www.diabeticretinopathy.org.uk

General

Check ups for your diabetes

David Kinshuck

 

At the start of your diabetes

Children

Children and parents will be taught how to look after their diabetes by specialist nurses in the paediatric department. This is a very specialist subject, not covered in detail here.

 

Adults

Diabetes education courses

Daily....feet

Foot  infections can spread rapidly. Great care is needed, especially if you have neuropathy (reduced feeling in your toes).

feet care

Daily ...Sugar/glucose

Everyone wants to know how often they should test their blood sugar. The table below is a guide. Remember urine checks detect a relatively high amount of sugar.

Diabetes UK advise that every diabetic should test their own blood sugar. If you do not know how to test, by a kit and ask your nurse to show you how.

However, there is no point in testing if you find your sugar levels are high and take no action. See type 1/type 2 on insulin page, or type 2 page.

If your sugar is high, 'action' includes adjusting your insulin dose (perhaps the next day), eating less (especially if overweight), or exercising more. If your sugar is low, with a hypos, you need to drink and eat, perhaps reducing your insulin dose.

 

Glucose testing type 2...how often
not test if very infirm
test when ill, & every week, at different times of day very well controlled & diet only
every day, at different times if trying to get better control
4 times a day insulin dependant, seeking very good control Sensors are highly recommended for all people with type 1 diabetes: Freestyle or Dexcom.  (? type 2 multiple injection insulin uses also)
6-8 times a day  insulin dependant, seeking very good control Sensors are highly recommended for all people with type 1 diabetes: Freestyle or Dexcom.  (? type 2 multiple injection insulin uses also)

 

checks ups for diabetes

Remember, you only notice one out of 3 of your hypos, so if you test and notice a low sugar, you may be experiencing other hypos at different times.

Your nurse will advise you how often it is best to test. You need to test more if you are ill (infections cause sugar levels to rise, needing more insulin), or very physically active or stressed.

You need to test less if you have a regular lifestyle and your sugar and long term control is good without hypos (HbA1c < 6.5% /48mmol/mol preferred, 7.5 /58mmol/mol accepted for most insulin users).

Generally aim for a sugar level before meals of 5-7 mmols/l, and less than 10 mmols 2 hours after a meal. See the glucose testing page.

 

 

the glucose testing and medication adjustment cycle

the glucose testing cycle  Enlarge diagram

 

1 week-3 monthly tests

This is a very rough guide. If you are a type one diabetic who has been recently diagnosed, some checks are not so necessary, but help from your specialist nurse is needed each month as above.

If you are trying to achieve better control, of sugar, blood pressure or weight, then monthly checks with your specialist nurse can be very helpful. So if you have high blood pressure, and want to achieve a lower pressure to help your eyes, you may need monthly checks, changing or increasing medication at each check until controlled.

Similarly, regarding your sugar if you are not well controlled, most people will benefit from 4-8 weekly advice from their nurse. If your HbA1c is up and you want to lower it, you will need to adjust your dose of insulin (or tablets) regularly until it comes down. Inevitably you may do this too well and notice hypos, and your nurse will need to advise you how to avoid these.

Excellent control of diabetes is achieved in European countries by this regular patient-nurse contact, every 4-8 weeks.

 

Yearly review..by doctor & nurse

Yearly check ups & education

  1. eyes   at optometrist
  2. feet, with instructions for self care: doctor will check circulation and feeling
  3. diet advice yearly; more often eg. if overweight and trying to lose weight
  4. weight (but 2 weekly if trying to lose weight)
  5. tests for neuropathy and heart by doctor
  6. blood pressure, thyroid, electrolytes, cholesterol, tests
  7. statin treatment for most non-pregnant patients, especially if cholesterol is more than 5
  8. full blood count
  9. kidneys... protein in urine (microalbumenuria)
  10. exclude Cushings AEM 16
  11. type 1 diabetes if you have fluctuating blood sugars (insulin users)
  12. Annual educational review

Diary & Targets

diary

Keeping a diary is important. Remember, some doctors and nurses will look at you diary, and do not know what a 'good' blood pressure, sugar, HbA1c, or cholesterol level is. However, your main specialist nurse will be able to tell you how you are doing. Write down your day to day sugar levels and problems, and the results of your checks (HbA1c, Blood pressure, cholesterol).

To prevent or significantly delay retinopathy and most other diabetic problems, it would be ideal if you could achieve

Cholesterol

Depression

People with diabetes often become depressed. Discuss the situation with your doctor if you thinks this is happening to you, if you cannot sleep, do not want to go out, feel unhappy, do not want to meet new people and go to new places. See for advice, and see this page.

 

Summary

Enlarge diagram