Check ups for your diabetes
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.
- Bleak picture BMJ18
- Adults also need to be taught about their diabetes. General advice includes information about a healthy diet, and advice as to how to reduce weight if overweight. Ask for an appointment with a dietician if you are having problems controlling your diabetes, or need to lose weight but can't. The education courses opposite are invaluable.
- Adults need to learn how to test their own blood sugar; everyone should do this unless they are too old or poorly.
- A chiropodist should advise you how to look after your feet, and an optometrist expert in detecting retinopathy should check your eyes (and do this every year as below).
- Be part of a diabetes care team. 9 questions for your team.
- exclude Cushings AEM 16
- Wash daily
- dry between toes especially
- apply moisturiser
- examine feet every day for cuts or anything unusual.
- Avoid direct heat and hot water bottles (you may have reduced feeling).
- Check shoes fit well, and check inside of shoes every day for sharp objects.
- Cover breaks with sterile dressing.
- Seek help if blisters develop.
- Do not use sharp instruments. No corn plasters...they contain acid.
- see Nice recommendations
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 hypi, you need to drink and eat, perhaps reducing your insulin dose.
|Glucose testing...how often|
|not test||if very infirm|
|every week, at different times of day||very well controlled, diet only|
|every day, at different times||most non-insulin dependant patients|
|4 times a day||insulin dependant|
|6-8 times a day||insulin dependant, seeking very good control|
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% preferred, 7.5 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 cycle Enlarge diagram
- blood pressure
- Check weekly at home if trying to lose weight , every 2 weeks clinic if you need help
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.
- More than half of diabetic patients are not having the recommended tests (BMJ 2010). And a personal view...when the results are high the results are often not acted on, so the result is often largely ignored.Again, 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.
- Your doctor and nurse need to check how you are coping with your diabetes. Trying to achieve good control can be hard work. Is the diabetes making you feel depressed? If so, tell your doctor. Trying to enjoy life is the best way to control your diabetes, as long as you don't eat, drink, or smoke to much!
- Yoga and Tai chi can help you relax, and walking, cycling and swimming are amoungst the exercise that can make your diabetes much easier to control. An hour's walk a day to keep the doctor away, as they say.
- Type 1 patients are more prone to coeliac disease, and should be checked if anaemic or iron deficient.
Yearly check ups
- eyes at optometrist
- feet, with instructions for self care: doctor will check circulation and feeling
- diet advice yearly; more often eg. if overweight and trying to lose weight
- weight (but 2 weekly if trying to lose weight)
- tests for neuropathy and heart by doctor
- blood pressure, thyroid, electrolytes, cholesterol, tests
- statin treatment for most non-pregnant patients, especially if cholesterol is more than 5
- full blood count
- kidneys... protein in urine (microalbumenuria)
- type 1 diabetes if you have fluctuating blood sugars (insulin users)
- lifestyle & exercise & smoking
- education about diabetes
- insulin doses and regime
- how to adjust insulin
- how to test blood glucose
- blood pressure and cardiovascular risk factors
- not everyone is able to read leaflets etc See
- patients should have attended the relevant educational program, eg DAFNE for insulin dose adjustment
- contact details of support groups
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
- see targets
- blood pressure about 130/80, but less if you have maculopathy (serious eye problems) or kidney damage
- HbA1c of 6.5%, although 7% is very good for many people.
- Recent publications advise all adults with diabetes (if not pregnant) may benefit from statin treatment, whatever the cholesterol level. See immediately below.
- walking...5000-10000 steps a day to keep your ophthalmologist away.
- the evidence good control helps 2009
- lowering lipids to prevent retinopathy, from the DCCT study here.
- Generally all type 2 patients age >40 y should use a statin if well tolerated, and many younger patients also unless they have a very low risk of cardiovasular disease. See the CARDS study.
- See here for a pilot study, and here for more details. Statins should generally be used (if there are no side effects) in all patients with diabetic maculopathy see.
- But if your triglyceride level is elevated (>2.2mmol/l) and HDL level low (<1.0mmol/l) , you may need a fibrate such as Supralip.
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.
Using the internet may improve contact between patients and professionals can be very helpful and improve diabetic control, here also. We recmmend about reading advances once a year, and joining Diabetes UK.
Patients can feed in their results to their nurse/doctor, and receive advice as how to lower the levels further and avoid hypos. This author believes this should be introduced in the UK.