Diabetes History, Explanation

Question 1

Brief history

-key questions you’d like to ask

Answer 1

What has brought the patient in today?

• discuss diagnosis?
• explain test result?
• discuss management?

What are their symptoms

• feeling thirsty, going to the bathroom often, fatigue
• weight loss

Risk factors?
FHx 
CV risk factors
-medication for HTN, cholesterol
-alcohol, smoking
-physical activity

Question 2

Understanding

-

Answer 2

If unaware of diagnosis - what do you think is causing your symptoms?
If aware of diagnosis - what is your understanding of diabetes

Question 3

Concerns

Answer 3

Ok, before I start explaining XYZ, is there anything you’re concerned about?
Is there anything you’d like to have addressed during this consultation?

Question 4

Explanation

• what is diabetes?
• normal physiology

Answer 4

Ok, so I’ll go through what diabetes is and how we manage it

Normal physiology

• Imagine you are hungry and you’ve ordered a pizza. The delivery person comes, rings the doorbell and you can open the door to accept the pizza
• Our cells work in the same way too, sugar is food for our cells. The sugar is delivered to our cells via our blood and a substance called insulin rings the doorbell to let the sugar into the cell so it can eat.

Question 5

Explanation

• causes
• T1DM pathophysiology
• T2DM pathophysiology

Answer 5

What is T1DM

• In T1DM, the delivery person with your pizza cannot ring the doorbell. This is because it does not have the insulin it needs to ring it.
• This can be due to a mixture of genetic and environmental factors

What is T2DM

• In T2DM, the delivery person with your pizza rings the doorbell but the doorbell is broken.
• This can be due to a mixture of genetic and environmental factors
• He instead leaves it at your door
• the doorbell doesn’t ring, so you don’t know if the delivery person came. So you keep ordering pizzas because you’ve still got no pizza
• this continues and pizza boxes are piling up outside your door and start to pile up by the road
• this is similar to what happens when you don’t have insulin to let sugar into your cells, it build up in your blood and starts to damage the blood vessels

Question 6

Explanation

-complications

Answer 6

High amounts of sugar in your blood damages your blood vessels of

• your kidneys leading to kidney problems
• your heart, increasing the risk of heart attacks
• your brain, increasing the risk of strokes
• your eyes, leading to loss of vision
• your nerves, leading to loss of feeling in your feet and legs
• infections and injuries that you get will take longer to heal

But it’s really good that you came to see your GP when you did because diabetes is a condition that we can manage together. And with the right support, we can reduce the likelihood that you get these complications

Question 7

Explanation

-management

Answer 7

I don’t want to overload you with too much information today, I’ll briefly outline how we can manage diabetes now. Afterwards, we can arrange a followup appointment to discuss management in more detail and I can get you some leaflets that go through what we’ve discussed today. How does that sound?

Diabetes can be managed with medication but the likelihood of patients developing the complications that I mentioned earlier is reduced a lot further if patients also make some lifestyle changes too. But we can support you in making these changes.

With diabetes, you will need to keep your blood sugar levels within a safe range. We will teach you how to monitor this

So earlier you mentioned that you had XYZ risk factors

• Reducing your intake of foods high in sugar, salt, saturated fat
• Increased physical mv => weight loss
• smoking cessation, cut down alcohol

Your medical team will support you

• booking you in for regular followup appointments to monitor your blood sugar levels and for complications
• they will also support you with your medication and make adjustments where needed

Question 8

Closing the consultation

-summarise to 3 key points

Answer 8

Before I summarise the key points, do you have any questions?

I appreciate that I’ve given you a lot of information. Like I mentioned earlier, we can make a follow up appointment to discuss management in more detail and provide you with leaflets that go through what we’ve discussed today.

1. T1DM is like when the pizza delivery person cannot ring the doorbell because he doesn’t have the insulin to do so
2. T2DM is like when your pizza delivery person cannot deliver the pizza because the doorbell is broken
3. Untreated diabetes can damage your blood vessels which can affect the function of your heart, brain, eyes, kidneys and nerves
4. But the risks of these problems happening can be reduced by making lifestyle changes and taking medication