1 Assessing diabetes complication risk factors
1.1 Having tests
The following story (Case Study 1) illustrates that diabetes care is about more than checking your blood glucose level regularly. However, it can be difficult for people to understand why certain tests need to be taken and what the results mean. This can lead to them not following treatment, or indeed not even having the tests done.
Case Study 1
Mrs Begum attends a hospital diabetes clinic (such as that signposted in Figure 1) for her diabetes annual review. She does not speak English, so she has brought her 14-year-old daughter with her to interpret. She cannot understand why she has been asked to attend the clinic because she only has ‘mild’ diabetes, treated with tablets. The clinic is so crowded, with people who look much sicker than she is. She does not feel she has anything wrong with her, because she does not feel ill. When she eventually gets to see the doctor, he tells her she must take some more tablets to control her blood cholesterol, because the results of a previous blood test showed it was high.
Try to imagine what it is like for someone like Mrs Begum (Case Study 1) attending a busy diabetes clinic, and not understanding what is being said or done. For example, what difficulties do you think can arise when a family member is used to interpret in this situation? Why does Mrs Begum think she has ‘mild’ diabetes? Do you think she will take the cholesterol-lowering tablets?
The diabetes annual review consists of numerous tests, which can be confusing or disconcerting for anyone with diabetes who does not understand what they are for. This course describes what these tests are, why they are important, and the purpose of them. Mrs Begum may not get a clear explanation from her daughter who is interpreting for her. This may be because the daughter does not understand the explanation given to her by the doctor, or it may be because her daughter wants to protect her mother from worrying about the results of the tests. This may be the reason why Mrs Begum believes she has ‘mild’ diabetes. Alternatively, her doctor or nurse may have told her that she has ‘mild’ diabetes. This can unfortunately happen sometimes in the mistaken belief that Type 2 diabetes is somehow not as serious as Type 1 diabetes, because usually it can be managed, at least in the early stages, by diet or diet and tablets rather than requiring insulin injections.
All people with diabetes are at risk of diabetes complications if their diabetes is not controlled. The good news is that the risk factors and early signs of this damage can be picked up at the diabetes annual review, and then the person with diabetes can work with their diabetes team to prevent or limit the damage. You can see, therefore, that without an understanding of what cholesterol is, and what damage it can do, Mrs Begum may not take her cholesterol-lowering tablets.