bexley-diabetes newly diagnosed book.pdf

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Information Bookletfor People with NewlyDiagnosed Type 2Diabetes

2011-2012

Bexley Diabetes


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Information Booklet for People with Newly Diagnosed Type 2 Diabetes 2011-2012

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Contents page

Introduction / your diabetes team 3

Details about your diagnosis and your diabetes team 4

What happens following your diagnosis? 5

How can you learn more? 8

The annual review, what is involved? 10

Your care plan 11

Always be in control of your diabetes 12

Retinal Screening for people with diabetes 14

Looking after you feet 18

Monitoring your diabetes 19

Entitlements / Insurance 21

Reference list: other opportunities to access information 22

Diabetes UK / Local Diabetes UK Support Group 23

We would like to acknowledge Eli Lilly, Novo Nordisk and Sano-aventis for their generosity in helping towards the printing costs of this booklet.

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IntroductionYou, or a member of your family have recently been diagnosedwith Type 2 Diabetes. This information pack has been designedto guide you through your rst six-months following diagnosisand offers you an insight into how your diabetes can be successfullymanaged, what care to expect and the resources available. Thispack includes:Information booklet for people with newly diagnosed type2 diabetes.

If you require this booklet in large print, please contact thePatient Advice and Liaison Service (PALS) on 0800 3289712.

Diabetes UK booklets and information:• Understanding diabetes: Your essential guide• Eating well with Type 2 diabetes• Diabetes Care and You - What diabetes care you can expect

• Local services: information sheet 2011-12

X-PERT education programme• Information leaet and self referral form

Diabetes UK Bexley support group yerSpace for your diabetes review summaries

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Your diagnosis Your GP or nurse has informed you that you have diabetes, which

has been conrmed by a blood test. Either your fasting bloodglucose (before breakfast) was above 6.9mmol/l, or a randomblood glucose (after food) was above 11mmol/l.

HbA1c

Fasting blood glucose

Random blood glucose

Date of diagnosis

Diagnosis: Type 1 or 2

Your diabetes team

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What happens followingyour diagnosis?The booklet entitled “Diabetes care and you – what care toexpect” outlines the responsibilities of the diabetes teamfollowing your diagnosis with Type 2 diabetes and ongoing. Youare considered as part of the team, working in partnership withhealthcare professionals as you manage your diabetes.

DiagnosisYou may have many questions following your diagnosis. A seriesof appointments will be available to you with a member of yourpractice diabetes team. Please use this opportunity to learnabout:• How to successfully manage you diabetes• Services available for you to access• Other investigations, looking for risk factors associated with diabetes.

Assessment and Goal settingFollowing diagnosis is a great time to reect on your currentlifestyle and health and consider making achievable changes. It’sworth asking the following questions:• How do I feel about being told I have diabetes?• What’s good and what’s not so good about my life and my

health?• What inuences how you live your life?• How healthy are you at the moment?• What realistic changes can I make to help me manage my life

and my health better?• What support will I need to achieve changes long term?

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Appropriate referralYour diabetes team will act as a resource, explaining about localservices that have been designed to help people with diabetes.You will need to decide which meet your own needs.A variety of services are available throughout the area.Examples of services:At your own practice: • Your personal care plan• Weight loss programme

• Stop smoking advice• Blood pressure checksSpecialist diabetes services:• X-PERT education programme (see page 8-9)• Individual appontment with a dietician• Referral to the local diabetes eye screening service

• A subsidised nail cutting service for people over the aged of 50• Podiatry for people which recognised foot problems• Referral to the Consultant Diabetologist

• Referral to Diabetes Specialist NursesHealthy Living services:Information about local services can be found on the

Bexley Council website: [email protected] refer to the information sheet for up-to date news aboutlocal services, included in this pack.

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EducationTo allow you to make informed decisions about how youmanage your diabetes, education is vital. Please refer to pages8-9 & 22-23.

Maintenance (ongoing support)Please refer to the booklet “Diabetes Care and You - What dia-betes care to expect”. It clearly identies the care you are enti-tled to at diagnosis and ongoing. You should have:• Follow up determined by individual needs

• Blood test at least 6 monthly to assess your diabetes control• A formal annual review of all your tests, investigations and

examinations (see page 9 for more information)• Further education when you are ready• Care plan review• Contact details for your diabetes team for support and ad

vice by phone between visits• Blood pressure check at least 6 monthly if you are taking

blood pressure tabletsYour diabetes team follow local diabetes guidelines that arereviewed regularly and based on research ndings and nationalguidelines.

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How can you learn more?People living with diabetes have a crucial role in managing their

condition on a day-to-day basis. Supporting self-care is at thecentre of our local diabetes model. Education is a vital part ofthis support package and Bexley Care Trust has invested in theaward winning X-PERT Education Programme.

The X-PERT Programme runs over 5 weeks and consists of ve,2.5 hour sessions. The programme is specically designed forpeople with Type 2 diabetes following diagnosis or at any time inthe future, if education is identied within care plans.

Courses run during the day and in the evening and are held atsuitable venues with disabled access and ample parking.

The new X-PERT TasterThis is now available for peoplenot wanting to commit to the fullprogramme. X-PERT taster involves

one 2.5 hour session highlightingthe subjects normally covered in therst week:• What is diabetes?• The Diabetes Health Prole• The Lifestyle Experiment

You will also be given the programme’s handbook which includesthe full X-PERT programme.

For more information please talk to your diabetes team or accessThe local diabetes website: www.diabetesbexley.org.uk

Referral is normally made by your Diabetes team or you can referyourself using the leaet enclosed in this pack.

© Dr Trudi Deakin 2003

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Other education availableYour diabetes team

The team are a good resource for:• Information about diabetes• Local services and referral pathways

Diabetes UK Bexley Support GroupContact details on page 23.

Reference listFor a list of other education options, refer to page 22.

Specialist diabetes teamA multi-disciplinary team providingeducation to practice teams andservices to people with diabetes.

Website: www.diabetesbexley.org.ukAccess the local website for a wealth ofinformation and links to useful sites.

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The annual review - what is involved?Your annual review is an opportunity to:• Assess your diabetes control and discuss treatment options• Assess your general wellbeing and risk factors associated

with diabetes• Discuss any worries and concerns you have• Discuss your health priorities• Learn more about diabetes and healthy living• Ensure all screening procedures have been completed:

Blood glucose control (blood test +/- home monitoring)Kidney function (urine test and blood test)Blood fats (fasting blood test)WeightLegs and feet (foot assessment)Blood Pressure

• Eyes (see page 14-17)• To discuss the results of these tests

and identify individual goals to work towards and the support needed to achieve this within a care plan

When will the annual review take place? Depending on your practice, this will vary. Some practice organisethe annual reviews to take place during the month of your birth,so every year you know when it’s due.

What will be expected of me?You will be expected to attend two appointments at your Practice,approximately one month apart, plus a separate eye screeningappointment at one of four local opticians.Some practices will askyou to have your blood tests collected separately

The rst appointmentThis will include the screening procedures listed above.What do I need to take with me?

• An early morning sample of urine• Easily removable shoes / socks / hosiery• An accurate list of medication that you are actually taking

(this may differ from your repeat prescription)


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Once all results have been collected, they will be sent to you inadvance of your next appointment, giving you the opportunity toconsider possible changes to improve your health.

The second appointmentwill be with a qualied member of the practice diabetes team, todiscuss your results and things that matter to you. Then you canmake decisions together about what to do next. Your care plan isa record of how you plan to manage your diabetes.What do I need to take with me?• Your results letter, with any questions or potential goals you

would like to work towards• Your monitoring diary and blood glucose meter (if you monitor your blood glucose)• An accurate list of medication• For people on insulin, we advise you to bring your injection devices in case updates are available.You will be given a copy of your care plan following this appointment

Ongoing supportThis will depend on your individual care plan. Please refer to thebooklet “Diabetes care and you – what diabetes care to expect”.It clearly identies the ongoing care you are entitled to as well asyour responsibilities. Consider the following:• Follow up according to your agreed care plan

• Blood test at least 6 monthly to assess your diabetes control• Formal annual review of all your tests, investigations andexaminations (See page 10)

• Further education when you are ready• Care plan review• Contact information allowing you to access your diabetes

team for support and advice by phone between visits• Blood pressure check at least 6 monthly if you are taking

blood pressure tabletsYour diabetes team follow local diabetes guidelines that are reviewedregularly and based on research ndings and national guidelines.

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8. Have more whole grains, lentils, pulses,nuts and seeds

9. Drink alcohol in moderation10. Experiment with herbs to replace salt 11. Don’t be tempted by diabetic foods / drinks

Always be in control of your diabetes Aim to eat healthilyFor more information please refer to the Diabetes UK leaetEating Well with Type 2 Diabetes or access the Diabetes UKwebsite, click on “Are you newly diagnosed?”, then follow thelink to Our guide to shopping and menu planning.

1. Watch those portion sizes

2. Eat more fruit and vegetables

3. Try to eat regular meals, with some starchycarbohydrate foods at each meal

4. Try to have less saturated fat

5. Use monounsaturated oil

6. Aim for 2-3 portions of oily sh per week

7. Consider the overall amount of carbohydrate you eat. All carbohydrate foods and drinksturn to glucose in the blood

8. Have more whole grains, lentils, pulses,nuts and seeds

9. Drink alcohol in moderation10. Experiment with herbs to replace salt

11. Don’t be tempted by diabetic foods / drinks


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Be active • Consider activities you enjoy• Exercise should make you warm and slightly out of breath• Build up to a level suitable for you30 minutes of physical activity, 5 days a week, is thenational recommendation

Cut out smokingSmoking is especially bad forpeople with diabetes.One in

every two smokers will dieprematurely of a smoking relatedillness unless they stop smoking.

Don’t forget your medicationTaking tablets and insulin even when you are ill is part ofself-managing your diabetes. If you decide to stop or reduce anymedication please inform your GP or diabetes team.

Eye screeningDiabetes is the leading cause of blindness in the workingpopulation in the UK. Eye screening once a year will help preventblindness. If you miss your appointment, please ensure you bookanother. Refer to pages 14 -17 for more information.

Feet need attentionPlease refer to page 18.

Go to all of yourDiabetes appointmentsIt is much easier to control yourdiabetes if you know how youare doing. Knowing your resultsand having reachable targets will

allow you to manage yourdiabetes and not allow diabetesto manage you.


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Retinal screening for peoplewith diabetes Diabetes can cause changes to the small blood vessel networkin the body. The eyes have a small blood vessel network andover time, the vessel walls can weaken and leak blood and othersubstances into the retina (the light sensitive layer inside the eye)- this is called Diabetic Retinopathy.

These leakages can cause distorted vision affecting central and/orperipheral vision. Often there are no symptoms until the diseaseis at an advanced stage - therefore it is very important that anychanges are detected as easily as possible. This is the aim ofretinal screening.

As a person with diabetes,you will be offered anannual retinopathyscreening appointment ata local Optician’s practice,which has been tted withspecial cameras to takephotographs of the retinasto check for any diabeticchanges. The screener hasbeen accredited to a national

standard.The retinal screeningappointment is different toa routine eye examination.Please refer to page21 for more information:Entitlement.

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Normal retina

Diabetic Retinopathy

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Frequently asked questionsWhat does the appointment involve?

• The screener will ask some questions - checking contact details are correct, how you manage your diabetes and if youare taking any medications - please bring an up to date list.

• A vision check - please bring your distance spectacles if youwear any. Some drops (Tropicamide) will be put in your eyes- these are used to enlarge (dilate) your pupils, allowingbetter quality images of the retinas.

• The drops take approximately 20 minutes to work andgradually wear off over a few hours; during this time yourvision will be blurred and it is important that you DO NOTDRIVE to and from your appointment.

• After 20 minutes the screener will take photographs of yourretinas using a special camera.

• You should allow up to an hour for your appointment.

• These images are then analysed for any diabetic changes andshould further assessment be necessary an appointment atthe local Hospital Eye Department will be arranged.

Who is more at risk of Diabetic Retinopathy?• People with poorly controlled blood glucose• People who have had diabetes for a long time• People with high blood pressure and/or cholesterol• Pregnant women

Do all people with diabetes have to attend?YES - all people with diabetes aged 12 or over will be invitedfor retinal screening every year. The exceptions to attending arethose already under the care of the hospital eye department dueto diabetic eye problems. If you are under the care of a hospital

eye department for other eye conditions you should attendretinal screening as well.

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What if I detect problems between appointments?If you experience any visual problems between screeningappointments it is important you consult your Optician.

How can I prevent Diabetic Retinopathy developing?• Keep your blood glucose, blood pressure and cholesterol

within the targets agreed with your Diabetes Team• Maintain a healthy diet and keep active• Attend your annual retinal screening appointment• Attend your NHS eye examination

Contact informationTo arrange, or rearrange an appointment, or for further informationabout the screening programme, please telephone 0208 776 3854or email [email protected]: Digital Retinopathy Screening Manager

Summit HouseGlebe WayWest WickhamKent BR4 0RJ

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Looking after your feetIt is very important that you look after your feet and have them

checked as part of your annual review. Diabetes can affect boththe nerves and the blood supply to your feet. Maintaining goodcontrol of your blood glucose and carrying out the following carewill help to prevent problems.

• Wash your feet daily. Test the water temperature to avoidscalding accidents.

• Dry, especially between the toes. Cut and le toe nails

following the contour of the nail. If you are unable to cut your own toe nails, please discuss this with your diabetes

team. A local subsidised nail cutting service is available.

• Apply moisturiser (or hand cream) to keep your skin suppleand to prevent cracking. Do not apply cream between toes.

• It is ESSENTIAL to examine your feet daily for cuts or anythingunusual.

• Breaks in the skin should be covered with a dry, steriledressing. Do NOT burst blisters, avoid any further friction andobserve daily.

• NEVER use sharp instruments on your feet. DO NOT use cornplasters as they contain acids.

• AVOID direct heat and hot water bottles. Loss of pain andsensitivity make these dangerous.

• Remember high blood glucose levels can affect the rate ofhealing and breaks in the skin may take longer to heal. Olderpeople are most at risk.

• Ensure shoes t well. Have your feet measured and considerthe width of shoes as well as length.

• Check inside shoes for sharp objects, stones etc.

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MEAN BLOOD GLUCOSE mmol/l over the last 2-3 months

Monitoring your diabetesThere are a number of ways to monitor your diabetes control.

1. HbA1c (Glycated Haemoglobin)A blood test used to determine your mean blood glucose levelover the past 2-3 months. Every person with diabetes will beoffered this test at least six monthly. HbA1c provides a reliableand efcient means of monitoring your diabetes control.

HbA1c resultsHbA1c results are currently given as a percentage. However, theway in which HbA1c results are reported in the UK is changing.From 31 May 2011, HbA1c will be given in millimoles per mol(mmol/mol) instead of as a percentage (%). To help make senseof this please refer to the table below.

HbA1c blood testA measurement of your diabetes (blood glucose) control.For key to readings see page 20

% H

b A 1 c ( m m o

l / l )

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

14 (130)

13 (119)

12 (108)

11 (97)

10 (86)

9 (75)

8 (64)

7 (53)

6 (42)

5 (31)

4 (20)

3 (9)

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2. Blood glucose monitoringTesting your own blood glucose at home is not a routine requirementunless you are using insulin or certain medication that can causeyour blood glucose to drop below 4mmol/l.

In such cases you will be given detailed guidance by yourDiabetes Team.

There may be times when you may choose to monitor at home:

• As an education tool to learn about the effect of lifestylechanges and food intake.

• If your HbA1c is above target, home monitoring can be usedto identify problems and inform treatment.

• During illness, a time when your blood glucose may increase.

In all the above situations, a short, intensive period of testing atvarious times during the day, pre and 2-hours post meals, isoften benecial.

Meters are available from your Practice Diabetes Team. It isimportant that you receive full support, education & training inthe use of the meter & strips, how to calibrate the meter, how tokeep records and when it is important to seek medical help.

3. Urine testingNot an accurate form of monitoring, although preferred by somepeople who want a rough guide to detect abnormally high levelsof glucose in the body.

HbA1c test Control Eqv’ Home Tests

4.1-6% or 21-42mmol/l Normal Range 3-6 mmol/l

6-7% or 42-53mmol/l Good Control 6-8mmol/l7-8% or 53-64mmol/l Adequate Control 8-10mmol/l

8-9% or 64-75mmol/l Poor Control 10-12mmol/l

9-11% or 75-97mmol/l Very Poor Control 12-15mmol/l

>11% Or > 97mmol/l Serious Problems 15mmol/l or more


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EntitlementsPeople who take medication to help control their diabetes,

regardless of age, are entitled to free prescriptions. You cancollect an exemption form (FP92A) from your GP. This mustbe signed by your GP before it is sent off.All people with diabetes are entitled to a free annual uvaccination. It is strongly recommended that you havethis vaccine. You are also entitled to a free pneumococcal (pneumonia) vaccine. This is only required once.People with diabetes are entitled to a free eyesight test.However, as retinal screening is now an annual event, thefrequency will depend on other clinical reasons – not diabetes.This may be one or two years and you should be advised byyour optometrist.Dental treatment is not free, although it is recommended thatyou visit a dentist every 6-months to help prevent gum disease.

Insurance Motor InsuranceYou are advised to inform your insurance company that you havebeen diagnosed with diabetes. Failure to do so may result in yourinsurance becoming invalid.

Personal insurance: includes life, travel &health insuranceIt is important that you declare your diabetes when applyingfor any policy. Any policy you hold at the time of diagnosisis unaffected but you are advised to inform the insurancecompanies.

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Reference list: other ways to learn more Books

Carbs & Cals: A visual guide to carbohydrate and caloriecounting, Chris Cheyette and Yello Balolia, 2010.Type 2 Diabetes: Answers at Your FingertipsDr C Fox & Dr A Kilvert, London: Class Publishing, 2007.Diabetes in South Asian People ExplainedTahseen A Chowdhury & Laila T King.Diabetes: a practical guide to managing your health

R Walker and J Rodgers, Dorling Kindersley, 2004.WebsitesBexley Diabetes www.diabetesbexley.org.ukNHS Diabetes www.diabetes.nhs.ukDiabetes UK www.diabetes.org.ukNational Institute of Clinical excellence (Nice) www.nice.org.uk

CourseOpen University course: SK120 Diabetes CareA 5-month distance learning course, cost £215. Apply via theDiabetes UK website or www3.open.ac.uk.

Diabetes UKInformative websiteCareline contact details: 0845 120 2960 or [email protected].

Literature including recipe books, booklets on subjects related todiabetes and magazines:

Diabetes For Beginners (Type 2)Diabetes UK: a magazine at diagnosis or as a refresher. Availablefree of charge from your local diabetes UK support group, aswell as Diabetes UK for £3.

Balance Bi-monthly magazine.

Type 2 diabetes: a new beginning starter packThe pack consists of a DVD, a specially designed 36 page leaetalong with copies of ‘Know your labels’ and ‘Know your numbers’.


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Diabetes UKDiabetes UK is the charity for people with diabetes,

their family, friends and carers. Their mission is toimprove the lives of people with the condition andwork towards a future without diabetes.

Membership line: 0800 138 5605Care line on 0845 120 2960 Website: www.diabetes.org.uk for a wealth of Information and support.

Local Diabetes Support GroupThis group was formed in 2000 and offers mutual support,sharing information about the condition and good practicein current care and treatment as well as campaigning forimprovements in diabetes health care provision within Bexley.

No membership fee is payable and meetings are held at 7.30pmon the 3rd Friday of each month (except August) at the UnitedReformed Church, Geddes Place, Bexleyheath. Anyone affectedby diabetes whether a patient, carer or relative, is welcome toattend and it is an opportunity to meet with others in a friendlyand informal atmosphere. Various health care professionalsspeak at meetings on topical issues from healthy eating, activity,eye & foot care, to medication and research.

A monthly newsletter is sent out containing up-to-dateinformation of the group’s activities and news on new initiativesin diabetes care and research. A variety of social events are alsoarranged throughout the year. Further information about thegroup can be obtained by contacting the Executive Secretaryon 0208 302 2446 or at www.bexley.diabetesukgroup.org.

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