Diabetes Care

If you have recently been diagnosed with diabetes or would like to know more about diabetes and what you can do to help yourself  then please see the information below. Click on Type 1 diabetesType 2 Diabetes or  Diabetes and Me for general information from Diabetes UK. Please see below for more specific information about how we as a practice are supporting you and what is available locally as well. 

What is diabetes?

Type 1 diabetes

About 8% of people with diabetes in the UK have type 1 

What is type 1 diabetes?

Insulin and diabetes. Some positives of type 1 diabetes. My child has type 1 diabetes. Coping with type 1 diabetes. Not sure where to start with type 1 diabetes – try the Learning Zone today

Type 2 Diabetes

About 90% of people with diabetes in the UK have type 2 diabetes.

Newly diagnosed with type 2 diabetes? What is type 2 diabetes? I have type 2 diabetes – what can I eat? Some people can reverse type 2 diabetes – want to find out more? How do I treat my diabetes?

Sandeep has been supported by others since his type 2 diagnosis in 2015. Not sure where to start with type 2 diabetes – try the learning zone today

Diabetes and Me

Your relationship with diabetes is personal, so your experience on the Diabetes UK website should be too. That’s why they have created Diabetes and Me, so you can save useful information, your favourite recipes and anything else you’re interested in.

You will need to know what type of diabetes you have. If you are unsure then please log into your electronic health record and see what is in your Problems List where it should state whether you have type 1 diabetes or type 2 (or diet controlled diabetes or non-Insulin dependent diabetes). Please note some patients with type 2 diabetes may be treated with insulin and occasionally patients with type 2 diabetes may become type 1. If you are unsure what type of diabetes you have, please speak to your doctor or nurse.

1. Get access to your GP electronic health record so that you can see what your doctor or nurse has written in your notes about you and understand your healthcare needs better

2. Your practice nurse will usually be able to help you with your diabetes monitoring and management. You can book an appointment with the nurse by going online. 

3. Make sure you know what medications you are taking, when to them as well as why. Also know how to order your repeat prescriptions so that you never run out or forget. Ordering prescriptions online is the best way to do this, We have a clinical pharmacist who can help you with your medications too if you are struggling.. 

4. There are 15 important checks and balances you should have at least once a year. Make sure you do not miss any.

5. Check your blood test results and learn to understand them. The Patient Access app shows your results and also graphs them for you so that you can easily see the trend as well (if your HbA1c is going up or down for example). 

5. Use the Evergreen Life PHR app to monitor your wellness as well as accessing your GP electronic health record via your smartphone. You can monitor your happiness levels, your diet and also your fitness levels too. 

6. Your lifestyle is very important. Do a Healthpledge today – designed by our own Patient Participation Group to help improve it now. 

7. Read the Pioppi Diet and reduce your risks of diabetes as well as cardiovascular risk and obesity too! 

8. You may also wish to join the Low Carbohydrate Programme. Try for free for 1 week. Costs £14.99 per month or £69.99 per year (price correct on 29.12.2019)

Patients with diabetes often think they need to check their blood glucose levels at home regularly. This is usually not the case for patients with type 2 diabetes unless you are on insulin or medication that may cause you to have a hypo- see here for those who need to check their blood glucose levels. If you are unsure then please ask to speak to a doctor or nurse.

Diabetes UK

Learn about Living with Diabetes from Diabetes UK including dealing with illness, travel, insurance, your child and diabetes, employment, driving, sex, pregnancy, help with giving up smoking & emotional issues

Diabetes UK – 15 healthcare essentials
The care you should receive

Summary of Main Messages from latest Type 2 Diabetes guidance

Work with your doctor or nurse to identify targets for you to reach
Ideally Blood Pressure should be less than 140/90 in clinic (average home BP monitoring should be less than 135/85) or 130/80 if patient has kidney, eye damage or stroke. If aged more than 80 then aim for Blood pressure less than 150/90. See Diabetes and Blood Pressure
Lifestyle changes are beneficial in helping to control diabetes and limit complications
Going on structured education courses are key to gaining a better understanding of how to manage. Go on a local DESMOND course
Patients without cardiovascular disease do not need antiplatelet therapy (aspirin or clopidogrel)
Ideally aim for HbA1c less than 48 mmol/mol (6.5%) with lifestyle change / metformin
Lifestyle changes are beneficial in helping to control diabetes and limit complications
Patients without cardiovascular disease do not need antiplatelet therapy (aspirin or clopidogrel)
If HbA1c rises above 7.5% then aim to bring down to less than 53 mmol/mol (7.0%) with further medication and individualised care
Self managing of blood glucose is important if you are on medications which may cause you to suffer with hypoglycaemia – this is particularly important if you drive or use heavy machinery 
For more information, see Clinical Knowledge Summaries – Management adult type 2 diabetes

Helping patients with DIABETES to get the best out of the NHS

This web-site is about helping you to understand how you can get the best out of the practice and other resources.

You may ask why?

The most recent patient survey has shown that patients want to be able to see the clinician sooner (ie less than 2 weeks) and on time (i.e not have to wait an hour for a scheduled appointment) and feel that all their concerns have been met. It has been independently confirmed that the practice already offers more appointments than the average to its patients.

So how can we meet the demand? 

Being prepared for the consultation greatly helps as does recognising the length of the appointment slot and helping the clinician to stay within the time limit.

You may ask how?

There are some simple steps that are essential for you to understand that will help you on your journey of discovery for your health and well-being:

What condition do you suffer with? 

Diabetes is often described as Type 1 Diabetes Mellitus or Insulin Dependent Diabetes or Type 2 Diabetes Mellitus or Non-Insulin Dependent Diabetes. This latter category includes patients that may be diet-controlled or those who are taking anti-diabetic tablets. It is important for you to know which type of diabetes you have as this affects your management significantly. You should find this term in your GP-held record. 

Click here to learn more about PrediabetesImpaired Glucose Tolerance and Impaired Fasting Glucose

What does Diabetes Mellitus mean? 

Here are some links and resources for diabetes that you may wish to see: 

Welcome to Type 1 Whiteboard
Trevor and the Perks of Diabetes
The Women’s CHAI Project
Chapatti and Chat cookbook for diabetes

Chapatti & Chat – Food made with love

Download the free book “Chapatti & Chat – Food made with love” developed with the support of Oldham Council to help raise awareness and creatively educate in the prevention of diabetes in adults from South Asian communities.

What help is available for you to use?

This condition is primarily managed by the nurses. They can check your blood glucose readings that you may be testing at home, blood pressure readings, order tests and review them, check any problems you may be encountering and do a medication review for you. They can also advise on things you may wish to consider and discuss things that you may have learned during your journey of discovery. They can also check that you have had your annual retinal screening and feet checks done

The health care assistants can check your height and weight and do any blood tests you may need as well as check your urine sample.

Doctors can see patients whose control remains poor or if you are developing further complications that need careful management or if you are having difficulties due to possible side effects. 

Specialist Diabetic Nurses look after those patients who have particular poor control or those who are being started on insulin therapy. You can learn more about the Diabetes and Vascular service by clicking here.

Pharmacists, podiatrists and opticians also have a wealth of experience and knowledge on the management of diabetes and can give you further tips and helpful advice

There is a blood pressure machine in the waiting room for you to check your blood pressure whenever you come to the practice.

There is also a telephone support line to provide urgent Diabetes advice and telephone support as detailed below

Monday to Friday 8am till 10pm

Weekend and Bank Holidays 9am till 1pm

Telephone advice line 0161-366-2354

What does the condition mean for you?

You need to know what your target blood pressure (140/80 or 130/70 if you have other complications too) and target cholesterol (less than 5 mmol /l or less than 4 mmol/l ideally) and LDL (less than 3 mmol/l or less than 2mmol/l ideally) and HbA1c (less than 7.5% or less than 6.5% ideally) should be and what other risk factors you have that need to be managed eg whether you smoke or not or if you are obese or whether you suffer with ischaemic heart disease or kidney disease. You also need to know what is expected of you in the course of a year even if your blood pressure and symptoms are well-controlled. Finally you can monitor your own blood pressure, weight and smoking status and blood tests and urine test as a way of seeing how you are doing. This information should be in your GP-held record for you to see.

What needs to happen now and in the future?

The typical patient with diabetes which is well controlled needs the following:

  1. Fasting blood tests and urinalysis once a year with the healthcare assistant– checking you are not anaemic (Haemoglobin), kidney function (Sodium, Potassium, Urea, Creatinine and eGFR), Liver function tests (ALT, AST, albumin), a measure of how your blood sugars have been on average over the previous 3 months (HbA1c),  lipid profile (Cholesterol, HDL, LDL, triglycerides). Thyroid function tests (Thyroxine, TSH) and urinalysis (dip stick urine checking for protein and blood) as well as microalbuminuria
  2. Blood Pressure reading at least twice a year 6 months apart. You can do this on your own! This is the minimum needed but you are encouraged to do this more often by using the practice blood pressure machine in the waiting room or buying a blood pressure machine yourself so that you can monitor it at home / work yourself. The local pharmacies all sell reasonably priced blood pressure machines and can give you more details about them.
  3. Medication Review every 6 months usually with the nurse if you have good control or every 3 months if you have poor control

What can you do to help?

As this is a new way of working, it is worth discussing this with the nurse to see how this can be done the first time you decide to take control.

  1. Get access to your GP-held record. Without knowing what is in your records and what you need to do, it will be very hard to know what to do when and with who. This is an essential first step for anybody with any condition or who wants the best from the practice.
  2. Ideally we want you to book in with the healthcare assistant for fasting blood tests and urine test if you have not had them done for 6 months or prior to your next medication review. At the same time, ask to book in with the nurse a week later. The nurse will check your records and book you in for you. (This is because the nurse needs to check who is the most appropriate person to do the medication review dependent on what else you may also suffer with).
  3. Remember to ask for a yellow topped urine bottle from the receptionist which you can bring with you when you have your blood tests. You can do this when you turn up to the surgery and are waiting for the healthcare assistant or bring it with you. This needs to be checked once a year for microalbuminuria
  4. Bring your blood pressure readings and weight with you to show to the nurse or doctor if you have been checking them at home.
  5. Record your blood pressure twice a day for a week and then take an average of your readings. Ideally you could download a form from here and bring them when you see the doctor or nurse. 
  6. Also make a note of when you had your retinal screening done and had your feet checked by the podiatrist.
  7. Look at the web page – pre-consultation care – and go through it prior to your review with the clinician. This can help us to understand your needs better and what you want out of the consultation. If there are no specific issues AND all the tests are normal and you are well-controlled, it may even be possible to conduct the medication review over the telephone. This must be with the agreement of the clinician and if you are happy with this. We think many people may benefit from this but we do not want to prevent anybody from coming to the surgery of they so wish.. Understanding your needs is key to a successful outcome of the medication review. See the above mentioned websites to help you to understand what your needs are. Initially you may need the clinician to help you understand how to look at the websites and what they mean for you.