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RE: [IPk] diet, blaming the nhs etc
By management tools, I mean things like working out people's carb ratio. And
yes, the formula won't work for everyone, but it will work with most people,
and it's a hell of a better starting point than just saying oh, have five
units with your breakfast and we'll see how you get on. And this can be
scaled to people's abilities and interests: people who are likely to read
labels can be told that say, 1 unit covers 9g or 15g or whatever of carb,
and people who aren't can be told, have two units or one unit for a slice of
brown or white sliced pan, a large apple, blah. Have this many units for a
level bowl of pasta with tomato sauce. Don't object what size bowl! They can
have sample bowls in the same way they have sample plastic potatoes to show
people how to measure things.
Another tool: if you are drinking, you need to eat more or have less
insulin. My partner works with someone who ended up unconscious in casualty
because she didn't know this, and she's been diabetic since childhood.
Another tool: giving people a sliding scale of insulin adjustments for
sickness that is based on their carb ratio. Again, not too difficult: you
have sheets saved on a computer by carb ratio, so someone who gets 10g per
unit gets a different sliding scale than someone who gets 15g per unit. My
clinic does give out a sickness management sheet for people on insulin, but
it uses the same sliding scale for everyone, regardless of insulin
sensitivity. Making sure everyone knows they must take their long acting
insulin even if they're not eating.
Another tool: high blood sugar insulin. A sheet that says, if you test
before a meal and your blood sugar is x mmol above your target blood sugar,
take y extra units of insulin and wait at least z minutes/hours before
eating, if at all possible. These sheets would also be saved by carb ratio.
And then at every clinic visit there would be a short procedure to remind
people of the information they need to be reminded of, such as sickness
management. None of this requires difficult or innovative paedagological
method: it just requires the recognition that in diabetes,
information=better management=better health.
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