Diabetes care at NPMC AND Willen Medical Centre

Our aim is to provide a service that encourages partnership in decision-making, supports you in managing your diabetes and helps you to adopt and maintain a healthy lifestyle.

For those living with diabetes we hold annual care planning reviews and our clinics are held every week day except Thursdays. 

The diabetes team is made up of:

Diabetic Clinic Manager:  Liz Hurry
Specialist Diabetic GP:  Dr Rocque and Dr Karia
Specialist Diabetic Practice Nurse:  Linda Sterry / Rachel Worsley / Nicola Hudson
Healthcare Assistants:   Clare Campbell / Rachel Green / Lauren Somerville

We recognise that living with diabetes becomes a lifelong learning process, whether you have just been diagnosed or had diabetes for some time.  Monitoring your health when you have diabetes is crucial to preventing some of the complications associated with diabetes.  This involves knowing your blood glucose, blood pressure and blood fat levels as well as the condition of your feet and getting your eyes screened for retinopathy.

It is essential that you understand your diabetes as well as possible so that you are an effective member of this team. 

For more information about diabetes and the different types please visit diabetes uk at : https://www.diabetes.org.uk

A 30 minute appointment in the morning with the Health Care Assistant in preparation for your annual diabetic review.

At this appointment the following tests will be carried out and your results will be posted to you prior to your review appointment in order to assist you in planning for this.

BLOOD PRESSURE

Blood pressure measures the pressure of your blood in the arteries and is given as two figures eg 130/80mmHg. The first figure is the systolic measuring the pressure when your heart pumps and the second figure is the diastolic measuring the pressure in-between beats.

A target BP of below 140/80 lowers the risk of complications.

If you have kidney or eye problems then a lower target of 135/75 is better but the lower your BP the better.

Weight and body mass index – BMI

Your body mass index measures your weight compared to height. Being overweight increases the risk of many medical conditions including heart disease, arthritis and premature death. It can also make you diabetes and blood pressure more difficult to control. Walking 30 minutes a day will improve diabetes control, help with weight loss and improve how you feel.

A BMI of between 19 - 25 is associated with the lowest risk to your health.

HbA1c - DIABETES CONTROL

HbA1c refers to “glycated haemoglobin” and is and average of glucose control looked at over the past 2-3 months. This is an important part of how your diabetes is managed. It is measured as a percentage and mmols.

Once you have been diagnosed with diabetes a level of between 6% - 7%  (42mmols-53mmols) is associated with a lower risk of complications.

A slightly higher range of 7% -8 % (53-64mmols) is acceptable for the elderly and/or frail.  

CHOLESTEROL

Cholesterol is a fat in your blood and the lower the level the better in order to reduce your risk of heart attack and strokes.

The target is 4mmols or less.

Eyes – Retinal Screening

Diabetes is the commonest cause of blindness which can be prevented if any changes in your eyes are detected early enough. It is important you attend for retinopathy screening every year when you receive your invitation and you should also see your optician annually. The better your diabetes control is the less likely it is to get complications with your eyes so if your result comes back showing changes please speak to your diabetes nurse to discuss your results.

KIDNEY TESTS

BLOOD - A kidney blood test will test for levels of a substance called Creatinine.

The target level is between 49-90umol/l.  If the level is higher than this you will need your medication reviewed and more frequent monitoring of your kidneys.

This test also measures eGFR (estimated Glomerular Filtration Rate). This is the rate at which your kidneys filter waste products; it does get less as you get older so lower targets as set for this age group.  

Target levels should be between 60 and 100ml/min

URINE - This test is an important part of your kidney function and is taken once a year. It is called ACR –Albumin Creatinine Ratio and it is tested from a urine sample sent to the lab which looks at the amount of tiny particles of protein your kidneys may be leaking (Microalbuminuria).

Healthy kidneys shouldn’t leak protein so if they do you will be offered a medication called an ACE inhibitor (name ends with pril). Special attention needs to be paid to your blood pressure and blood glucose control.

Feet –Neuropathy test

Good foot care is essential and to help identify any problems which could potentially lead to complications. Your feet will be checked at your annual review for blood flow and damage to nerves and skin. We can then score your risk and discuss any action required at your second care planning appointment.

A face to face or telephone appointment for an ‘annual review’ with Linda, Rachel or Nicola, our diabetic nurses.  This should be made for three weeks after your preparation appointment in order for us to have time to send you results and relevant information.

This review will enable us to work together to review every aspect of your care in order to support you in living the healthiest life possible thus reducing complications.  There will be time to discuss:

• Your general wellbeing; how you are coping with your diabetes at home, work, school or college.
• Your current treatment, your diabetes control, including your home monitoring results and hypos and any problems you may be having.
• You should feel free to raise issues that may be concerning you such as: discussion about smoking, alcohol consumption, stress, sexual problems, physical activity and healthy eating issues. Effective diabetes care is normally achieved by team work, between you and your diabetes care team. Looking after your diabetes and changing your lifestyle to fit in with the demands of diabetes is hard work, but you’re worth it.
• You will not always get your care right; none of us does, but we are here to support you. Ask questions and request more information especially if you are uncertain or worried about your diabetes and/or treatment. Remember the most important person in the team is you.

The following list of responsibilities is given to help you play your part in your own diabetes care.

• To attend your scheduled appointments and inform the diabetes care team if you are unable to do so.
• To take as much control of your diabetes on a day-to-day basis as you can. The more you know about your own diabetes, the easier this will become.
• To learn about and practice self-care which should include dietary education, exercise and monitoring blood glucose levels.
• To examine your feet regularly or have someone check them.
• To know how to manage your diabetes and when to ask for help if you are ill, e.g. chest infection, flu or diarrhoea and vomiting.
• To know when, where and how to contact your diabetes care team.
• To build the diabetes advice discussed with you into your daily life.
• To talk regularly with your diabetes care team and ask questions you may have.

Patients can use this link to Healthy Living, a free web-based NHS structured education programme, clinically proven to help users to live well with type 2 diabetes. It can help users to feel confident in managing diabetes, improve mental wellbeing, and make and maintain healthy lifestyle choices.

Before you become pregnant

Good blood glucose control before and during pregnancy is important and can reduce the risk of complications for both women and babies. In order to ensure that your blood glucose control is as good as it can be by the time you become pregnant, you should continue to use effective contraception until you are ready to start your family. The following is a list of things to do before you become pregnant (or straight away if you are already pregnant):

• Stop smoking.
• Reduce/stop your alcohol intake.
• If you need to lose weight or improve your diet ask your GP or the Diabetes Team for a referral to a dietitian.
• See your GP for a medication review.
• Start 5mg of folic acid (from your GP).
• Your GP will also arrange for you to have eye and kidney checks and will advise you to improve your HbA1c (long-term glucose control) level if it is too high.
• Start monitoring your blood glucose at home.

Pregnancy in diabetes

Once you are pregnant contact the Diabetes Specialist Nurse/Diabetes Lead Midwife (details below) or ask your GP to refer you to them as soon as possible. They will then support you throughout the rest of your pregnancy to ensure that your glucose control is as good it can be in order to keep you and your baby as healthy as possible.

Useful contact numbers:

Diabetes Lead Midwife, Tel 01908 995237 – Email: DiabetesMidwife@mkuh.nhs.uk

Diabetes Specialist Nurse, Tel 01908 995967 - Email TDSNT@mkuk.nhs.uk

Antenatal Clinic, Tel 01908 995238 - Email ANC@mkuh.nhs.uk

Antenatal Day Assessment Unit, Tel 01908 996481 Labour Ward

Useful websites for information about diabetes in pregnancy:

Diabetes UK: https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy

National Institute for Health and Care Excellence: https://www.nice.org.uk/guidance/ng3/ifp/chapter/About-thisinformation

NHS Choices: https://www.nhs.uk/conditions/pregnancy-and-baby/diabetes-pregnant/

Milton Keynes University Hospital: http://www.mkhospital.nhs.uk/index.php?option=com_sobipro&pid=56&sid=166:maternity&Itemid=355

Here are also some really good links to websites for patients https://www.diabetesonthenet.com/ in particular the following ones to help as part of a virtual review.

• Self-monitoring of blood glucose (SMBG) for those with a clinical need, ensure test strips and lancets are available. If guidance needed on how to use monitor, provide link to online guidance, or talk through by telephone or video.
• SMBG diary: https://bit.ly/2ZjeyAX
• Video instructions on how to perform a finger-prick blood glucose test: https://youtu.be/eOsY84oYqKg. 
• Remote foot assessment - ask the person to document symptoms related to the feet and legs, visually check all parts of their feet themselves (using a mirror or with help from a household member), including identifying dry or cracked skin, changes in colour, ulcers, rashes or blisters. If changes or concerns are identified, try to arrange photos to be shared prior to the consultation. The Diabetes UK “Touch the Toes” test uses the validated Ipswich Touch Test. Guidance and leaflet can be downloaded: https://bit.ly/36iRCDx.
• Provide link to Injection Technique Matters’ YouTube patient videos: https://bit.ly/2zLeShj.

Useful links:

Weight loss - https://vimeo.com/455409111/68c1de629d
Stress - https://vimeo.com/455426920/ff979d8c51
Cholesterol - https://vimeo.com/455433180/23365ff3de
Prediabetes - https://vimeo.com/455437364/4ffd0edfa7