11/13/24, 8\:17 PM Guide | Explaining diabetes

Explaining diabetes

Table of contents
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Introduction

Being able to share information in a clear and concise way is an essential skill in all
simple explanations, such as why a blood test may be needed, to more complex situations, such as explaining a new diagnosis.
Often, sharing information with a patient occurs naturally during a consultation. However, providing clinical information may
also be the primary focus of an appointment, and in these situations, it is crucial to have a structured format to communicate
e
There are an estimated 4 million people living with diabetes in the UK, which represents 6% of the population. This means that
understanding how to explain a diagnosis of diabetes is a key clinical skill. This guide is a step-by-step approach to explaining
a diagnosis of diabetes and should be used in conjunction with our “Information giving - an overview” guide.

Structure

Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information
being shared is about a procedure, a new drug or a disease, the BUCES structure (shown below) can be used.
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Explanation structure

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before
explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps to
establish rapport and creates an open environment in which the patient can raise concerns, ask questions and gain a better
understanding of their problem. After introducing yourself, it is important to take a brief history (this is the
structure)\:
What has brought the patient in to see you today?
What are their symptoms?
Are there any risk factors that can be identi
For example, a diabetic patient may describe feeling very tired, urinating often and feeling very thirsty.
Tip\: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial and you do not want to spend all
your time taking a history when you are meant to be explaining a diagnosis! A rough guide would be to keep the introduction
and brief history between 1-2 minutes maximum.

What does the patient understand?

Following a brief history, it is important to gauge the patient’s knowledge of their condition. Some patients may have a family
member with diabetes and therefore have a fairly good understanding of what the condition entails (be careful to di
between insulin-dependent and non-insulin-dependent). Other patients may have heard of diabetes, but only have a vague
understanding of the important details. The patient sitting before you may not even know at this point that they have diabetes -
you may be the
Due to these reasons, it is important to start with open questioning. Good examples include\:
" W h a t d o y o u t h i n k i s c a u s i n g y o u r s y m p t o m s ?"
" W h a t d o y o u k n o w a b o u t d i a b e t e s ?"
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" W h a t h a s b e e n e x p l a i n e d t o y o u a b o u t d i a b e t e s s o f a r ?"
Open questioning should help you to determine what the patient currently understands, allowing you to tailor your
explanation at an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks
(i.e. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and non-verbal
communication such as nodding).
Checking the patient’s understanding should not be solely con
throughout by repeatedly ‘chunking and checking’
.
Tip\: Try using phrases such as\:
“ J u s t t o c h e c k t h a t I a m e x p l a i n i n g d i a b e t e s c l e a r l y , c a n y o u r e p e a t b a c k t o m e w h a t y o u
u n d e r s t a n d s o f a r ?”
. This is far better than only saying “ W h a t d o y o u u n d e r s t a n d s o f a r ?” as the onus is placed upon the quality
of your explanation rather than there being an issue with the patient’s ability to understand.
At this point, it can also be helpful to determine whether the patient understands what management options are available and
to ascertain what is most important to the patient.

What are the patient's concerns?

The patient’s concerns should never be overlooked. A diagnosis of diabetes can be a signi
of worries. Asking the patient if they have any concerns before beginning your explanation allows you to speci
is most relevant to the patient, placing them at the centre of the explanation. The “ICE” (ideas, concerns and expectations)
format, can provide a useful structure for exploring this area further.

ICE

Ideas\:
What does the patient think is causing their symptoms?
What is their understanding of the diagnosis?
Concerns\:
What are the patient’s concerns regarding their symptoms and diagnosis?
Expectations\:
What is the patient hoping to get out of the consultation today?

Explanation

After determining the patient’s current level of understanding and concerns, you should be able to explain their condition
clearly. Diabetes can be confusing to medical students and doctors, let alone patients. Avoid medical jargon so as not to
confuse your patient.
You should begin by signposting what you are going to explain to give the patient an idea of what to expect.
Diabetes can be explained by using the metaphor of a car, a key and a garage.
Tip\: Use the mnemonic “Normally We Can Probably Manage” to help you remember the structure of explaining a disease.

Normal anatomy/physiology

“ A f t e r w e e a t a m e a l , t h e f o o d i s b r o k e n d o w n i n t o s u ga r , w h i c h i s r e l e a s e d i n t o o u r b l o o d . T h i s s u ga r i s t h e f u e l f o r a l l t h e c e l l s
t h a t m a k e u p o u r b o d y , a n d n e e d s t o g e t f r o m t h e b l o o d i n t o t h e c e l l s f o r t h e m t o f u n c t i o n p r o p e r l y .
”
Explain to the patient that they should think of sugar like a car, insulin like a key and the cells in their body as a garage.
“ W h e n y o u d r i v e h o m e , y o u u s e y o u r k e y , t h e ga r a g e o p e n s a n d y o u c a n p a r k y o u r c a r . T h i s i s w h a t n o r m a l l y h a p p e n s i n o u r
b o d y t o o . I f w e i m a g i n e s u g a r i s t h e c a r , t h e c e l l s a r e t h e ga r a g e , a n d a h o r m o n e c a l l e d i n s u l i n i s t h e k e y , s u ga r c a n o n l y e n t e r
t h e c e l l s w h e n i n s u l i n i s w o r k i n g p r o p e r l y .
”

What the disease is

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“ I n d i a b e t e s , t h e s u g a r c a n n o t g e t i n t o t h e c e l l a s t h e i n s u l i n i s n o t w o r k i n g p r o p e r l y . I f w e t h i n k o f i t i n t e r m s o f a c a r n o t b e i n g
a b l e t o g e t i n t o t h e g a r a g e - t h i s w o u l d c a u s e c o n ge s t i o n o n t h e r o a d s . T h i s a l s o h a p p e n s w i t h s u ga r - i t c a n n o t g e t i n t o t h e
c e l l s a n d t h e r e f o r e b u i l d s u p i n t h e t u b e s o f t h e b o d y w h i c h s u p p l y t h e c e l l w i t h b l o o d . T h i s b u i l d-u p o f s u g a r i n t h e b l o o d c a n
c a u s e d a m a g e t o t h e c e l l s i f i t r e m a i n s t o o h i g h f o r t o o l o n g - w h e t h e r t h a t b e t h e c e l l s o f t h e h e a r t , e y e s , l i v e r , k i d n e y s e t c .
”

Cause of the disease

There are two main causes of diabetes and both centre around problems with insulin.
Type 1 diabetes involves a combination of genetic and environmental factors (e.g. viral infections as an initial trigger for the
disease) that ultimately results in the patient's immune system destroying their insulin-producing cells in the pancreas. As a
result, they are no longer able to produce insulin and are therefore reliant on insulin injections for the rest of their life.
Type 2 diabetes also involves a combination of genetic and environmental factors (e.g. diet, obesity and overall lifestyle).
People with type 2 diabetes have a combination of inadequate insulin production and increased insulin resistance (the cells
ignore the insulin and don't allow the sugar in).

Problems/complications

Outlining potential complications of diabetes is necessary so that the patients can identify problems early and seek medical
advice. Being aware of common problems will encourage patients to adhere to their treatment and remain vigilant.
It is important not to scare the patient, but to explain that you are outlining the potentials risks so that they are aware of them.
When discussing potential complications explain that you and the patient will need to work together as a team to reduce the
likelihood that they'll occur.
Link the build-up of sugar in the blood back to the complications of diabetes. For example, high levels of sugar in the blood can
damage the blood vessels of\:
the kidneys causing kidney failure
the heart which can increase the risk of heart attacks
the brain which can increase the risk of stroke
the eyes causing loss of vision
the nerves of the lower limbs causing peripheral neuropathy
Also, outline how diabetes can cause slow healing of wounds and explain the risk of diabetic ulcers (including what these look
like).
Tip\: O
the team including a specialist nurse who will help to coordinate their care.

Management

Reinforce to the patient that they need to work with you as a team to achieve a good result.
Start by explaining what the patient can do to manage their condition. Including\:
Lifestyle change\: healthy diet (avoiding foods high in sugar), losing weight, regular exercise
Stop smoking (if relevant)
Emphasise the importance of tight glycemic control
Attending diabetic checks
Encourage good foot care and regular podiatrist appointments
Then explain how you as the doctor will be managing their condition. Important points include\:
Regular check-ups to screen for diabetic complications
Regular blood tests to check blood sugar levels
Counselling on starting metformin (this helps the garage recognise the key i.e. increases insulin sensitivity) or other oral
hypoglycaemics
Managing any complications as they arise
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Closing the consultation

Summarise the key points back to the patient.
Ask the patient if they have any questions or concerns that have not been addressed.
" I s t h e r e a n y t h i n g I h a v e e x p l a i n e d t h a t y o u’ d l i k e m e t o g o o v e r a ga i n ?"
" D o y o u h a v e a n y o t h e r q u e s t i o n s b e f o r e w e
Arrange appropriate follow-up to discuss their diabetes further. Acknowledge that you have discussed a large amount of
information and it is unlikely that they will remember everything.
O
t th i f ti ( l i l d ti t i f d NHS Ch i )
Source\: geekymedics.com
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