Information leaflet for MDI patients. Improving Diabetes using Diasend

Transcription

1 Information leaflet for MDI patients Improving Diabetes using Diasend

2 Contents Easy Steps for Setting up Diasend Account 2 Finding the resources on the internet 3 VIP Patient Diasend Assessment Template 4 Why are these patterns happening? 6 How much total daily insulin are you taking and how much is background/basal? 7 Making changes to insulin by 10-20%: Make one change at a time. 8 Reviewing the progress 9 Glossary of terms 10 VIP Patient Diasend Assessment Template 12 VIP Patient Diasend Assessment Template 13 Looking after and sharing information about your child 14 1 NHS Leaflet Improving Diabetes using Diasend

3 Easy Steps for Setting up Diasend Account 1. Go to : - Save this site as a favourite in your browser 2. Click on Register here 3. Set up your account: Enter Enter personal details Share Data: Enter the clinic code: Login with your and password 5. Click on the Tools tab 6. Install the Uploader for your computer: Double click on the Windows or Apple Mac icon and follow the instructions 7. Double click the uploader icon on your desktop Improving Diabetes using Diasend NHS Leaflet 2

4 8. Connect your meter or pump to the computer via the USB cable. It will upload to 100%. To get the cable: a. Abbott NEO & Libre Request a Yellow micro USB for Diasend upload: Contact Abbott on free b. Glucomen LX Plus 2 & Aero 2 Request a cable for Diasend upload: Contact Glucomen on Go to to view your uploaded results. Contact Diabetes Home Care on or us at diabetes.results@bch.nhs.uk should you want to discuss your download. You must be at your computer looking at the upload when you call. Finding the resources on the internet There are online resources to help you become a Diasend VIP. They can be found at: SMj5eGtHQ0 gmqljtg3iy06e79z0e There are videos for: Diasend account set up for Mac Diasend account set up for PC How to upload your device to Diasend Assessing a Diasend Report This assessment booklet is also available in PDF form to be downloaded. 3 NHS Leaflet Improving Diabetes using Diasend

5 VIP Patient Diasend Assessment Template V: Values: Values per day: Finger prick tests: Period Average: Average BG: Values below goal: Hypos: View Patterns: I: Insulin: Total daily insulin dose (TDD): Daily basal/background insulin: % basal/background (basal/background TDD x 100): Current insulin to carbohydrate ratio: Current insulin sensitivity/correction factor: P: Patterns & Plan: Patterns: Potential causes Plan: Suggested changes (10-20% changes) and review: Improving Diabetes using Diasend NHS Leaflet 4

6 1. Login to diasend 2. Click on the Comparisons tab, then logbook/table, then select two weeks as shown below. Values per day: Frequency of blood glucose checks: 0-4 = too low 5-10 = ideal 11+ = May be too many Period Average: Average Blood glucose for two weeks: What will your HbA1c be if your average blood glucose stays the same for three months? 5 HbA1c mmol/mol Finger Prick HbA1c% Average blood Glucose Clinic 3 month old Measurement % % % % % % % 80 Clinic 3 month new Measurement % 91 >16.0 >11.5% >102 NHS Leaflet Improving Diabetes using Diasend Diabetes effect on energy & mood Diabetes effect on future health

7 Values below goal: Number of episodes of hypoglycaemia over two weeks: 0-3 = less than expected for an in target HbA1C 3-6 = Expected with a target HbA1c 7 + = Too many and need to reduce over the next two weeks Identify times of the day where the glucose levels are out of target consistently: Reds are high glucose levels Blue are low glucose levels Green are in target glucose levels Why are these patterns happening? Consider: Have there been any changes in routine, illness, school vs. holidays? Accuracy of Carbohydrate counting and giving all insulin doses for snacks? Treating hypos adequately? Activity management? Is the background insulin too much or too little? Assess the blood glucose change from before bed to waking, what happens most of the time? Is the bolus insulin at different times of day too much or too little? Assess the blood glucose before meals when in target (green) What happens to the blood glucose to the next meal, is it still in target? Are the correction doses working when the blood glucose is high? Improving Diabetes using Diasend NHS Leaflet 6

8 Identify times when a correction is given (red), what happens to the blood glucose by the next meal, has it returned to target (green)? If you wish to check the patterns observed and changes to make, please contact the diabetes team. If you feel confident to make changes yourself, then continue with the assessment. How much total daily insulin are you taking and how much is background/basal? Add daily background/basal insulin to total daily bolus insulin to get your total dai-ly dose (TDD): E.g. 15 units Lantus + Novorapid 5 units breakfast, 5 units lunch, 10 units evening = 35 units (TDD) Calculate your Basal/background % of TDD by the following sum: Background/basal units TDD x 100. Using the above as an example: x 100 = 43% Basal/background % expected 25-50% If <25% and average BG is high then increasing basal/ background would be indicated If <25% and lots of hypoglycaemia then reducing the bolus insulin would be indicated If >50% and average BG is high then increasing bolus would be indicated If basal >50% and lots of hypoglycaemia then reducing the basal insulin would be indicated 7 NHS Leaflet Improving Diabetes using Diasend

9 Making changes to insulin by 10-20%: Make one change at a time. Write down your insulin to carbohydrate ration and insulin sensitivity factor if you calculate your doses manually: Basal/background increase insulin dose: 10% = Current basal/background x % = Current basal/background x 1.2 Basal/background decrease insulin dose: 10% = Current basal/background x % = Current basal/background x 0.8 Insulin to carbohydrate ratio or Insulin sensitivity/correction factor increase insulin dose: 10% = Current ratio or sensitivity/correction factor x % = Current ratio or sensitivity/correction x 0.8 Insulin to carbohydrate ratio or Insulin sensitivity/correction factor decrease insulin dose: 10% = Current ratio or sensitivity/correction x % = Current ratio or sensitivity/correction x 1.2 Improving Diabetes using Diasend NHS Leaflet 8

10 Reviewing the progress Wait at least three days and review to see if the problem has been resolved. If resolved, review the download in another two weeks, if not make further changes. If you re contacting the Diabetes Team for support in making changes, arrange a time when you are looking at the download. Then make the suggested changes following this assessment process. Set a timescale for review and expectation for average BG if changes are successful. 9 NHS Leaflet Improving Diabetes using Diasend

11 Glossary of terms Background/basal insulin: is needed to keep blood glucose levels under control, and to allow the cells to take in glucose for energy. Background/Basal insulin: is usually taken once or twice a day depending on the insulin, or delivered hourly from an insulin pump as a basal rate. Basal Rate: the hourly background/basal insulin delivered hourly from an insulin pump. Blood glucose: the main sugar found in the blood and the body's source of energy. Bolus: an amount of insulin taken to cover a rise in blood glucose from a meal or snack, and may also include a correction dose. Correction dose: The amount of insulin administered to bring the blood glucose from a high level back to target. The insulin sensitivity/correction factor determines the correction dose. HBA1c: a test that measures your average blood glucose level over the last 2-3 months. Also called Haemoglobin A1C. Hyperglycaemia: higher than normal blood glucose. Fasting hyperglycaemia is blood glucose above a desirable level after not eating for at least 8 hours. After meal hyperglycaemia is blood glucose above a desirable level 1 to 2 hours after eating. Improving Diabetes using Diasend NHS Leaflet 10

12 Hypoglycaemia: also called low blood glucose, a condition that occurs when one's blood glucose is lower than normal. Signs include hunger, nervousness, shakiness, perspiration, dizziness or light-headedness, sleepiness, and confusion. If left untreated, hypoglycaemia may lead to unconsciousness. Hypoglycaemia is treated by consuming glucose either in glucose tablets or a carbohydrate-rich liquid. Insulin to carbohydrate ratio : A ratio that specifies the number of grams of carbohydrate covered by each 1 unit of rapid- or short-acting insulin. Insulin sensitivity/correction factor refers to the number of mmol/l 1 unit of rapid acting insulin lowers your blood glucose 11 NHS Leaflet Improving Diabetes using Diasend

13 V: Values: VIP Patient Diasend Assessment Template Values per day: Finger prick tests: Period Average: Average BG: Values below goal: Hypos: View Patterns: I: Insulin: Total daily insulin dose (TDD): Daily basal/background insulin: % basal/background (basal/background TDD x 100): Current insulin to carbohydrate ratio: Current insulin sensitivity/correction factor: P: Patterns & Plan: Patterns: Potential causes Plan: Suggested changes (10-20% changes) and review: Improving Diabetes using Diasend NHS Leaflet 12

14 V: Values: VIP Patient Diasend Assessment Template Values per day: Finger prick tests: Period Average: Average BG: Values below goal: Hypos: View Patterns: I: Insulin: Total daily insulin dose (TDD): Daily basal/background insulin: % basal/background (basal/background TDD x 100): Current insulin to carbohydrate ratio: Current insulin sensitivity/correction factor: P: Patterns & Plan: Patterns: Potential causes Plan: Suggested changes (10-20% changes) and review: 13 NHS Leaflet Improving Diabetes using Diasend

15 Looking after and sharing information about your child We have a duty of care to help patients and families understand how information about them is kept and shared and we include the following information in all our patient leaflets: Information is collected about patients relevant to their diagnosis, treatment and care. We store it in written records and electronically on computer. As a necessary part of that care and treatment we may have to share some patient information with other people and organisations who are either responsible or directly involved in the patient s care. This may involve taking the patient s information off site. We may also have to share some information for other purposes; such as research etc. Any information that is shared in this way will not identify the patient unless we have the patient s and parent s/carer s consent. If you have any questions and/or do not want us to share that information with others, please talk to the people looking after your child or contact PALS (Patient Advice and Liaison Service) on Improving Diabetes using Diasend NHS Leaflet 14

16 Birmingham Women s and Children s NHS Foundation Trust Steelhouse Lane Birmingham B4 6NH Telephone Fax: Website: Author: John Pemberton Produced: April 2017 Review Date: April2017 Version CPADS: 56208