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RE: [IPk] diet, blaming the nhs etc



I like it :-)

I'm just playing with the idea of a Balanced Scorecard approach for bg
monitoring - more detail when I have time.

Julian


> -----Original Message-----
> From: Elizabeth OShea [mailto:email @ redacted]
> Sent: 16 August 2001 09:48
> To: email @ redacted
> Subject: 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.
> 
> elizabeth
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