| 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 and/or tablets have all their care provided at the surgery. Patients needing insulin sometimes start off with hospital appointments, but may then transfer to GP care once their diabetes is under control. If you have a diabetes related problem that needs treatment by a specialist, you can choose to be referred to Nottingham or Derby. 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 Abi on 0115 932 5229 to book an appointment which suits you. Abi will try to answer any questions you have about booking diabetes appointments. When you telephone for an appointment, please say if there is a particular diabetes 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 a urine test. Please have the blood tests done at Ilkeston Community Hospital at least two weeks before your appointment. You will need to have fasted from 8pm the day before, only drinking tap water. The urine sample needs to be the first urine of the day, in a white topped pot, and can be handed in at the same time as the blood tests. We now have a direct computer link with the laboratory at Nottingham City hospital, and once your results have been checked, they can be posted directly into your computer record ready for your appointment.
Your appointment.
You will see one of the diabetes nurses for 20 minutes, followed by a ten-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 your visit.
Diabetes care plan.
The nurse and doctor will discuss with you a plan for your diabetes care for the next 12 months. This may include lifestyle changes such as diet and exercise, and also changes to your tablets. The doctor will also authorise in your notes changes to your tablets that the nurse can then make during the next year. |
| Who will be involved in your diabetes care? |
Administrative staff. Abi Rowe is our auxiliary nurse who makes appointments for the annual review clinic, and can also do weight and blood pressure checks.
Nurses. We have three diabetes practice nurses: Jean Craddock, Theresa Fox, and Hayley Disney. Our district nurses work in 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 particularly 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 suggest cutting down on fatty and sugary foods, and eating more fish and chicken, and aiming for 5 portions of fruit and vegetables a day. It is best to eat three regular meals a day with healthy snacks in between meals if you are hungry. Starchy foods are good for keeping hunger at bay, and high fibre ones such as bread with “bits” in, low calorie baked beans, and basmati rice are particularly good at releasing sugar into the blood very slowly, and helping you lose weight. For more information on healthy eating and diabetes, please talk to our practice nurses, or ask for a leaflet from Diabetes UK or us. We also can 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 pressure, 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. How much exercise should we all do? Thirty minutes five days a week. Don’t feel overwhelmed by this and give up now! If a hectic lifestyle, or painful joints limit you, why not include a five-minute walk 6 times a day?
What is the best exercise for me? An expert once said “The one you’ll still be doing a year from now”. You’ve got to find something you enjoy doing, that fits into your day. Please ask the nurses for a very helpful leaflet they have recently written for their top tips on exercising to lose weight. |
| 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 how much weight loss it would be sensible for you to aim for. Don’t set yourself unachievable goals and set yourself up to fail. If you set a small goal and succeed, we can all celebrate at your next appointment, and you will feel more motivated to keep on with your weight loss. Choose a sensible time to lose weight, not when you are feeling weighed down by pressures at home or work. 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 to your stress by talking about weight loss at just the wrong time! The real secret to losing weight and keeping it off long-term is for you and your family to get in to lifelong healthy eating patterns, especially when you are shopping. Those tempting biscuits, crisps and chocolate bars will be much easier to resist if they are still on the shelves in the supermarket, rather than on the shelves of your kitchen cupboard! |
| Tablets to control glucose (sugar) levels. |
When a patient at Littlewick or the Dales is diagnosed with diabetes in adulthood, we start off by encouraging a healthy lifestyle, and initially this is often all that is needed to bring sugar levels under control. However, because diabetes is a progressive illness, and over time the body produces less insulin, sooner or later most people also need to have tablets to control their sugar levels. The diabetes team have recently written a protocol for diabetes care at Littlewick and the Dales, based on the Nottingham guidelines on the management of diabetes, and various national and international guidelines. This should mean that you 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 Littlewick and the Dales are metformin and gliclazide, and these are often used 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. It cannot cause hypo attacks (low blood sugar), and does not cause weight gain. It can help prevent heart disease. It can cause bowel upsets if started too quickly, and so we recommend increasing the dose very gradually.
Gliclazide: this works by making the pancreas release more insulin to lower blood sugars. It can cause weight gain, and very occasionally can make blood sugar go too low causing 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 tablets. A small proportion of our patients with type 2 diabetes find that after years of treatment with diet and tablets, their sugar levels rise and they need insulin injections. Although people often dread the idea of insulin, they usually feel much better once their sugar levels are under control again, and often say that they wished they had started insulin earlier. If people needing insulin are not under the care of a specialist already, we usually refer them to the diabetes specialist nurses to teach them all that they need to know about starting insulin. They usually run group sessions so that patients are learning together with other people with diabetes needing to start insulin. |
| Why on earth do I need so many tablets? |
| If you’ve ever thought of taking a suitcase with you to collect your monthly supply of tablets you’re probably not alone! Diabetes can be kept under control, and the serious complications can be prevented, but it generally takes a lot of hard work and a lot of tablets. A lot of research has been done in the last ten years to see what happens to people with diabetes whose sugar levels, blood pressure and cholesterol are very well controlled, compared with people whose levels are running a little high. The people with very well controlled diabetes lived longer, and had much fewer heart attacks, strokes, and kidney and eye problems. Our aim is to work with you to achieve the best possible diabetic control, so that your diabetes causes as few problems as possible. This is often initially possible with diet and exercise alone, but over time, tablets will probably also be necessary. As a nation, 50% of the long-term tablets that doctors prescribe aren’t taken as the doctor intended. This is often because people don’t know what the tablets are for, and can’t see any immediate benefit. If a tablet doesn’t suit you, or you’ve never been told what the tablet is for, please tell us. We’d far rather know if you were not taking the tablets than fill up the precious space in your bathroom cupboard with unwanted tablets! |
You should find that each of your 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. The most common ones we prescribe are bendroflumethiazide, atenolol, enalapril, ramipril, and felodipine.
3. Medication to lower cholesterol. The most common ones we prescribe are simvastatin and atorvastatin
4. Medication to thin the blood to prevent heart attacks and strokes, such as aspirin, clopidogrel, and warfarin.
5. Medication for conditions other than your diabetes. It would be impossible for us to list here all the possible medications that you might be taking, but any of the doctors or nurses would be very happy to answer any questions you might have. |