Technology is rapidly changing the world of some type 1 diabetics. The creation of Freestyle Libre (a small white patch which provides a continuous indication of blood sugar levels) has revolutionised diabetes care.
The most widely used indicator of blood sugar control is hba1c. Hba1c is very useful but is also quite crude. It gives an average of the previous three months but does not show you how this average was achieved.
I’ve usually been a well-controlled diabetic but in 2018 personal circumstances changed, and my sugar levels began to spiral out of control, swinging from highs of 15 and above and crashing into hypos. My hba1c reading was a low reading of 6 percent. After losing consciousness, I was desperate to access more support. Accessing this was difficult. Because of a history of good hba1c readings, I was told not to worry. I tried to obtain a faster acting insulin (Fiasp) but could not provide the evidence needed to obtain it. Continue reading “Diabetes and the digital divide: A patient’s perspective.”
‘Giving up smoking is easy. I’ve done it 100s of times’ Mark Twain
Most people who have given up smoking will probably be familiar with this well-known quote. We all will have made behaviour changes. Some are so effortless we may not even be aware we have made them. Others can fill us with dread. New Year’s resolutions we know will probably be ‘thrown out of the window’ by February.
People who work with behaviour change often use models to help them work in a more appropriate and time efficient manner. One of the most commonly known behaviour change models is the ‘stages of change’ by Prochaska and DiClemente. Within this model people usually transition through six stages (pre-contemplation, contemplation, preparation, action, possible relapse/ lapse) before they finally reach a more stable setting known as ‘maintenance’. This transition can happen at different rates and depend on many various external and internal factors. Continue reading “The different dimensions of working with behaviour change. Exploring internal and external influences”
We shop, bank, socialise and work via the internet. Online healthcare seems a natural progression in our heavily technology dominated lifestyles. There could be many benefits to being able to engage with our healthcare via the internet and it may help to create more flexibility and convenience in our increasingly hectic schedules.
But some people have genuine concerns about this sort of technology being implemented. Perhaps we should all have some concerns, as there may be points in our lives when circumstances change, we become older, and the implications for online healthcare could become greater. Continue reading “Online access to medical records: Patients and clinicians voice some of their concerns.”
I am a well-controlled type 1 diabetic, but there are certain situations where even well-controlled diabetics can find themselves in tricky situations. One of these is during pregnancy and the period afterwards. Changing insulin requirements and pressures to keep low blood sugars during pregnancy and breastfeeding can dramatically increase the risk of hypoglycaemia. Continue reading “Safer systems in the home: How a plug and a box changed my life”
I have a friend, Matt. He is a lean and muscular build and has a BMI of 20.57, which puts him in the healthy weight box. He is 49 years old and very active. He walks, cycles and I have completed a seven-day mountain GR5 mountain hike with him. He also has a PhD in Nutrition. Not really the sort of person you would expect to be at risk of type 2 diabetes, but in 2016 Matt had an hba1c blood sugar reading of 43. This puts him in the ‘pre-diabetic’ and ‘at risk’ category. Continue reading “Diabetes. Who is really at risk?”
When training clinicians about IRIS (the General Practice domestic abuse service) they would sometimes tell me that they had made many referrals into the IRIS service that year. Occasionally this would happen at a practice from which I had received no referrals at all.
Intrigued by this discrepancy I would ask more questions. It transpired that the clinicians thought that they were referring into the service (IRIS) but in fact, what they were actually doing was signposting to the service. This ‘difference’ made all the difference, and the intended recipient was usually lost in the process. Continue reading “Engaging potentially vulnerable client groups. Referrals and signposting. What’s the difference?”
Many of us are already using online healthcare facilities. ‘Patient Access’ has been available for some time. I use it myself for convenient repeat prescriptions. The area of digital health technology is growing at a phenomenal rate as it is being incorporated into apps and internet access. Government policy intends that ‘electronic personal health records’ will eventually be accessible to every adult in the UK via the internet and are supporting an NHS app to help create this future vision. This means that patient investigation results, prescriptions, health files and appointment booking facilities will be available for the general population to access from their personal computers and smartphones. Continue reading “ELECTRONIC PERSONAL HEALTH RECORDS. There are many benefits but what about the risks?”
The SafeLives Dash is the most commonly used risk assessment tool available to help professionals assess the risk of serious harm and homicide for domestic abuse victims. It has been absolutely invaluable in my work.
When risk assessing women who experienced domestic abuse, I have always asked the question ‘Are you very frightened?’ It is question number two on the DASH. Fairly frequently, they would respond to the question by saying ‘No, I’m not feeling frightened.’
I would continue the assessment. ‘Have you ever been raped?…. Have you ever been strangled?’ They would sometimes reply ‘Yes’ despite having just told me that they were not feeling afraid.
Continue reading “Are you afraid? Identifying victims of domestic abuse. Ask the question but don’t always expect a straightforward answer”
Domestic abuse is more common than you may think. Approximately 27% of women, 15% of men and 24% of children will experience an abusive relationship at some point in their lives. People who are experiencing domestic abuse will have more contact with health services than an average patient. A study conducted in Hackney showed that approximately 17% of women in a general practice waiting room may have experienced physical violence within the last year. With high rates of prevalence, it is essential that health services are well equipped to understand and respond to domestic abuse appropriately.