Chest pain; heart or gullet?

What, then, are our duties towards insulin dependent diabetic patients in relation to home blood glucose monitoring ? Doctors' attitudes will vary, but all patients should be made aware of the technique and, if interested, be given or loaned equipment for a trial period. Those choosing to continue will need further guidance. The choice between a reflectance meter and strips suitable for direct visual reading is an individual one, but whichever method is used the patient's competence should be assessed. There are sources of potential error,21 and repeat checking of technique and accuracy is necessary. Patients will tire quickly of producing large numbers of results if they do not understand or are not told how to use them, so arrangements are needed for individual follow up by a physician. The results may point towards the need for radical changes in insulin treatment, and if these are not undertaken monitoring becomes no more than a record of poor control. All this means that if more patients are to use self monitoring effectively, demands on staff time will increase and efficient schemes will be needed for the education of patients. The emergence of the specialist nursing teacher is a step forward, but all those concerned with diabetic patient care, including family practitioners, can play a part by becoming familiar with self monitoring techniques.