OET letter for a patient with diabetes: what to include about insulin, glucose and education
In an OET Nursing letter about a patient with diabetes, include only the diabetes details the reader needs to act: the current regimen with any recent changes, the recent glucose pattern written as a range in full words, any hypoglycaemia, and what the patient can or cannot yet manage alone. Leave out old readings, long-stable history and routine education the reader will not follow up.
Why diabetes cases need careful selection
Diabetes appears in many nursing case notes, sometimes as the main reason for the letter (a new insulin start, a hypoglycaemic episode, a foot ulcer) and sometimes as background to something else (a hip fracture in a patient who also has type 2 diabetes). The notes are often full of numbers: glucose readings, doses, HbA1c, weights. The challenge is deciding which of those numbers the reader needs, and turning them into clear sentences.
A useful test, the same one used in case-notes selection: would the reader do anything differently if this detail were missing? If not, leave it out.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| The type of diabetes when it explains the plan ("type 2 diabetes, now on insulin") | The year of diagnosis, unless recent and relevant |
| The current regimen, especially any change and why it changed | Every dose change over past years |
| The recent glucose pattern, as a range or trend | Individual readings, unless one is a hypo or clearly abnormal |
| Hypoglycaemic episodes: when, how low, how treated | Normal readings on every day |
| What the patient can and cannot do (inject, monitor, recognise a hypo) | A full list of education leaflets |
| Diet or eating problems that affect insulin (poor appetite, vomiting) | General healthy-eating advice already given |
| Foot or wound problems linked to diabetes | Past podiatry visits with normal findings |
| What you want the reader to do (review dose, monitor, continue education) | Routine observations that were normal |
If diabetes is only background, it may need just one clause: "She also has type 2 diabetes, which is well controlled with metformin." If the letter is about diabetes, it will usually take a paragraph or more.
Turning diabetes notes into sentences
Notes are written in shorthand; your letter should not be. See abbreviations and case notes to full sentences for the general method. Common diabetes conversions:
| Note | Letter sentence |
|---|---|
| T2DM, dx 3/12 ago | "He was diagnosed with type 2 diabetes three months ago." |
| BGL 6–9 last 3/7 | "His blood glucose levels have been between 6 and 9 mmol/L over the past three days." |
| Hypo 2.8 @ 0300 15/6, tx juice, resolved | "On 15 June he had a hypoglycaemic episode at 3 a.m., with a blood glucose level of 2.8 mmol/L, which resolved after he drank fruit juice." |
| Glargine ↑ 18 → 22 units nocte | "His insulin glargine has been increased from 18 to 22 units at night." |
| Self-injecting with supervision, not yet confident | "He is able to inject his insulin under supervision but is not yet confident doing so alone." |
Keep units (mmol/L, units, mg) as they are, and write frequency in words ("twice daily", "at night"). The medications guide explains how to present doses and changes.
Common diabetes letter situations
New insulin start, discharge to home with community nursing
The reader (often a community or practice nurse) needs the regimen, the patient's skill level and the follow-up plan. Lead with the insulin start, then glucose pattern, then what still needs supervision.
Hypoglycaemia that led to an admission or change
The reader needs to know what happened, why it probably happened (missed meal, dose error, reduced appetite) and what was changed. One clear sentence on the episode is better than a list of every reading.
Diabetes as background to another problem
A patient admitted with pneumonia or a fracture may also have diabetes. Mention it if it affects care (glucose was raised during infection, insulin was adjusted, wound healing risk). If it was stable and unchanged, a short clause is enough.
Worked example (invented case)
Case summary (invented): Mr Daniel Okafor, 58, bus driver, admitted 10 June with a right foot ulcer and raised blood glucose. Type 2 diabetes for 8 years, previously on metformin only; HbA1c on admission 82 mmol/mol. Started on insulin glargine 14 units at night, increased to 18 units on 14 June. Blood glucose 7–10 mmol/L for last three days. One hypoglycaemic episode (3.4 mmol/L) on 13 June before breakfast, treated with glucose tablets. Ulcer cleaned, dressing every second day. Has been taught to inject and check his glucose; injects correctly but forgets to rotate sites. Lives with wife. Hypertension, on ramipril, unchanged. Appendicectomy 1990. Discharged 17 June. Task: write to the community nurse requesting ongoing support with insulin and wound care.
Selection decisions:
- In: new insulin and current dose, reason (high HbA1c), glucose range, the hypo and how it was treated, injection skill and the site-rotation problem, foot ulcer care plan.
- Out: appendicectomy (irrelevant), ramipril (unchanged and unrelated to the request), job (unless the task mentions driving and the reader must address it).
Sample letter body:
Dear Ms Patel,
Re: Mr Daniel Okafor, aged 58
I am writing to refer Mr Okafor, who was discharged today after treatment for a right foot ulcer and poorly controlled type 2 diabetes, for ongoing support with insulin management and wound care.
Mr Okafor was admitted on 10 June. As his HbA1c was 82 mmol/mol on metformin alone, he was started on insulin glargine, and his dose has been increased to 18 units at night. His blood glucose levels have been between 7 and 10 mmol/L over the past three days. He had one hypoglycaemic episode on 13 June, with a level of 3.4 mmol/L before breakfast, which resolved with glucose tablets.
He has been taught to inject his insulin and monitor his glucose. Although his technique is correct, he does not yet rotate his injection sites.
His foot ulcer has been cleaned and requires a dressing change every second day.
I would be grateful if you could visit him to supervise his insulin injections, reinforce site rotation and continue his wound care. Please do not hesitate to contact me if you require further information.
Yours sincerely,
The letter keeps the numbers that drive the reader's work and explains the one skill gap. Want to check a letter like this? Try a timed case in practice or check your own letter.
Mistakes to avoid
- Copying every reading. A table of glucose values belongs in the chart, not the letter.
- Leaving shorthand. "BGL", "T2DM", "hypo" and "nocte" should be written out.
- Missing the change. If the dose changed, say from what to what and why.
- Hiding the skill gap. What the patient cannot yet do is often the reason the reader is involved.
- Over-explaining diabetes. The reader is a health professional; you do not need to explain what insulin does.
For more general errors, see common OET Writing mistakes.
Sources
This guide is medEmu's writing advice, not official OET guidance; all patients, readings and case notes are invented and are not clinical advice. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.