Chronic Illness - Diabetes

Overview

There are 2 forms of diabetes.

Type 1 Diabetes is a form that means the body has stopped producing insulin for some reason, and requires a daily injection to replace this hormone and hence lower blood sugar levels. This type usually occurs in young people including children.

Type 2 Diabetes is the most common form, with the incidence increasing in the UK at a fast rate, largely because of the nation's rising obesity. The body develops a resistance to insulin, therefore it does not process sugar as well as it should and this leads to raised blood sugar levels. Dietary changes and tablets are usually required to treat this type, but some may require insulin in the long-term to improve their control.

Healthy Lifestyle is essential

Raised blood sugar levels can damage blood vessels, both large and small. This means that uncontrolled diabetes can have implications for our heart, kidneys, eyes, and also our nerves, which supply sensation. It is for this reason that firstly diagnosing and then effectively managing diabetes is so important. This starts with maintaining a healthy lifestyle, and the following links may help you obtain more information.

Important measures for a healthy lifestyle include

Getting checked for diabetes.

There may be a number of reasons getting checked for diabetes may be advised.

  • As a patient you may wish us to check it. This is fine and can be arranged via a blood test. It is often worth discussing the reasoning behind your request with a member of the health care team as there may be other things that we may wish to check also. If you are aged between 40-75yrs (need to confirm age range) then please be aware you will be invited into the NHS health screening programme, and this includes a test for diabetes.
  • If you are overweight, you have an increased risk of diabetes. Finding out you have it early, will help with the condition in the long-term.
  • There can be an increased risk of individuals developing diabetes if close family members have the condition. This may prompt a diabetic check if there are any similar symptoms.
  • There are certain medical problems, which make checking blood glucose important. This will be arranged and advised by your G.P.

The test for diabetes is a simple one and involves a fasting blood test. This means that it is advised not to eat or drink anything other than clear fluids from 10pm the night before your test. It is advisable therefore to attend for the blood test as early as possible the next morning. This enables the individual to eat normally after.

If the blood test result suggests diabetes then it may be repeated before a diagnosis is confirmed.

What will happen when I am diagnosed?

If you are diagnosed with diabetes, then your doctor will advise an appointment with our nurse for initial advice and information. You will be given advice on a healthy lifestyle, which can include a referral to a local specialised course. She will also answer any questions you may have. From this appointment we will organise for you be called to a local opticians to have an annual eye test, something we recommend strongly that you attend. You will then receive an invitation to attend our diabetes clinic approximately 3 months later. This is seen as adequate time for you to address any lifestyle issues and hopefully see how all your hard work has paid off by an improvement in your blood test. Please note that if your doctor is particularly concerned about you, they may start treatment immediately upon diagnosis; this being the case always for patients with Type 1 Diabetes.

Diabetes Clinics

Diabetes clinic is held every Monday Morning at Lion Health, 2 Lowndes Road, New Diabetics - Tuesday Morning at Lion Health. You will be invited to this clinic by letter once per year, and we strongly recommend you attend. If those times are not convenient for you, we have some capacity to see you in normal surgery, please rearrange your appointment via reception, making it clear it is for your yearly diabetes follow-up.

With the invitation letter, you will be requested to have some blood tests BEFORE coming to the appointment and asked to bring an EARLY MORNING URINE sample. TO ensure we make the most of your appointment, it is essential that you do these.

When you arrive at the clinic, you will see one of health care assistants who will do the following:

  • Check your weight and height
  • Check your blood pressure
  • Examine your feet
  • Send off the urine sample you provide to the laboratory for further investigation
  • Offer healthy lifestyle advice including access to weight management and smoking cessation clinics.

You will then be asked to wait to see either a doctor, senior nurse or our clinical pharmacist, who will assess your results and medication. They will discuss and complications you may have, and agree with you an action plan that will hopefully reduce any future risks to your health. These targets include:

  • HbA1c (a measure of your blood sugar control over the last 6-8 weeks). A target of 7% is associated with the lowest risk of complications
  • Blood pressure- A target of less than 140/80 lowers your risks, but if you have kidney disease, aim is less than 130/80
  • Cholesterol lowering- it is recommended that people with diabetes aged over 45yrs should be on a cholesterol-lowering drug, a statin irrespective of what their cholesterol level is.
  • Weight management- if you have a BMI greater than 25 (23 in South Asian), then this is associated with higher risks of heart disease and premature death.
  • Kidney disease- we will get an idea if your kidneys have any damage from your diabetes by the blood and urine test we do.
  • Eye test- we will encourage you to attend your chosen optician for a yearly appointment when you receive the invite through the post.
  • Complications- if you have had a previous heart attack or stroke, we will also be able to discuss any difficulties you may be having at this appointment.

This action plan may require a follow-up appointment during the next year. You will be advised the details of this at the appointment. If you would like to make a record of your diabetes and other risk factors control, please feel free to download the following sheet and complete at your appointment.

Downloadable action plan sheet from LES

Injection therapy in Type 2 Diabetes

People with Type 2 diabetes do sometimes require injection therapy for their treatment to achieve good targets. Some find this a difficult decision, but we would like to reassure you that that there are many benefits to starting this medication and often you will feel better on it. If you do have concerns and your doctor or nurse has suggested insulin may be the next step, please feel free to complete the following questionnaire. Bring it to clinic with you and show us it, so that we can discuss your anxieties and try to come up with solutions.

Both our nurses are trained to start injection therapy. They will show you the different pen devices and equipment required for it. They will also advise ways in which you can adapt the new treatment plan into your daily routine. We recommend that you bring a family member or close friend to this appointment so they can hear the advice given also. During this period, we will ask you to either attend clinic or arrange telephone contact on a more frequent basis, so that we can help you achieve the right dose for you. Once we have stabilised the treatment regimen, you will go back to routine follow-up, which is every 6 months. We would also encourage you to ask for help with maintaining a healthy lifestyle during this period. There are available courses locally to gain a better understanding should you require.

Further Information

www.diabetes.org.uk

Forms

Downloadable action plan sheet from LES
Questionnaire about insulin initiation.
How to use insulin PDF