Supporting a person new to type 2Friday, 24 September 2021
A diagnosis of type 2 diabetes may come as a shock, or be expected if there are others in the family already living with it.
As a health professional, one of the first steps is to make sure the person completes a National Diabetes Services Scheme form to join the NDSS. This gives them access to programs, information and services including subsidised products to help them manage their diabetes. Once they join the NDSS they will receive a starter pack with lots of information on how to manage their diabetes and where to go for extra support.
Now for a quick reminder!
Type 2 diabetes is a condition that results from too much glucose in the blood. An easy way to explain type 2 diabetes is: “insulin is the key that unlocks the cells of the body for glucose to enter and be used as energy. In type 2 diabetes, there are changes to how the insulin works to unlock the cells which may cause insulin resistance and an inability for the pancreas to keep with the demand for insulin”.
How is type 2 diabetes diagnosed?
As health professionals, we know how important it is for diabetes to be diagnosed early so treatment can start as soon as possible. A person may have symptoms which lead to diagnosis; however, for others diabetes may be diagnosed as part of a routine health check. To diagnose type 2 diabetes a blood test is taken from a vein on the arm and examined at a pathology lab. The test may be either:
- A fasting glucose test ≥ 7.0mmol/L
- A random glucose test taken any time of day ≥ 11.1 mmol/L (confirmed by second abnormal fasting glucose test on a separate day)
- A 75g oral glucose tolerance test (OGTT) with either a fasting level ≥ 7.0mmol/L or a 2 hour blood glucose ≥ 11.1 mmol/L
- Or an HbA1c ≥ 6.5%/48mmol/mol (on two separate occasions)
Person centred consultation
Once the person is diagnosis with type 2 diabetes, the GP should ideally provide a person-centred consultation assessing clinical signs and symptoms, as well as the person’s thoughts, fears, preferences and expectations, and their social situation. The is explained further in the RACGP Management of type 2 diabetes: A handbook for General Practice (2020).
GP Management Plan (GPMP)
Within in the first few weeks after diagnosis a GP management plan (GPMP) should be developed in consultation between the GP and the person living with diabetes. The GPMP incorporates their needs, values and choices as a person living with type 2 diabetes and is tailored specifically to meet them. Research shows that people living with diabetes are more likely to engage actively in self-management and achieve optimal health outcomes if these management plans are person-centred.
As part of this plan the person living with diabetes is eligible to five subsidised allied health consultations per calendar year as part of what is called a Team Care Arrangement (TCA).
People with diabetes can benefit from referrals to a podiatrist, dietitian, diabetes educator or exercise physiologist in particular.
First Nations and rural support
First Nations People are able to access an additional five visits to health professionals under Medicare Follow-up Allied Health Services for People of Aboriginal and Torres Strait Islander Descent forms. In rural and remote locations there is also access to primary health network funding. Federal Government funding provides additional allied health services to rural and remote regions. Go to the interactive map locator to find your local Primary Health Network.
Lifestyle modification plays an important role in the management of type 2 diabetes and may be supported by allied health and specialist support services. After diagnosis type 2 diabetes in some patients can be managed with diet and exercise alone although often oral medication is required.
The Annual Cycle of Care
The diabetes Annual Cycle of Care is a checklist that helps you review your diabetes management and general health.
People living with diabetes can reduce their risk of developing complications by keeping their health on track. This includes keeping blood pressure, blood glucose levels and blood fats as close to normal as possible. It’s also important to have regular dental checks and pay attention to other parts of the body that can may be at risk, such as feet, kidneys and eyes.
Some things, such as blood glucose levels, can be checked by the individual. Others like teeth, feet, kidneys and eyes will need to be checked by healthcare professionals.
We call these checks the Annual Cycle of Care. Some of the checks are below:
- HbA1c (three month average of your blood glucose levels)
- Cholesterol levels
- Kidney health
- Foot health
- Blood pressure
Structured diabetes care programs
Education to support self-management is an integral part of diabetes care. People living with diabetes and their carers should be offered a structured, evidence-based education program at the time of diagnosis, with an annual update and review. This education about the condition will assist in the person self-management of diabetes.
People living with diabetes can obtain further education and support through Diabetes NSW & ACT and the National Diabetes Services Scheme (NDSS). There are online diabetes programs as well as webinars, with booking available here.
An example of this is the Type 2 and me online program that is a great start for the person who is new to diabetes. They can also call the NDSS helpline on 1800 637 700 to speak to a diabetes educator, dietitian, exercise physiologist or psychologist.
Remember, when they join the NDSS they will receive a starter pack with lots of information on managing their diabetes.