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Well, that’s no good …

September 15th, 2015 | by Danish Association
Well, that’s no good …
Patient Stories
178

Diabetes letterbox doctor Soren Urhammer and diabetes nurse Jeanette Olsson work in the diabetes clinic at Frederiksberg Hospital. Diabetes has followed them an ordinary Thursday when they visit.

Text: By  Helen H. Heidemann,
article is from the member magazine February 2015.

The time is eight forty-five Thursday morning. Consultant Søren Urhammer and diabetes nurse Jeanette Olsson at Frederiksberg Hospital confederations on diabetes outpatient clinic where patients first see Jeannette and afterwards Soren on annual inspection.

The first in the outpatient clinic at Jeanette’s 48-year-old Charlotte Birch, who has had type 1 diabetes for 20 years. The day before was Charlotte for eye screening with Jeanette. The trial has not yet been answered. 14 days earlier filed her urine and had blood samples taken for the year follow.

– I have had problems with my Achilles tendon since the summer and has not been able to run my usual three trips a week. Therefore, I know that my long-term blood sugar is increased, says Charlotte Jeanette almost before she sat down.

And she’s right. Jeanette look at the numbers.

– Yes your HbA1c (long-term blood sugar) has increased slightly from 58 to 63 mmol / mol (7.5 to 8%). I know you eat healthy and exercise when you can, so you may need to increase your insulin dose – but you gotta talk to Soren afterwards, so I will let him decide today.

Feet

Charlotte Birch is measured its vibration sensitivity in the feet of diabetic nurse Jeanette Olsen
Photo: Claus Bjorn Larsen

Jeanette measuring blood pressure, she weighs Charlotte and check out Charlotte’s stomach and thighs for insulin infiltrates, which are accumulations of fatty tissue under the skin that can occur anywhere on the body where insulin is injected.She also asks Charlotte, how many items she drinks a week, measure her pulse and her vibration sensitivity in the feet to see if the nerves have been damaged by diabetes.

It’s Charlotte’s sense of touch is not.

– You have an amazing sense of touch and have perfect feet. Do you go for regular podiatry?

– Yes, every fifth, sixth week.

– It is a good investment, says Jeanette.

Egg white substance in the urine
consultation continues with Soren.

– I’m not worried about your long-term blood sugar levels, because there is a natural explanation for that you have been slightly higher in the most recent period. How much insulin you take?

They discuss the number of units, long-acting and rapid-acting insulin, and Soren pleased to Charlotte’s slightly higher long-term blood sugar means that she has had fewer low blodsukre lately.

Weighing

Up on the weight! Charlotte Cleyton Jorgensen is weighed with the nurse, before heading to the doctor
Photo: Claus Bjorn Larsen

– Your albumen in urine is marginally elevated, he continues as he looks at the numbers.

– Hm, I had shown just had a period when I dropped the urine sample.Can not play into, asks Charlotte.

– Yes, it can certainly be a source of error, but I think we take a new urine sample already next time again to be sure.

Egg white substance in the urine can be a sign of kidney problems, but there is no concern that the track at the doctor.

– Everything looks very fine Charlotte.

Many insulin shock
Soren Urhammer must see 16 patients with various endocrine diseases between the hours of 8:45 and 12:30. Nine of them have diabetes.

Two have canceled, and do not show up.

– It is unusual, but a little fortunate, for we have disease today, says he sometimes consultations, where he also must brief a few younger doctors who, because of lack of staff also has a full program today.

Three -læger

Nurse Anita Wild Meier comes by with a question regarding a previous hospitalized patients with diabetes
Photo: Claus Bjorn Larsen

The next, who has diabetes and must see Jeannette and Sean, is 32-year-old Charlotte Jorgensen.

She has recently moved to Tresiba as long-acting instead of Lantus.

– I take 12 units Tresiba for the night instead of six units Lantus, she says Søren.

– It is a very big difference! Hm … why, you ask Charlie.

– Otherwise, I lie over 15 in the morning.

Charlotte shows Søren its blood glucose readings on the iPad. He wonders 2.0 and 3.9 before bedtime.

– Well Charlotte, that’s no good …

– I eat something before I put me to sleep, and I like to be taut in blood sugar control. I get so tired and feel uncomfortable all the time when I lie too high.

Charlotte has experienced more than ten insulin shock, and it concerns the consultant, although Charlotte has not received an insulin shock since March last year.

– You still eat no lunch, ask Charlie.

– No, I’m not hungry for lunch! I would just like to eat twice a day.

Sean and Charlotte discuss back and forth, and agree that Charlotte should reduce its long-acting insulin dose at night.She gets renewed its prescriptions – including a glukagonsæt. Glucagon is a hormone that increases blood sugar if you have gone into insulin shock.

– I live alone, but because I’ve had so many insulin shock, send my sister to me every evening a text message. If I do not answer, she rings. I do not take the phone, she sends or my mother an ambulance. My neighbor also has a key so they can come in and help me.

Large transformation

Then the 61-year-old Pia Hvam Larsen’s trip. She has type 2 diabetes and get both Metformin, Victoza and insulin. In the past year she has gone from 26 to 13 units of insulin because she has lost 27 kg.

– Your treatment has always been good, so it was better, and now it’s super. It’s a big change that has happened to you, says Soren, as he looks Pias journal.

Long-term blood sugar level is kept up with and is down to 48 mmol / mol (6.5%).

Pia measures the blood glucose three times a day eight-ten days before, she will for control.

– Søren do like to have some blood glucose profiles to look at, but I do not measure in everyday life, but it goes very well anyway, she notes.

Diabetes Control

Most type 1 diabetics goes to check on a diabetes clinic at a hospital.Most people who have type 2 diabetes, are by their general practitioner. However, the studies are the same.

Every three months, you should get checked:

  • HbA1c (long-term blood sugar)
  • Blood pressure

Once a year you should get checked:

  • Kidneys
  • Eyes
  • Feet
  • Cholesterol

HbA1c targets:

  • Type 1 diabetes:
    less than 58 mmol / mol (7.5%)
  • Type 2 diabetes:
    less than 48 mmol / mol (6.5%), however, higher by cardiovascular disease

Will be lower

Next patient is 39-year-old Brian Hansen, who has had type 1 diabetes for about a year.

Consultation

Brian Erik Hansen discusses its numbers with Chief Soren Urhammer who think that Brian has a very low long-term blood sugar
Photo: Claus Bjorn Larsen

– I can clearly feel when I come down to three, but I have not yet had an insulin shock, he says to the doctor, who respond to Brian’s low long-term blood sugar at only 34 mmol / mol (over 5%).

– I think yes, that the recommendation of 53 (7%) for type 1 diabetes is too high. I want to have a long-term blood sugar similar to what people who do not have diabetes, have, and I work hard – both with my diet and exercise.

This morning’s consultations are slowly coming to an end.

– It’s been a good day at the clinic, says Søren Urhammer who welcomed can note that the schedule is kept reasonably.

– For the patients – besides the many other things at a consultation – also important that we keep the time, he says.

 

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