General practices are under increasing pressure to initiate insulin in type 2 diabetes, as it would be more efficient for the health service and more convenient for most patients. There are many different approaches to starting insulin, but it is essential for practice nurses to work closely with patients and progress slowly to ensure successful and safe outcomes.
Starting insulin treatment for type 2 diabetes
Chronic kidney disease: the no tears review
Many drugs are cleared from the body by the kidneys, so careful medicines management is especially important in people with chronic kidney disease (CKD). This article explains how to ensure CKD patients receive recommended therapies designed to protect their kidneys and reduce their risk of a heart attack or stroke.
On the beat: Controlling heart rate in angina and heart failure
Controlling heart rate is a key element of good care of patients with angina or heart failure. In this article we explore the benefit of effective heart rate control to reduce hospitalisation and alleviate symptoms. Measuring heart rate is simple, and can provide valuable benefits for many patients.
Editorial 2 – If I had one wish for improving the management of liver disease…
How to use glycaemic index as a dietary tool for controlling type 2 diabetes
Glycaemic index (GI) is a hot topic, often misunderstood by healthcare professionals and patients. This article fills the gaps by explaining the low-GI diet in detail, describing the benefits and barriers to using GI in practice, the benefits in patients with diabetes and the controversy that surrounds it. The aim is to help primary care professionals to make informed decisions on when and how to use GI in helping patients with diabetes to plan their diet.
Modern insulin therapy reviewed
As the use of insulin therapy becomes more common in the ever-growing population of people with diabetes, practice nurses need to be aware of the range of insulins now available and how they work as they take on more responsibility for the management of these patients. In this article, we look at the production and role of insulin in the body and how type 1 and type 2 diabetes affects this. Moving on to newer insulins, we review how longer-acting insulins are used to mimic the characteristics of natural background insulin, the role of shorteracting insulins available for mealtime bolus doses, and the use of insulin mixtures in practice.
Post-MI patients: the no tears review
This second article focuses on safe and effective prescribing of medications which will reduce risk of further cardiovascular events. This series provides a ‘hands on’ practical guide to conducting medication reviews of long-term cardiovascular conditions. In this issue, we look at how to ensure post-myocardial infarction patients are taking the right medications at the right doses to ensure they get maximum benefit.
How to carry out an annual review for patients at high CVD risk
Putting Prevention First, the national strategy for cardiovascular risk assessment for people aged 40 to 74 years, remains high on the healthcare agenda regardless of NHS changes. The “Cog Man” on the cover of the guidance and leaflets distributed to practices and pharmacies highlights the close links between the heart, brain, kidneys and diabetes and underlines the comprehensive nature of vascular risk assessment. In this article, we look at how to carry out an annual review in high-risk people with a cardiovascular risk score of 20% or higher but who do not have high blood pressure, diabetes, chronic kidney disease or atrial fibrillation.
Caring for patients with anaemia of chronic disease
Many patients presenting in general practice will, at some time, complain of tiredness and lack of energy. Investigations to discover the cause are often conducted and will usually include blood tests such as a full blood count to see if anaemia is to blame. Patients may assume that all anaemia is iron deficiency anaemia but there are, of course, different types of anaemia. Interpreting investigations correctly and acting on them appropriately can ensure that the patient gets the right diagnosis and appropriate treatment.
Physical activity: getting people moving to prevent CVD
If physical activity could be taken as a tablet, the dramatic benefits it achieves in reducing cardiovascular disease and diabetes as well as many other conditions mean all of us would be on it. But many people currently miss out because it takes more effort to increase physical activity than popping open a tablet bottle. This article sets out the evidence for physical inactivity as a major cardiovascular risk factor and how to put the evidence into practice and get patients moving.
