PGEA-accredited distance learning package for the Primary Care team

Diabetes and Primary Care, Spring, 2004

Supported by an educational grant from Aventis

How to complete the learning module ...

Marking & feedback guaranteed within 2 months

Each issue of Diabetes and Primary Care contains a continuing education module. Each module carries 2 hours PGEA accreditation for GPs; nurses can complete the supplement to use towards their PREP requirements. Participants should be able to complete the supplement within 2 hours. This can then be submitted to the address on the application form for assessment and feedback. Certificates will be awarded to all health professionals completing the supplement to the required standard. No payment is required.

Standards to be achieved

To receive a certificate, the answers provided must meet the following criteria:

1. All questions within the supplement must be answered.

2. The minimum number of answers to individual questions should be given where specified.

3. Factual knowledge around the subject area, plus the case studies, will be compared with specimen answers for accuracy.

4. Questions around your own practice will be assessed for an adequate level of completion. Brief answers are acceptable.

The feedback (GUARANTEED WITHIN 2 MONTHS) will indicate one of two things:

a) You have successfully completed the questions and will be awarded accreditation and a certificate.

b) Your answers have been inadequate, and comments will be provided.

You will also receive a set of specimen answers against which to compare your own work.

EACH MODULE FOLLOWS A STANDARD FORMAT, RELATING TO ONE AREA OF DIABETES CARE

Section 1: Seeks information about your factual knowledge around the subject area

Section 2: Provides factual information to enable you to revise and refresh your existing knowledge (this section will contain no questions for you to answer)

Section 3: Presents two or three case studies to provide you with an opportunity to apply your knowledge to different patient scenarios

Section 4: Invites you to answer questions about the treatment of a number of patients within your practice around the subject area

Section 5: Asks how completion of the supplement will influence your future practice

Diabetes and Primary Care reserves the right to hold back certificates where the above standards have not been met

DIABETES AND RAMADAN

Readers can, if they choose, use this section to gain accreditation and feedback (marking guaranteed within 2 months).

Section 1a. List three changes in someone's daily routine during Ramadan that could have an effect on their diabetes.

Section 1b. What advice or suggestions would you give someone with type 1 diabetes about managing their diabetes during Ramadan?

Section 2. This section is provided for readers wishing to refresh their knowledge. Readers may choose to defer reading this section until completion of the rest of the module.

DIABETES AND RAMADAN

Ramadan is the holy month of the Islam religion, and falls in the ninth lunar month of the Islamic calendar year. The time of year it falls will vary, as it moves forward by 10 days each year. This means in 2004, Ramadan will be from 15 October to 14 November.

Muslims comprise 5% of the population of the UK, and although there are more Muslims in certain areas, it is likely that there are Muslims in most areas of the UK. For Muslims, fasting during Ramadan is an important part of their faith, and is obligatory for all healthy Muslim adults. Some groups of people are exempt from fasting: children under 12, the elderly, women who are menstruating, pregnant or breastfeeding, travellers, and people who are seriously unwell. Most people with diabetes would not consider themselves exempt from fasting (even some that are in the exempt categories), and unless people are very ill or pregnant, advising people to break their fast can be unhelpful and is unlikely to be acted upon. It is much more helpful to negotiate how their diabetes treatment can be optimised during Ramadan.

How does Ramadan affect diabetes?

The main changes to someone's daily routine that affect diabetes are that no food or drink is taken between dawn and sunset, which could be up to 18 hours each day if Ramadan falls in the summer months. In addition. blood tests (including self monitoring) are considered by many to be a break of fast, as are taking oral medication and insulin during the fasting hours. In the non-fasting hours, two meals are taken--sehri (before dawn) and iftar (after sunset). Large amounts of sugary drinks, sweet foods, fried and carbohydrate-rich foods are consumed. The sugary drinks and sweet foods are usually taken as soon as the fast is broken, before the evening meal.

Diabetes treatment during Ramadan

If someone's blood glucose is treated with healthy eating and physical activity with no additional medication, it can be helpful to raise their awareness that their blood glucose may rise higher than usual during the evening and night if they eat large amounts of sweet foods. Asking them to identify what they are prepared (and able) to alter about their food intake is likely to engender useful discussion. The more they are involved in making decisions about how they can alter their food intake, the more likely it is that they will carry out those alterations.