Taken from Holt, P. (2011) Managing hypoglycaemiaIndependent Nurse 17/10/11 18-29-30
| HbA1c DCCT (%) | 6.0 | 6.5 | 7.0 | 7.5 | 8.0 | 8.5 | 9.0 | 9.5 |
| HbA1c IFCC (mmol/mol) | 42 | 48 | 53 | 59 | 64 | 69 | 75 | 80 |
To raise blood glucose, take one of the following:
If blood glucose is still below 4mmol/l after 10 mins, or if patient doesn’t feel better, repeat one of the above treatments.
When feeling better, eat some starchy food such as a sandwich or a banana, monitoring blood glucose afterwards.
Washing hands with water increases the accuracy of blood glucose testing, a Japanese study has found. Cleaning with alcohol swabs did not improve accuracy, however.
Hirose, T. (2011) Glucose monitoring after fruit peeling: pseudohyperglycaemia when neglecting handwashing before fingertip blood sampling. Diabetes Care 34, 3, 596-597
NSAIDs are generally used to manage pain associated with osteoarthritis. However, because of the risks associated with NSAIDs (renal/gastric complications, dyspepsia, VTE) this will not be suitable for all patients. NSAIDs can be taken orally but also topically, which may be an option for some.
Paracetamol may be used in palce of NSAIDs, but prolonged use at the maximum dose may cause gastro intestinal problems so this needs to be considered.
Opioids have not been proven to be hugely effective in osteoarthritic pain, and prolonged use can lead to dependence and increased tolerance even when a lower dose is combined with paracetamol. It also has the potential side effects of nausea and constipation.
This leaves steroid injections; these are effective for up to 3 months but are not suitable for diabetes due to their ability to destabilise blood glucose.
The holistic approach is essential, and lifestyle counselling may be required if a patient is inactive and/or overweight.
Physiotherapy may be beneficial as may acupuncture (although its efficacy has not been proven sufficiently through clinical trials).
According to Azmina Govindji (Diabetes Welllness News April 2011) the latest advice to those with diabetes is that a diabetic diet is a healthy diet, one that is low sugar (not no sugar). A lifestyle of exercise and good diet is essential, consuming low levels of salt, sugar and saturated fat, and high in fibre.
A small amount of sugar can be combined with low glycaemic carbohydrates (pasta, pulses, oats) as low glycaemic foods stabilise gblood glucose, which helps prevent the blood glucose increasing too rapidly. It is also important to consider that all diabetic patients are entitled to a NHS dietitian.
