Care planning review

Care planning review The annual diabetes review is an ideal time to have your care planning review. Care planning is a process that should be available to all people with diabetes. It:
  • allows you to be more involved in decisions about how your diabetes is managed
  • gives you a say in every aspect of the care you get
  • helps you to work towards goals that are personal to you
  • helps you to work in partnership with your diabetes team.
The care planning appointment is a chance to talk about the results of your annual diabetes checks (these are included as part of the 15 healthcare essentials) with your healthcare professional, talk about your experiences and discuss how you feel, set goals, and create an action plan to help you manage your diabetes. Your healthcare professional can help you to understand the results of your diabetes checks, provide you with information and advice, talk about different options – for example, different types of medication available to you – and refer or signpost you to support in your local area. A care plan is a written document of all these discussions, goals and actions. Testing There are a range of tests which will be carried out:
  • Blood glucose levels
  • Urine testing
  • HbA1c (Glycated haemoglobin) or fructosamine
  • Blood pressure (hypertension)
  • Blood fats (lipids)
  • Blood glucose levels
Blood glucose targets It is important that the blood glucose levels being aimed for are as near normal as possible (that is in the range of those of a person who does not have diabetes). These are:
  • 5–5.5mmol/l* before meals
  • less than 8mmol/l, two hours after meals.
There are many different opinions about the ideal range to aim for. As this is so individual to each person, the target levels must be agreed between the person and their diabetes team. The target blood glucose ranges below are indicated as a guide. Children with Type 1 diabetes (NICE 2015)
  • on waking and before meals: 4–7mmol/l
  • after meals: 5–9mmol/l.
Adults with Type 1 diabetes (NICE 2015)
  • on waking: 5–7mmol/l
  • before meals at other times of the day: 4–7mmol/l
  • 90 minutes after meals: 5–9mmol/l.
Type 2 diabetes (Diabetes UK Council of Healthcare Professionals 2015)
  • before meals: 4–7mmol/l
  • two hours after meals: less than 8.5mmol/l.
Pregnant women with diabetes (NICE 2015)
  • fasting: below 5.3mmol/l
  • 1 hour after meals: below 7.8mmol/l or
  • 2 hours after meals: below 6.4mmol/l
  *millimoles per litre: a measurement of the concentration of a substance in a given amount of liquid.       Change in measurement of HbA1c From 01 June 2009, HbA1c in all people with diabetes will be measured in millimoles per mol as well as by percentage. The UK is responding to the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) call for all countries to adopt the same measurement to make it easier to compare HbA1c results between laboratories throughout the UK and worldwide. Both the old and the new measurements will be given until 1 October 2011, when people with diabetes will receive their HbA1c measurement only in millimoles per mol. A blood glucose conversion chart is below.
mmol/l mg/dl   mmol/l mg/dl   mmol/l  mg/dl
1 18 9 162   17 306
2 36 10 180 18 324
3 54 11 198 19 343
4 72 12 216 20 360
5 90 13 234 21 378
6 108 14 252 22 396
7 126 15 270 23 414
8 144 16 288 24 432