Diabetes

Diabetes affects many body systems so good care needs a multidisciplinary team approach. It is important to remember that we can only support you. You are the most important partner in managing your diabetes. Without your engagement and motivation we will not achieve our combined treatment goals. 

You may be offered appointments with the following professionals.

• Diabetes Specialist Nurse (Cindy) – We are lucky to have a highly qualified and experienced diabetes specialist nurse working in the surgery. Cindy is our diabetes lead and will manage your diabetic care. 
• Health care assistants (HCA) - The HCA might take your bloods, check your feet and blood pressure or arrange other monitoring such as blood glucose machines. 
• GP – The doctor's role in diabetes management is limited. Cindy might ask for the GP's help in managing complications of diabetes or where another medical condition has an overlapping impact, e.g. kidney, heart or vascular disease. 
• Podiatrist – to keep an eye on your feet.
• Dietician – to help gain optimal control by helping you adapt your eating habits.
• Smoking adviser – to assist with stopping smoking.
• Eye screeners – to keep an eye on your eyes and prevent deterioration in your sight.
• Endocrinology Consultants – Sometimes we need to make a referral to a consultant diabetes specialist for input.

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.

We aim to review all patients with diabetes once every year. Sometimes if your condition is newly diagnosed or if poorly controlled you may be offered more frequent reviews. The diabetes team will guide you.

We will undertake to do the following annually:

• Hba1c blood test (indicator of diabetic control)
• U+Es (kidney function test)
• Lipids (Cholesterol check)
• Check your blood pressure
• Check your feet
• Offer lifestyle and dietary advice
• Discuss how diabetes is affecting you psychologically and offer support
• Give you an influenza (Flu) vaccine

As well as seeing you annually to give you the support, advice and medications you need to manage your diabetes effectively we aim to achieve treatment targets as set out by the NIHCE (the national institute for health and care excellence) guidelines. Sometimes these targets are neither desirable nor achievable, e.g. when tight control may lead to hypos or unwanted side effects. In that case we will agree therapeutic targets with you in the clinic.

The targets are complicated and vary according to your condition but broadly we aim for these targets in most diabetics are:

• Blood sugar, measured with Hba1c, of less than 48mmol/mol
• Blood pressure less that 140/80mmHg (or lower in some individuals)

• Cholesterol less than 4mmol/L (or non-HDL drop >40%).