Diabetes Champion HandbookReaches parts of the community other services don’t reach

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Log on to the Volunteer Resources section of our website to access expenses forms and other materials

www.knowdiabetes.org.uk

© Triborough Public Health London 2013. This publication may not be reproduced without permission from the publisher.

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Contents

Introduction 5

The Diabetes Champion Project

What is a diabetes champion? 6 Our commitment 6Your commitment 7

Health and safety of champions

Guidelines 8If things go wrong 8Complaints 9Expenses 9

Undertaking the role of Diabetes Champion

Key MessagesWhat is Diabetes? 10Symptoms of undiagnosed Diabetes 10Risk Factors 11Complications 12Treating Diabetes 12Prevalence 13Healthy Lifestyles 15Support and Health Checks 16

Outreach 18Organising events – a stall, community event, faith group and

coffee morning

AppendicesAppendix 1:

Additional information 20Type 1 diabetes summary 20

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What is clinical / medical advice 21Urgent health concerns or ‘red flag’ situations 21

Appendix 2: Other ResourcesDiabetes Champion role description 22Key qualities of a champion 23Event Record Sheet 24Diabetes Quiz 25Food Pictures 26Eat Well Plate 33Caribbean Eat Well Plate 34Eat Well Key Points 35Body Map 36GP letter 37Involvement form 38Diabetes Mentor Self Referral form 39Myths and Beliefs 40

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Introduction

Welcome to your role as a Diabetes Champion. We hope you will find this handbook, which you helped to develop is helpful.

We have included some useful guidance, procedures, signposting information and relevant forms. The procedures described here are new and may change as the project develops in partnership with the champions and project partners, so the handbook should be used together with what you learnt from your training to support you in providing a good quality service.

Remember you can contact us if you have any questions and queries. Enjoy the experience of championing. You will make a valuable difference.

Judith Ralphs Peter Gilbert Howard Tingle Public Health Manager Senior Diabetes Volunteer Champions Co-ordinator020 7641 4663 020 7736 0044 07984 410 569jralphs@westminster.gov.uk peterhgilbert@gmail.com howardetingle@yahoo.co.uk

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Diabetes Champion project

What is the Diabetes champion project?

The Diabetes Champion Project developed from the Hammersmith and Fulham Diabetes Service User Group, as a way local people could raise awareness of diabetes in their communities and help reduce the growing number of people developing type 2 diabetes.

The Group recognised that people living with diabetes and their carers and family members have valuable knowledge and experience, which enables them to work with those with type 2 diabetes in what is an innovative and peer led approach.

What is a diabetes champion?

Diabetes Champions are people who….

Are members of our local communities, who have experience of diabetes in some way. They will raise awareness in the community about diabetes, the risk factors associated with diabetes, how to reduce or delay the possibility of developing diabetes, and how to test for diabetes. They will sign post those with diabetes to appropriate support and healthy lifestyles to prevent complications. See page 22 for the role profile in full

Our commitment to you

The Champion Coordinator will Provide you with support to ensure you feel confident in your championing role and

are able to be a great champion! Provide you with any relevant information, updates and leaflets Run quarterly group supervision meetings Deal with any problems, concerns or complaints Prompt you to return activity sheets Ensure your expenses are paid

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Your commitment to us

You will Be a champion for at least 1year following your training Attend the group supervision meetings Undertake at least four events over 12 months Be reliable, well organised and trustworthy, e.g. working well with your fellow

champions, doing your part, turning up on time Complete the activity documents and other necessary records Contact the Champion Coordinator if you have any problems, concerns or complaints Follow procedures and good practice as outlined in this handbook Work within Westminster City policies of confidentiality, dignity and respect and

within the limits of your role (see Role Description on page 22). You will not give clinical / medical advice about treatment or medication. This can only be given by a trained medical professional (see page 21 for further information on clinical / medical advice).

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Health and safety of champions

It is vital that both you and your fellow champions are safe at all times. Here are some guidelines:

Guidelines

Risk assessments - will have been carried out in most Community Centres already, but you may need to do one if you are meeting in a non-health related venue for the first time. Please contact the Champion Coordinator for advice on risk-assessments if you are unsure.1

Where and how to meet - Ensure that you meet in a public space in which you feel comfortable. Do not meet at people’s homes.

o Ensure you can contact other people in case of emergency e.g. by mobile phone.

o Plan your seating arrangements so that you can see the door.o Find out where the fire exits are in the place that you are meeting.o If you feel unhappy about any aspect of your meeting, ring the Champion

Coordinator for advice. You should not receive / give any money. Any gifts should be checked with the

Champion Coordinator first before acceptance. Health and safety is everybody's responsibility.  If you see something, report it or

ask the relevant person. Do not lift anything you find too heavy or awkward

If things go wrong…

The training you have received, ongoing supervision and the guidance in this handbook will help us work together to make your role enjoyable and effective. However, if for any reason you do not keep to these commitments e.g. by breaking confidentiality, being consistently unreliable, acting inappropriately or behaving in a way not consistent with being a champion, we will terminate your honorary contract. This will be done immediately without notice, as outlined in your honorary contract because we have a duty to ensure we provide members of the public with a safe, confidential and high quality service.

Complaints

1 (A risk assessment is a systematic way of looking at a specific activity and deciding what the possible problems, dangers and risks are that are involved in that activity in a specific location and taking actions to reduce the risk.)

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If you are unhappy about any part of the champion project please call the Judith Ralphs (Senior Public Health Officer) to talk about any concerns on. We will strive to sort matters out quickly. Members of the public can also be given this number if they are unhappy with any aspect of the project

Expenses

This is a volunteer role but it is important that you are not out of pocket and we will try to pay expenses quickly (Expenses form Appendices page 25) All payments will be paid directly into your bank account through BACS (Appendices page 26).

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Undertaking the role of diabetes champion

Key messages about diabetes to be given to participants at events

What is Diabetes?

What is Type 2 Diabetes?

Carbohydrates (starchy and sugary foods) are converted to glucose by digestion which fuels the body. Insulin is a hormone produced by the pancreas, which helps the glucose enter the cells where it is used as fuel for energy, so we can work and play It is vital for life

Diabetes mellitus is a condition where the amount of glucose in the blood is too high because

the body is unable to use insulin effectively, or the pancreas is unable to make enough insulin In some cases the pancreas cannot make any insulin (Type 1)

Type 2 Diabetes tends to develop after 40 but owing to changes in lifestyle is being seen in younger people including teenagers. Asian, Arab and Afro-Caribbean Cultural groups are most at risk from age 25 onwards.

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Symptoms of undiagnosed diabetes

Tiredness Frequent urination Thirst Blurred vision Cuts not healing Genital thrush/itching

People may have one or more of these symptoms. Some people may report none of them despite developing diabetes.

Risk Factors

A close family member who has type 2 diabetes Damage to the pancreas High carbohydrate/calorie diet Obesity Apple shape; more than 31.5 cm waist in women 37cm in men Lack of exercise Stress Other health conditions e.g. high blood pressure, heart disease Developing diabetes during pregnancy People over 40, or over 25 and African-Caribbean, Asian or from a minority ethnic

group Women with polycystic ovary syndrome who are overweight

Complications

Neuropathy: damage to the nerves, erectile dysfunction Cardio vascular disease: stroke, heart attacks, poor circulation Kidney disease Obesity from tablets Slow wound healing, ulcers Eye problems: retinopathy

Treating diabetes

Diabetes is serious because it can lead to life-threatening complications. Although diabetes cannot be cured, the good news is it can be treated very successfully.

The main aim of treatment of both types of diabetes is to achieve blood glucose, blood pressure and cholesterol levels as near to normal as possible. This, together with a healthy

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lifestyle, will help to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.

Type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity. Tablets and/or insulin may also be required to achieve normal blood glucose levels.  There are several kinds of tablets for people with Type 2 diabetes. Some kinds help the pancreas to produce more insulin; other kinds help your body to make better use of the insulin that your pancreas produces. Another type of tablet slows down the speed at which the body absorbs glucose from the intestine. 

Type 2 diabetes is progressive.  If diabetes cannot be controlled through lifestyle changes and tablets a doctor may recommend that a person takes insulin injections.

Type 1 diabetes, which is caused by an auto-immune reaction, cannot be prevented and is treated either by insulin injections or by an insulin pump and a healthy diet, and regular exercise is recommended.  Insulin cannot be taken by mouth because it is destroyed by the digestive juices in the stomach. People with this type of diabetes commonly take two to four or more injections of insulin each day.  If someone has Type 1 diabetes, insulin injections are vital to keep them alive and they must have them every day.

For more detailed information on Diabetes see Appendices page 20

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Prevalence

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Summary of key points

Around 850,000 people in UK have Type 2 diabetes but are unaware of it.

Diabetes is serious. If left untreated it can lead to serious sometimes life-threatening complications.

The good news is that early diagnosis of Type 2 diabetes can reduce the risk of complications

People from Black, Asian and Minority Ethnic communities are likely to develop long term complications 5 years sooner.

People from the South Asian, Arab and Black African Caribbean communities are at risk of developing diabetes from the age of 25

Four hundred people in the UK are diagnosed with diabetes every day.

You can lead a full and healthy life with diabetes, but the key is getting diagnosed as early as possible

Being overweight is a risk factor of Type 2 diabetes

To reduce your risk of Type 2 diabetes, eat a healthy balanced diet, maintain a healthy weight and be physically active

It is estimated that 10 per cent of the NHS budget is currently spent on diabetes.

Healthy Lifestyles

We know that those at risk of and living with diabetes will benefit from healthier lifestyles

Key messages

• Think about changing an aspect of lifestyle

• Eat more fruit and vegetables

• Reduce saturated fats e.g. animal fats

• Follow a high fibre diet

• Think total carbohydrates not just sugar

• Eat three meals a day with smaller portion sizes

• Lower intake of salt and alcohol

• Engage in physical activity: sport, dancing, walking, gardening, climbing stairs…

• Take steps to improve emotional well being

• Make links and connect in the Community

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Support and Health Checks

We know too that people will improve their health if they are diagnosed with diabetes as early as possible

Key messages to give to communities and individuals;

• Go and get tested if you become aware you are at risk of developing diabetes

• GPs are able to check for diabetes and provide good management for the condition

• For those with diabetes, ensure you have regular health checks and support at your GP Practice, this includes;

• Long term blood glucose and fats

• Blood pressure

• Eyes (Retinopathy screening)

• Foot examination

• Kidneys/urine tests

GPs should also offer the following support options

Weight measured and weight management support offered

Smoking status recorded and support to stop smoking

Emotional & psychological support

Referral to a local diabetes education course

Information and specialist care if you are planning a baby

Opportunity to see a diabetes specialist

Champions can also signpost to the following relevant services

• Diabetes Education

• Diabetes Mentoring

• NHS Stop smoking services

• Health trainers

• Back on track psychological services

• Physical activity

• Healthy eating advice

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Outreach work, “Going boldly where none has gone before” Champions in training identified the following activities needed to arrange events;

Organising events - a stall, community event, faith group or coffee morning

Keep a look out for local events and use existing networks. You may be e-mailed details by the Champion coordinator

Here are some pointers and guidelines to help you prepare and facilitate your session

Preparation Delivery and Engagement

Cof

fee

Mor

ning

Make contact with local group; own networks word of mouth

Decide on a venue: community centre? library?

Agree time and place

Come along as a Peer Role model

Be tactful, use approach appropriate to audience: e.g. a talk or more of a discussion if group is small

Help group to set targets

Agree to come back another time to discuss progress.

Stal

l

Contact organiser and alter in case s/he is not around.

Agenda and timings: set up, duration, clear up

What resources are provided: tables, stall, chairs etc

Look at the community make up, numbers expected, position of stall

Is there a cost? Negotiate as a non profit health awareness cause

Agree: budget, methods of transportation, number of champions needed

Resources: water cups and bin bags, tape measure balloons, table cloth/cover, goody bag, pens, note pads

Prepare stand to look interesting and inviting

Agree method of delivery, where are champs to stand

Brochures/leaflets/poster in appropriate languages

Ask engaging questions to passers-by e.g. what do you know about diabetes? Have you any questions about diabetes?

Conversations can be brief or long, perhaps just a leaflet given

Engage with other stall holders to build up links and contacts for other events

Transport materials

Pack away

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Faith

Gro

up Identify a faith group and

place of worship

Enlist help of Pastor/Secretary/Priest/Imam

Venue?

Identify audience; whole congregation or specific group?

Agenda with timings. How long will you talk for?

Facilities; e.g. microphone, refreshments

How to get there

Ice breaker

Use open discussion e.g. anyone know what is T1 or T”, what is diabetes? What are the common symptoms? What are the complications? Can you help yourself?

Pictures e.g. food pictures in appendix or down load some

Show DVD

Sign posting preventative measures

Accessing services, education info packs

Com

mun

ity E

vent

Target a group e.g. a Somali or Nigerian cultural organisation

Identify a venue

Make personal contact with manager

Undertake risk assessment

Introduction/Ice breakers

What is diabetes?

T2 Diabetes

Symptoms

*Risk Factors see page 11 in this hand book

Management

Sign post them e.g. diabetic screening

Lifestyle issues: increased activity, diet, handling stress, healthy principles, lose weight

Tea break

Test

Use quizzes

Community diabetes courses support

Show DVD story of person with diabetes

Other helpful resources:Diabetes UK website for a list of resources which can be ordered online e.g. leaflets, tape measures; Diabetes UK 15 points of care, different language booklets Also British Heart Foundation Website for resources.See Volunteer Resources section of www.knowdiabetes.org.uk

Appendices19

Appendix 1: Additional Information

Type 1 diabetes summary (for reference)DefinitionPeople with Type 1 diabetes have insulin deficiency. Insulin is a hormone and, in Type 1 diabetes, the cells in the pancreas which produce insulin are attacked by antibodies leading to loss of function. Insulin is necessary for life and people with Type 1 diabetes must inject insulin daily to replace the lost hormone. Most people use an insulin pen for delivery, although an increasing number are using an insulin pump attached to their bodies, which usually provides tighter control.

Good ControlTo achieve good glucose control people with Type 1 diabetes need to test their blood glucose regularly by pricking their fingers, mainly before meals and before bed, need to count the carbohydrate content of meals and snacks and take account of exercise. Sharps bins are available on prescription for disposal of lancets, needles and used test strips.

PregnancyType 1s planning to become pregnant need to achieve and maintain particularly tight control and should discuss their plans with their doctor.

Hypoglycaemia (Hypos)Like some people with Type 2 diabetes who also inject insulin, people with Type 1 diabetes are prone to low blood sugars (hypoglycaemia), when they have too much circulating insulin and not enough glucose in the bloodstream. (Some tablets for Type 2s, which stimulate the pancreas to produce more insulin, particularly the sulphonylureas, may also cause hypos.) They should always carry glucose tablets with them for emergencies. The two best-known brands are Glucotabs which come in a plastic tube and Dextro-Energy which comes in a paper wrapper. Excessive alcohol consumption may cause hypos up to 24 hours later. Over time people with Type 1 diabetes may become less aware of when they are going low. Frequent injection into the same spot causes lumps under the skin which interfere with the release of insulin and may cause hypoglycaemia. If called to a serious hypo, the ambulance service will usually administer a glucagon injection, which causes the liver to release stored glucose. Carers can obtain a glucagon kit from their GP but need to be shown how to use it by a diabetes specialist nurse.

KetonesIf the blood glucose is high in Type 1 diabetes, cells become starved of glucose and switch to fat metabolism causing Diabetic KetoAcidosis (DKA). If the blood glucose readings are above 14 mmol/L, people with Type 1 diabetes should test their urine or blood for ketones. Test strips for this are available on prescription.

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People who use insulin must tell the Driver & Vehicle Licensing Agency (DVLA) and their insurance companies.

Education for Type 1sEveryone with Type 1 diabetes should be offered a carbohydrate counting course to improve self-management. These courses are offered in the community and by the surrounding hospital diabetes clinics. Booklets can be purchased in book stores on carbohydrate values and several apps are available for mobile phones.You can also look up information on Type 1 diabetes on the Diabetes UK website.

What is clinical / medical advice?

The difference between what is and what is not clinical / medical advice depends on both the answer and the question. If a complete answer to the question may be given without interpretation of the condition, it is acceptable to answer the question e.g. ‘Is burning pain a sign of neuropathy?’ If an interpretation of a medical condition is necessary for a complete answer, the question is asking for some form of diagnosis or treatment advice, which is clinical/medical advice e.g. ‘I have burning pain. Do you think it is neuropathy?’

Any questions about medicines, dose adjustment, alternative therapies or any question that requires information about healthcare delivery should be referred back to the person’s GP.

Urgent health concerns or ‘red flag’ situations

If you are speaking to someone with diabetes who is feeling dizzy, hungry, sweaty, trembling or finding it hard to concentrate or express themselves, they may be having a ‘hypo’ (hypoglycaemia) and you must get them to take some glucose tablets, or some fizzy drinks (not diet drinks) or some sweets like jelly babies.

If you speak to someone with diabetes who has any of the following problems, you should recommend that they go and see their GP as soon as possible:

They are suffering from worsening mood, depression or anxiety They have a new foot problem or an existing foot problem getting worse, They have sudden and sustained raised blood glucose levels, particularly if they

have another illness or infection at the same time. They are experiencing any loss of vision or sudden or severe change in eyesight;

They should contact the Western Eye Hospital Casualty Department (details on page 20) or go direct to their nearest eye casualty department.

NB: This list is not comprehensive. If you are concerned, recommend to the person that they see their GP as soon as possible.

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Appendix 2: Other Resources

Diabetes Champions Role Description

Main Aim: To raise awareness in the community about diabetes, the risk factors associated with diabetes, how to reduce or delay the possibility of developing diabetes, and how to test for diabetes. Sign post those with diabetes to appropriate support and healthy lifestyles to prevent complications.

Role description:

1. To attend two days of training on diabetes and on how to give a talk to a group.2. To set up and organise diabetes awareness meetings with community groups

including networking outreach with the support of the coordinator.3. To give 4 - 6 talks a year on diabetes at community groups or at health fairs.4. To act as a signposting person on diabetes for local community groups.5. To report back to the coordinator after any group meeting on the numbers attending

and how the meeting went.

Person Specification:

1. Preferably living with diabetes, Type 1 or Type 2, or a carer of someone with diabetes or very interested in Diabetes.

2. Willing to be trained to deliver a standard presentation.3. Able to talk to a small group of people about diabetes.4. Links with people or groups in the community e.g. member of a community

organisation, linked to schools, member of an activity group.5. Outreach and networking skills6. Able to give a talk both in English, and in own community language; particularly

useful to have champions who can speak Somali, Arabic or Polish as well as English.

7. Outgoing with good communication skills8. Interested in preventing the steep rise in diabetes.9. Interested in helping those with diabetes to access services and make changes in

lifestyle to prevent complications 10.Aware of the limits of their knowledge about diabetes and able to signpost someone

to their healthcare practitioner or to the Diabetes UK helpline if they have questions the champion cannot answer or questions about medication.

11.Willing to signpost people in the community into testing services and healthcare services.

12.Able to display the following personal qualities: trustworthy, professional, reliable, confidential, caring and efficient.

13. Willing to attend at least four meetings a year of all diabetes champions.

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Key Qualities for a Diabetes Champion include

Good listener Open body language Passionate Inspirational Approachable Trust builder- able to connect with people To speak the common language, be it mother tongue or just in a way your audience

understands Reliable Flexible Able to influence Confident Organised Able to work within role boundaries, know own limits Sensitive to cultural needs Maintain confidentiality Net-working Realistic Honest Non judgemental Well informed about key messages regarding diabetes and available services

Of course you do not have to have them all; you will have your own personal strength

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Tri-Borough Diabetes Champion Event Record Sheet Champion Name/s;

Please complete this form, so we have a record of your work after each event you do, either as a paper copy or as an electronic version and return by the last Friday of every month by email to Howard Tingle howardetingle@yahoo.co.uk or by post to; Judith Ralphs, Senior Public Health Officer, Behaviour Change Team, Triborough Public Health, Westminster City Hall, 64 Victoria Street, London SW1E 6QP

Q1 Date of event

Q2. Type of community interaction: (Please Circle or X)

community meeting health fairs/events GP surgery place of worship coffee morning

other conversationsQ3 In which borough did the interaction happen?

Hammersmith and Fulham

Kensington and Chelsea

Westminster Other

Q4 In which postcode was this meeting? Give full post code eg NW15JD

Q5 How many people were engaged at the interaction?

Q6 Approximately what percentage of attendees was BME?

Q7 Approximately what percentage of attendees had diabetes?

Q8 At which cultural group was this event aimed? Please be specific (i.e. Jamaican rather than Caribbean, Tamil rather than Indian)

Any other comments?

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Diabetes Quiz T= True F= False

The Liver produces insulin T F

No insulin is produced with type 2 Diabetes T F

Insulin allows the blood glucose to be used by body cells T F

Type 1 is more serious than type 2 T F

Only Type 1s inject insulin, Type 2s take tablets T F

Diabetes increases you risk of heart attacks T F

Thirst and drowsiness are signs of un-diagnosed diabetes T F

Diabetes affects eyes T F

More people have type 2 diabetes T F

The complications of diabetes can’t be reduced T F

As it is incurable, there is no point visiting the doctor for check ups T F

T1 can be prevented T F

People with diabetes suffer higher levels of depression T F

Diabetes effects sexual function T F

King Henry VIII died of diabetes’ complicationsT F

Remember you can ask your audience to think of ways to make these meals healthier meals as an interactive exercise; you can also add culturally specific pictures for your events

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You can ask participants to mark on this picture which parts are affected by diabetes as an interactive exercise

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Date:

Dear GP Practice

------------------------------------------------- Recently attended a community diabetes event run by Triborough Public Health NHS Diabetes Champions. At the event it was identified that your patient could be at risk of developing diabetes. It was recommended that your patient have a check for diabetes. We hope you can offer your patient an appointment.

If you have any questions please contact: Judith Ralphs jralphs@westminster.gov.uk Senior Public Health Officer

Behaviour Change TeamTriborough Public HealthDirect Line 020 7641 4663

Yours sincerely,

Diabetes Champion

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Do you want to keep involved? Are you interested in helping other people with diabetes?  (Please circle)  

Yes No Perhaps

We have several roles for volunteers e.g. Peer Educators, Champions, Champions and Diabetes Service User Involvement.

If you are interested, please write your contact details below and we will get back to you with more information:

Name:

Address:

Contact Phone Number:

Email:

Thank you for completing this form and please give to the Diabetes Champion.

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Diabetes Mentor Project: Self-referral Form

Do you have diabetes or have you been told you have pre-diabetes? Would you like some support in living with diabetes or preventing it, from someone who understands? If so, the free Diabetes Mentor Service could help.

Diabetes mentors are local people living with diabetes or carers (or ex-carers) of people with diabetes. Mentors are trained volunteers, not healthcare professionals, and will not give clinical advice. Mentors can help by listening and working in partnership with you to move you forward. They can provide information and signpost you to useful services.

The kinds of issues that can be covered might include: What is it like living with diabetes? I’ve just been diagnosed and am finding it difficult. What does healthy eating or healthy lifestyle mean? I find it really hard to keep to my diabetes care plan. What does taking exercise mean? Where do I go for information and help? I am feeling low or anxious about my diabetes and wish there was someone I could

talk to about how I feel.Or you may have other issues you would like to discuss.

If you are interested contact Peter Gilbert, Senior Diabetes Volunteer, with your details: email peterhgilbert@gmail.com Tel 020 7736 0044.

Or complete the slip below and post to:Judith Ralphs Behaviour Change TeamTriborough Public HealthWestminter City Hall64 Victoria Street,London SW1E 6QP Direct Line 020 7641 4663

Or email the information to judith.ralphs@westminster.gcsx.gov.uk _________________________________________________________________

I am interested in knowing more about seeing a diabetes mentor, please contact me.

Name: .................................................................................................................................

Address: .................................................................................................................................

Phone number(s): ................................................................................................................

Email (if applicable): ................................................................................................................

Type of diabetes: .......................... GP Practice: .............................................................39

Myths and Beliefs T= True F=False

You can’t prevent it T F

It is good to be big; indicates prosperity T F

It’s in my family; there is nothing I can do about it T F

Our women are naturally round T F

Diabetes only affects old people T F

The type of diabetes you get as you get older is not so serious

T F

We have always had plenty of butter and salt in food and it never did us any harm

T F

People have been healthy on our food for years. Why change now!

T F

Lots of oil and sugar make food tasty. My family won’t eat it without

T F

If take-aways were really unhealthy, they wouldn’t allow them

T F

Western food must be better than food from back home T F

Ideas about healthy food change all the time, there is no clear agreement

T F

Diabetes is just too much sugar, I can eat anything else T F

Can you add any more you know of?

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www.knowdiabetes.org.uk/

2 October, 2013

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