Diabetes mellitus


To improve the quality and duration of life of people with diabetes

  • By the maintenance of near normal blood glucose levels
  • By the reduction of risk factors such as smoking, obesity, hyperlipidaemia and hypertension.
  • By the early detection and treatment of complications
  • By the early diagnosis of diabetes
  • To educate and empower the patient to achieve both psychological as well as physical well being
  • To educate members of the Primary Health Care Team (PHCT) caring for patients with diabetes and to evaluate its effectiveness.

Staff Requirements and responsibilities

Risk Factors Associated with Diabetes

Recommended Lifestyle

Education to be covered

This should not be attempted in one visit - small amounts at a time backed up with literature. Enter into notes all that has been covered.


An adult needs to know:

Areas to be Covered

  1. Driving - it is a legal requirement that all people with diabetes inform their insurance company, if they fail to do so they may not be covered if they are involved in an accident, even if they are the innocent party. If on tablets or insulin they need to inform DVLA. If on sulphonylureas (e.g. gliclazide) or insulin need to be aware of the danger from hypos. Don’t miss meals. Test blood. Carry snacks. Stop driving immediately if unwell.
  2. Explanation of Diabetes - aetiology- cause and relationship between food, treatment and control. Effects of exercise & illness. Important to address the psychological aspects and patients concerns. Ascertain patient’s knowledge base and answer questions rather than ‘pot filling’ with advice.
    • Type 1 - insulin deficient Treatment and effect of pills/insulin - most
    • Type 2 to start on diet only.
  3. Diet, Exercise and Alcohol - all patients to be referred to dietician.
  4. DAMES = Diet, Acarbose, Metformin, Exercise, Suphonylureas
  5. Self Monitoring -
    Type 2
    usually only need to test their urine - 2 hours post prandial. Explain relationship between glycosuria and food intake and exercise levels. Use as education tool as well as for monitoring control.
    Type 1
    to do BMs. Usually started off in hospital and most under secondary care or shared care. Test before meals and bed. Best to do blood series (4 times throughout the day), then rest for a few days unless needing to do extra for symptomatic monitoring e.g. extra exercise, different food intake, alcohol, unwell, driving.
  6. Reasons for good control - well being (feel better, less tired), prevention of complications.
  7. Illness - do not stop treatment. Type 1 frequent monitoring, check ketones, ? extra insulin, maintain carbohydrate intake (in liquid form if necessary), maintain fluids. If necessary - Contact GP SOS.
  8. Identification - Bracelet or card
  9. BDA - encourage joining the British Diabetic Association (give application form).
  10. Eyes - Importance of annual check up with opticians. Will be given a form to take to opticians at every annual check up.
    If newly diagnosed - do not get new glasses until diabetes is controlled (6 months) or could waste patient’s money!
    rapid lowering of blood glucose can damage the retina.
  11. Foot Care - Young and capable, without problems - can look after their own feet - after receiving instructions on foot care, dangers, breaking in new shoes, and to see nurse if any problems. Others - refer to chiropodist (and give hygiene instructions etc. with reasons WHY)
  12. Free prescriptions - if on treatment involving diabetic drugs or insulin, eligible for free scripts.

Metabolic targets

Diabetic annual review: nurse

3 monthly and 6 monthly checks: nurse

General practitioner

Newly diagnosed patients (Type 2)



Bradley Cheek 1999