary water until you feel better. Maybe keep a sugary drink with you at all times. If these feelings persist or you feel drowsy, go immediately to A&E.
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Additional points
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Check patient’s understanding of explanation, invite questions
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Follow-up – arrange appropriate follow-up, e.g. with diabetic nurse / dietician
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Leaflet – offer more info, in form of handout, + of support groups
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About the Author
by: Admin
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Word Count: 796
Date: Fri, 22 Jan 2010 Time: 4:19 PM
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