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					Patient Held Record
      Diabetes




      Patient Name
Diabetes Health Record

This record will help you receive the best care for your diabetes, provide vital information if
you are taken ill and provide you with information about your diabetes.
Please complete all the relevant details on this record filling it in as and when you meet with
Health Care Professionals. You should bring it with you to all your appointments and ask the
person that you see to fill it in also. You can use the section at the back to make your own
notes.

This Record includes:

       1. Patient Held Records – a rationale
       2. Personal details & telephone contact numbers
       3. Medical details: diabetes history and other past medical history
       4. Explanatory notes & glossary of terms
       5. Medication charts; diabetes medications and others
       6. When you are unwell: treatment of emergencies & illness
       7. Checklist for education
       8. Personal care plans / targets
       9. Diabetes Review Record (check-ups)
       10. Personal notes
       11. What to expect
1. Patient Held Records – a rationale
Standard 3 of the Diabetes National Service Framework (DNSF) 2001 (to view this
document see Resources on the right hand side of this page), states that all individuals with
Diabetes should receive a service supporting successful self-management of Diabetes,
encouraging a partnership in decision making to achieve end goals. There should be an
agreed, shared, plan of care.
There is widespread recognition that people with Diabetes should be involved with their care.
It is the patient and their families that experience the consequences of both disease and
treatment. Recognising this highlights the need for education and care that not only provides
expertise but also embraces psychosocial challenges.
Self-management programmes and education programmes such as DAFNE (link to DAFNE
http://www.diabetes.org.uk/good_practice/education/examples/education1.htm
http://www.dafne.uk.com/) and the Expert Patient Programme (link to expert patient
http://www.dh.gov.uk/AboutUs/MinistersAndDepartmentLeaders/ChiefMedicalOfficer/Whats
New/CMOAtLarge/CMOPastVisits/fs/en?CONTENT_ID=4102506&chk=QkH8rQ) have in the
last few years fuelled the belief that considerable benefits can be gained from empowering
the individual with Diabetes to make key decisions about their care.
The DNSF delivery strategy 2002 refers to the concept of individuals carrying with them a
personal record of care that includes treatment regimens and test results as a step on from
the pilot projects under way to meet the NHS Plan commitment that people receive copies of
clinical correspondence. Up to date records will facilitate continuity of care between the
individual themselves and the numerous and varied Health Care Professionals with whom
they come into contact.
There is a subtle difference between a Patient Held Records and Care Plan; the former
being a systematic means of capturing ongoing information about a persons treatment
needs and the latter a mutually agreed process with goals for improving an individuals
diabetes and in turn well being. The DNSF Delivery Strategy links the two, believing the ideal
personal diabetes record should include
      An agreed care plan
      Setting management plans between reviews to foster understanding and ownership of
       the set goals
      Identification of health, social and education needs, who is responsible for them and
       how they will be met
      Identity of a named contact

Diabetes UK has been asked to provide templates for Patient Held Records (to visit see
Resources on the right hand side of this page. It is felt that whilst there are general principles
that should always be applied and included, individual areas should adapt these to take
account of their local needs.
2. Personal details & telephone contact numbers

 Name

 Address

 Phone Number                   Home:   Work:                    Mobile:

 Date of Birth

 NHS Number

 Ethnic Origin

 Religion

 Interpreter Phone

 Language Spoken

 Emergency Contact Name                 Relationship to you

 GP Name

 GP Surgery

 GP Phone: (day)                                (out of hours)

 Community Pharmacist                                  Phone

 Diabetes Nurse Name                                   Phone

 Chiropodist Name                                      Phone

 Dietician Name                                        Phone

 Hospital Diabetes Specialist                          Phone

 Hospital Number                                       Phone
3. Medical details: diabetes history & other past medical history


Type of Diabetes

Date of Diagnosis

Weight at Diagnosis

HbA1c at Diagnosis

Symptoms at diagnosis

Family History: include diabetes, blood pressure, heart disease, stroke or high cholesterol and
who it affected if known




Initial Treatment




Your Past Medical History - Note especially any high blood pressure, high cholesterol levels,
angina, heart attack or heart surgery, and stroke or similar event:
4. Explanatory Notes & Glossary of Terms
This is your Personal Diabetes Health Record; it is your record of important information about
your diabetes care. Taking this record and the information collected in it to all appointments will
help to improve communication between yourself and the healthcare professionals looking
after you.
Please take your record with you to all appointments including:

       Your GP
       The hospital diabetes clinic
       The eye clinic
       Your optician
       The diabetes nurse
       The dietician
       Your chiropodist/podiatrist
       The hospital accident and emergency department; ask someone to bring it in for you
        if you have to be admitted to hospital
    »   The District Nurse


To the Health Care Professional in completing this record please:
       Be concise
       Discuss the entry to be made with the individual before completing
       Date and sign every entry
       Entries only to be made in black ink
       Make your entries legible (many people will be using the information contained here)



Telephone Help Lines
In addition to your local GP, Practice Nurse and Diabetes Specialist Nurse the following
Numbers may be helpful to you:
       NHS Direct 0845 4647
       Diabetes UK Careline 020 7424 1030 (Lines are open Monday to Friday 9am-5pm)
       Novo Nordisk 0845 6005055 1730-2300 mon-fri and 0830-2300 weekends and bank holidays
       Sanofi Aventis 0845 606 6887 24hours a day 7 Days
       Lilly Customer care 01256 315999
Your insulin manufacturer may have a helpline service; ask your Health Care Professional
about it and fill the details in below:
Insulin Company Helpline


Blood Glucose Monitor; the manufacturer of your blood glucose monitor may offer after care
services. Ask your health care professional about it and fill in the details below
Manufacturer Care Services




Glossary of Terms and Tests
Blood glucose/sugar level - the amount of glucose (sugar) in the blood.
Blood pressure (BP) - the pressure level within the arteries, which indicates how hard the
heart is working to pump the blood round the body.
Body mass index (BMI) - a measure of how overweight or underweight you are. It is
calculated by Weight (kg) divided by Height (m2). A BMI of 20-25 is considered normal, 25-
30 overweight and over 30 is very overweight. If overweight, loosing weight will help you
control your diabetes (benefits include improved blood glucose levels, a lowered blood
pressure, lower cholesterol and other fat levels, reduced risk of stroke and heart attack,
improves energy levels and well-being).
Waist circumference measurement
Waist Size Categorisation

Sex                  Healthy              Increased risk       High risk

Male                 69 – 94 cm           94 – 101 cm          More than
                     27 – 37 in           37 – 39 in           101 cm 40 in

Female               61 – 80 cm           80 – 87 cm           More than
                     24 – 32 in           32 – 34 in           87 cm 35 in


This measurement is preferable to BMI.
Cataracts - cloudiness and thickening of the lens of the eye.
Cholesterol - a type of fat in the blood. Too much cholesterol in the blood may increase
your risk of developing heart disease. (see Resources on the right side of this page for) Foot
pulses and sensation - checks made on the blood supply and amount of feeling in the feet.
HbA1 (or HbA1c ) - a blood test which indicates the average level of your blood glucose
during the past three months. Known also as Glycated Haemoglobin. The result is written as
a percentage with the average target being 7% (see Resources for).
HDL - high density lipoprotein, often referred to as good cholesterol, it carries cholesterol
away from the arteries. High levels of these can protect people from heart disease and
stroke.
Hyperglycaemia - high blood glucose level.
Hypoglycaemia - low blood glucose level.
Normal blood glucose/sugar level is between 4 – 7 mmol/l
Hyperlipidemia - another name for high cholesterol or triglyceride levels.
LDL - low density lipoproteins, known as bad cholesterol, too much LDL in the blood can
cause it to collect on the artery lining, leading to narrowing and hardening.
Microalbuminuria - a test for very tiny amounts of protein in the urine.
Protein - urine is checked for the presence of protein with test strips to test for damage to
the kidneys. Protein can also be found when there is an infection in the urine.
Retinopathy - damage to the back of the eye (retina).
Triglyceride (TG) - a type of fat in the blood.
Urea and Creatinine - blood tests to check for kidney damage.
Visual acuity - an eye test which involves reading a letter chart.
ACR – this is a special measurement of urine which checks for kidney damage.
5. Medication charts; diabetes medications and others


Your Allergies




Name of          Date         Strength Amount (how much and   What is it   Date & Reason
Diabetes         Prescribed            at what time of day)   for?         Treatment
Medication                                                                 Stopped




Insulin Delivery Device
Needles Used

Type of Glucose Monitoring          Blood                     Urine

Monitoring Device Used:

Strips Used

Lancets Used

Finger Pricker Used
Names of other                                          How often do you
                  Date Prescribed    Strength                            What is it for
Medications                                             take it




6. When you are unwell: treatment of emergencies & illness

Hypoglycaemia (‘hypo’) occurs when the blood glucose level is too low (below 4 mmol/l)(see
Resources on the right hand side of this page for patient information leaflets on
Hypoglycaemia). This should not affect you if you manage your diabetes with diet alone.
There can be a number of causes:
             A meal or snack is missed
             Too much insulin has been taken
             Unexpected / excessive activity or exercise
             Alcohol
             Hot weather
      It can come on suddenly and in a person who is not unwell.
      Symptoms vary for each individual but may include; sweating, shaking, irritability,
       confusion, feeling faint.
      Stop what you are doing and take sugar or a sugary drink immediately e.g. glucose
       tablets, lucozade or other non-diet drink. Follow that short acting carbohydrate with
       some longer acting carbohydrate e.g. sandwich, milk and 2 rich tea biscuits or your
       next meal if due.
      Hypergylcaemia- high blood glucose levels (above 7 mmol/l). Coma can occur at high
       levels (higher than 15mmol/l) although this is rare.
      Hyperglycaemia can build up gradually over days or even weeks but can also become
       a serious problem more quickly in some.
       Monitor blood glucose levels frequently; every two to four hours. Ask someone to help
        if you are unable to so yourself.
       It is important NOT to stop taking your tablets or insulin; when unwell our bodies react
        by raising blood glucose levels worsening diabetes control.
       Drink plenty of unsweetened fluids.
       If you cannot eat, try to take in some carbohydrate consider soups, milk drinks, ice
        cream, ordinary squash, try small amounts little and often.
       Check for ketones in your urine or blood


7. Checklist for Education Sessions

Below is a list of topics that you may need to know about. Some are very important; the
nurse or doctor should discuss them with you regularly. Some may not be relevant to you. If
you are unsure, please ask.
 Topic                                                          Dates Discussed
 What is diabetes?
 Diet
 Tablets
 Physical Activity
 Insulin & injection technique
 Hypoglycaemia
 Hyperglycaemia
 Illness
 Blood testing
 Urine testing
 Foot care
 Importance of eye checks
 Smoking
 Alcohol
 Complications of Diabetes
 Driving/insurance
 Travel
 Sexual health
 Planning pregnancy
 Diabetes UK
 Free prescriptions
8. Personal Care Targets and Care Plans
This is a plan agreed between you the person with diabetes and the Health Care Professional
giving dietary, physical activity, weight and self-management targets, including suggested
frequency of check-ups etc.


 Dietary Goals




 Comments (with dates)




 Physical Activity Goals




 Comments (with dates)
Care Plans
Date         Problem / Target   Actions / to do   Evaluation
9. Diabetes Review Record (check-ups)


Date                        3 - monthly   6 - monthly   9 - monthly   Annual

Review control

Weight / BMI / waist
circumference
Blood pressure
         Lying or sitting

         Standing

Foot examination
  General condition

Pulses

Sensation

Urine tests
         Glucose

         Protein

         Microalbuminuria

Blood tests
       Glucose level

       HbA1c

Total cholesterol
       HDL
       LDL

       Triglyceride

Eye examination
       Fundoscopy

       Visual acuity

       Retinal photograph
Date of next visit


10. Personal Notes and Queries

Use this section to note anything about your diabetes that you would like to discuss.




11. What Diabetes Care to Expect

Research has shown that people with diabetes get fewer complications, and may live longer,
if they have regular check-ups, even if they do not feel ill in any way. You should agree with
your doctor how often these checks should be, but at the very least, you should make sure
someone examines the back of your eyes once a year.


For more details, see the leaflet, ‘What diabetes care to expect’ available free from Diabetes
UK. To order this leaflet call freephone 0800 585 088.


This Patient Held Record is adapted from Diabetes UK

				
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