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Courses on diabetes awareness

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folks, i was just wondering if anyone had ideas about any diabetes workshops or courses that could help us in treating the diabetes epidemic that is unfolding as a result of atypicals.

Does anyone think it is a good idea to qualify on  treatment of diabetes?

If so, any suggestions about any courses available?

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Diabetes is a vast specialty (not just a disease) in itself. Anything more than managing long term diabetics already on treatment, should be left for the specialists. I dont think a non diabetes specialist would benefit with a short course on diabetes as it wouldnot qualify him any further than MBChB.

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I think people who develop diabetes should be referred on to a specialist. If I had diabetes, I'd like to see somebody who is a specialist in the area, and not a psychiatrist who has got some qualification on the subject.

Of course, learning more about diabetes is good for us (and our patients). I don't know of any courses though.

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Dear colleagues,I understand your opinions . This is the age when you have diabetic specialist nurses who undoubtedly treat very well. There have been a few instances during which a diabetic opinion was the hardest thing to get. I was suggesting a good basic knowledge of starting antidiabetics based on a few parameters which could minimise waiting time for the patient. I was not suggesting to jeoparadise patients health by treating renal complications etc. I was talking of the very basic issues here. It believe that it is important to hone your skills as you rise in medicine.

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But guevera its best to leave it with the medics. I am sure you don't want to be sued by some patient.

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[highlight]I was suggesting a good basic knowledge of starting antidiabetics based on a few parameters which could minimise waiting time for the patient.[/highlight]

The trickiest part of diabetes management is initial work up and starting treatment. This is where diabetes specialists are most necessary. Once patients are on treatment long term follow up is not difficult and is done mainly by GPs or diabetes nurses.

In most trusts Diabetes Nurses are far more easily accesible and willing to review diabetic patients on non medical wards than diabetes/medical doctors.

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I agree. It is like asking a GP to assess and initiate treatment for a patient presenting with psychotic symptoms. They would not want to do that. As said Diabeteology not only is a vast field but a rapidly changing specialty. My friend who is a registrar in endocrinology is saying completely different from what he was saying two years ago.

Of course I agree with the fact that our role should be more educational in prevention of diabetes and may be taking care of long term management in patients with chronic psychotic illness once the diabetes is stable.

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Hi Balmu, I agree with your assertion but we do ask our GP's to initiate and monitor antidepressant medication and ask them to initiate referral to secondary care only after the failure of 2 SSRI's. I know consultants who write back to the GP immedietely if they have not tried atleast 2 antidepressants. I do acknowledge that it is a very specialised area but we can learn the basics and try to initiate treatment. I am sure we, as qualified medical practitioners can do that, wat u think.

I can give you an example. I work in LD where the nurses are trained only in LD and not Mental Health which has a lot of implications with regards to monitoring those with Mild LD and Schizophrenia as the nurses interpret even ruminations as being Psychotic phenomena. This incident initiated a lot of sessions about Mental Health awareness.

I think it is important to broaden knowledge cos it never goes waste.

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Guevara, I would agree with you that increasing awareness is a good thing. I would never say no to learning more about diabetes (or other medical ailments). However, I would not want to take responsibility to initiate prescribing. If one of my patients develops diabetes, I will give them the usual advice of diet etc, but I will wait for them to be seen by the Diabetes team. I have initiated hypoglycaemic drugs or even insulin, but always following advice from the endocrinologist.

I think the idea of training on specific aspects of medicine so that we don't have to refer on is the kind of thing HMG is after: minimum skill base. Where do you put the limit? Soon we could all be generalists.

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Differentiating Type 1 from Type 2 diabetes can be challenging. Obviously treatment depends on which type it is. Assessment  for end organ damage starts at the onset of diabetes and this involves ophthalmologists, renal physicians, cardiologists, vascular surgeons, podiatrists and pain specialists. Doctor diagnosing and treating diabetes has to make plans for longterm management and follow up. Not calling in specialists at the right time may have devastating consequences. Diabetes may be a presenting manifestation of chronic pancreatitis, multisystem auto immune disease, adverse drug effect or even pancreatic cancer. It is not just a number(high blood glucose) that you are correcting but it is deranged multisystem physiology. It is extremely annoying for a deiabetologist to encounter a mismanaged patient who has suffered irreversible end organ damage. It is time Non diabetes specialists realised their limitations and left the responsibilty to the qualified specialists. Treating diabetes is not just starting a tablet or insulin but is a major management issue of significant proportion of general population. Doctors should realise that most diabetics die of long term complications of the disease and learn to respect patient's right to quality health care.

These are only few thoughts.. Reasons could go on and on..

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I can endorse your view that everyone has in this group. I think we are all medically qualified to appeciate your opinion. I have been in a position during which i had to call some medical reg who is busy with his work and a treatment is initiated over the phone. It is very annoying. Acceleration, do you really think these medical regs care a toss about the long term management in our patient group. They just dont want to know a lot about '' psychaitric patients'' and give us a quick fix answer. Even they have to refer to ophthalmologists, renal physicians and so on. The general medics cant deal with all the complications.

I have been here long enough to realise that some medical diagnoses are not within our remit due to legal and other reasons but we, as psychiatrists are quite good in looking at illnesses in a biopsychosocial manner. Diabetes is an illness which can have a similar treatment which includes this combination. We can, at times be better placed than a 2 minute conversation with a medical sho or reg to start these '' important medication'' caused sometimes '' iatrogenically'' by us.

I am not championing for the cause of treating diabetes but i can give you an example . I had to manage a LD case load with complex epilepsy. It was very difficult initially. Our patients had to go to the A and E sometimes for clusters of seizures and to my dismay, their medication got altered so haphazardly by medics and A and E SHO's that it was difficult for us to establish the most appropriate dosage. I took it up as a challenge, sat in specialist clinics with a professor. I can manage or atleast initiate treatment for simple epilepsies. I was encouraged by my consultant to do a Post Graduate Diploma in epilepsy.

Medicine is an ever changing speciality and we, as doctors should try to broaden horizons . I appreciate all your views and it was really useful but i strongly feel that we can make a difference to our patients if we know more and try to get into the depths of the conditions which sadly are caused by some of the medication we prescribe.

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Hi Balmu, I agree with your assertion but we do ask our GP's to initiate and monitor antidepressant medication and ask them to initiate referral to secondary care only after the failure of 2 SSRI's. I know consultants who write back to the GP immedietely if they have not tried atleast 2 antidepressants. I do acknowledge that it is a very specialised area but we can learn the basics and try to initiate treatment. I am sure we, as qualified medical practitioners can do that, wat u think.

I can give you an example. I work in LD where the nurses are trained only in LD and not Mental Health which has a lot of implications with regards to monitoring those with Mild LD and Schizophrenia  as the nurses interpret even ruminations as being Psychotic phenomena. This incident initiated a lot of sessions about Mental Health awareness.

   I think it is important to broaden knowledge cos it never goes waste.

The incidence of diabetes among the client group I work is extremely high & I sometimes find it annoying when I have to liaise with the medics about every minute aspect of their care, as my consultant likes to play it safe.I think the importance of some basic knowledge of diabetes management for Psychiatrists is now being increasingly recognised & there are courses run on this topic for psychiatrists . I attended one organised by the University of Manchester earlier this year & found it extremely useful.Although it hasn`t meant that I do more in terms of managing diabetes, I has definitely made me more confident when on the phone to the Med Reg.

http://www.diabetes.org/for-health-professionals-and-scientists/psychiatric-patient.jsp

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Trying to gain knowledge about various diseases and trying to treat them are two completely different issues. It is appreciable that psych trainees are broadening their knowledge base by learning about non psych diseases.

Med Reg is one person who has least attention to long term management of cases due to the amount of work that he is expected to complete and also due to his mindset due to shift working patterns... 'I finish at 9pm anyway'. If the matter is not urgent, you always get a better quality opinion and follow up by referring your case to relevent medical specialty (Cardiology/Renal/Diabetes etc). Trust me there are exceptions to this, you might get a comprehensive medium term plan and follow up even in the middle of the night from a med reg. Thats where the importance of specialist nurses like diabetes nurses, they will always offer to follow up a chronic medical disease whereas a med reg hardly ever offers follow up.

I can bet on the fact that Psych trainees know so much more about managing medical diseases as compared to the poor knowledge of non psych trainees about managing psych illnesses. No doubt on this.

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I can appreciate your views Acceleration. I can give you an example. We had a pt with epilepsy who was on 100 mg bd lamotrigine for seizure control . He had a cluster of seizures with GE reflux due to alcohol misuse. He was taken to the A and E and they cut his lamotrigine down to 100 mane and 175 mane hoping that the GE reflux was a side effect. He was also instructed that he was on a high dose which is not true as Lamotrigine has a BNF upper limit of 400 mg. He suffered a nasty seizure the following week as you can appreciate that it could have been due to the dose reduction. A few incidents like this have made me wonder about their treatments. Sometimes, our patients are initiated Antidiabetics and receive no follow up. I am not sure if this pertains only to a few hospitals or all of them

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This example highlights a different problem. Not checking BNF for drug dose is incompetence. Reducing Lamotrigine sounds like an unusual and inexperienced way of controlling reflux disease when there are much simpler and effective methods available. Such things unfortunately continue to happen in A&E.

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