Diabetes introduction Being diagnosed with diabetes can be bewildering and distressing. There is often a great deal of information to take in and it can mean starting one or more new tablets. At the time of diagnosis people often have preconceived ideas about the effects that diabetes can have on their welfare. Whether you have recently been diagnosed, or have lived with diabetes for some time, we are here to help you adapt to living with diabetes, and minimise any impact that it might have on your life.
Newly Diagnosed Diabetics Patients who have recently been diagnosed with diabetes will need to see the doctor and practice nurse a few times in the first few months. During this time patients and carers will be given support, information and advice about managing diabetes. This will involve some blood tests being done at the surgery but these will be kept to a minimum. It is not usually necessary for patients to check their own blood sugar right away unless they particularly wish to do so. Patients will be given the opportunity to see a dietician for initial dietary advice, since this is the single most important part of achieving good control of diabetes. The practice nurse can give additional dietary advice. You may also be referred to DESMOND which is for patients diagnosed with Type 2 diabetes and is about self-management group education, usually held over 1 day opr 2 half days. You can take a partner or friend and this group offers you support and healthy food choices in an attempt to lower your HbA1c, control weight, improves your understanding of diabetes and promotes positive changes to your lifestyle and your wellbeing. It is also important that all newly diagnosed patients are seen for a diabetic eye check (Retinal Screening) This is a more thorough and detailed examination than is usually done when being assessed for glasses, and involves having a photograph taken of the back of the eye which your Optician does not normally do. The Doctor or Practice Nurse can arrange for this to be done.
It is also worth considering joining Diabetes UK, an excellent charity which will send out some very useful information about managing and living with diabetes, as well as advertising local events. (https://www.diabetes.org.uk) .
How Often Will You Need To Be Seen? We aim to review all patients with diabetes on a regular basis – at least once every year or more frequently if some aspect of control needs closer attention.
Who Is Involved With Care? Diabetes can affect many organs in the body, and good care therefore needs a team approach, involving a number of health professionals. This can seem a bit daunting to start with, but with proper organisation the inconvenience and aggravation can be minimised. However, first and foremost, the patient must be involved in their own care, and health professionals are there to help and support the patient in their own management.
Some of the complications of diabetes may not cause any symptoms to the patient initially. It is only by having regular checks that these complications can be detected early, and appropriate treatment given before they start to adversely affect ones health. The following health professionals are the main ones involved in regular care to look for early signs of any complications, and offer advice about appropriate management.
• Podiatrist – to check the condition of your feet.
• Dietician – to help gain optimal control by helping you adapt your eating habits.
• Practice nurse – to offer advice on any aspect of your care.
• District nurse – to help those patients who are unable to come to the surgery.
• Smoking advisor – to assist with stopping smoking.
• GP – to help interpret your blood test results, and give advice about your medication.
The majority of patients are looked after within general practice only, and do not need to be referred to the hospital. However, patients with more specific or difficult problems may be referred to the hospital consultant or diabetic liaison nurses.
Yearly diabetic clinics provide an opportunity for the appropriate team members to come together thereby minimising the inconvenience to patients of having to visit different people in different places at different times. You will be invited in to see the Health Care Assistant or one of our Practice Nurses who will take your bloods (you do not need to starve overnight before the blood test) check your blood pressure, weight and check your feet for any changes. It is helpful if you bring a sample of urine from the first time you pass water that day, when you come to that appointment. If you would like somebody to accompany you to the clinic, we are quite happy for him or her to sit in on your consultations.
Although the clinic is an opportunity to ensure that all the necessary blood tests etc. have been done, it is also an opportunity for patients to raise any concerns or problems that they might have. If there is anything that you wish to ask or that you are not sure about, you must feel free to talk to any of the healthcare staff that you see in the clinic. They will all be happy to try to answer any questions.
If a patient is housebound, and therefore unable to attend the diabetic clinic, alternative provision can be made for home visits.
In addition to the annual diabetic clinic, patients should be seen by the Retinal Eye Screening Service each year for a diabetic eye check. This will not be done at the time of the clinic appointment in the surgery. A reminder should be sent to your home address when an annual review is due. This service is now a mobile screening service.
Also in addition to the above annual checks those patients who have problems with their feet i.e. classed as being moderate or high risk, will be seen by the Community Diabetic Podiatrist. They are trained in recognising problems which may occur with diabetic patient’s feet and can help alleviate those problems. If you see a Chiropodist or Podiatrist regularly anyway you still need to get your feet checked by the Diabetic Podiatrist as diabetic patients can develop more complex problems with their feet.
VIRTUAL DIABETIC CLINIC OR VDC
Following your initial appointment with the Health Care Assistant or the Practice Nurse your bloods will be looked at by the Doctor in a Virtual Diabetic Clinic. They will also check if you have had Retinal Screening and a Foot Check. They will then decide if you need to come back into the surgery for a follow up appointment either with a GP or the Practice Nurse. You will be sent your results in the form of a letter together with an appointment to see one of the above. Please look at your results and bring them with you to the appointment and if you have any questions the GP or Practice Nurse will be happy to discuss these with you.
If the GP who looks at your blood results feels that you do not need to be seen again you will be sent your results for your information with a covering letter explaining that.
Sometimes if a patients HbA1c is getting slightly higher you will be invited in for a blood test to check this again in 3 or 6 months following your initial appointment. This is what we call Target HbA1c and you just need to see our Health Care Assistant to have this simple blood test done. We will send you a reminder letter nearer to the time.
Other Things to Remember
If you take tablets or insulin to help control your blood sugar, you are entitled to a prescription exemption certificate, which enables you to get all your prescriptions for free (not just those that relate to your diabetes).
You must notify DVLA if you are started on tablets for diabetes control, or insulin. This does not mean that you will have your licence taken away, but they do need to know about your condition. HGV and PSV drivers should ask the doctor or nurse when to notify DVLA.
• Insulin Dependent Diabetes Trust
• Diabetes UK