Preparing for the diabetes clinic: getting the most out of your appointment
There are potentially many issues to discuss within a limited 15 minute appointment time. In order to get the most out of your appointment we would generally recommend providing as much information as possible.
Clinic questionnaire
If you use insulin we will typically ask you to complete a 2 page questionnaire in advance of your appointment. By collecting this basic information (including doses, injection sites, low blood sugars (hypoglycaemia) and driving), your doctor should have more time to focus upon your concerns and any problem areas they may have identified.
Click here to see the clinic questionnaire
Home blood glucose measurements
WE STRONGLY RECOMMEND SIGNING UP FOR A DIASEND PERSONAL ACCOUNT - LEARN MORE BY CLICKING HERE
IF YOU ARE A FREESTYLE LIBRE USER WE WOULD RECOMMEND YOU USE LIBREVIEW RATHER THAN DIASEND
If you use insulin we would ask you to bring your blood glucose meter with you (if you use several meters, please bring them all) as we can download the stored information and present your blood glucose results on the clinic computer. This can be hugely helpful in identifying patterns and providing advice on adjusting insulin doses. Some examples of this are provided below:
Example 1 Black dots represent each blood glucose reading in the past few weeks. The blue line indicates the average blood glucose across the day. This patient had frequent overnight hypoglycaemia and required adjustment of their long-acting insulin dose.
Example 2A This patient had good blood glucose control at lunch time and tea time but higher readings in the morning and on the few occasions when glucose levels were checked before bed.
Example 2B This is the same patient from 2A. Each colour represents a single day of the week. It highlights the need for a few more ‘before bed’ measurements, as it appears the teatime insulin doses are failing to prevent a significant rise in glucose.
Example 3A This patient has better morning blood glucose readings compared to later in the day.
Example 3B This is the same patient from example 3A. The daily trend is often a substantial rise in blood glucose between breakfast and lunch / evening meal. A higher dose of morning quick acting insulin is likely to be required to help control this.
If you record your blood glucose results in a diary, we would encourage you to share this information with the clinic doctor.
If you usually check your blood glucose less often than has been recommended (or do not check at all) we would suggest that, for a couple of weeks leading up to your appointment, you start checking regularly. It is almost impossible to offer sensible advice about insulin dose adjustment without seeing some glucose results. Patients are often concerned or embarrassed about their results and either stop checking or do not wish to bring them to the clinic - this is often where patients have most to gain from bringing results along. The purpose of the clinic is to help, not to judge, in these situations.
It is unfortunately still not uncommon to hear patients say they "thought they would get a row" about blood glucose results which are higher than ideal. In reality, nobody offering diabetes care in the Royal Infirmary of Edinburgh would approach a problem in this manner. The role of the clinic is to support and advise, not to chastise. All patients are treated in a respectful and supportive manner.
'Intensive' blood glucose monitoring
Patients on multiple daily injections or insulin pumps may benefit from a short spell (around a week) of 'intensive glucose monitoring' in advance of clinic appointments. Performing extra checks, recording these and sharing the information prior to attending the clinic may help customise your clinic appointment towards dealing effectively with key issues. Further information on 'intensive glucose monitoring' can be found by following this link:
Link to intensive glucose monitoring section
Please have a look at the ‘learning more about diabetes ’ section of the website for more information on diabetes control and carbohydrate counting.
Medication
It is useful to bring a list of all the medication (including doses) you are currently taking along to the clinic.
Blood pressure
Some patients use home blood pressure monitoring devices. If you have access to a home blood pressure monitor, it is useful to perform both morning and evening measurements for a few days leading up to your appointment. The information provided from a set of home recordings is typically much more valuable than a single measurement taken in clinic.
The British Hypertension Society has published a list of approved home blood pressure devices, the cheapest of which is £20.
Summary
In summary, the more information you are able to share with the clinic doctor, the more fruitful your consultation is likely to be. We recognise that many patients find it difficult to monitor their blood glucose as often as may have been recommended but we would be keen that a set of checks are performed in the days or weeks leading up to clinic; this will help ensure that your diabetes clinic appointment is a useful experience.
