DIABETES CARE

at
REGENT STREET SURGERY

It is Important to know that it is quite possible to lead a full, active and

long life in which you feel totally in control of your diabetes.

Diabetes is a slowly progressive condition for which there is no known cure

at the present time. It is diagnosed by measurement of abnormally high
levels of sugar in the blood. Prolonged high levels of sugar in the blood can
lead to complications in parts of the body, especially the eyes, kidneys,
heart and feet. The main challenge with diabetes is to reduce the
chances of developing these complications. This requires lifelong control
of blood sugar levels, and continual monitoring of risk factors and this is the
main reason why a great deal of time is invested in providing expert help in
managing it.

Unlike many medical conditions, where tablets are often all you need to
control the illness, diabetes requires you to aim to be an expert in
management of the condition. A lot of effort is put in by the NHS, but you
are on own for 99.6% of the time. The principles of treatment are well
established, but everyone is unique and needs to fine tune their medication,
diet and lifestyle to make it work for them.

RISK FACTORS.
Those mentioned below are modifiable and if managed well can reduce the
chances of complications developing.

WEIGHT
VERY important in diabetes, especially Type 2*. Getting weight down
is VITAL.
If you are obese and have diabetes Type2*, obesity is likely to be
the illness causing you to have diabetes.

80% of people are obese when diagnosed with Type 2 diabetes and in a
few cases at diagnosis, weight reduction can almost eliminate the condition
altogether by helping the body to heal itself.

In any event, getting into the normal weight category for height will make the
control of Type 2 diabetes easier. Being too fat causes the body to be
resistant to insulin, as mentioned below*. This risk factor is considered by
many doctors to be the most important one to manage.
EXERCISE
Should be close to the top of anyone’s health list, diabetes or not. The
health gain from exercise is so great one often wonders why drugs are so
much more likely to be prescribed than exercise.

In the context of heart disease a male of 50 can almost HALVE their 10-
year risk by exercising. The current recommendation is 30 minutes, 5
times a week of some exercise that is at least mildly strenuous.

SMOKING
Like petrol and matches, smoking and diabetes do not go well together.
Smoking makes heart disease more likely and as diabetes is associated
with an increased risk of heart disease, smoking is strongly discouraged.
Did you know for instance that smoking is a higher risk than having high
cholesterol levels in the context of heart disease? Don’t smoke. Seek help
from your doctor or nurse to cut it out.

BLOOD PRESSURE
There is an increase in cardiovascular events (heart attack, stroke) with
increased blood pressure and this is further increased in the presence of
diabetes. It would seem logical therefore to reduce blood pressure and
reduce the risk. Numerous studies have shown this to be effective. Because
blood pressure is, in the vast majority of cases, a risk factor and not a
disease, targets are set using the best available evidence. The blood
pressure recommendations are set out in the table below.

CHOLESTEROL
Cholesterol is a vital component of the tissues in every animal including
humans. Because of this, the body does not rely on its owner to eat the
correct foods to provide cholesterol, but the liver produces most of it for
them. Having said that, if one is taking an excess of cholesterol in the diet
every day, it is likely that reducing cholesterol intake will give a worthwhile
drop in cholesterol levels. Foods containing cholesterol are any that derive
from animals including milk products.

An excess of cholesterol in the blood is associated with an increased risk of

heart disease and stroke and this is further increased in the presence of
diabetes. Reducing cholesterol levels in the body has been shown to
markedly reduce rates of heart disease and stroke. The success of the
statin drugs in bringing this about has been widely publicised. They work
in the liver by directly blocking production of the building blocks of
cholesterol synthesis. It also seems to reduce heart disease even if the
cholesterol level is low to start with.

It is likely you will be recommended to take a statin. Like blood pressure

lowering drugs the treatment should be considered lifelong.
Of course, tight control of blood sugar levels is the cornerstone of
diabetes management. The clinical staff will advise on this, but it is
much more effective if your weight is in the normal range, and you
exercise regularly.

* Diabetes can be broadly split into two types; Type 1 and Type 2. Typically Type 1 tends
to occur early in life and happens because the body stops producing insulin,(a hormone that
lowers sugar levels in the blood).Therefore sugar levels are high and insulin needs to be
injected to bring them down.
Type 2 is far more common and tends to begin in later life. Is not caused by a lack of
insulin, but because the tissues that insulin works on have become resistant to it. Therefore
the insulin cannot work properly and sugar levels stay high. This condition managed by
treatments other than insulin for the majority of people.

Whilst less than 1% of the population has Type 1 diabetes, Type 2 is far more common and
rising in prevalence, currently 1 in 20 of the UK population is affected.
At Regent Street Surgery we provide a comprehensive
Diabetes Management Service.
The approach to diabetes care is in line with current recommendations of
the National Institute for Clinical Excellence (NICE).

For those newly diagnosed, we have undertaken to provide a free 1-year

subscription to Diabetes UK, which issues 6 highly- readable magazines a
year. Indeed we encourage everyone with diabetes to join Diabetes UK
(www.diabetes.org.uk). The subscription is very reasonable and an excellent
source of information. We can also provide a patient- orientated textbook on
diabetes ‘Living with Diabetes’, which contains all you need to know and
more including topics such as driving, insurance, foreign travel, etc.

There is a very active and enthusiastic local Diabetes UK group which

meets several times a year at Stonehouse Community Centre. There is a
poster in the surgery waiting room, but any staff will be able to help if you
are interested. The group often invites specialists in diabetes to give a talk,
and are a good resource which we are lucky to have. Do think about joining
up. It is sometimes good to know you are not suffering alone.

Diabetes Clinic.
We offer an annual review with the Doctor or Nurse. What we do is
explained below and there is a table at the end summarising the tests
recommended for monitoring. We like to manage diabetes ‘in-house’ for the
most part, but we can access other care if necessary. A 20-30 minute
appointment is offered yearly. If you are on medicines or your diabetes
management is being adjusted, you may be recommended to have more
frequent appointments.

However, the emphasis is on education and self-

management . You should view the clinic as a service you
can access according to your own personal requirements.

The aims and objectives of the clinic we offer are outlined below:

• Firstly deal with any issues regarding diabetes that concern you.

• Next a check on sugar control and discussion of dietary issues to

include weight management if needed. . For Type 1 diabetes we also
talk about hypoglycaemia and check insulin regimens and injection
sites.

• We will also talk about your physical activity levels.

• Then a look at risk factors and perform various tests to decide on

what treatment to recommend. This will include:
o blood pressure measurement 3 monthly if raised or on
medication, 6 months to yearly if normal

o blood tests 6-12 monthly to check that all is well . We will

arrange checks of kidney function, cholesterol, liver function if
on statin drugs, HbA1c levels (to measure control of the
diabetes over the preceding 6 weeks)

o We will also check the urine for protein, which can be an early
sign of complications.

o We will look for late complications of diabetes. You may be

aware that diabetes is more likely to affect some tissues more
than others, especially the small blood vessels called
capillaries. Therefore we arrange a check of the back of the
eye called the retina. A team from Gloucestershire Hospitals
Trust provide this service every 12-18 months. This takes
place at our surgery. If you have diabetes you will be invited to
undergo this test called retinopathy screening. We would
strongly recommend this as a lot of eye disease caused by
diabetes can be treated effectively and preserve sight. You
will also be invited by your optician for routine sight checks .

o The blood test and urine test are to look for early changes of
kidney disease which can be treated. They also check that
your body is responding well to any medication you may be on.

o We will check the pulses in the feet to check the circulation,

and also test the skin monitor the state of the nerves in the
leg. One of the late complications of diabetes is a condition
called peripheral neuropathy, which is when people lose the
sensation in the legs and feet. This can be modified to some
extent by good control of sugar and other risk factors.
Symptoms can mostly be managed with medication.

o Because of potential problems with circulation and nerves in

the feet, we arrange an appointment with a foot specialist
called a podiatrist .

o We have access to Diabetes Consultants at Gloucestershire

Royal Hospital. We use this service for children, pregnancy,
and pump therapy.

o We can also deal with paperwork regarding letters to travel

companies, airlines, etc at this time.
The list below is a guide to the testing you need to monitor diabetes. We will
remind you when these are due.

All targets are based on current NICE guidance apart from those for blood pressure.
These are based on Diabetes UK consensus agreement, which will be reviewed in
light of future guidance,

Desirable Desirable
targets targets
TEST How often? Type 1 diabetes Type 2 diabetes
HbA1c 3-6 monthly 7.4% or less 7.0% or less
usually a 6
monthly
BLOOD TEST
Blood Pressure 3 monthly if on <135/85 <140/80
Normal kidney tablets, 6-12
function monthly if not
Blood Pressure 3 monthly <130/80 <135/75
Reduced kidney
function
Cholesterol Yearly <5.0 mmol/l <5.0 mmol/l
BLOOD TEST
BMI (body mass yearly Caucasian Less than 25
index ; kg/m2) Non Caucasian Less than 23
Kidney Yearly
function, Liver BLOOD TEST
function, (may be more
frequent if
treatment
changes)
Kidney Yearly
function URINE TEST
Eye checks 12-18 months. A hospital service which visits the
at Regent surgery. In addition a general eye
Street Surgery test will be arranged through your
normal optician.
Foot Checks Yearly at the
podiatry centres
locally.

Please do your best with diabetes. Well-controlled people will have far fewer
late complications and live a near normal life. We understand that it is a difficult
condition to manage, and that sometimes despite your best efforts the control
is not as good as you would expect. We are here to help in any way we can,
so please use our service to help yourself.
Remember, you can ignore your diabetes, but it will not ignore you.