UNIT 3 DIABETES MANAGEMENT

STUDY FOCUS
Reading : Identifying main ideas and locating specific information
Vocabulary: Managing and exploring diabetes
Writing : Identifying, acknowledging and incorporating the patient's
perspective

Exploring the topic

In pairs or groups, discuss the following questions.
 What are the most common types of diabetes?
 How does diabetes affect the body?
 What treatments are available for diabetes?

STUDY BOOST 1 : READING AND VOCABULARY

READING 1
Read Texts 1-6 and choose the most suitable answer A, B or C. An example (0)
has been done for you.

BOOSTER TIP

For this task, identify key words in the questions and texts which will help you to
locate the information you need to answer each question.

0 The diabetes information table indicates that the onset of type 2 diabetes usually
occurs:
A before the age of 40.
B at the age of 40.
C after the age of 40.

Diabetes information table

TYPE 1-insulin dependent TYPE 2-non insulin

diabetes mellitus (IDDM) dependent
diabetes mellitus (NIDDM)
Age of onset Usually <40 Usually >40
Onset Sudden Gradual

[ 1 ] UNIT 3 DIABETES MANAGEMENT

 Insulin production None or very little Too little or ineffective
Symptoms Blurry vision, frequent Increased appetite and
urination, increased thirst. dark patches on
appetite and thirst, mood armpits and neck frequent
changes and irritability, urination, blurry vision.
tiredness and weakness, tiredness and weakness,
unexplained weight loss unexplained weight loss.

Treatment Healthy eating and meal Healthy eating and meal

planning, increased planning. increased
physical activity blood physical activity blood
glucose level checks, glucose level checks, oral
insulin, injections or pump medication may be
needed. insulin injections
may be needed

1 According to the pre-diabetes screening guide, one of the screening methods

A offers greater convenience for patients.
B is more accurate than the other tests.
C should always be repeated.

Pre-diabetes screening guide

To identify pre-diabetes, there are three blood testing methods which are currently
recommended:
 Fasting plasma glucose
 2-hour post 75g oral glucose challenge
 HbA1c

The HbA1c test does not require fasting or a lengthy stay at a pathology clinic and
may be the preferred option for patients and physicians.

It is important to note that for patients where the suspicion for pre-diabetes is high
and test results return within the normal range, repeat testing within 12 months
should be considered using one of the other two screening options.

2 According to the extract from the Clinical Practice Handbook, when a patient's
blood glucose level (BGL) falls below 4mmol/L, the healthcare professional
should
A administer fast-acting insulin
B re-check the BGL after 15 grams of carbohydrate have been consumed.
C encourage the patient to drink diet soft drink.

[ 2 ] UNIT 3 DIABETES MANAGEMENT

Extract from Clinical Practice Handbook for Student Nurses :
Nursing Interventions for type 1 diabetes patients

HYPOGLYCAEMIA occurs when a person's blood glucose level (BGL) has dropped
below 4mmol/L

Hypoglycaemia must be treated quickly to prevent the BGL from falling further which
may lead to loss of consciousness or seizures.

If a patient's BGL has dropped below 4mmol/L, immediately give 15 grams of a fast-
acting carbohydrate.

Choose 1 of the following :

 6-7 jelly beans
 4-6 pieces of hard candy
 1/2 can of soft drink (NOT diet soft drink)
 1/2 glass fruit juice
 3 teaspoons of sugar or honey
 glucose tablets or gel equivalent to 15 grams of carbohydrate

Check BGL again after 15 minutes.

If BGL remains at or below 4mmol/L give another fast-acting carbohydrate and

review BGL.
If BGL has risen above 4mmol/L, provide one of the following as a snack:
 1 slice of bread
 1 glass of milk
 1 piece of fruit dry biscuits
 1 small tub of low-fat yoghurt
Ensure carbohydrate is included at the next meal. Pasta and rice are good options.

3 The guidelines for discharge planning require the healthcare professional to

A make arrangements for the patient to visit a diabetes care provider.
B confirm the patient is able to manage their illness.

[ 3 ] UNIT 3 DIABETES MANAGEMENT

 C inform the patient of the costs of their hospital stay.
1 Guidelines for discharge planning for newly-diagnosed insulin-treated
patients

1.3 Inpatient diabetes self-management education

 Assess the patient's level of understanding of their diabetes diagnosis

 Check the patient's understanding of self-monitoring of blood glucose, including
indication, frequency, sites for testing and home blood glucose goals
 Determine the ability of the patient to conduct self-monitoring of blood glucose
levels-supervise patient checking own blood glucose level

 Check knowledge of hyperglycaemia/hypoglycaemia - teach signs, symptoms,

treatment and prevention.

 Teach the patient when and how to administer medications, including method of
administration and the proper use and disposal of needles and syringes

 Outline nutritional care plan, highlighting the importance of consistent eating

patterns and carbohydrate counting

 Instruct the patient on the safe management of diabetes during periods of illness,
specifically insulin dose adjustment and monitoring

 Provide contact details for a diabetes care provider.

Note: Ongoing education and support will be provided by a dedicated diabetes

health care team after discharge.

4 The excerpt from the Midwife Training Manual suggests that babies born to
mothers with gestational diabetes may
A have diabetes at birth.
B be born with high blood glucose levels.
C suffer short-term adverse health effects

[ 4 ] UNIT 3 DIABETES MANAGEMENT

Excerpt from Midwife Training Manual

Gestational Diabetes
There is a high risk of pre-term birth for women with gestational diabetes, although
many pregnant women continue their pregnancy to full term and begin labour
spontaneously.

There are health implications for babies of mothers with gestational diabetes. The
baby can grow very large, increasing the likelihood of a problematic delivery which
may result in the need for intervention with forceps or a vacuum device. For this
reason, obstetricians may elect to deliver slightly before the due date by inducing
labour or scheduling a caesarean section.

After the birth, there is a greater risk that these babies may develop jaundice and
breathing difficulties, both of which are usually temporary, and may also struggle to
feed. They may also have low blood glucose levels as they produce more insulin
than is usual for a newborn baby. This is to compensate for the higher blood glucose
levels in their mother's bloodstream.

Babies who require special care may be transferred to a neonatal intensive care unit
(NICU) to ensure any problems that occur can be treated quickly. The baby will not
be born with diabetes Blood glucose levels in the mother will usually return to normal
after giving birth and most women will no longer have diabetes after the baby is born.
There remains an increased possibility of gestational diabetes in subsequent
pregnancies with both mother and baby having a greater risk of developing type 2
diabetes later in life.

5 The purpose of this email is to

A remind staff about procedures relating to blood glucose monitoring.
B highlight the need to involve residents in designing their care plans.
C schedule a medication review for residents with diabetes.

Blue Sky Care Home

Email
To : All staff
SUBJECT: Blood glucose levels

A blood glucose monitoring routine is devised for each resident in consultation with
the resident, their family and physician. Blood glucose monitoring routines are based
on the individual needs of the resident and consider their personal circumstances.

[ 5 ] UNIT 3 DIABETES MANAGEMENT

All blood glucose measurements must be recorded in the appropriate chart. The
resident's target range must be clearly written at the top of the chart and referred to
at each measurement in line with their blood glucose management plan.

Any changes to the insulin regimen instigated by the resident or recommended by

medical staff are to be documented in the chart and reported to the resident's
physician for review.

6 The extract from Essential Medicine indicates that the first blood test in
suspected cases of diabete ketoacidosis (DKA) measures levels of
A venous blood glucose
B arterial blood glucose
C capillary blood glucose

Extract from Essential Medicine : Diabetes Mellitus

6 Acute management of diabetic ketoacidosis (DKA) in adults

6.1 Diabetic ketoacidosis is a life-threatening emergency associated with significant
mortality Rapid assessment is essential as people with DKA can deteriorate very
quickly

Initial point-of-care investigations to be undertaken:

 A capillary (finger prick) blood glucose measurement (critical level > 15mmol/L)
should be taken Ensure there is no sugar on the skin where the skin prick is
made.
 Capillary blood ketones (critical level > 1.5mmol/L) should also be taken.

Always follow this test with a formal venous blood glucose level test.
Arterial blood is not needed as routine.

In patients with elevated blood glucose levels and ketones who are not acidotic,
close monitoring and aggressive management are essential to prevent progression
to DKA.

[ 6 ] UNIT 3 DIABETES MANAGEMENT

VOCABULARY PRACTICE 1A: MATCHING MEANING

The words and phrases in Column A appear in Texts 1-6. Choose the most
suitable word or phrase from Column B for each word or phrase in Column A.
Write your answers in the space provided.
An example (0) has been done for you.

COLUMN A COLUMN B

0 adjustment A a procedure to test people for symptoms of a disease

1 subsequent B unclear, indistinct
2 consistent C can be potentially fatal, can result in death
3 compensate D actions taken to intercede to improve outcomes
4 aggressive E to reestablish a balance
5 interventions F a minor modification
6 life-threatening G constantly done in the same way
7 screening H a state of being unresponsive
8 instigated I Initiated
9 loss of consciousness J intensive
10 blurry K following occurring later

Write your answers here.

0 1 2 3 4 5 6 7 8 9 10
F

VOCABULARY PRACTICE 1B : COMPLETE THE SENTENCE

For Questions 1-5, choose the most suitable word from the box to complete
each sentence.
There is one extra word that you do not need to use. An example (0) has been
done for you.

consistent screening subsequent instigated

blurry life-threatening compensate

0 The patient's symptoms were consistent with a diagnosis of diabetes to

chemotherapy, the tumour had reduced to 60% of its original size.

2 Patients presenting with symptoms of fever, cough, sore throat, breathing

difficulties are being referred to the dedicated COVID-19____________ clinic

[ 7 ] UNIT 3 DIABETES MANAGEMENT

3 Scientists have discovered that an improved sense of hearing may
______________ for loss of sight vision after

4 The ophthalmologist advised the patient he would experience______________

vision after having drops instilled and should not drive for 4 hours.

5 If left untreated, chronic health conditions such as diabetes, asthma and cardiac
disease may be________________.

READING 2
Read the text about living with type 1 diabetes. For Questions 1-5, choose the
most suitable answer A, B or C. An example (0) has been done for you.

BOOSTER TIP

For this task, read the text carefully to locate the specific information required
for each question. Read the details closely to ensure clear understanding of
the text and questions.

Living with type 1 diabetes

I was diagnosed with type 1 diabetes at the age of 11,’ says Dr Linda Miller, a
chemical pathologist, now aged 65. Treatment was basic back in those days and
primarily involved using a special kind of test tape to check if glucose was present in
urine, injecting fixed doses of insulin and frequently seeing the doctor.’

The way in which type 1 diabetes is managed has changed considerably since Dr
Miller was diagnosed in 1957. Nowadays, precise doses of insulin can be calculated
according to accurate blood glucose level readings and users have the choice of
administering via a needle and syringe, an insulin pen or an insulin pump.

Significant technological advancements over the years, such as the development of

continuous glucose monitoring (CGM) devices, have allowed diabetes patients
greater independence to self-manage their disease. These CGM devices measure
interstitial glucose levels in subcutaneous tissue rather than glucose levels in the
blood. A tiny sensor attached to a transmitter is implanted under the skin to record
glucose readings which are sent to a receiver for interpretation. If glucose levels drop
or rise rapidly. CGM devices can trigger an alarm which alerts the patients to act
quickly to prevent a hyperglycaemic or hypoglycaemic episode.

According to Dr Miller, incorporating continuous glucose monitoring into the diabetes

care plan of young adults who require assistance with tracking their blood glucose
levels improves glycaemic control.

[ 8 ] UNIT 3 DIABETES MANAGEMENT

A limitation of most CGM devices, however is that they do not completely remove the
need for capillary (finger prick) blood glucose testing using a blood glucose meter.
This is because blood glucose meters provide more accurate results than continuous
glucose monitoring, and are vital in situations where the glucose level is changing
rapidly. Capillary blood glucose levels are also required to calibrate the COM device
at intervals determined by the manufacturer

Flash glucose monitoring which operates in much the same way as continuous
glucose monitoring, involves a sensor being scanned with a reader or smart device
to obtain a glucose level reading Flash glucose monitoring (Flash GM) devices do
not automatically alert the user if glucose levels are outside of the desired range.
However, some brands of Flash GM devices allow users to program their device to
activate an alarm if glucose levels become unstable.

In both CGM and Flash GM devices, blood glucose data can be sent to a
smartphone app or other compatible device, allowing trends and patterns to be
identified and giving users and their medical team valuable insight into how to best
tailor treatment.

‘A life-changing device for me personally has been a new type of insulin pump. One
of the challenges of diabetes is delivering the correct dose of insulin at the time it is
needed, explains Dr Miller, who was fortunate to be one of the first patients to be
fitted with the device.

The pump Dr. Miller is referring to is a hybrid closed loop insulin pump system, which
improves glycaemic control by continuously monitoring blood glucose levels and
automatically adjusting the doses of insulin based on the readings. The insulin is
then delivered into the body when it is required. Think of it as an artificial pancreas,
says Dr Miller. This technology will hopefully lead to fewer potentially dangerous
fluctuations because blood glucose levels will be mare stable"

However, it is not yet a fully automatic system. The amount of carbohydrate

consumed at mealtimes must be manually entered to calculate bolus insulin doses,
which help to prevent blood glucose levels from becoming unstable. From a
maintenance point of view, the sensor requires periodic calibration and parts may
need to be repaired or replaced from time to time.

As for the future, Dr Miller remains optimistic A new class of drug, baricitinib,
currently used to treat rheumatoid arthritis, is being investigated for possible use by
people with type 1 diabetes to protect insulin-producing cells from immune attack. It
is hoped that, if successful, this drug will halt the progression of disease in people
newly-diagnosed with diabetes. it's not a cure, but it's certainly a very promising step
in that direction, concludes Dr Miller.

[ 9 ] UNIT 3 DIABETES MANAGEMENT

Questions 1-5

0 When Dr Miller was first diagnosed with type 1 diabetes the management of
diabetes included
A administering customised doses of insulin.
B occasional consultations with the doctor.
C regular testing for glucose in urine.

1 Dr Miller was born in

A 1963
B 1946
C 1957

2 Dr. Miller supports including continuous glucose monitoring (CGM) in the

diabetes care plan because
A it enables patients to have more control over managing their condition
B patients no longer need to use capillary blood glucose testing
C young adult diabetes patients will avoid rapid changes in glucose levels.

3 Flash glucose monitoring (Flash GM) devices

A send an instant warning to patients about changes in their glucose levels
B continuously display a patient's glucose level readings without scanning to a
smart device
C provide useful data so doctors can offer the patient appropriate individualised
treatment

4 Dr Miller says the greatest benefit of the new hybrid insulin pump is that it
A removes the need for the patient to manually calculate carbohydrate amounts
consumed at mealtimes.
B calculates and administers accurate doses of insulin into the body as and
when required.
C does not require any maintenance after being fitted to the patient

5 Current research hopes to prove baricitinib that is effective in

A preventing insulin-producing cells from being destroyed.
B treating rheumatoid arthritis.
C diagnosing people with type 1 diabetes

[ 10 ] UNIT 3 DIABETES MANAGEMENT

VOCABULARY PRACTICE 2 : WORD FORMS

For Questions 1-5, choose the most suitable answer A, B, or C to complete

each sentence. An example (0) has been done for you.

0 X-ray images are sent to a radiographer for_________________

A interpret B interpretation C interpreted

1 Medical device manufacturers recommend that devices should be professionally

at_______________regular intervals to ensure accuracy.
A calibrate B calibration C calibrated

2 After losing a tooth in an accident, the patient consulted a periodontist to discuss

a dental_______________
a dental B implanting C implanted

3 _______________advancements have had a significant impact on the lives of

people with diabetes.
A Technologically B Technology C Fluctuation

4 ______________ oestrogen levels may cause multiple symptoms in menopausal

women.
A Fluctuate B Fluctuating C Technological

5 Living with a chronic illness can provoke a wide range of emotions, including
anxiety, fear and
A depression B depressing C depressed

READING 3

Read the text about the prevention of diabetes complications. For Questions
1-10, choose the most suitable phrase (A-K) to complete each sentence. Write
your answers in the space provided.
An example (0) has been done for you.

The prevention of complications of diabetes

Chronic complications of type 1 diabetes are largely associated with (0) inadequate
control of blood glucose levels (BGL). BGLs which exceed the normal range over
long periods of time can cause serious damage to large blood vessels
(macrovascular, resulting in heart attack and stroke, and damage to
(1)__________________ (microvascular), which can lead to feet, eye and dental
problems.

Patients who manage their diabetes well can significantly reduce the risk of serious
complications, including (2)_____________. Feet are particularly susceptible to

[ 11 ] UNIT 3 DIABETES MANAGEMENT

diabetic nerve damage and (3) ______________ to the feet and toes. For people
with diabetes, this means they may not notice a cut or other minor injury to their feet,
which should (4)_____________________. If these minor injuries do not heal, they
can lead to serious infections, for example, ulcers (5) _____________________
which may result in amputation of toes, feet and other infected areas.

Recommended foot care guidelines for diabetes patients :

 Wash and clean feet every day and look for bruises blisters or cuts.
 Cut toenails regularly.
 Ask a friend or family member to help you to (6) ___________________and cut
your toenails for you if you cannot see or touch your feet by yourself.
 Wear shoes and socks which maintain effective blood circulation and prevent
damage to the feet.
 Visit a podiatrist to have your foot health assessed every six months.

Like diabetic neuropathy, diabetic retinopathy is also the result of raised BGLS over
a long period, causing small blood vessels to the eye to weaken or become blocked.
Treatment is required to prevent blurred vision or loss of vision. People with diabetes
have an increased risk of developing cataracts. These may need to be surgically
removed and (7)______________________.

Recommended eye care guidelines for diabetes patients :

Have regular eye checks every two years with an optometrist who will
(8)_____________________. Visit an ophthalmologist for further specialist eye
treatment if referred by the optometrist.

Patients with diabetes are strongly encouraged to be proactive in maintaining good

dental health. If BGLs are not controlled, the high levels of glucose in the saliva will
exacerbate the growth of bacteria in the mouth, causing mouth and gum infections,
(9)___________________ and ‘oral burning’. Some initial symptoms of mouth
problems include painful, swollen or bleeding gums.

Recommended dental care guidelines for diabetes patients

 Brush teeth and floss daily.
 Drink water to stay hydrated and avoid sugary drinks.
 Visit a dentist for a complete mouth, (10)______________________ with a
professional clean every 6 months

A assess any changes in your eye health

B and gangrene

[ 12 ] UNIT 3 DIABETES MANAGEMENT

C gum and teeth check-up
D replaced with an artificial intraocular lens (OL)
E Inadequate control of blood glucose levels (BGL)
F such as gingivitis, periodontitis and xerostomia
G small blood vessels
H perform regular foot checks be treated
J diabetic neuropathy
K reduction in blood flow and sensation

Write your answers here.

0 1 2 3 4 5 6 7 8 9 10
E

VOCABULARY PRACTICE 3 : WORD FORMATION

Read the text about diabetic nephropathy. For Questions 1-10, write the
correct form of the word given in bold to complete each sentence. You may
need to check the words in a dictionary if you are unsure of the appropriate
verb, noun, adjective or adverb form to use. An example (0) has been done for
you.

DIABETIC NEPHROPATHY
What is diabetic nephropathy?

Diabetic nephropathy describes the chronic (0) complication of (0) complicate

diabetes which damages the capillaries inside the kidneys after a
(1) prolong
(1)____________period of elevated blood glucose levels (BGL).

What are common symptoms? (2) swell

Common symptoms of diabetic nephropathy include 1:
(3) retain
 (2) _____________of the face, hands, ankles and feet from
fluid (4) frequent
(3)______________ (5) nausea
 urinating more (4)________________ than normal
 feeling tired and (5)___________

How does it affect the body? (6) filter

Kidneys function as a (6)____________ system to excrete waste
(7) assess
products and excess fluid from the body through urine.
Damage to the kidneys is (7) _____________through the amount of (8) progress
albumin found in urine samples.
(9) fail
(8)________________of kidney disease into kidney

[ 13 ] UNIT 3 DIABETES MANAGEMENT

 (9)______________indicates future dialysis or kidney transplant for the
diabetes patient.

How can risk factors be avoided? (10) weigh

 Control BGLs, blood pressure, cholesterol levels
 Exercise regularly and maintain a healthy (10)________

Discussion
 1 What essential information should be given to newly-diagnosed type 1 diabetes
patients ?
 2 How important is it for diabetes patients to maintain good general health?
 3 What impact have developments in technology had on the lives of diabetes
patients?

STUDY BOOST 2 : SPEAKING

Identifying, acknowledging and incorporating the patient's perspective

1 Communication strategies to elicit and explore the patient's perspective.

Throughout the consultation, there will be opportunities to explore the patient's
perspective through eliciting their ideas, concerns and expectations.

BEGINNING THE CONSULTATION

At the start of the consultation, using open questions will enable the healthcare
professional to capture and explore the patient's perspective

Examples
How can I help you today?
What can I help you with today?
What can I do for you today?

DURING THE CONSULTATION

As the consultation progresses. It is important to gather information from the patient

in order to gain insight into their health and current condition.

Examples
How are you feeling generally?
What seems to make your symptoms better/worse?

[ 14 ] UNIT 3 DIABETES MANAGEMENT

How are your symptoms affecting your daily life?
Which symptoms are worrying you the most? Tell me more about your symptoms

Asking specific questions will help to explore how the patient may respond to a
particular course of action.

Examples
How do you feel about checking your own blood glucose levels?
Have you considered having a community nurse visit once per week?

CONCLUDING THE CONSULTATION

At the end of the consultation, it is important that the patient feels that their
expectations have been met in terms of addressing their concerns. This may include
checking that they have understood what was discussed.

Examples
Does that all make sense?
Shall I summarise what we have talked about today?
Is there something else I can help you with?
Do you have any other concerns?

2 Communication strategies to acknowledge the patient's cues

Responding to verbal cues

Patients share their thoughts and feelings directly through spoken language and
indirectly through non-verbal facial expressions and gestures.

In terms of recognising spoken cues, it is important to indicate to the patient that you
have heard what they have said and are incorporating their perspective into your
responses. Repeating back key words or ideas that the patient has expressed will
demonstrate that you have understood and are acknowledging what they have said.

Examples
Pet owner : I think the nurse had better hold my dog while he is being
vaccinated.
Veterinarian : Yes I will ask the nurse to hold your dog for you.

Patient : I am finding it really difficult to get out of a chair

[ 15 ] UNIT 3 DIABETES MANAGEMENT

Occupational therapist: Have you thought about a motorised armchair which will
support you when you are trying to stand?
Patient : I have been wondering if I should have a cholesterol check
Physician : Why are you specifically interested in a cholesterol check?

Patient : I cannot do the squats you recommended.

Physiotherapist : What are you finding difficult about the squats?

Responding to non-verbal cues

Patients display non-verbal cues in a number of ways. Facial expressions and body
language may reveal how a patient is feeling. Interpreting these non-verbal cues can
help the healthcare professional to explore the patient's perspective more effectively.

Examples
You seem a little confused by the information I have given you.
I sense you have some concerns about what I have just told you
I understand that this is frustrating
You are very quiet is there anything else you would like to ask?

3 Communication strategies to relate explanations to identified patient needs

It is important for healthcare professionals to relate their explanations to the
information gained from the patient. This helps the patient to understand the
rationale for conclusions and decisions regarding their situation. It also reassures the
patient that their perspective has been heard, understood and incorporated into the
decision-making process.

Examples

I understand (that) you have not had much time to do these exercises, so let us do
them together now.

I know (that) you do not like needles, but an intravenous iron infusion will help you to
feel so much better as you are anaemic

You mentioned (that) you drink a lot of fruit juice I need to tell you it is damaging the
enamel on your teeth.

You said (that) you find it difficult to breathe when lying down. We need to
investigate why.

[ 16 ] UNIT 3 DIABETES MANAGEMENT

SPEAKING PRACTICE 1: CHOOSE THE APPROPRIATE RESPONSE

Match the sentences in Column A with the most suitable response in Column
B. Write your answers in the space provided. An example

COLUMN A COLUMN B
PATIENT HEALTHCARE PROFESSIONAL
0 I am worried that the ECG will hurt. A What would you like to ask first?
1 I have not seen you for a while I have B Yes, that is right. I will be back to
alot of questions for you. shower you soon.
2 thought I would be running again by C Shaky? You had better sit down while I
now examine you.
3 I am wondering if there is another way B No, it is pain-free. It will not hurt at
control the pain all.
4 I am not sure if I understand. E I will check your temperature in a
moment.
5 The deep breathing exercises are F Running? Well, we are working towards
really painful. I do not like doing them. that.
6 I am feeling very shaky this morning G Unfortunately, it is not suitable for you,
but there are other types of eye surgery
which may help.
7 I thought you were giving me a H Well, how do you feel about checking
shower this moming your own blood pressure at home?
8 I would like to ask about laser eye I I Would you like me to explain it again?
surgery.
9 Do I need to come in every day to J Another way? We can try a different
have my blood pressure checked? medication.
10 I think I might have a fever, K I understand the deep breathing
exercises are painful, but, in your case,
they are really important to help prevent
pneumonia.

Write your answers here..

0 1 2 3 4 5 6 7 8 9 10
D

SPEAKING PRACTICE 2: WHAT WOULD YOU SAY?

What would you say to show you are understanding and incorporating the patient's
perspective in the following situations?
1 a patient who is expecting an expired prescription to be dispensed
2 a patient who does not appear to understand the explanation you have given
3 a patient who wants an immediate diagnosis but needs to undergo testing
4 A claustrophobic patient who is reluctant to have magnetic resonance imaging
(MRI)

[ 17 ] UNIT 3 DIABETES MANAGEMENT

5 a patient with multiple symptoms who does not know what to discuss first
6 a patient who is deep in thought and quiet at the end of the consultation

SPEAKING PRACTICE 3 : ROLE PLAY

ROLE PLAY 1

Work in pairs as healthcare professional and patient. Read your role play card
to familiarise yourself with the task. Take a few minutes to plan what you are
going to say. You can make notes during the preparation time if you wish.

BOOSTER TIP

For this task, demonstrate that you have identified, acknowledged and incorporated
the patient's perspective into your responses.

ROLE PLAY 1

SETTING : MATERNITY CLINIC ROLE A : HEALTHCARE PROFESSIONAL

Your 30-year-old patient is at 26 weeks' gestation and has recently been

diagnosed with gestational diabetes after failing a routine oral glucose
tolerance test. The patient is feeling anxious about the diagnosis. You are
going to speak to the patient about managing the condition.

TASK
 Find out what the patient knows about her gestational diabetes diagnosis.
 Ask about symptoms.
 Advise the patient that she should not require insulin. The condition will be
managed by following allow GI diet.
 Inform the patient that she will need to test her blood glucose levels 4 times per
day. Explain how to measure blood glucose levels, including the need to do a
fasting test first thing in the morning.
The remaining tests should be taken 2 hours after meals.
 Inform the patient what their target blood glucose range is. The fasting level must
be less than 5.0mmol/L The post-meal level must be less than 6.7mmol/L

[ 18 ] UNIT 3 DIABETES MANAGEMENT

 Advise the patient what they should do if they have an elevated blood glucose
level reading [Keep a written record of blood glucose level readings and contact
your diabetes educator of you have two high readings in a 7-day period.)
 Tell the patient to contact the maternity clinic at any time if they have concerns.
 Reassure the patient that the condition usually resolves following childbirth. A
repeat oral glucose tolerance test will be conducted 6 weeks after delivery to
check that the condition has resolved.

ROLE PLAY 1

ROLE B : PATIENT SETTING : MATERNITY CLINIC

You are 30 years old and 26 weeks pregnant. You have recently been
diagnosed with gestational diabetes. You have not noticed any symptoms. You
are feeling anxious about the diagnosis. A healthcare professional is going to
speak to you about managing your condition.

TASK
 When asked, say that you know that you have gestational diabetes and you know
little about the condition.
 If asked about your symptoms, explain that you have not noticed any symptoms.
 Appear concerned that your condition will be managed through diet alone as you
believed diabetes should always be treated with insulin.
 Act surprised when told you need to check your blood glucose levels 4 times per
day.
 Appear overwhelmed by the amount of information you are given regarding
checking your blood glucose levels.
 Tell the healthcare professional that you do not feel confident about self-
monitoring your condition.
 Ask if you will have gestational diabetes after you give birth.

[ 19 ] UNIT 3 DIABETES MANAGEMENT

[ 20 ] UNIT 3 DIABETES MANAGEMENT
ROLE PLAY 2

Work in pairs as healthcare professional and patient. Read your role play card
to familiarise yourself with the task. Take a few minutes to plan what you are
going to say. You can make notes during the preparation time if you wish.

ROLE PLAY 2

ROLE A HEALTHCARE PROFESSIONAL SETTING : MEDICAL CLINIC

Your patient is 22 years old, morbidly obese and was diagnosed with type 2
diabetes 3 years ago. He/She has been advised in previous consultations to
make significant lifestyle modifications to avoid medication and potential
diabetes-related complications in the future.

TASK
 Ask whether your patient has adopted any of the recommended lifestyle changes.
Ask your patient what changes he/she has made to his/her diet.
 Remind your patient that he/she needs to decrease fat intake, increase fibre
intake, eat smaller portions and consume fewer calories
 Ask your patient how much exercise he/she does in a week.
 Remind your patient that he/she should aim for a minimum of 30 minutes of
moderate intensity
 physical activity per day and a 30-minute session of high intensity exercise per
week.
 Ask your patient if he/she has managed to stop smoking.
 Recommend a program to stop smoking
 Ask how much sleep your patient has. The goal is 6-9 hours per night.
 Find out how your patient manages stress, Stress management is important for
people with diabetes. Your patient should consider using mindfulness techniques
to manage stress.
 Suggest counselling with a specialist diabetes educator to help your patient to
develop a plan to implement the recommended lifestyle changes

[ 21 ] UNIT 3 DIABETES MANAGEMENT

ROLE PLAY 2

ROLE B : PATIENT SETTING MEDICAL CLINIC

You are 22 years old and have had type 2 diabetes for 3 years. You enjoy going
to parties with friends, socialising and staying up late. At previous
appointments, you have been instructed to change your lifestyle to include
eating healthier food, taking regular exercise and stopping smoking. However,
you have not made any changes.

TASK
 Be defensive when explaining that you have not made any of the recommended
changes to your lifestyle. You feel that your type 2 diabetes diagnosis is not
affecting your health.
 When asked, say that you have not made any changes to your diet. You live with
friends and you all eat a lot of fast food and high calorie snacks. It is too time-
consuming to make home-cooked meals for yourself
 Agree to make some changes to your diet.
 When asked, say that you do no regular exercise, but you dance at parties.
 When asked, say that you only smoke occasionally.
 When asked, say you usually sleep for about 9 hours per night When asked, say
you manage stress by spending time with friends and relaxing.
 When advised to undergo counselling, question the need for counselling and say
that you do not think it is necessary at this stage.

[ 22 ] UNIT 3 DIABETES MANAGEMENT