Diabetes Tests and Care

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HbA1c Blood Test

This is a blood test done at Ilkeston Community Hospital every 3-6 months. It shows how high your blood glucose has been over the two months before the test. A results of less than 7% shows that your blood sugars have been excellently controlled. If the result is heigh than 7%, then the diabetes nursers and doctors at the practice will discuss ways of reducing it, usually by diet, exercise and changing your medication. All the evidence about providing good quality diabetes care for people whose diabetes is controlled by diet and medication, show that the HbA1c test is the most accurate way of keeping a check on your blood sugars. You are always welcomed to ask us for your latest HbA1c results, so that you can monitor your diabetes control.

 

Diabetes: What to do when you are ill

Viewing the following PDF will provide you with some very useful information regarding diabetes

Diabetes PDF

 

Home blood glucose testing (Patients not already on Insulin)

This involves pricking a finger and placing a drop of blood on a special plastic strip which is then inserted into a monitor. The monitor will then tell you the results of the test. The vast majority of people who diabetes is controlled by diet and medication do not need to do home testing for blood glucose. All diabetes care can be based on the accurate HbA1c blood test, however there are a few situations where it is useful to test blood glucose at home: 

 

  • During times of illness, especially if you are vomiting or being sick. 
  • For people whose diabetes is not controlled on tablets, we are recommending insulin treatment. It is useful to practice using a meter as regular home testing is needed when starting to use insulin. 

 

Urine Testing (Patients not already on Insulin)

This is where a special plastic strip is dipped into a urine sample and the colour change is compared against a chart. The colour shows how much glucose is in the urine sample. When blood glucose is running very high, glucose will be found in the urine. However if it moderately high, there is often no glucose trace in the urine. This can then be falsely reassuring, as people start to relax there healthy diet. Therefore we recommend Urine Testing as a way of first diagnosing blood glucose levels, but to reassure yourself we recommend getting the HbA1c blood test as well.

Further Information

If you would like further information on diabetic monitoring, please one the diabetes nurses or doctors. If you already have a blood glucose machine and you are unsure how to use it, our pharmacy technician can give a demonstration.

Diabetes care

Where

Diabetes clinics are held each week at both Littlewick and The Dales, so you can be seen at your usual surgery. Most people with diabetes controlled by diet or medication have all their care provided at their usual surgery. Patients needing insulin sometimes start off with hospital appointments, but then transferred to a GP for future care once their diabetes is under control. If you have a diabetes related problem that need treatment by a specialist, you can choose to referred to Nottingham or Derby hospital. Our district nurses can visit patients who are completely housebound at home for their diabetes checks. 

When

You should receive an invitation letter for a diabetes annual review appointment at approximately the same time each year. The letter will ask you to phone our health care assistants on 01159 325 229 to book an appointment which suits you. They will try to answer any questions you have about booking diabetes appointments, however do also mention if there is a particular nurse or doctor you would like to see. In between the annual review appointments, you will be asked to see one of the diabetes nurses in a routine surgery appointment, booked in the usual way.

How does the annual review appointment work?

Before your appointment

 

  • The letter you receive each year will contain forms for blood tests and urine tests. Please have blood test done at Ilkeston Community Hospital at least two weeks before your appointment. 
  • You will need to have fasted from 8:00PM the day before, only drinking tap water.
  • The urine same needs to be the first urine of the day, in a white topped pot, which can be handed in a t the same time as the blood tests.
  • We now have a direct computer link with the laboratories at Nottingham Hospitals, so we are able to check your results faster. Once checked, they'll be posted directly in your computer record ready for your appointment.
     

At your appointment

 

 

  • You will see one of the diabetes nurses for 20 minutes, followed by a 10 minute appointment with one of the diabetes doctors.
  • We do our best to run to time, but as there is a lot to cover in a short time, we ask you to allow an hour for visit.

 

Who will be involved in your diabetes care?

Administrative staff

Health Care assistants who will make appointments for the annual review clinic and can also do weight and blood pressure checks. 

Nurses

We have two diabetes practice nurses: Jean Craddock and Hayley Disney. Our district nurses work with the community visiting housebound patients.

Doctors 

Diabetes clinics at Littlewick are covered by Dr Pizzey, Dr Owen and Dr Halls. Appointments at The Dales are with Dr Halls or Dr Pizzey.

What treatments are there for diabetes?

A healthy diet

There is nothing particular unusual about the recommended diet for someone with diabetes as the principles of healthy eating are the same whether you have diabetes or not. We would suggestion cutting down on fatty and sugary foods, eating more fish and chicken with an aim for 5 portions of fruit and vegetables a day. It is best to eat three regular meals a day with health snack in between if you are hungary. Starchy food are good for keeping hunger at bay and high fibre foods such as as rice are particularly good at releasing sugar int the blood slowly and helping you to loose weight. For more information of health eating and diabetes, please talk to our practice nurses or ask for a leaflet form Diabetes UK. We can also refer you to our local dietician who specialises in giving dietary advice to people with diabetes.

Exercise

Exercising regularly can help you lose weight and achieve your ideal blood, sugar and cholesterol levels. It will not only help you to avoid the complications of diabetes, but make you feel better while you're doing it. You should aim to do about 30 minutes, 5 days a week. As exercise is done regularly, it has to be something you enjoy doing and fits into your everyday routine. Please ask a nurse for a leaflet with some top tips of exercising.

Weight loss

If you are overweight, losing weight is the best way to get your diabetes under control. Talk to the diabetes nurses or doctors about much weight loss it would be sensible for you to aim for. Don't set yourself unachievable goals, as smaller goals are more successful and increase your motivation. Choose a sensible time to loose weight, not when you are feeling pressure from work or home. If you are feeling stressed or depressed, please tell the nurse or doctor so that we can help you through this time rather than adding the pressure to loose weight as well. 

Tablets to control glucose (sugar levels)

When a patient at Littlewick or The Dale is diagnosed with diabetes in adulthood, we start off by encouraging a healthy lifestyle, which most of the time is all that is needed to bring sugar levels under control. However diabetes is a progressive illness and over time the body produces less insulin. Sooner or late most people also need to have medication ton control their sugar levels. The diabetes team have recent written a protocol for diabetes care at Littlewick and The Dales, based on the Nottingham guidelines on the management of diabetes, with various national and international guidelines. This means that you should receive the same treatment whichever member of the team you see and that your care is based on the best evidence available. The two most commonly prescribed drugs at both surgeries are metformin and gliclazide, these are often take together.

Metformin

This works by reducing the amount of glucose produced in the liver and causing other parts of the body to take up more glucose, so that the glucose level in the blood does not run so high. I cannot cause hypo attacks (low blood sugar) and does not cause weight gain. It can help prevent heart disease. It can cause bowel upset is started too quickly, so we recommend increasing the does very gradually.

Gliclazide

This works by making the pancreas release more insulin to low blood sugars. It can cause weight gain and very occasionally can make blood go too low cause a hypo attack.

Insulin Treatment

Type 1 diabetes is almost always diagnosed in childhood and requires insulin immediately. Type 2 diabetes is generally diagnosed in adulthood and can usually be controlled with diet and medication. A small proportion of our patient with type 2 diabetes find that after year of treatment with diet and medication, their sugar levels rise and they need insulin injections. Although people often say that they wished that had start insulin earlier. If people needing insulin are not under the care of specialist already, we usually refer to the diabetes specialist nurses to teach them all that they need to know about starting insulin. The usually run group sessions so that patients are learning together with people with diabetes needing to start insulin.

Why do I need so many tablets?

Diabetes can be kept under control and the serious complications can be prevented, but it generally take a lot of hard work and medication. A lot of research has been done in the last 10 years to see how patients whose sugar levels, blood pressure and cholesterol are very well controlled to those whose weren't as controlled. The people who controlled them well lived longer and had few heart attacks, strokes, kidney and eye problems. Our aim is to work with you to achieve the best possible diabetic control, so that your diabetes causes a few problems as possible. This is often done by controlling your diet and exercise along, but over time medication will most likely be necessarily. If you do not understand or do not see the benefits of taking certain medication, please do see your doctor or nurse as we here to help guide you through your diabetes.

Your should find that each of you medications fit into one of the following groups:

 

  1. Medication to lower blood sugar such as metformin, gliclazide, rosiglitazone, insulin.
  2. Medication to lower blood pressure such as bendroflumethiazide, atenolol, enalapril, ramipril and felodipine.
  3. Medication to lower cholesterol such as simvastatin and atorvastatin
  4. Medication to thin the blood such as aspirin, clopidogrel and warfarin 
  5. Medication for conditions other than your diabetes. If you have any questions about taking different medications together, please ask your doctor or nurse.

 


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