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Diabetes Centre

Type 2 Diabetes

Adjusting to being told you have diabetes will take time and the first few weeks after the news, life will be full of questions. This information is for people with Type 2 diabetes and aims to give you and your family information to help answer some of these questions and to be used as a guide now and in the future.

Although fitting diabetes into your life can be daunting, with help from family, friends and your ‘diabetes team’, you can learn how to deal with it, take control and get on with your life.

If you would like this information in a booklet format then please contact our Diabetes Centre via our Switchboard on 0191 233 6161 where a member of our staff will be happy to help.

Contents


What is Diabetes?Show [+]Hide [-]

Diabetes is becoming more common. There are around 1.3 million people in the UK with diabetes.

Diabetes occurs when the body does not produce enough INSULIN. Insulin is a hormone made by an organ in the body called the pancreas and then released into the blood stream when you eat food. We all need food to give our body energy. Some of our food, specifically sweet and starchy food (carbohydrates: such as bread, rice, pasta, potatoes, chapattis and sweet foods) will be digested and turned into glucose (sugar). When the glucose in our blood rises we need insulin to allow the glucose to enter the body’s cells to provide us with this energy. The glucose and insulin levels will then fall until the next time it is needed, such as the next mealtime or snack. If we do not make enough insulin when we eat carbohydrate foods, the level of glucose will rise too high (called hyperglycaemia) and you will feel unwell. You may recognise some of the symptoms of hyperglycaemia:

  • Extreme tiredness
  • Increased thirst
  • Passing large amounts of urine
  • Blurred visionWeight loss
    High blood glucose (hyperglycaemia) can cause damage to your health over the years.  This effect is particularly noticeable in the eyes, heart, kidneys and feet.  The key to preventing these problems is to keep your blood glucose as near to normal as possible.

Types of Diabetes

There is more than one type of diabetes.  If the pancreas continues to produce some (but not enough) insulin, this is called Type 2 Diabetes. The main problem in Type 2 Diabetes is that your body becomes resistant to the insulin you produce, initially the body tries to manage the high blood glucose levels by producing more insulin, but this does not work as the pancreas becomes worn out and the body eventually lacks insulin. This process is called insulin resistance. This is why diabetes does not go away and normally progresses over time. Type 2 Diabetes is treated by maintaining a healthy lifestyle that incorporates a healthy diet and exercise.  However, tablets or even insulin may also be needed at some stage.

Type 1 Diabetes is when the pancreas is unable to produce insulin because the body's immune system attacks the cells within the pancreas that make insulin.  You therefore need to replace this lack of insulin and this has to be done by injecting insulin.  Insulin cannot be taken (as a tablet) by mouth as it would be destroyed before it had any effect.

You have Type 2 Diabetes.

What causes Diabetes?

The exact cause of diabetes is unknown, but Type 2 Diabetes is more common in people with a family history. Other factors involved are: 

  • Being Overweight.
  • Being less active.
  • Getting older.
  • Steroids.
  • Damage to the pancreas, such as infections or surgery.

Treatment and tabletsShow [+]Hide [-]

Type 2 Diabetes is treated using different combinations of therapies, the choice of therapy depends on many factors and differs from individual to individual:

  • Healthy diet and exercise.
  • Healthy diet, exercise and tablets.
  • Healthy diet, exercise, tablets and insulin injections.

Diabetes tablets (also known as oral hypoglycaemic agents) are very important in the treatment of Type 2 Diabetes. They work by lowering the blood glucose level. They do this by either stimulating the pancreas to produce more insulin, or by helping the body to use the insulin, that it does produce, more effectively.

You are advised to follow a healthy diet and to become more active (to help control your weight) in addition to the treatment chosen.

Type 2 Diabetes is a progressive condition and over time your treatment may need to be changed to help keep your blood glucose levels well controlled.

Diabetes tablets are not the same as insulin. Insulin cannot be taken in tablet form because it would be destroyed by the stomach before it could work.

If you do need insulin treatment your Diabetes Specialist Nurse will explain what you need to do and help you.

If you are admitted to hospital for an operation, procedure or complaint, you may be given insulin during that time.

There are several different types of diabetes tablets and are named according to their group/family:

Sulphonylureas

They work by helping the pancreas to produce more insulin and make it work more effectively. Some examples of tablets in this group are called: Tolbutamide, Gliclazide, Glimepiride, Glipizide.

Side effects of these tablets may include feeling nauseous and stomach upsets, some increase in weight and occasionally skin rash.

The main drawback of sulphonylureas is that they can cause your blood glucose level to fall, causing hypoglycaemia, (See Hypoglycaemia - low blood glucose for more information)

Biguanides

The only tablet in this group, available in this country, is Metformin. It works by stopping the liver making new glucose and by making insulin carry glucose into muscle cells more effectively. It is often used in people who are overweight because it reduces the amount of glucose absorbed through the gut.

The main side effects of Metformin are an upset stomach, nausea, indigestion and diarrhoea. These side effects are lessened if the tablets are taken with or immediately after food. These problems often wear off after a few weeks and the dose is gradually increased.

If you take Metformin tablets then a blood test will be taken every year to check your liver and kidney function. (If you have liver or kidney problems Metformin can cause a rare condition called lactic acidosis). Your Doctor will advise on this.

Metformin when taken alone does not normally cause hypoglycaemia, although they can occur if it is taken with a sulphonylurea or alcohol.

Thiazolidinediones. (Glitazones)

There are two tablets currently available in this group: Pioglitazone and Rosiglitazone. They work by allowing the insulin that the body produces to work more effectively. They also help to protect the cells in the pancreas, so that the cells can produce insulin for longer. These tablets can also have a beneficial effect on the cholesterol (blood fats) levels in the blood.

The main side effects of these tablets can include headaches, swelling (build up of fluid) and weight gain.

If you take these tablets you should have regular blood tests to check your liver function.

This group of tablets can not be used on their own, they are prescribed in combination with either a sulphonylurea or Metformin.

Prandial Glucose Regulators

These tablets, such as Repaglinide and Nataglinide only last for a short time to make your pancreas work harder to produce more insulin after you have eaten. They are given about half an hour before each meal. If a meal is missed, the dose is omitted. Side effects can include stomach upsets, nausea and skin rashes. They can cause hypoglycaemia, but this is less likely because they are short acting.

Alpha-glucosidase Inhibitors

Acarbose is the one tablet of this type used in this country. It works by slowing down the digestion of food in the intestine and the absorption of glucose. It means that the blood glucose level rises more slowly after meals. Acarbose should always be chewed with the first mouthful of food or swallowed whole immediately before food. Acarbose can cause wind, rumbling stomach, feeling of fullness or diarrhoea. These side effects can be lessened by starting with a small dose first and then slowly increasing.

Hypoglycaemia can occur if Acarbose is taken in combination with a sulphonylurea. If you do have a hypo, it is important to take glucose only in the form of glucose tablets/sweets or a sugary drink. Because this tablet works by slowing down the digestion of starchy food, taking something such as bread or biscuits will not work.

Insulin Injections

Insulin injections are also used to help control blood glucose levels, if  your blood glucose control is worsening and your diabetes tablets are not as successful. Insulin is also given during times of illness, surgery or emotional stress. Insulin can only be given by injection. Do not worry, if you need to start insulin injections as your Diabetes Team will guide and support you.

What to do if you forget you diabetic tablets

It is important to take your tablets regularly as prescribed, but it is possible to forget from time to time.

If it is only an hour or two after your normal time, then take your tablets as soon as you remember. If it is longer, then miss out that dose and take the next tablets at your usual time. Do not double up the next dose.

If you find that you are frequently forgetting to take your tablets, then discuss this with your G.P or Diabetes Team, as it may be possible to simplify your treatment.

Other medication

Patients with diabetes are at risk of developing heart disease, stroke and poor circulation. Therefore in addition to the medicines prescribed to control your blood glucose:

  • You may be advised to take tablets to lower your cholesterol level.
  • You may be advised to take a daily aspirin.
  • You may need tablets to control your blood pressure.

Some medications are known to interact with each other. This can include medicines you can buy over the counter, herbal supplements and alcohol. If you have any concerns about medicine interactions then check with your Pharmacist.

Complications (blood pressure and blood cholesterol)Show [+]Hide [-]

Diabetes if not carefully managed, can cause long-term problems with your general health, known as complications.  Controlling your blood glucose levels and avoiding other risk factors can reduce the risk of developing these complications.

These include problems with your:

  • Eyes (retinopathy)
  • Kidneys (nephropathy)
  • Feet (neuropathy)
  • Circulation
  • Heart

The treatment of Diabetes aims to keep blood glucose levels as near to normal as possible and therefore preventing or reducing the risks of developing long-term complications.

There are other factors however that can increase the risk of developing complications, these include:

  • Smoking
  • High blood pressure
  • Raised blood fats or cholesterol levels
  • Not having a balanced diet
  • Being inactive and not exercising
  • Excessive alcohol intake
  • Depression

Complications – a close up

Head - Eye damage:

Diabetes can cause damage to the retina which is the layer at the back of the eye. It is important to have your eyes examined and retinal photography once every year

Stroke:  The risk of stroke is increased in people with diabetes

Body:

  • Heart:  Heart disease and heart attacks are also more common
  • Kidney damage:  This is caused by the blood vessels that supply the kidney becoming damaged and in many cases can be successfully treated
  • Erection problems:  Some men with diabetes can develop difficulty in having an erection
  • Foot problems:  Can occur due to damage to either the blood supply or the nerve supply to the feet and risk can be greatly reduced by daily foot care

Preventing Complications

Research has shown that keeping blood glucose levels within target ranges can reduce the risk of developing complications.  You will be given advice as to your own target levels and can discuss these with your diabetes care team. 

In addition, targets are importantly set for your blood pressure and blood cholesterol (fats). These levels will be monitored closely and treatment commenced if necessary.  You should also expect that at your annual review appointment, your eyes and feet will be examined.

Blood Pressure is the amount of outward pressure that your blood puts on the walls of your blood vessels. It is measured in two numbers: systolic and diastolic. If your blood pressure is too high then this can lead to heart attacks, strokes, eye, kidney and circulation problems.

Blood Cholesterol (also called blood fats or lipids) are small globules of fat that circulate around the body. There are different types, but there are two that are important:

  • HDL is the good cholesterol.
  • LDL is the bad cholesterol, having too much LDL increases your chances of having heart problems and strokes.

There are some actions and lifestyle changes you can personally make to further reduce your risk of developing the complications of diabetes:

  • Eating a healthy balanced diet is very important
  • Maintaining your weight or perhaps losing weight if you are overweight
  • Doing regular exercise or activities such as walking, swimming cycling or dancing.
  • Not smoking/stopping smoking – smoking is particularly harmful for people with diabetes
  • Attend your appointments and check-ups.  This can detect and potential problem early on and it can then be appropriately treated
  • Stick to recommended guidelines for alcohol intake: 21 units per week for men and 14 units per week for women.


Sometimes the thought of complications can worry or depress people. These feelings are natural, as living with diabetes demands a lot of your energy and time and diabetes will be with you for the rest of your life. These emotions can make controlling your diabetes even harder. If you feel you are struggling with depression, anxiety or worry much of the time, let your GP or Diabetes Team know, as feeling better will help you control your diabetes.

Healthy eatingShow [+]Hide [-]

The aim of treating your diabetes is to try and achieve near normal blood glucose levels. The types of food recommended for people with diabetes are based on healthy eating and can be enjoyed by anyone. The picture below shows the 5 main food groups:

[Picture]


The green segment is fibre, which comes from plants and includes baked beans, fruit and vegetables. Fibre helps keep your bowels healthy and we obtain a lot of vitamins and minerals from this group.

The red segment is carbohydrate, foods which contain sugar and starches and they have an impact on blood glucose. We should get most of our energy from starch, which includes bread, potatoes, cereals, rice and pasta and we should eat less refined sugar found in cakes, biscuits, sweets and chocolate.

The blue segment includes dairy products such as milk, yoghurts and cheese and the general advice is to choose lower fat versions, such as skimmed or semi-skimmed milk and be careful of the amount of hard cheese eaten.

The yellow segment includes fats and sugars and the advice is to cut down on this group of foods. Sugars occur naturally in some foods such as milk (lactose) and fruit (fructose). We should obtain less of our energy from refined sugars. This group of foods can lead us to become overweight and a high intake of fat is linked to health problems such as heart disease, high blood pressure and raised cholesterol levels in the blood. There are three main types of fat: saturated, polyunsaturated, monounsaturated. For a healthy heart cut back on saturates found in pies, pastry, sausages, butter, cheese, cake and biscuits. Polyunsaturated and monounsaturated are a better choice for your cholesterol levels and are found in vegetable oil, olive oil and olive oil spreads. But remember they are still fats and contain a lot of calories. Certain types of fat are good for you such as the fat found in oily fish like sardines, mackerel and salmon.

The red segment is protein found in pulses, nuts, meat, poultry, fish and eggs. Protein is important for body growth and repair.

Sodium is mostly found in food in the form of salt. Salt can worsen high blood pressure. Two thirds of sodium we eat comes from processed or ready made meals. It is advisable to cut back on salt and not to add salt to meals at the table.

How can I manage my diet?

A healthy lifestyle with a well balanced diet and regular exercise may mean changing lifelong habits and routines, but this is important in controlling your diabetes. Blood glucose levels change depending on what you eat and how physically active you are throughout the day.

The general principles are:

  1. Try to be more active 
  2. Eat less saturated fat but include some good oils e.g. monounsaturated oils in moderate amounts. Cut down on fried foods. 
  3. Eat less sugar, sugary foods and sugary drinks. 
  4. Lose weight if you are overweight. 
  5. Try to have 3 balanced meals a day. There is usually no need for snacks. 
  6. Starchy carbohydrates foods should be eaten in moderation because they have an impact on your blood glucose but are an important part of each meal e.g. bread, potatoes, cereals, rice, chapattis and pasta. 
  7. Have 5 portions of vegetables and fruit a day (combination, NOT 5 of each). 
  8. Alcohol can be enjoyed but needs to be taken in sensible amounts.
  9. Try not to add salt to food at the table.
     

Menu ideas: 6 easy steps to getting the balance right

Step 1: Healthy carbohydrate should form the basis

Carbohydrates are an essential part of healthy eating when eaten in moderation, they provide a great source of energy. Try a variety of carbohydrates but pay attention to the quantities shown.
 
Bread

  • 1 medium bread roll (granary, wholemeal, rye, oatmeal)
  • 2 slices medium cut bread
  • 1 pitta bread 
  • 1 bagel (plain or herb) 
  • 1 English muffin
  • 1 medium chapatti

Potatoes

  • 1 medium jacket potato (180g /6oz cooked weight with skin)
  • 4-5 egg size potatoes
  • 4 tablespoons mash potato
  • 7- baby new potatoes
  • 1/3 plate of oven chips

Pasta

  • All varieties of pasta (and try wholemeal too) 
  • 6 tablespoons cooked pasta (120g / 4oz before cooking)

Rice

  • Basmati rice is slower releasing which means it will fill you up for longer.
  • 4 -5 tablespoons cooked rice (about 120g / 40z before cooking) (try the wholemeal
    variety too)

Cereal

  • 2 weetabix
  • 2 shredded wheat
  • 6-7 tablespoons of plain cereals e.g. All-bran, Branflakes, Cornflakes, Fruit & Fibre, Rice Krispies, porridge
  • 3 tablespoons muesli only

Step 2: Add a tasty protein filling

Meat, fish, eggs and pulses provide protein. Choose lean sources of meat such as skinless chicken and red meats with all visible fats removed.

Snack Meal. Sandwiches or on toast:

  • 2 thin slices lean cold meat (turkey, beef, ham or lean bacon) flavour with mustard
  • 2oz/ 60g tinned fish omega-3 oils: salmon, pilchards, sardines, mackerel, herring (in brine or tomato sauce)
  • 1 egg
  • Small tin baked beans
  • Small pot cottage cheese
  • Match box size of hard cheese

At main meals:

  • 3oz/90g lean roast meat, stew, mince, chicken, turkey (size of a deck of cards!)
  • 2 grilled sausages
  • 3-4 fish fingers
  • 5-60z/ 150-180g cooked fish (not fried)
  • 2 eggs (not fried)
  • 4 tablespoons cooked beans or pulses in place of meat
  • 40z/120g Soya, tofu or quorn

Step 3: Fill up on plenty of salad and vegetables

Add to your meals plenty of salad or vegetables to help fill you up, and to pack in the vitamins and minerals. They can be all varieties of vegetables including fresh, frozen, cooked, salad, soups. They can also be eaten in between meals if you are hungry.

  • Cucumber, carrot, celery sticks — great with cottage cheese
  • Tomatoes, onion, salad or spinach leaves
  • Raw vegetables such as broccoli, mange tout and sliced peppers
  • Try vegetable soup
  • Peas, sweetcorn

Step 4: Fruits are terrific but remember they contain a natural sugar (fructose) so will have to be eaten in moderation

Remember the 5 portions of fruit and vegetable per day is the recommended amount (it is a combination- not 5 of each!)

Try to aim for 3 pieces of fruit per day and try to vary the fruits.

  • 1 medium pear 
  • 1 medium orange
  • 1 medium apple
  • 2 small Satsumas
  • 1 small banana
  • 1 handful of grapes (approximately 6-10)
  • 2 slices of melon
  • 2 plums
  • 6 strawberries
  • 1 tablespoon dried fruit
  • 3-4 dried apricots
  • 1 small glass (100ml) of fresh fruit juice can count as 1 of your 5 portions of fruit and vegetables per day but remember to only have a small amount.
  • Keep a store of canned fruit in natural juice in your cupboards.


Step 5: Dairy foods, great source of calcium

Include a dairy portion with each of your meals. Dairy foods are well known to keep teeth healthy and bones strong. Remember to choose low fat varieties, they contain just a much calcium.

  • 1/3 pint milk (200mls) semi or fully skimmed
  • small carton diet / light yoghurt or fromage frais e.g. weight watchers, muller light
  • loz/30g hard cheese (match box size)
  • 4oz/120g cottage cheese (small pot)
  • 2 dairylea light slices

Step 6: Keep your fluid levels up

Aim for 6-8 cups of fluid per day and choose wisely:

  • Water, tap or bottled, sparkling or still
  • Tea, coffee (no sugar use artificial sweeteners only)
  • Diet drinks
  • Low-calorie or sugar free pop

Weight Loss

Being overweight puts you at risk of developing many health problems. Achieving a healthy weight helps your diabetes and your blood glucose control.

Advice for losing weight

  • Increase your physical activity.
  • Eat a healthy diet.
  • Aim to lose weight gradually: 1-2 lbs (1kg) per week.
  • Eat a variety of foods, sit down and enjoy your meal.
  • Choose filling foods: wholemeal bread, wholegrain cereals, whole-wheat pasta, brown rice, fruit and vegetables.
  • Avoid snacking.
  • Eat less fatty food.
  • Grill, microwave or steam/poach food instead of frying.
  • Limit the amount of biscuits, cakes, pastries chocolate and crisps, even the low fat ones.
  • Use low fat dairy products: semi-skimmed milk and low fat cheese.
  • Try to cut down on alcohol, it is high in calories.

AlcoholShow [+]Hide [-]

There is no need to give up alcohol because you have diabetes however, it is important to be sensible about the amount of alcohol you drink because it is high in calories and increases your weight and your blood pressure.

Recommendations:

Women - 14 units per week = no more than 2 units per day.
Men -21 units per week = no more than 3 units per day.

What is a unit?

1 unit =

  • ½  pint beer, lager, cider –ordinary strength
  • 1 standard measure of spirit – pub measure (25ml)
  • 1 small glass wine – (125ml)
  • 1 small glass of sherry – (50ml)

Remember many ciders, special brews, beers, lagers and alcopops are much higher in alcohol volume 5-7% which means 300ml is equivalent to 2 units.

Healthy alternatives for foods which contain fat and sugar Show [+]Hide [-]

Choose these

Avoid these

 Artificial sweeteners e.g. sweetex, canderel, hermestasa, splenda  Sugar
 Diet drinks, low calorie or slim line  Sugary drinks
 Low calorie alternative e.g. light, diet  Milkshakes, condensed milk, drinking chocolate, malted drinks
 Sugar free chewing gum  Sweets: cough sweets, mints, toffee, chocolates, boiled sweets, black bullets, fruit gums, ice-lolly, diabetic sweets
 Fruit, diet yoghurts, sugar free jelly, sugar free packet desserts  Sponge puddings, fruit pie, cheese cake, meringues, trifle, Swiss roll, gingerbread, Danish pastry, icing, marzipan
 1-2 biscuits a day: rich tea, ginger nuts, marie, osbourne, jaffa cakes, fig rolls, garibaldi  Chocolate biscuits. Cream filled biscuits e.g. custard cream, bourbons, flap jacks cereal bars
 Plain breakfast cereal: weetabix, branflakes, cornflakes, porridge  Frosties, coco pops, muesli
 Grill, dry roast, oven bake, microwave, stew, steam boil, griddle  Frying
 Olive oil based spreads and oils or rapeseed  Butter, lurpak light, lard, dripping
 Cottage cheese, low fat cheeses, — 4oz per week (100g)  Limit hard cheese, cheese sauces, pizza, macaroni cheese, lasagne
 Vinegar, balsamic vinegar, low fat dressings  Mayonnaise, salad cream, dips, coleslaw and potato salad
 Salad snacks e.g. carrot sticks, celery  Crisps, biscuits, nuts, Bombay nuts
 Boiled potatoes, jacket potato, low fat oven chips  Chips, fried wedges, roast potatoes
 Low fat yoghurt, low fat fromage frais  Cream
 Low fat milk e.g. semi skimmed or fully skimmed  Full cream milk
 Lean ham, chicken ,turkey (without the skin)  Sausages, burgers, tinned meat, pies, pastries
 Choose ready made meals that contain less than 15g fat per serving  Avoid high fat ready made meals

 

Exercise and sportShow [+]Hide [-]

Research has shown that regular exercise is good for your general health as well as for your diabetes. Moderate activity (that is, activity that raises your heartbeat and makes you slightly out of breath but still able to talk) can:

  • Help you achieve and maintain a healthy weight. 
  • Help reduce raised blood pressure.
  • Improve your muscle tone and strength and bone strength.
  • Improve your circulation and keep your heart strong.
  • Lower the level of harmful fats (cholesterol) in the blood.
  • Help you sleep better.
  • Help you manage stress, which helps you feel better about yourself.

Exercise helps to reduce your risk of developing heart disease by lowering the level of triglycerides (harmful fats) and raising the level of HDL or ‘good cholesterol’ in your blood.  Exercise can also help to lower blood pressure. High blood pressure contributes to many of the long term complications that can occur with diabetes.

Exercise helps you lose weight or maintain your weight by burning calories.  By following a healthy diet and exercising regularly, you can lose weight and maintain it at a desirable level.  Exercise over time will increase the amount of muscle and decrease the amount of fat stored in your body.  Muscle cells use more glucose and improve your blood glucose levels.

Whatever activity you are most likely to do, the most important thing is to be active and often.

You do not have to join a gym or spend a fortune on the latest fitness equipment or clothing. You are more likely to keep it up if you pick activities that you enjoy and which are easy to build into your everyday life. Housework, using the stairs instead of the lift, walking instead of using the car for short trips, gardening are all ways of increasing activity. Exercise with family and friends can be more fun and mutual support can be a real help, try walking, dancing, swimming for example. Even if you have a physical limitation that means you can not do any of the above, there are still ways you can exercise such as armchair exercises. If you have been inactive for a number of years, your body will take time to adjust, as your heart and muscles tone up. You will gradually feel less stiff and more energetic.

Ideally we should all do 5 sessions of physical activity each week. Each session should last about 30-45 minutes. If you are new to exercise then gradually build up the intensity (how hard) and the frequency (how often) of your activity.

As a rough guide you should feel warm, even sweaty, your breathing will be deeper and your heart will beat faster and you will soon feel the benefits.

Tips for starting:

  • Walk somewhere every day.
  • Make activity a regular habit.
  • Build activity up gradually rather than trying to do it all at once.
  • Fit an enjoyable activity into your daily routine.
  • Five minutes of activity every day is better than nothing at all.

There are many activities available in your area  that are suitable for your particular needs, from Leisure Centres, Community Facilities and Voluntary Organisations. There are a range of programmes and sessions throughout the City for men and women. For those with specific health problems there are special Exercise Referral Sessions, that your GP or Practice Nurse can refer you to.

Activity and blood glucose levels.

Once you are active on a regular basis you may need to talk to your Diabetes Team, in case your diabetes medication need to be adjusted.

If your diabetes is treated with insulin or sulphonylurea tablets you should monitor your blood glucose levels before and after activity, to check that your blood glucose level is not to low (below 4 mmols/l)

Test your blood glucose levels after unaccustomed or vigorous activity.

If you are suffering from hypoglycaemia (discussed in more detail under Hypoglycaemia - low blood glucose) you should have a sugary drink or glucose tablets. Also having a snack before bed helps prevent night-time hypoglycaemia.

If your blood glucose levels are higher than usual or you are unwell, seek medical advice and do not exercise.

Water

Drinking too little water and losing too much fluid through sweating can:

  • Cause you to become extremely fatigued during exercise
  • Inhibit your ability to get the most out of your exercise
  • Worsen your diabetes control

In your body, it does the following things:

  1. Carries glucose, oxygen and fats to working muscles and removes wastes like carbon dioxide and lactic acid.
  2. Helps absorb your body’s heat and gets rid of it through sweating.
  3. Eliminates wastes through the urine.
  4. Helps digest food as part of your saliva and gastric secretions.
  5. Lubricates joints and cushions tissues and organs.

Remember to drink enough during sessions of exercise or increased activity.

Blood glucose controlShow [+]Hide [-]

By maintaining a healthy diet, keeping your weight down, being active on a daily basis and taking your prescribed medication correctly, can improve your diabetes control as well as improve your general health and well-being.

Blood glucose control is balanced by the amount and type of food you eat, the activity you do and the treatment you take.
There are a number of ways to keep a check on your diabetes. Blood glucose control is measured using: urine tests and blood tests. Simple tests can be performed at home. Urine tests are measured as a percentage and blood tests are measured using a monitoring meter in millimoles of glucose present in per litre of blood.

Another important blood test is performed at your clinic visits called Glycosylated Haemoglobin, also known as HbA1c.  This measures the amount of glucose that has been ‘attached’ to the red cells in your blood stream.  It is used as a guide as to how your daily blood sugars have been over a period of 2-3 months. It is important to understand the targets for both your blood glucose and HbA1c.

What Is The Best Level For Blood Glucose and HbA1c?

The figures for blood glucose and HbA1c can look similar.  However, they are different.  The target for a persons’ HbA1c and blood glucose may vary.  Discuss yours with the diabetes team.  The following diagram may help:

 Blood Glucose  mmols  HbA1c
 Normal   4 – 6  Less than 6.1%
 Good Control   4 – 7  Less than 6.5%
 Fair Control   Often more than 9   6.5% - 7.0%
  Poor Control   Frequently more than 10   7.5% and over

      
Blood Glucose and Urine Monitoring

As you will already be starting to realise, the key to managing your diabetes is controlling your blood glucose (sugar) level, and understanding how your tablets, food and activity levels affect your blood glucose.

When you are first diagnosed with diabetes your blood glucose levels may be high.  With the help of your Practice Nurse, Dietician, Doctor or Diabetes Specialist Nurse, your treatment will be adjusted until your blood glucose levels gradually return to within the normal range. Maintaining your blood glucose levels as near to normal as possible, helps you to feel and stay well and reduces the risk of you developing problems associated with your Diabetes.  As blood glucose levels can be so changeable it is not always possible to determine just by how you are feeling so testing is important to detect when levels are high (hyperglycaemia) and low (hypoglycaemia).

You will be advised which form of testing is most suitable and appropriate for you, either urine testing or blood glucose testing.

Urine Testing

Urine testing is suitable for those whose diabetes is treated by healthy diet alone or with diet and Metformin tablets. The test is quick and easy and uses test strips which change colour (for example Diabur 5000 or Diastix). Records of the urine tests can be kept on a chart or in a diary and should be brought to each clinic visit. Ideally, all the results should be negative, but if there are a lot of positive results, your treatment may change.

How frequently you need to test varies, but a basic guide is: twice daily on two days a week (before breakfast and 2 hours after a main meal). This should be enough in most cases.

Urine testing is done as follows:

  1. Hold the end of the testing strip in the stream of urine as you pass it, only a second or two is needed.
  2. Shake off the excess urine.
  3. Wait the appropriate time (approximately 2 minutes).
  4. Compare the developed colour with the coloured chart on the bottle.
  5. Record the result as % of glucose.
  6. Throw out the used test strip.
  7. Replace the stopper on the bottle of strips and keep at room temperature.

How to measure your Blood Glucose Levels

Blood glucose testing is suitable for those whose diabetes is controlled by healthy diet and more than one diabetes tablet or those who are transferring to insulin injections.

The normal range for blood glucose is 4-7mmol/l (millimoles of Glucose present per Litre of blood). Blood testing once or twice a day at different times, on three days of the week is usually enough.

Usual times for testing may include:

  • Before each meal and at bedtime
  • Before and after exercise
  • If you think you may be going low (hypo)
  • If you suspect blood glucose is high
  • During changes of treatment.

A blood glucose measurement can be easily carried out using a small drop of blood from the finger, using a finger pricking device designed to be virtually painless and a blood glucose monitoring meter.

  1. Hands should be washed and dried thoroughly.
  2. Milk the blood towards the end of the finger.
  3. Prick the side of your finger (as this is less painful) and try to swap fingers each time to avoid getting sore.
  4. Squeeze the finger gently until you have a good drop of blood.
  5. Apply the blood to the testing strip as you have been shown or as the instructions indicate.
  6. The blood glucose meter will give you the result.

Monitoring your diabetesShow [+]Hide [-]

There are many different meters available to purchase. They are not available on NHS prescription, however the test strips and lancets for the finger pricking devices are. The meter reads the test strip digitally and will provide a result in 5 – 30 seconds depending on the meter chosen. Calibration of test strips is done according to the manufacturers instructions. Special features of the meter such as being able to test on alternative sites e.g., forearm may be appropriate for you and your Practice Nurse/Diabetes Specialist Nurse will be able to advise you.  However, when doing so remember to update your prescription information at your GP practice to ensure you obtain the correct strips for the new meter.

It is advisable to carry your blood glucose monitoring equipment with you.  When you measure your levels, record them in a diary which will help you to see patterns in your day to day blood glucose levels. Some meters have the facility to download results into your computer.  This diary/printout will also be helpful when you attend appointments, so that your Diabetes care team can advise you of any necessary adjustments to your treatment, aiming to improve your overall control.

Blood glucose levels can swing up and down for lots of different reasons.  Don’t worry if you get the occasional high result (that happens to everybody) and is most often diet related.  However, if blood glucose levels are consistently high or low, it would be advisable to discuss this at your clinic appointment or with your Diabetes Nurse, as it may require adjustment to your treatment.
In times of illness, poor control or pregnancy an increase in testing is often required.

Hypoglycaemia - low blood glucoseShow [+]Hide [-]

What is a hypo?

It is a medical term for low blood glucose level.  A low reading is classed as 4mmol/l or below. Hypos may occur in patients treated with insulin and certain diabetic tablets. However hypos do not occur if your diabetes is treated with diet alone or with diet and Metformin tablets and this section does not apply to you at present.

What can cause a hypo?

There are a number of causes:

  • Delaying or missing a meal
  • Not eating enough
  • Too much diabetes medication or insulin
  • Exercising more than usual (Sport; Spring cleaning; Gardening; Dancing)
  • Alcohol in excess, or if taken without food
  • Stress
  • Increase in temperature which can include saunas, sunbeds or warm weather

Symptoms of a hypo

The beginning of a hypo will feel different to each individual, and they even can differ from one to the other.
You may feel:

  • Shaky
  • Sweaty
  • Slightly confused
  • Hungry
  • Bad tempered

You will soon learn to recognise your own warning signs and how to act on them.

TREATING A HYPO

Mild Hypoglycaemia (If blood glucose is below 4mmol/l)

Treating a mild hypo is quite simple: you need to take some fast acting energy foods to bring your blood glucose levels up. Take:

  • 2/3  Glucose/Dextrose tablets
  • Sugar (2 tsp) in tea/coffee
  • Lucozade (100mls)
  • Any sugary pop (not diet drinks)
  • Glass of fruit juice
  • Chocolate, snack size chocolate bars.

If you take a tablet called Acarbose (Glucobay), your hypo needs to be treated with glucose not sucrose, because the tablet works by interfering with sucrose absorption.

Glucose = Lucozade, glucose sweets, sports drinks.
Sucrose = ordinary sugar, biscuits, cakes, sweets.

When you feel better, to prevent the blood glucose from dropping again, follow this with either your meal if it is due, or a good snack. Such as:

  • Sandwich
  • Fruit
  • Biscuits and Milk
  • Bowl of Cereal
  • Or the next meal if it is due.

Moderate Hypoglycaemia

If you do not respond quickly enough to the symptoms of mild hypoglycaemia the hypo event may then proceed to moderate. Normal thought processes start to leave you, and other people nay start notice your symptoms and you may not.  You can behave oddly or appear drunk so it is wise to tell family or friends about this, so they can recognise any of these symptoms and help you if necessary.

They should not take any notice if you try to refuse their help, and need to take immediate action.  Initial treatment is the same as above if you are still able to swallow liquid.  Also jam or honey can be put in the side of your mouth and rubbed from the outside.  You can also use GlucoGel (formally known as HypoStop Gel) which can be bought at chemists.  However swallowing reflex must be ensured to use these treatments.

If you were to pass out (become unconscious), your friends or family should follow the guide on severe hypoglycaemia.

Severe Hypoglycaemia

Rarely, you may not respond to the warning signs of a hypo and become unconscious.  If this happens it is important that family, friends and work colleagues know what to do.  They will need to:-

  • Call 999 immediately for an ambulance.
  • Inject you with Glucagon (Glucogon Kit), if it has been prescribed for you and they have been instructed how to use it.
  • Not give you anything by mouth as this may cause you to choke.

When sugar levels rise you will regain consciousness.  Once you are awake have a sugary drink.  Continue to have small amounts of sugary drinks until you feel well enough to eat in order to prevent another hypo.

If you have recurring hypos speak to your diabetes team

Useful tips to help with hypos

  • Always carry carbohydrate
  • Carry or wear diabetes identification
  • Tell family, friends and people at work about hypos and how they can help
  • Avoid driving if blood glucose is low
  • If someone tells you that you need to have some glucose, take it and argue later
  • Try not to skip or delay meals
  • Test your blood glucose levels regularly
  • Try and find out what caused your hypo and you may

Coping when you are illShow [+]Hide [-]

Illness and infections tend to raise blood glucose levels.  This will happen even if you are not eating as much as usual or are being sick.  It is important at these times not to stop taking your tablets. If you do, your blood glucose levels will keep rising.  Blood glucose levels will return to your usual range once you are better.

Illnesses and infections that can upset your diabetes control:

  • Colds, bronchitis, flu, sore throat
  • Vomiting and diarrhoea, stomach upsets
  • Urinary infections, cystitis
  • Skin infections, boils, skin ulcers, inflamed cuts, abscesses

Sick Day Rules

Guidelines to follow:

  • DO NOT STOP YOUR DIABETIC TABLETS
  • If you are unwell, act immediately and seek prompt treatment for infections.
  • Try to eat a normal diet.  If you can not manage this, replace with fluids such as milk or juice.
  • Drink plenty of water: 1 – 2 litres/day (5-7 pints). Sipped throughout the day.
  • Keep testing your urine or blood, at least 4 times a day. Keep a record of results.
  • Consult your GP or Diabetes Specialist Nurse if:
  • You are vomiting and unable to keep anything down. 
  • You do not improve quickly.
  • Your blood glucose levels remain high.
  • Your blood glucose level is low.
  • You are worried.

Seeking advice at an early stage can prevent a more serious situation developing.

Easy to eat carbohydrates

Here are some foods that may be useful alternatives to solid food when you are feeling unwell.

  • Milky drinks
  • Soup
  • Fruit juice
  • Squash or fizzy drinks, Lemonade, Coke
  • Ice Cream
  • Yoghurts
  • Drinking chocolate, Horlicks, Ovaltine, Complan, Build Up

Foot careShow [+]Hide [-]

Diabetes can affect both the nerves and the circulation to your feet.  If this happens your feet are at risk due to poor sensation and poor circulation; however you can help to prevent these problems if you take extra care of your feet.

Prevention is better than cure

Dos

  • Wash feet daily always ensuring water is at the correct temperature.
  • Dry feet well especially between the toes.
  • Apply moisturiser to keep the skin supple and prevent cracking, however, not between the toes as the skin can get too moist and soggy.
  • Look at your feet daily and pick up any problems such as cuts, redness, swelling, discharge or pus.
  • Cut and file nails straight across.  Any breaks in the skin should be covered with a clean dry dressing.  Do not burst blisters and seek advice if concerned.  Contact a Podiatrist if you have any problems.
  • Buy well fitting shoes and remember shoes should fit your feet not vice versa.
  • Check inside your shoes for any objects that should not be there. 
  • Give up smoking.
  • Take regular exercise.
  • Keep your blood glucose well controlled.

Do Nots

  • Never use sharp instruments on your feet.  Also corn plasters contain acids, so do not use. If any problems seek advice from a Podiatrist.
  • Avoid direct heat and hot water bottles.  If your sensation is at all dulled these can be dangerous.
  • Never walk barefoot. It is not recommended to use foot spas.

Remember diabetes can affect how quickly breaks in the skin heal so this may take a little longer than expected. It is also very important to control your blood glucose levels to as near normal as possible to promote healing and reduce the risk of infection.
A thorough assessment of both the blood supply and the nerve supply to your feet will be carried out at each annual review appointment and any changes will be discussed with you.

Diabetes, if not very well controlled, can damage the nerves in your feet and legs.  This is called neuropathy, this can cause numbness, burning, tingling or pain. This loss of feeling means that you may not be aware of discomfort, such as a blister developing or you may not notice your shoes rubbing or that the bath water is hot.

Diabetes can also affect the circulation in your feet, which means that any cuts or sores may not heal up very well. You can help stop problems developing by taking extra care of your feet.

Smoking and drugsShow [+]Hide [-]

As we all know, smoking is dangerous (and expensive).  It is linked to cancer, chest problems, heart attacks and strokes.

It is especially important for people with diabetes not to smoke, as the risk of heart attacks, angina, strokes and circulatory problems are already higher.

If you want to stop smoking, there is help available through your Practice Nurse at your GP Surgery.  There is also a specialist Smoking Cessation Service in Newcastle and North Tyneside.  They both provide advice, support, education and when appropriate recommend Nicotine Replacement Therapy.  (Speak to your Diabetes/Practice Nurse).

Drugs

Drugs both legal and illegal can lead to problems with your health. Drugs can affect people in different ways depending on the type, amount and purity of the drug. Drugs may affect individuals with diabetes and make their blood glucose difficult to control. Drugs are unpredictable and the affect on your diabetes will be unpredictable. The best way to avoid problems is to avoid taking them, particularly the more addictive ones (including tobacco).

Prescription exemptionsShow [+]Hide [-]

You do not have to pay prescription charges, if you have diabetes that is treated with diabetes tablets or insulin. You are allowed to apply for a prescription exemption certificate, which is shown to the Pharmacist when you pick up your prescriptions. You can get an application form (P11) from Post Offices, Social Security Office and GP Surgery or some Chemists.  This form must be signed by your GP.

This means that all your diabetes tablets, insulin, needles, lancets, test strips and all other non-diabetic medication that is prescribed for you is free of charge.

DrivingShow [+]Hide [-]

Having diabetes does not stop you from driving a car, but if you are treated with diabetes tablets or insulin, you must by law, inform the Driver and Vehicle Licensing Agency (DVLA) as soon as possible after diagnosis. If your diabetes is treated by diet alone, you do not need to inform them, but you must let them know if your treatment changes, for example, from diet alone to diet and tablets. You must also inform them if you have had your diabetes for some time but are applying for a licence for the first time.

The address is:

Driver and Vehicle Licensing Agency (DVLA)
Drivers Medical Branch
Swansea
SA99 1TU

www.dvla.gov.uk/welcome.htm

When you apply for a licence, on the application form, answer yes to the question about diabetes and give details whether your diabetes is treated by tablets, insulin or by diet alone.

A Diabetic 1 form must be filled in, if you are treated with insulin.  This does not mean that you will be refused a driving licence, you will be issued with a licence for one, two or three years. If you are treated with tablets or diet alone you may be issued with a “til 70”  licence.

The DVLA needs to be sure that every driver is safe on the road and you must inform them if you develop any problems or diabetes complications which may affect your ability to drive safely.

If you take insulin you cannot hold a licence for a:

  • Large Goods Vehicle (LGV)
  • Passenger carrying vehicle (PCV).

If you currently have such a licence and start using insulin, you must inform the DVLA and stop driving that vehicle.
The only exception is for a small number of people who had insulin treated diabetes and were given a licence before April 1991, when the law changed.

If you feel hypo when driving:

  •  Stop the car as soon as it is safe to do so.
  • Immediately take some glucose tablets or glucose drinks or biscuits or some other form of carbohydrate.
  • Remove the ignition key and move into a passenger seat.  (This is to prevent any suggestion that you are in charge of the car whilst under the influence of any drugs, which includes insulin).
  • Only continue your journey when you are fully recovered.


You should not drive if you:

  • Have a lot of hypos or have difficulty in recognising the early warning signs of hypo.
  • Have problems with your eyesight (that is not corrected with glasses).
  • Have weakness and numbness in your arms or legs.

If you are worried, discuss this with your Diabetes Team.

You must also tell your Insurance company of your diabetes, for your policy to be valid.  If your Insurance company wants to charge you a higher premium, get quotes from other companies.

InsuranceShow [+]Hide [-]

Having diabetes can affect both your existing insurance policies and many new policies that you might choose.

Although diabetes can be treated, people with diabetes are more likely to develop medical complications and because of this risk, insurance companies take this into consideration when deciding on premiums and cover.
The Disability Discrimination Act 1996 has reduced the problem of insurers loading premiums

You should tell insurance companies about your diabetes, even if they do not ask about your health, to prevent your policy being invalidated.

It may be a good idea to get a few quotes from different insurance companies, for more realistic quotes and advice on all aspects of insurance cover and financial planning, such as motor, travel, house insurance, critical illness, life insurance and mortgages.

EmploymentShow [+]Hide [-]

The vast majority of jobs are open to people with diabetes if you are treated by diet alone or diet and tablets, providing you do not have diabetic complications. There are some exceptions, if you are treated with insulin, because an unexpected hypo at work could put your life or others in danger, eg.

  • The Police Service
  • The Fire and Ambulance Service
  • The Armed Forces and Merchant Navy
  • The Prison Service
  • Train Driving
  • Airline Pilot, air traffic control and cabin crew
  • Driving large goods vehicle or buses
  • Working offshore
  • Coal face work

If you are already employed when you develop diabetes, it is sometimes possible to continue.

Shift work is made easier if you have flexible insulin regime and do regular blood tests and your diet and insulin doses can be rearranged.  Your  Diabetes Specialist Nurse or Doctor can help with an individual plan.

Diabetes is covered by the Disability Discrimination Act (1996) protecting you from being refused work or dismissed because of your diabetes.  Also changes in European Union Law in October 2004 are expected to remove employment bans.  Any problems experienced at the work place can be discussed with your Diabetes Team.

Holidays and travelShow [+]Hide [-]

Planning ahead will make sure that holidays and travelling are stress free.  The following points will help you enjoy your holiday.

  1. Prepare and plan well in advance.  Your  Diabetes Specialist Nurse or GP can help with more detailed advice, but you will need to contact them at least two weeks before you go away.
  2. Make sure you take a good supply (and spares) of tablets or insulin, pen devices, needle clipper, test strips, monitoring equipment, etc., in your hand luggage.  (Flying at high altitude can cause freezing in the baggage hold, so do not pack your insulin in your suitcase).  Your particular equipment may not be available in some countries and some insulins have a different name.
  3. It is important that you carry or wear some form of diabetes identification, to prevent confusion or in case you are ill abroad.  Although you do not need to declare your diabetes equipment when passing through Customs, it is a good idea to take a letter from your Clinic or GP explaining that you  have diabetes and need to carry insulin, pen devices and monitoring equipment.
  4. Ensure that you take out appropriate medical insurance.  Some policies do not cover diabetes or diabetes emergencies.  Check your policy includes all of  this, make sure the insurance company knows that you have diabetes.  In E.U. countries, free or reduced cost emergency treatment is available, but an E111 card must be produced, (application form available from Post Offices), but does not cover all medical services and equipment.
  5. Prepare for the journey.  In case of delays or hypos, take extra food/snacks with you that include quick acting carbohydrates, such as biscuits or glucose tablets.
  6. Vaccinations are recommended when travelling to certain countries.  Check with your travel agent or GP/Practice Nurse at least 3 months in advance.  Some vaccinations can cause a mild upset in general health, so do not have then just before you go.
  7. If you suffer from travel sickness, make sure you get some effective tablets from your GP/Pharmacist before leaving.  If you do become ill on holiday, such as sickness and diarrhoea, you can substitute food with fluids containing carbohydrates, such as sweetened drinks.  NEVER STOP YOUR TABLETS OR INSULIN EVEN IF YOU CANNOT TOLERATE SOLID FOODS.  You should monitor your blood sugar levels frequently and adjust your insulin as needed.   If the illness or sickness and diarrhoea persist or you are worried SEEK MEDICAL HELP.
  8. Insulin can be safely kept at room temperature for up to 28 days, (below 25 C / 80 F).  In a hot country insulin can be kept reasonably cool in your hotel room, if a fridge is not available.  Keep your insulin out of direct sunlight.  Cool bags/boxes are useful if you are travelling by car, camping or backpacking.  There are some specially designed travel kits, ask your Diabetes Specialist Nurse for details.  Any supplies left after the holiday that cannot be used in 28 days should be thrown out.
  9. Going on a long journey does need more thought and can be discussed with your Diabetes Specialist Nurse or GP well in advance.  If flying across time zones your usual routine, tablets and insulin doses will need to be adapted.  Going East to West the day is longer and you will need an extra meal and extra insulin.  Going West to East, the day is shorter and your insulin may need to be reduced.
  10. Food, alcohol and activity are often different on holiday.  Remember all these things can affect your blood glucose, you will need to test to check for high and low blood sugars.
  11. Things to think about in a hot climate:
    • Watch for hypos, insulin can be absorbed faster so monitor regularly. 
    • Some meters or testing strips may not perform well in very hot weather or if there is sun cream on the skin.
    • Sun safety, use a high factor sun cream and do not sun bathe too long to prevent sunburn.
    • Avoid walking barefoot on the beach.
    • Drink plenty sugar free fluids to prevent heatstroke.
  12. Things to think about in a cold climate: 
    • Insulin should not be allowed to freeze and should be thrown out if it does.
    • Some meters or testing strips may not perform well in very cold weather.
    • Wear warm socks and sensible shoes to avoid injury to feet.

Planning a pregnancyShow [+]Hide [-]

Many women who have diabetes have healthy pregnancies, however it requires much more thought and careful planning.

During the very early weeks of a pregnancy, until at least 12 weeks, your developing baby is very sensitive to high blood glucose levels.  This increases the risk of some abnormalities or malformations in babies such as spina bifida (incomplete closing of the spinal column), heart and kidney problems.  The risk of malformation is four to ten times greater in babies of women with diabetes.  However the chances of any of these problems occurring are much lower if you can keep your blood glucose tightly controlled – less than 7.5mmol/l after meals.

Taking folic acid 5mg tablets daily for 12 weeks before and into the pregnancy has been shown to also reduce the spinal problems that can occur in the baby.

Once you have decided to plan a pregnancy and, before you have stopped using contraception, talk to your diabetes team.  A special women’s health clinic is available to give you support and advice and help you achieve good blood glucose control before and during the time you are trying to conceive.  The following checklist of things you can do to get your pregnancy off to a healthy start:

  • Tell your GP/Diabetes team is you are planning a pregnancy.  Ask for an appointment at a specialist clinic. Your diabetes treatment may need to be changed.
  • Continue using contraception until you have been seen at the specialist clinic.
  • Discuss your medications with your GP.  Some medicines including those to treat high blood pressure should not be taken any may need to be changed.
  • Try to stop smoking.  Smoking can harm your baby.
  • Begin to take folic acid 5mg tablets – on prescription from your GP.
  • Choose healthy food – arrange to see a Dietician.
  • Good blood glucose control is a key factor and is important before and during your pregnancy.  Discuss your individual targets with your diabetes team.  Ensure you know how to manage hypoglycaemia.

Planning a pregnancy will take a bit of working out but will give you a good chance of having a healthy baby.  Once you find you are pregnant inform your diabetes team straight away and arrangements will be made for you to be seen at a specialist Obstetric Diabetic Clinic.

Care to expectShow [+]Hide [-]

Effective diabetes care is achieved by teamwork, between you and your diabetes care team.  The most important person in the team is you.

Members in your Diabetes Team

  • Yourself
  • Hospital Diabetologist
  • Diabetes Specialist Nurse
  • Clinic Nurse
  • Medical Secretaries
  • Administration Staff
  • Practice Nurse
  • Dietician
  • Retinal screener/Ophthalmologists/Optometrist
  • Podiatrist/Chiropodist
  • Pharmacist
  • Psychologist
  • GP

Your diabetes care team will:

  • Inform you about your diabetes, blood sugar control and how to monitor.
  • Give you information on the benefits of a healthy diet and exercise.
  • Provide you with regular information and opportunities for education.
  • Support you on how to manage your diabetes when you are ill or when your blood sugar is low and how to adjust your insulin correctly.
  • Provide formal medical clinic reviews and keep a check on your HbA1c, weight, blood pressure, eyesight, feet, kidneys, cholesterol levels and watch for any developing complications.
  • Discuss the effects of diabetes and your lifestyle, e.g. Work, driving, holidays, diet, exercise, insurance.
  • Help you make informed decisions about your treatment and care.

It is your responsibility to:

  • Attend your appointment.
  • Take as much control of your diabetes as you can and learn how to manage your diabetes.
  • Talk to your diabetes care team and ask questions about your control.
  • Learn how to look after yourself when you are ill or when you are hypos and how to look after your feet.
  • Follow a healthy lifestyle.
  • Know how to contact your diabetes care team, know who to contact in an emergency and how to use your clinic appointments effectively.

Looking after your diabetes is hard work.  You will not always get it right, none of us does, but your diabetes care team are there to support you.

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