CHOOSING A CARE HOME

 

CHOOSING A CARE HOME

Moving home is an important decision at any time of life. The following tips may be helpful if you, or someone you care for, is an older person with diabetes considering a move to a residential care setting.

Check

Before you visit any care provider it is always helpful if you, or someone you trust can do some research. Take a look at things like:

• The Care Quality Commission report for the service.


• If the service is approved by the local council.


• What other people think about the provider.


• What level of care service is provided, eg will you need nursing provision?


• If the location and surroundings seem right for you.


• If the service suits your cultural needs.

Visit

Visiting at different times of the day, or staying for a few days to get the ’feel’ of the place is always a good idea. Speak to different members of staff, other residents and relatives, take notice of the decor and cleanliness, room sizes and facilities, food options and meal times. Look to see what activities are going on and how staff behave with residents and each other.

Ask about bringing your own furniture or possessions, whether guests can stay overnight or visit at any time, and how much choice and freedom you will have to live life the way you enjoy it.

Ask

There are some questions you could ask which might help to give you a better idea of how the care home can meet your diabetes needs:

• Are staff experienced in caring for people with your type of diabetes and what diabetes training have they had?


• Have staff had training in nutrition, exercise/activity benefits and mental health for older people with diabetes?


• Is there a member of staff who is responsible for diabetes care in the home?


• Does the care home have a written diabetes policy?


• Are staff able to support you with blood glucose monitoring or insulin administration, if this is something you require or may require, in future?


• Is there a system to support accurate self-medication?


• Do residents with diabetes have written diabetes care plans?


• Do residents with diabetes have an annual diabetes review?


• How will food options fit with your likes, preferences and diabetes needs? Is there support to keep active and exercise?


• How are hypos managed? Is there a written policy for hypo management and prevention?


• Is there a GP responsible for the home or can you choose your GP or keep your existing GP?


• Is there access to a Diabetes Specialist Nurse?


• Is there a podiatrist/chiropodist who visits or access to a foot care team?


• Is there access to eye screening?


• Is there access to a dietician?


• What support is there to attend hospital appointments?

 

 

 

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TYPE1UNCUT – VIDEOS FOR AND BY YOUNG ADULTS WITH TYPE 1 DIABETES

 

TYPE1UNCUT – VIDEOS FOR AND BY
YOUNG ADULTS WITH TYPE 1 DIABETES

 

 

How did the #Type1uncut project come about?

Diabetes UK was funded by the Garfield Weston Foundation to provide a series of online resources to help young adults aged 16-30 with Type 1 diabetes to manage their condition. (Although that’s not to say that some of the resources won’t be just as relevant for anyone older or younger!)

Free factsheets

The first phase funded the creation of a series of factsheets for young people to give to others to let them know about Type 1 diabetes (available to download for free on this page).

#Type1uncut

 

For the second phase of the project Diabetes UK has worked with 26 young adults with Type 1 diabetes, from all four nations of the UK, to co-create a YouTube channel of videos about subjects that matter to them.

The group have worked with Diabetes UK both face to face and through social media to help bring #Type1uncut to life. We also plan to hold regular Google+ Hangouts with a wider audience, using some of the videos as starting points for discussion.

We hope that people will find the content useful, and share it on social media using the hashtag #type1uncut – and that more young people with Type 1 diabetes will be keen to create videos for the channel.

#Type1uncut YouTube channel

We launched #Type1uncut with the first seven videos during Diabetes Week,  8-14 June 2014, with more new videos over the following months.

The group has grown and over the summer we've been working on our next films - watch out for videos about hypos during Hypo Awareness Week, 29 September 2014 to 5 October 2014, followed by subjects including sport, sex and research later in the year.

 

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DIABETIC KETOACIDOSIS (DKA)

 

DIABETIC KETOACIDOSIS (DKA)

 

Consistently high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, and will cause the body to become acidic – hence the name 'acidosis'.

DKA is a life-threatening emergency

Although most common in people with Type1 diabetes, anyone who depends on insulin could develop diabetic ketoacidosis. In exceptionally rare cases, people controlling their diabetes with diet or tablets have been known to develop DKA when severely ill.

The most likely times for DKA to occur are:

• At diagnosis. (Some people who do not realise they have Type 1 diabetes do not get diagnosed until they are very unwell with DKA.)


• When you are ill.


• During a growth spurt/puberty.


• If you have not taken your insulin for any reason.


• DKA usually develops over 24 hours but can develop faster particularly in young children. Hospital admission and treatment is essential to correct the life-threatening acidosis. Treatment involves closely monitored intravenous fluids, insulin and glucose.

How to recognise DKA:

• High blood glucose levels: DKA is often (but not always) accompanied by high blood glucose levels. If your levels are consistently above 15mmol/l you should check for ketones.


• Ketones in the blood/urine. Ketones are easily detected by a simple urine or blood test, using strips available on prescription.


• Frequently passing urine


• Thirst


• Feeling tired and lethargic


• Blurry vision


• Abdominal pain, nausea, vomiting


• Breathing changes (deep sighing breaths)


• Smell of ketones on breath (likened to smell of pear drops)


• Collapse/unconsciousness.

What to do if you have symptoms of DKA

If you have high blood glucose levels and any signs of DKA you must contact your diabetes team immediately. Left untreated, DKA can be fatal. If picked up early, it can be treated with extra insulin, glucose and fluid.

• Make sure you check for ketones if your blood glucose is over 15mmol/l.


• You may need to take extra insulin.


• You may need to test your blood glucose and ketone levels frequently (e.g. every two hours).


• Drink plenty of unsweetened fluid.

If you are unable to eat, replace meals with snacks and drinks containing carbohydrate to provide energy (e.g. sips of sugary drinks, sucking boiled sweets).

 

 

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KIDNEYS (NEPHROPATHY)

 

KIDNEYS (NEPHROPATHY)

Kidney disease can happen to anyone but it is much more common in people with diabetes and people with high blood pressure. Kidney disease in diabetes develops very slowly, over many years. It is most common in people who have had the condition for over 20 years. About one in three people with diabetes might go on to develop kidney disease, although, as treatments improve, fewer people are affected.

What is kidney disease?

The kidneys regulate the amount of fluid and various salts in the body, helping to control blood pressure. They also release several hormones. Kidney disease (or nephropathy to give it its proper name) is when the kidneys start to fail.

If the kidneys start to fail they cannot carry out their jobs so well. In the very early stages there are usually no symptoms and you may not feel unwell, this can mean there are changes in blood pressure and in the fluid balance of the body. This can lead to swelling, especially in the feet and ankles.

As kidney disease progresses, the kidneys become less and less efficient and the person can become very ill. This happens as a result of the build up of waste products in the blood, which the body cannot get rid of. Kidney disease can be a very serious condition.

Why are people with diabetes more at risk?

Kidney disease is caused by damage to small blood vessels. This damage can cause the vessels to become leaky or, in some cases, to stop working, making the kidneys work less efficiently. Keeping blood glucose levels as near normal as possible can greatly reduce the risk of kidney disease developing as well as other diabetes complications. It is also very important to keep blood pressure controlled.

How does my doctor check for kidney disease?

As part of your annual health care review you should have a blood and urine test. Your urine will be checked for tiny particles of protein, called 'microalbumin'. These appear during the first stages of kidney disease, as the kidneys become 'leaky' and lose protein. At this stage, kidney disease can often be treated successfully, so this test is very important. The blood test will measure urea, creatine, and estimated glomerular function (eGFR) showing how well the kidneys are working.

I had protein in my urine but now the test is negative.
How can this happen?

Kidney disease is not the only reason for protein to appear in the urine. If you have a urinary tract infection (UTI) this can lead to protein being passed out in the urine. People with poorly controlled diabetes can be more prone to urinary tract infections because glucose in the urine provides a breeding ground for bacteria. This might need treatment with antibiotics.

In some cases, if the infection persists, it can cause damage to the kidneys, so it is very important for people with diabetes to visit their doctor if they develop a urinary tract infection.

What sort of treatment might be recommended?

This depends on the individual, the type of diabetes and other factors, such as blood pressure. Keeping blood pressure under control is extremely important, and tablets for lowering blood pressure are often used.

An increasingly common form of treatment for people with diabetes is ACE inhibitor or angiotensin II receptor antagonists (AIIRAs). These are particularly successful as they not only lower blood pressure but also help protect the kidneys from further damage. These medications are sometimes used in people who have normal blood pressure, due to their protective effect on the kidneys. Your doctor should discuss any treatment with you before starting you on it, explaining what it does and how it will help.

What if kidney disease gets worse?

There are many ways of treating kidney disease if the kidneys are no longer able to function properly. You may need to limit certain foods in your diet, such as protein foods or foods high in potassium, phosphate or sodium. This aims to prevent waste products building up in your body. As there may be a number of different things to consider, the diet can be quite complicated to follow. If you need to make any changes to your diet, you should receive detailed advice from a registered dietitian.

Controlling blood pressure is also very important. If the kidneys have been damaged, the filtering and cleaning of the blood cannot be done normally.

In some cases, dialysis might be needed to do this job for the kidneys. There are various types of dialysis, and your doctor will discuss with you which one would be best for you.

What can I do to look after my kidneys?

Taking care of your kidneys is an essential part of managing your diabetes.

• Attend all your medical appointments.


• Keep your blood glucose levels and blood pressure levels within your target range.


• Have your urine tested for protein and a blood test to measure kidney function at least once a year.


• Get help to stop smoking.


• Eat healthily and keep active.

 

 

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NERVES (NEUROPATHY)

NERVES (NEUROPATHY)

 

Neuropathy is one of the long-term complications of diabetes.

What is neuropathy?

Neuropathy is one of the long-term complications which affects the nerves. Nerves carry messages between the brain and every part of our bodies, making it possible to see, hear, feel and move. Nerves also carry signals that we are not aware of to parts of the body such as the heart, causing it to beat, and the lungs, so we can breathe. So, damage to the nerves can cause problems in various parts of the body.

Diabetes can cause neuropathy as a result of high blood glucose levels damaging the small blood vessels which supply the nerves. This prevents essential nutrients reaching the nerves. The nerve fibres are then damaged or disappear.

There are three different types of neuropathy: sensory, autonomic and motor.

Sensory neuropathy

Sensory neuropathy affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs, but people can also develop this type of neuropathy in their arms and hands.

Symptoms can include:

• Tingling and numbness


• Loss of ability to feel pain


• Loss of ability to detect changes in temperature


• Loss of coordination – when you lose your joint position sense


• Burning or shooting pains – these may be worse at night time.

The main danger of sensory neuropathy for someone with diabetes is loss of feeling in the feet, especially if you don’t realise that this has happened. This is dangerous because you may not notice minor injuries caused by:

• Walking around barefoot


• Sharp objects in shoes


• Friction from badly fitting shoes


• Burns from radiators of hot water bottles.

If ignored, minor injuries may develop into infections or ulcers. People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other diabetes complication.

Charcot joint is a rare complication of people with diabetes who have severe neuropathy. It happens when an injury to the foot causes a broken bone, which may go unnoticed because of the existing neuropathy. The bone then heals abnormally, causing the foot to be come deformed and misshapen. Treatment includes immobilizing the foot in a plaster cast and in some cases surgery.

Autonomic neuropathy

Autonomic neuropathy affects nerves that carry information to your organs and glands. They help to control some functions without you consciously directing them, such as stomach emptying, bowel control, heart beating and sexual organs working.

Damage to these nerves can result in:

• Gastroparesis – when food can’t move through the digestive system efficiently. Symptoms of this can include bloating, constipation or diarrhoea


• Loss of bladder control, leading to incontinence


• Irregular heart beats


• Problems with sweating, either a reduced ability to sweat and intolerance to heat or sweating related to eating food (gustatory)


• Impotence (inability to keep an erection).

Motor neuropathy

Motor neuropathy affects the nerves which control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves. This can lead to problems such as:

• muscle weakness, which could cause falls or problems with tasks such as fastening buttons.


• muscle wasting, where muscle tissue is lost due to lack of activity


• muscle twitching and cramps.

How is neuropathy treated?

There are many treatments available to relieve the symptoms caused by neuropathy. This may include medication for nausea and vomiting, painkillers for sensory neuropathy or treatment to help with erectile dysfunction. Good control of blood glucose levels can improve the symptoms of neuropathy and can reduce the progression of the nerve damage.

Steps you can take to avoid neuropathy

• Keep your blood glucose levels within your target range.


• Have your feet checked at least once a year.


• Tell your diabetes healthcare team if you think you’re developing any signs of neuropathy.


• If you think you’ve lost sensation in your feet, protect them from injury and check them every day.


• And talk to your diabetes healthcare team.

 

 

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EYES (RETINOPATHY)

 

EYES (RETINOPATHY)

 

Diabetic retinopathy or ‘retinopathy’ is damage to the retina (the 'seeing' part at the back of the eye) and is a complication that can affect people with diabetes. Retinopathy is the most common cause of blindness among people of working age in the UK.

What causes retinopathy?

To see, light must be able to pass from the front of the eye through to the retina, being focused by the lens. The retina is the light-sensitive layer of cells at the back of the eye – the ‘seeing’ part of the eye. It converts the light into electrical signals. These signals are sent to your brain through the optic nerve and your brain interprets them to produce the images that you see.

A delicate network of blood vessels supplies the retina with blood. When those blood vessels become blocked, leaky or grow haphazardly, the retina becomes damaged and is unable to work properly. Retinopathy is damage to the retina.

Risks to your eyes

Persistent high levels of glucose can lead to damage in your eyes. To reduce the risk of eye problems, blood glucose, blood pressure and blood fats need to be kept within a target range, which should be agreed by you and your healthcare team. The aim of your diabetes treatment, with a healthy lifestyle, is to achieve these agreed targets.

Smoking also plays a major part in eye damage so, if you do smoke, stopping will be extremely helpful.

Types of retinopathy

There are different types of retinopathy: background retinopathy, maculopathy and proliferative retinopathy.

Background retinopathy

The earliest visible change to the retina is known as background retinopathy. This will not affect your eyesight, but it needs to be carefully monitored. The capillaries (small blood vessels) in the retina become blocked, they may bulge slightly (microaneurysm) and may leak blood (haemorrhages) or fluid (exudates).

Maculopathy

Maculopathy is when the background retinopathy (see above) is at or around the macula. The macula is the most used area of the retina. It provides our central vision and is essential for clear, detailed vision. If fluid leaks from the enlarged blood vessels it can build up and causes swelling (oedema). This can lead to some loss of vision, particularly for reading and seeing fine details, and everything may appear blurred, as if you are looking through a layer of fluid not quite as clear as water.

Proliferative retinopathy

Proliferative retinopathy occurs as background retinopathy develops and large areas of the retina are deprived of a proper blood supply because of blocked and damaged blood vessels. This stimulates the growth of new blood vessels to replace the blocked ones. These growing blood vessels are very delicate and bleed easily. The bleeding (haemorrhage) causes scar tissue that starts to shrink and pull on the retina, leading to it becoming detached and possibly causing vision loss or blindness.

Once the retinopathy has reached this stage it will be treated with laser therapy. Beams of bright laser light make tiny burns to stop the leaking and to stop the growth of new blood vessels.

 

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CARDIOVASCULAR DISEASE

 

CARDIOVASCULAR DISEASE

Damage to the heart and blood vessels is collectively known as cardiovascular disease and people with diabetes have a higher chance of developing it. The term cardiovascular disease (CVD) includes heart disease, stroke and all other diseases of the heart and circulation.

Cardiovascular problems

Your major blood vessels consist of arteries which carry blood away from your heart, and veins which return it. Damage to these vessels is referred to as macrovascular disease.

Capillaries are the tiny vessels where the exchange of oxygen and carbon dioxide takes place. When damage occurs to these vessels it’s referred to as microvascular disease.

When fatty materials such as cholesterol form deposits on the walls of the vessels (known as plaque), furring up the artery and reducing the space for blood to flow, this is described as arteriosclerosis or atherosclerosis. If the plaque ruptures the artery walls, blood cells (called platelets) try to repair the damage, but this will cause a clot to form. Over time, the walls of the blood vessels lose their elasticity. This can contribute to the development of high blood pressure or hypertension, which can cause more damage to the blood vessels.

The force of the blood being pumped from the heart can make the clot break away from the artery wall and travel through the system until it reaches a section too narrow to pass through. If this happens the narrow section will become partially or completely blocked.

Blockage of an artery leads to the part of the body it supplies being starved of the oxygen and nutrients it needs. This is the cause of heart attack or strokes (affecting the brain).

Narrowing of the blood vessels can affect other parts of the body, such as the arms or legs. This is called peripheral vascular disease (PVD). PVD may produce intermittent claudication (pain in the calf muscle). If left untreated, amputation of the limb may eventually be necessary.

What causes cardiovascular disease?

Blood vessels are damaged by high blood glucose levels, high blood pressure, smoking or high levels of cholesterol. So, it is important for people with diabetes to manage these levels by making lifestyle changes such as eating a healthy diet, taking part in regular activity, reducing weight if you are overweight and stopping smoking.

Steps you can take to help prevent CVD

• If you smoke, ask for help to stop.


• Eat a healthy, balanced diet.


• Be more physically active.


• If you are overweight, try to get down to a healthy weight. Any weight loss will be of benefit.


• Take your medication as prescribed.


• Get your blood glucose levels, blood pressure and blood cholesterol checked at least once a year and aim to keep to the target agreed with your healthcare team.


• If you have any chest pain, intermittent pain when walking, impotence or signs of a stroke, such as facial or arm weakness or slurred speech, you should contact your doctor as soon as possible.

 

 

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FEET

FEET

People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other complication of diabetes. This is because diabetes may lead to poor circulation and reduced feeling in the feet. It is important to understand how foot problems develop and how they can be prevented or detected early so that they can be treated successfully.

How can diabetes affect your feet?

If it is poorly controlled, diabetes can damage nerves and blood vessels. Nerve damage is called neuropathy. There are three types of neuropathy, and they can all affect your feet:

Sensory neuropathy:

This affects the nerves that carry messages from the skin, bones and muscles to the brain and affects how we feel temperature, pain and other sensations. It is the most common form of neuropathy, mainly occurring in nerves in the feet and legs, and can lead to a loss of feeling and a failure to sense pain. This could mean that you might develop a blister or minor burn without realising it, which, if not treated properly, could become infected or develop into an ulcer.

Motor neuropathy:

This affects the nerves responsible for sending messages to the muscles about movements, such as walking. If the nerves supplying your feet are affected it could cause your feet to alter shape. Your toes may become clawed (curled)as your arch/instep becomes more pronounced or the arch may ‘fall’ causing flat feet. This can cause the bones in your foot to fracture (break) when stressed.

Autonomic neuropathy:

This affects the nerves which control activities which our bodies carry out all the time, which we have no control over. Damage to these nerves may affect your sweat glands, reducing secretions and making your skin dry and inelastic. If not looked after the skin may crack and become sore and prone to infection.

Circulation

Diabetes may also affect the circulation by causing the arteries to become 'furred up' (artherosclerosis). This can affect all the major blood vessels, especially those supplying the feet. Without a good blood supply, you will have problems with cuts and sores, which do not heal very well, and as a result of poor circulation, you may also suffer from cramp and pain in your legs and/or feet. If your diabetes is poorly controlled, you run greater risk of poor circulation and the problems associated with a poor blood supply to your feet. High blood pressure; a high fat content in your diet and, in particular, smoking, all increase the risk of poor circulation.

 

 

 

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HYPOS AND HYPERS

 

HYPOS AND HYPERS

Diabetes is a manageable condition, but key to successfully living with diabetes is balancing medication and insulin injections with food and activity. When that balance isn’t right, one of two things will happen: either blood glucose drops too low and hypoglycaemia (a hypo) results, or blood glucose rises too high and hyperglycaemia (a hyper) occurs.

No matter how much you know about diabetes or how careful you are, if your diabetes is treated, you are likely to experience some hypos or hypers. Check with your diabetes healthcare team if you are not sure if the treatment you are on is likely to cause hypos or hypers.

Hypoglycaemia (hypo)

Hypoglycaemia means ‘low blood glucose levels’ – less than 4 mmol/l*. This is too low to provide enough energy for your body’s activities.

Symptoms

Hypos can come on quickly and everyone has different symptoms, but common ones are: feeling shaky, sweating, hunger, tiredness, blurred vision, lack of concentration, headaches, feeling tearful, stroppy or moody, going pale.

Why do hypos happen?

There’s no rule as to why they happen, but some things make it more likely: excess insulin, delayed or missed meal or snack, not enough carbs, unplanned physical activity, and drinking large quantities of alcohol or alcohol without food. Sometimes there just is no obvious cause.

How to prevent a hypo

• Don’t miss a meal.


• Eat enough carbohydrate.


• Eat extra carbohydrate if you are more active than normal.


• Take your tablets and/or insulin injections correctly.


• Don’t drink alcohol on an empty stomach or drink too much alcohol.

Treating a hypo

If you are conscious, treat your hypo immediately with 15–20g of fast-acting carbohydrate:

• Small glass of sugary (non-diet) drink


• At least three glucose tablets


• Five sweets, such as jelly babies


• Small carton of pure fruit juice


• Glucose gel.

How to recognise and treat a hypo

[youtube https://www.youtube.com/watch?v=K_Yh8_nFZIk?wmode=transparent]

Glucose gel may be used if you are feeling drowsy and someone can help you, but it should not be used if you are unconscious. Glucose gel is available on prescription if you are treated with insulin. Some people may need to follow this treatment with a snack of 15–20g of slower-acting carbohydrate to prevent their blood glucose levels getting low again. This snack could be a sandwich, piece of fruit, cereal or some biscuits and milk – or even your next meal, if it’s due.

It’s recommended that you retest your blood glucose levels after 15–20 minutes and re-treat if your blood glucose levels are still less than 4mmol/l.

The choice of hypo treatment is up to you, so you’ll need to decide how much and which treatment works best for you.

Note: Don’t treat your hypo with foods that are high in fat such as chocolate and biscuits because the fat will delay the absorption of the glucose and won’t treat the hypo quickly enough.

If you become unconscious

If you have a severe hypo and become unconscious you will need help from someone to treat the hypo. They will need to:

• Put you into the recovery position (on your side with your head tilted back and knees bent)


• Give you a glucagon injection - some people with insulin treated diabetes are prescribed glucagon injections. Ask your diabetes healthcare team if you need one


• Call an ambulance if you don’t have a glucagon kit available or you have not recovered within ten minutes of receiving the glucagon injection. If no one is trained to give a glucagon injection an ambulance should be called immediately.

Note: Make sure your family and friends are aware that they mustn’t give you anything by mouth if you are unconscious or unable to swallow. Always tell your diabetes healthcare team if you have a severe hypo.

Should I keep my blood glucose levels high to avoid hypos?

No. It can be harmful for you if you try to run your blood glucose levels consistently very high. You may start to feel thirsty, go to the toilet frequently and feel tired. In the long term, prolonged high blood glucose levels can lead to complications such as blindess, heart attack, stroke, kidney disease and lower limb amputations.

How do hypos affect my blood glucose levels?

After you’ve had a hypo, your blood glucose level may actually rise. If you are on insulin, don’t be tempted to increase your dose. The rise may happen because you felt incredibly hungry during the hypo and ate to correct this. Your levels may also rise because hypos cause the body to mobilise its own glucose stores.

Why do some people have severe hypos without any warnings?

Research suggests that people who keep their diabetes very tightly controlled may have problems in recognising hypo warnings, and that if they have one severe hypo without warning, they’re more likely to have repeated episodes. People who’ve had diabetes for a long time may also lose their hypo warnings signs; however, they can often regain them by adjusting their diabetes treatment. If you’re having problems, talk them through with your diabetes healthcare team.

Things to remember: hypos

• Keep hypo treatments with you at all times.


• If you’re having night-time hypos, test your glucose levels before you go to bed and during the night – ask your healthcare team about the best times to test.


• Make sure you carry some form of identification – such as an identity card, bracelet or necklace – so that if you ever become unwell and are unable to communicate, people are aware that you have diabetes and can help.

Severe hypos

If a hypo is untreated there is a risk of losing consciousness and/or having a fit. While this is not common, if someone you are with has a severe hypo there are some key things to remember:

• Never give food or drink by mouth because there is a danger of choking. Place them in the recovery position (on their side with their head tilted back).


• If you have been given a glucagon injection and shown how to use it, inject it as you have been instructed. If not, or the person with diabetes has not recovered within 10 minutes of giving the glucagon injection, phone an ambulance.


• We recommend that all parents of children with diabetes should have glucagon and be trained how to use it.


• Call an ambulance if you don't have a glucagon kit available.

Will hypos affect my quality of life?

Hypos should not be frequent or severe. If they are, contact your diabetes healthcare team. Try to build a picture of any hypos you have to see if there are any trends and patterns. If there is, you may need to alter your diabetes treatment with the help of your diabetes healthcare team.

Night-time hypos

Low blood glucose levels do happen at night, and some people with diabetes may not be woken by the mild symptoms of a hypo. This means that your blood glucose level may drop further and the hypo may become more severe. If the hypo hasn’t woken you, you may feel very tired the next morning, or have a headache (a bit like a hangover).

The best way to confirm if night-time hypos are happening is to do a blood test during the course of the night. If a night-time blood test appears to shows night-time hypos your insulin dose may need to be adjusted.

Hyperglycaemia (hyper)

At the other end of the scale is hyperglycaemia or hypers. This happens when your blood glucose levels are too high – usually above 7mmol/l before a meal and above 8.5mmol/l two hours after a meal. There are several reasons why this may happen. It may be that you:

• Have missed a dose of your medication


• Have eaten more carbohydrate than your body and/or medication can cope with


• Are stressed


• Are unwell from an infection


• Or from over-treating a hypo.

Symptoms may include:

• Passing more urine than normal, especially at night


• Being very thirsty


• Headaches


• Tiredness and lethargy.

Treating hyperglycaemia

Treatment of hypers will depend on what caused them. If they are a regular occurrence, contact your diabetes healthcare team for a review of your medications and/or lifestyle. If your blood glucose level is high for a short time, emergency treatment won’t be necessary. But if it stays high you need to take action:

• Drink plenty of sugar-free fluids.


• If you are on insulin, you may need to take extra insulin.


• If you are feeling unwell, especially if you are vomiting, you must contact your diabetes healthcare team for advice.

How to prevent a hyper

• Be aware of your carbohydrate portions and how they may be affecting your blood glucose levels.


• When you are ill, continue taking your diabetes medication even if you aren’t eating, and contact your diabetes healthcare team if you need more information.


• Be as active as possible.


• Remember to take your insulin and diabetes medication, and always take them correctly.


• You may need more medication – discuss this with your diabetes healthcare team.

Treatment

If your blood glucose level is high for just a short time, emergency treatment won’t be necessary. But if it stays high you need to take action to avoid developing diabetic ketoacidosis.

Check your blood or urine for ketones if your blood glucose level is 15mmol/l or more. If ketones are present it is likely that you do not have enough insulin in your body, so you may need to increase the dose or give an extra dose. Talk to your diabetes team about how to do this. Make sure you drink plenty of sugar-free fluids. If you have ketones and are unwell, especially if you are vomiting, you must contact your diabetes team for advice.

Note: The best way to avoid hypos and hypers is by checking your blood glucose level regularly, and even more closely if:

• you have not eaten as well as expected


• you have done a lot of physical activity


• you are unwell


• there has been any change in the routine that might upset your diabetes management.

Keep something to treat a hypo or hyper with you at all times. Carry diabetes ID to alert people to your diabetes and help them to help you if you are having a hypo. Make sure people close to you know what your hypo symptoms are and how to treat a hypo or hyper.

 

 

 

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DIABETES COMPLICATIONS

DIABETES COMPLICATIONS

People living with diabetes may have to deal with short-term or long-term complications as a result of their condition.

• Short-term complications include hypoglycaemia diabetic ketoacidosis (DKA), and hyperosmolar hyperglycaemic state (HHS).


• Long-term complications include how diabetes affects your eyes (retinopathy), heart (cardiovascular disease), kidneys (nephropathy), and nerves and feet (neuropathy).

Impact on overall health

Long- and short-term complications can impact on a wide variety of parts of the body including eyes, heart, kidneys, nerves and feet. Read through the links and get to know the 15 healthcare essentials to find out more about complications, and how to reduce the risk of developing them. With all complications, keeping blood glucose, blood pressure and blood fat levels under control will greatly help to reduce the risk of developing complications. Regular check-ups are essential to help manage the condition.

• 
  

  Hypos & hypers

  
  


• 
  

  Feet

  
  


• 
  

  Cardiovascular disease

  
  


• 
  

  Eyes (retinopathy)

  
  


• 
  

  Nerves (neuropathy)

  
  


• 
  

  Kidneys (nephropathy)

  
  


• 
  

  Hyperosmolar Hyperglycaemic State (HHS)

  
  


• 
  

  Diabetic ketoacidosis (DKA)

  
  


• 
  

  Related condition

  
  

 

 

 

 

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YOUR CHILD AND DIABETES

YOUR CHILD AND DIABETES

Type 1 diabetes is the most common form of diabetes in children, although Type 2 diabetes is now on the rise. If your child has been diagnosed with diabetes, you may be feeling overwhelmed and worried, therefore we aim to provide you with information to help you and your child manage their diabetes.

You will find tips on how to encourage your child to eat healthy foods and getting them interested in physical activity. We help you prepare for your child’s diabetes care, by giving you information on testing your child’s blood glucose levels, the different types of insulin and how to manage insulin injections. Many parents may feel worried about their child with diabetes going to school, therefore we aim to reassure you by giving you advice on how to help your child receive good support at school.

Information for children and teenagers

Under-fives with diabetes

Check out our downloadable resource sheet, Teach your Tot about Diabetes, which covers the basic aspects of living with diabetes, there are 10 resource sheets in the set:

1. Introduction


2. Treatment


3. Blood glucose testing


4. Fruit and veg bingo game


5. Healthy, balanced meal jigsaw


6. Hypos - feelings


7. Hypos - treatment


8. Physical activity - puzzle


9. Physical activity - diabetes doesn't hold you back


10. Injection sites star chart.

You can use the resource sheets individually, or work through the series. Each sheet has instructions on how to use it, and is designed to be coloured in by your child.

School

Many parents feel anxious about their child going to school with diabetes, and being concerned about whether staff can look after your child is understandable. It takes time to fully understand diabetes, but with support school staff can become competent and confident in looking after your child.

It’s important that you communicate with the school. If it’s difficult to speak to your child’s teacher, keep a diary, which the two of you complete and pass to each other (via your child) at the start and end of each school day. In it, you could include blood glucose results or jot down if your child has had a hypo.

 

Healthcare plans

A healthcare plan is a record of your child’s medical needs at school and how they are going to be fulfilled. It’s important that everyone is involved in drawing this up. The plan should be reviewed at least annually, as treatment or needs can change.

 

Note: Teachers aren’t medically trained. So, unless they’ve taught a child with diabetes in the past, or

have experience of diabetes, their knowledge about it might be limited.

Meeting with school

When you meet with your child’s school, make sure you’re talking to the right people. At primary school, it’s vital that the class teacher and the head teacher attend, plus any relevant classroom or welfare assistants. At secondary school, meeting with a form tutor or the head of year will probably be most practical, as your child will have several different teachers for various subjects. They can then pass on any information to the rest of the teachers. Whether your child goes to primary or secondary school, the school nurse should also attend. Depending on their age, your child might want to talk about their diabetes on their own. But do offer for you or their PDSN to go with them.

Possible subjects to cover at the meeting

• If your child takes insulin during school hours what level of help will they need?


• Do they need help with blood tests? When? What levels are you looking for?


• Will your child need snacks/lunch at a particular time? How will that fit into the school day?


• Does your child need help with carb counting? Will your child need an extra snack before/during/after PE? If so, what do they need and when?


• What hypo warning signs should school staff look out for? How should they treat a hypo?


• What should staff do in the event of a high blood glucose level?


• Who’s going to help your child with the practical aspects of diabetes? It’s sensible to have two people trained up in case of sickness. And all staff should know how to recognise and treat a hypo.


• Does your child want to have their injections in a quiet, private place? Where would that be?


• Who should the school contact in case of a problem? Provide contact details of at least two people.


• Stress that your child doesn’t need a special diabetic diet – just the healthy, balanced diet recommended for every child – and that ‘diabetic foods’ are neither necessary nor recommended.


• Tell staff that your child may need to eat snacks in class, either because they need a snack at a certain time, or to treat a hypo.


• Advise school staff on what to do if your child doesn’t eat all of their meal.

Important diabetes equipment for school

• Hypo remedies, eg glucose sweets/sugary drink/GlucoGel, plus a snack if necessary.


• Insulin and insulin pen, plus spares in case of breakage. Insulin not in current use will need to be stored in the fridge – ask staff to keep an eye on the expiry date.


• Blood glucose meter and strips, plus spares in case of breakage/malfunction.


• If your child is on a pump, include spare pump equipment in case the tubing becomes blocked. This will only be worthwhile if your child can change the tubing, or if staff have been trained. If not, they’ll need an insulin pen and insulin.


• Ketone strips (either blood or urine).

Storing supplies

Hypo remedies must be kept with your child at all times. Older children will probably keep them in their school bag. For younger children, it might be easier to have a supply in the classroom, but make sure that it goes with your child if they move class or go out to play.

Other supplies, such as your child’s insulin and blood glucose meter, should be easily accessible. Your child should be allowed to carry these around if they wish. Again, for younger children who will need help with taking insulin and/or blood tests, it may be easier to keep them in a central place. But it’s vital that everybody knows where they are in case they are needed in a hurry.

Blood tests and taking insulin

If your child needs help or supervision with blood tests or taking insulin, make sure that at least two people have been trained in case one person is absent. Your PDSN should be able to provide training. Keep staff informed of dose changes and which injection sites should be used. Let staff know whether your child is happy to inject in front of other children or whether they would like to do it in a private place. Make sure staff know your child’s usual range of blood glucose levels and what to do if levels are outside of that range.

Note: If your child is on a pump, make sure you have a plan for what to do if there is any problem with it, eg a blocked cannula.

Food

• Stress that your child doesn’t need a special diabetic diet – just the healthy, balanced diet recommended for every child – and that 'diabetic foods' are neither necessary nor recommended.


• If your child has any particular dietary needs, explain these to school staff.


• Depending on your child’s insulin regimen, they may need to have meals and snacks at regular times. If so, tell staff that your child will need to be at the same lunch sitting each day, and may also have to be near the front of the queue.


• Tell staff that your child may need to eat snacks in class, either because they need a snack at a certain time or to treat a hypo.


• If your child needs help counting carbohydrates, think about how this can be done. For packed lunches, you can tell staff the amount of carbohydrates in each piece of food, so they can help your child work out how much insulin to have. If your child has school dinners, it may be possible for catering staff to give you menus, which usually have a nutritional breakdown.


• Advise school staff on what to do if your child doesn’t eat all of their meal.

Physical activity

Your child should test their blood glucose levels before and after physical activity and have a snack, if necessary. If the activity is prolonged, they may need to test and/or snack during as well. Glucose tablets or a sugary drink should be kept nearby in case your child feels hypo. Anyone supervising a physical activity must be aware of your child’s diabetes.

Exams

Stress can affect blood glucose levels. Your child may need to do extra blood tests before and during exams. Teachers or invigilators need to be made aware that your child will need to take food or drink into the exam in case they feel hypo. It may be possible for your child to get extra time for an exam, eg if they lost time because of treating a hypo. Talk to staff about this.

Bullying

Some children with diabetes do get bullied about their condition. Lots don’t – but it’s important to be aware of it as a possibility. If your child is being bullied, talk to their teacher or head teacher. Schools take bullying seriously and your child’s school should have a policy on it.

Getting your child to explain about their diabetes through a school project may help. By being upfront about their diabetes, your child may find the bullies soon realise there is very little to tease them about.

Problems

While many schools have an open attitude to children with diabetes, unfortunately some are less keen to provide the level of support that your child needs. This may be down to a lack of understanding, fear of getting something wrong and putting your child in danger, fear of litigation if something does go wrong, or lack of training or support from your paediatric diabetes team. But your child has a right to access all areas of the school curriculum, including extra-curricular activities, so it’s important that you, the school and your paediatric diabetes team work together.

Top school tips

• Give the school as much information as you can about diabetes in general and your own child’s particular needs.


• Involve your paediatric diabetes team right from the start and ask your PDSN to join you at any meetings with school.


• If school seems unwilling to get involved, it may be due to a lack of understanding or worries about things going wrong. Stay calm and offer clear explanations.


• It’s a difficult balance, but try to communicate the importance of looking after diabetes properly at school without frightening staff and putting them off. Your PDSN should be able to help with this.


• Know your rights – under the Equality Act of 2010, schools are not allowed to discriminate against pupils with a disability, and this includes diabetes.


• Find out who will be your main contact at school regarding your child’s diabetes care.


• Talk to your paediatric diabetes team about how they can support the school in looking after your child’s diabetes.


• Who should the school contact in case of a problem? Make sure contact numbers are kept up to date.


• Inform school staff straight away about any changes to your child’s diabetes management.

 

 

 

 

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TRAVEL & DIABETES

TRAVEL & DIABETES

People with both Type 1 and Type 2 diabetes can travel all over the world – diabetes is no barrier. Make the right preparations and you should be able to minimise any potential problems.

The diet for people with diabetes is the same healthy diet recommended for everyone so you should be able to choose items from the usual menu whilst away from home. If you are travelling alone, you may like to let the staff know when you check in as a precaution in case you become unwell during your stay.

Things to check before you go:

• Carry diabetes ID and a letter from your doctor if you are carrying insulin or an injectable medication.


• Take twice the quantity of medical supplies you would normally use for your diabetes.


• Flights often cross time zones. If you treat your diabetes with medication or insulin, it’s important you check with your diabetes care team. If you need to make any changes to your regime be mindful that a hot or cold climate may affect how your insulin and blood glucose monitor work.


• Make sure you have the free European Health Insurance Card (EHIC) if you are travelling to a European Union member country – it will ensure that you have easy access to healthcare in that country. Obtain your EHIC  or fill in a pack at the Post Office. Remember it is still advisable to buy travel insurance, as the card doesn't cover, for example, emergency repatriation, and not all countries give the level of cover of the NHS. Please be aware that if you follow the above procedure, the EHIC card is free. Beware of websites which offer to take care of the application for you: they are likely to charge an unnecessary administration fee.


• Buy travel insurance.

Packing for your trip

• Split your diabetes supplies in separate bags.


• If flying make sure you have some diabetes supplies in your hand lugguage in case your bags get lost.


• Pack extra snacks in case of delay with your journey.


• Make sure you have all your diabetes medication and equipment packed.


• If you are carrying syringes and insulin on your flight take a letter from your doctor.

Note: In some countries, blood glucose is measured in milligrams per 100 millilitres (expressed as mg/dl) and not in millimoles per litre (mmol/l). A blood glucose conversion chart is below.

mmol/l	mg/dl	mmol/l	mg/dl
1	18	13	234
2	36	14	252
3	54	15	270
4	72	16	288
5	90	17	306
6	108	18	324
7	126	19	343
8	144	20	360
9	162	21	378
10	180	22	396
11	198	23	414
12	216	24	432

Considerations when flying

Heightened airport security means that it is essential for people with diabetes to plan ahead in order to avoid running into last-minute problems. Airport restrictions are subject to change, so contact your airline directly or call the Department for Transport’s enquiry line on 0300 330 3000 for updates. Or you can go to the travel and transport pages on the Directgov website.

• Current security regulations state that liquid items are only permitted in hand luggage if they are in containers of less than 100ml. There are a few exceptions including essential medicines for the period of your trip, which may be permitted in larger quantities above the current 100ml limit, but will be subject to authentication. Passengers are also permitted to carry essential medical equipment through airport security, though all medication and equipment must be supported by documentation from a relevant qualified medical professional. The Civil Aviation Authority states: "It is essential that diabetic passengers carry adequate equipment (glucose meters, lancets, batteries) and medication in their hand baggage. It is also important that insulin not being used in the flight is not packed in the hold baggage as this may be exposed to temperatures, which could degrade the insulin, in addition there is also the potential that luggage may be lost en-route." It may be useful to print a copy of their FAQs to take with you when you go through security.


• Take a letter from your doctor or clinic which explains that you have diabetes, the medication you use and all the equipment you need to treat diabetes including insulin, insulin delivery devices, needles, blood glucose monitors, glucose tablets or liquid and ketone test strips. It would be helpful if the letter explains the need to carry all medications and equipment with you in your hand luggage and to avoid storing it in your luggage in the hold – problems will arise if luggage goes missing or your medication is spoiled. It would also be useful to take a recent prescription with you.


• Cabin crew may request medication be handed over for storage during the flight. Keep diabetes medication and equipment in the same bag to avoid anything being mislaid or lost.


• Should you have to place insulin in the hold, an airtight container (such as a flask) in the middle of your suitcase is ideal. Alternatively, if an airtight container isn’t available, wrap in bubble wrap, then in a towel and again place in the middle of your suitcase.


• On arrival, examine the insulin for crystals and discard the insulin if any are found. Even if it looks okay, you should test your blood glucose levels more frequently. If your levels appear abnormal, discard the insulin as it may be damaged and ineffective.


• Before travelling, find out where you can get supplies of insulin at your destination, in case of emergency. Contact your insulin manufacturer before the trip to see if your insulin is supplied in the country you are travelling to.
  
  
  
  • Eli Lilly & Company,
  
  
  • Novo Nordisk Ltd,
  
  
  • Sanofi-Aventis,
  
  
  
  It's also worth checking that it is sold under the same name.


• You can get your prescription sent to your destination by courier.


• If you treat your diabetes with a pump or use a continuous glucose monitor (CGM), it is essential that you contact your airline prior to travel, if possible a few weeks before you fly. Some airlines will require you to notify them of your medical equipment in advance and fill in additional paperwork before you fly. Failure to do this can, in some cases, result in passengers not being allowed to board the aircraft with their pump or CGM.


• You should also speak to your diabetes team – should you need to remove your pump for any reason, they can provide you with any extra equipment such as insulin pens and help plan your doses throughout your journey. People using Medtronic equipment can request an airport card from the manufacturer which gives technical details of the equipment, specifically for the purpose of airport security and cabin crew.


• The Civil Aviation Authority’s Advisory Health Unit recommends that people with diabetes should always contact their airline before travelling to discuss medical devices they intend to take on board aircraft.

Important: Caution around insulin pumps and CGM onboard aircraft is due to wireless functionality, which may interfere with aircraft communication and navigation systems. If your pump or CGM cannot function without a wireless signal, then you may need to be prepared to remove your CGM and pump and administer insulin with an insulin pen for the journey. You would also need to test your blood glucose levels manually with a standard blood glucose meter.

Is it safe to go through the X-ray machines or full-body scanners?

The advice given by the Civil Aviation Authority regarding pumps and scanners is as follows:

• "There are a number of manufacturers of insulin pumps and unfortunately they do not all give the same advice. This varies from assurance that the pumps can safely go through any screening equipment, including X-ray equipment, to advice that the equipment may be affected by even the low-dose X-ray equipment used in some whole-body scanners.
  
  "If you use an insulin pump, it is therefore important to contact the manufacturer of the particular pump that you use for advice. It is also sensible to contact your airline and the airports you will travel through, to find out their requirements if the manufacturer advises that your pump cannot go through some screening equipment."

For pumps that are not able to pass through body scanners, the advice is as follows:

• "There are some airports where you will not be allowed to travel if you refuse to be scanned. It is therefore advisable to check with your airline and the airports you will be passing through to see if they do allow an alternative check."

Tablets

There is no restriction on the quantity of tablets you take through airport security, but you would still need to take documentation from a medical professional or your prescription for authentication.

What meal should I choose from the menu?

Airlines can provide information on the times of most meals so you can plan your insulin. It is best to order the standard meal, though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets. Cabin crew are usually able to provide fruit, crackers or rolls.

What hypo treatment should I take with me?

Glucose tablets, Lucozade and fluids used to treat hypos can be carried on board along with longer-acting carbohydrates such as biscuits. Should you have any problems buying glucose tablets or Lucozade after going through customs, remember the following are effective in treating a hypo: any sugary non-diet drink, sugary sweets, fruit juice. Then to prevent blood glucose from dropping again, follow with longer-acting carbohydrate, such as a sandwich, fruit or biscuits.

What do I do about snacks?

On long flights, you may require snacks in between meals and at bedtime to prevent blood glucose levels going too low, so try to carry extra starchy carbohydrate foods, such as biscuits, cereal bars or fruit buns, on board the aircraft. If you are on insulin, monitor your blood glucose levels frequently and be prepared to make changes to your dosage.

Dealing with illness while abroad

You should talk to your doctor for advice before you go, and get information from the tourist office, embassy or high commission of the country you're visiting about getting medical treatment while you're there.

• Check your insurance policy, so you know what your insurers will pay for.


• Give the doctor the generic name – not just the brand name – of your medication.

 

 

 

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DEALING WITH ILLNESS

DEALING WITH ILLNESS

It is important to know how to cope with illness if you have diabetes, or if you know or care for somebody with the condition. You'll also need to know how to manage insulin or other diabetes medications, blood or urine tests, and diet during illness.

Illness and infections, as well as other forms of stress, will raise your blood glucose levels. As part of the body’s defence mechanism for fighting illness and infection, more glucose is released into the bloodstream and prevents insulin from working properly. This happens even if you are off your food or eating less than usual.

Diabetes and illness

People who do not have diabetes simply produce more insulin to cope, but when you have diabetes; your body cannot do this. As a result, your blood glucose levels rise, causing you to pass more urine and feel thirsty. This in turn can make you dehydrated. The symptoms of high blood glucose can add to those of the original illness or infection and make it much worse.

Dehydration and diabetes

For example dehydration is made worse when you have a temperature or are being sick. In some cases, blood glucose levels can become so uncontrolled that treatment in hospital is necessary. Severe dehydration and very high blood glucose levels may be serious for both those with Type 1 and Type 2 diabetes. That’s why being prepared, and following the necessary steps when ill, is vital to manage your diabetes well and avoid the worst effects of illness. Some conditions (eg Addison's disease, severe asthma, rheumatoid arthritis, and lupus) are treated with steroids. If you have diabetes, you may well find that your blood glucose levels rise while taking high doses of steroids for periods of time. This should not stop you taking steroids if your doctor has prescribed them, even if your blood glucose levels are affected, but you should discuss with your doctor how best to manage your diabetes while taking steroids. You may need an increase in medication or your medication to be changed. If the steroids have been prescribed for a short period to manage deterioration in your condition, your blood glucose levels will usually return to normal when you stop taking them.

Tips for dealing with illness

• Don't panic – contact your diabetes team who will help you if you have any queries or if you are unsure about what to do.


• Keep taking insulin and / or diabetes medications – even if you don't feel like eating. In some cases you may need to alter your dose – your diabetes team will be able to advise on this.


• Test your blood more often, at least every four hours, including during the night. If you don't test your blood glucose levels at home you should be mindful of signs of hypergylcaemia'


• Stay well hydrated. Have plenty of unsweetened drinks to avoid dehydration, and eat little and often.


• If your blood glucose level is 15mmol/l* or more, check urine/blood for ketones. If ketones are present, contact your diabetes team.


• If you don't feel like eating, are feeling sick or can't keep any food down, replace meals with snacks or drinks containing carbohydrates, which will provide energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you're vomiting, or unable to keep fluids down get medical help as soon as possible.

Accident & emergency (A&E)

You may be in a situation where you need medical attention for something other than diabetes, eg an accident or injury. This might involve a wait in the hospital for a while before being seen. Make sure you tell someone as soon as you arrive that you have diabetes and that you might need to eat to avoid going hypo (usually people are advised not to eat or drink while in A&E, in case they need surgery). If you feel you need to eat or drink, check with the staff first.

Hospital stay

You may have a stay in hospital (long or short). This may be for something diabetes related, or not. Here are some things to think about:

• The hospital should provide the insulin you normally use – but this may take some time so take some with you to avoid delays.


• Take your own supplies of diabetes equipment, eg blood-testing kit or pump supplies (they probably won't be able to provide this).


• Ward staff should be up-to-date with your diabetes care, but do check that they have discussed it with your diabetes team. If they haven't yet, make sure they do.


• Don't assume that everyone treating you will know you have diabetes – it's always better to be over-cautious and keep mentioning it.


• While in hospital, your blood glucose levels may be higher or lower than normal. Stress and longer periods of inactivity are just two reasons why. Your blood glucose levels might need to be tested more often and treatment adjusted.


• If you want to manage your diabetes care yourself while in hospital you should be supported

 

 

 

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TAKING CARE OF YOUR FEET

 

TAKING CARE OF YOUR FEET

People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other complication of diabetes. This is because diabetes may lead to poor circulation and reduced feeling in the feet. It is therefore important to understand how to take care of your feet.

10 steps to healthy feet

1. At least once a year your feet should be examined by an appropriately trained person. This is likely to be done by a doctor, nurse or podiatrist. You should always take your shoes and socks off so that they can do a proper assessment. Don’t be self-conscious about your feet.


2. After the foot check, you should be told what your risk is of developing foot problems.


3. If there is an increased risk of developing foot problems, you will be referred to a specialist team for expert input.


4. At home you should check your feet every day looking for signs of redness, pain, build-up of hard skin or changes in the shape of the foot.


5. If you have lost any sensation in your feet you need to be vigilant: you may not feel if you hurt your feet – for example, if you are walking barefoot and stand on something sharp, if a shoe doesn’t fit properly and rubs, or if you burn yourself on something hot.


6. Ask someone at home to monitor the feeling or sensation in your feet by doing the Touch the Toes test. This can be done between appointments and if you – or the person doing the test – notices any changes you should go to your GP.


7. Be careful when cutting toe nails and don’t cut down the sides as this encourages in-growing toenails.


8. Do not use corn-removing plasters or blades as these can damage healthy skin.


9. Always wear well-fitting shoes that protect and support your feet.


10. Keep your blood glucose levels well controlled.

Steps you can take to prevent problems happening

• Give up smoking.


• Keep your blood glucose, blood pressure and cholesterol levels as near normal as possible.


• Eat a healthy diet which is low in fat, sugar and salt, and high in fruit and vegetables.


• Make sure that your feet are not exposed to extremes of heat or cold.


• Take regular physical activity, for example a brisk walk each day.


• Make sure that your socks and shoes are comfortable and fit well.


• Check your feet daily, including in between your toes.


• Attend your annual foot review (for those over 12 years old).


• Know your risk of developing foot problems.


• Many people only see a podiatrist (chiropodist) on a referral, so make sure you keep any appointments you are given.


• Your shoes should be: broad fitting, have a deep and rounded toe area, be flat or low heeled, fastened by a lace or a buckle to keep the heel in the back of the shoe.


• Always examine the inside of your shoes for sharp objects or stones before putting them on and replace ruffled innersole linings. Avoid socks, stockings or tights with wrinkles or prominent seams.


• Garters and stockings or socks with elastic tops should also be avoided because they may restrict the circulation. Never wear socks with darned areas or holes.

 

 

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DIABETES WATCH

DIABETES WATCH

Diabetes UK is committed to ensuring that people with diabetes receive high-quality care wherever they live, and that they know what care to expect. Diabetes Watch is the method by which we will hold health services to account.

We will shine a light on the very best services, identifying examples of excellent care, and identify those areas where more needs to be done to ensure people with diabetes are provided with the essential care they need and expect.

Diabetes – what care should you receive?

We use the 15 healthcare essentials care standards set out by NICE and NHS Quality Improvement as the starting point. These include:

• blood glucose, blood pressure and cholesterol checks


• monitoring of eyes, kidney function, legs, feet and weight


• individual care planning, smoking cessation advice, emotional and psychological support


• guidance on accessing specialist care and education courses.

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CARE FROM HEALTHCARE PROFESSIONALS

CARE FROM HEALTHCARE PROFESSIONALS

Whether you have just been diagnosed or had diabetes for some time it is important that you get the right support for managing your diabetes. This will help to ensure that your diabetes, blood pressure and blood fats are all kept in check, as well as detecting any early signs of complications so that they can be caught and treated successfully.

Your diabetes team will monitor your diabetes control, and you should have a full diabetes check at least once a year.

 

This check is referred to as your annual diabetes review: its purpose is to check for early signs of complications and to enable you to lead a healthy life. The annual review consists of a few tests, often on different days, and with different healthcare professionals.

Getting the most out of your appointments

Before the appointment

• decide what you need to know


• write down the points you want to raise


• bring your blood glucose meter and results record with you, if you test


• bring any news features/stories or research that you have any questions about.

During the appointment

• listen actively – ask questions, give feedback and ask for clarification if you're unsure of anything


• make notes to help you remember what has been said


• check you've covered your list.

After the appointment

• review what’s been said and agreed


• make a note of anything you need to do before your next appointment.

Care planning review

The annual diabetes review is an ideal time to have your care planning review. Care planning is a process that should be available to all people with diabetes. It:

• allows you to be more involved in decisions about how your diabetes is managed


• gives you a say in every aspect of the care you get


• helps you to work towards goals that are personal to you


• helps you to work in partnership with your diabetes team.

The care planning appointment is a chance to talk about the results of your annual diabetes checks (these are included as part of the 15 healthcare essentials) with your healthcare professional, talk about your experiences and discuss how you feel, set goals, and create an action plan to help you manage your diabetes.

Your healthcare professional can help you to understand the results of your diabetes checks, provide you with information and advice, talk about different options – for example, different types of medication available to you – and refer or signpost you to support in your local area.

A care plan is a written document of all these discussions, goals and actions.

The short film below will help you to understand what care planning is, and how you can get more involved in your diabetes care.

Diabetes care planning

[youtube https://www.youtube.com/watch?v=pTIV3Zazt_Y?wmode=transparent]

 

 

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TESTING

 

TESTING

There are a range of tests which will need to be done to monitor your health and your diabetes. Some of these, such as your blood glucose levels, you will be able to do yourself. Others will be done by healthcare professionals.

• Blood glucose levels


• Urine testing


• HbA1c (Glycated haemoglobin) and fructosamine


• Blood pressure (hypertension)


• Blood fats (lipids)

Blood glucose levels

Self-monitoring of blood glucose can be a beneficial part of diabetes management. As part of the day-to-day routine it can help with necessary lifestyle and treatment choices as well as help to monitor for symptoms of hypo- or hyperglycaemia. Monitoring can also help you and your healthcare team to alter treatment which in turn can help prevent any long-term complications from developing.

Some people with diabetes (but not all) will test their blood glucose levels at home. Home blood glucose testing gives an accurate picture of your blood glucose level at the time of the test. It involves pricking the side of your finger (as opposed to the pad) with a finger-pricking device and putting a drop of blood on a testing strip.

Some people can't see the point of testing as they think they know by the way they feel, but the way you feel is not always a good or accurate guide to what is happening.

Blood glucose targets

It is important that the blood glucose levels being aimed for are as near normal as possible (that is in the range of those of a person who does not have diabetes). These are:

• 3.5–5.5mmol/l* before meals


• less than 8mmol/l, two hours after meals.

There are many different opinions about the ideal range to aim for. As this is so individual to each person, the target levels must be agreed between the person and their diabetes team.

The target blood glucose ranges below are indicated as a guide.

Children with Type 1 diabetes (NICE 2004)

• Before meals: 4–8mmol/l


• Two hours after meals: less than 10mmol/l

Adults with Type 1 diabetes (NICE 2004)

• Before meals: 4–7mmol/l


• Two hours after meals: less than 9mmol/l

Type 2 diabetes (NICE 2008)

• Before meals: 4–7mmol/l


• Two hours after meals: less than 8.5mmol/l

*millimoles per litre: a measurement of the concentration of a substance in a given amount of liquid

Blood glucose meters

Choosing a meter can be quite complex as new products are coming on to the market all the time. Some manufacturers have also produced computer software packages that enable you to look at trends in your blood glucose levels. Your healthcare team should help you with choosing a meter that suits your individual needs. It's essential that you are taught how to carry out a test properly – poor technique may lead to incorrect results which could lead to inaccurate medication dosing.

How to test your blood glucose levels

[youtube https://www.youtube.com/watch?v=H5uXed6TBlM?wmode=transparent]

 Test strips

• The strips used with meters are nearly always provided in batches of 50, but check with your healthcare team before choosing a meter. If you purchase testing strips from abroad or online you must check that they are calibrated to the same UK specifications.


• Meters for people with visual impairments: If you have a visual impairment that means you’re unable to use most of the meters for testing, there are some alternatives. Ask your healthcare team for advice.


• Finger-pricking devices and lancets: Finger-pricking devices are automatic devices that pierce the skin so that a drop of blood can be extracted for testing. They insert a lancet (a very short, fine needle) into the skin using a spring mechanism. The depth at which the needle is inserted can be adjusted depending on the thickness of the skin. Lancets are available in different sizes, or gauges. A higher-gauge lancet is generally less painful; however, you may not get enough blood to test with the higher-gauge needles. Lancets are designed to be used only once. If they are used more than once they become blunt and painful to use.

Worried about finger-pricking?

Many people new to life with diabetes worry about having to do blood tests. This is natural, and with help from their diabetes care team the majority of people adapt well and find it is not as bad as they feared. Anyone who is worried about doing blood tests should talk to their diabetes care team.

• There are ways to make blood glucose testing easier such as washing the hand in warm water and shaking it to increase blood flow before you test


• You should always use the sides of the fingers rather than the more sensitive fleshy pulp at the tips.


• Some blood glucose meters and lancing devices allow you to avoid the fingertips altogether and use less sensitive test sites, such as the upper arm or thigh.

Recording your results

It’s really important to record the blood tests that you do, to help you and your healthcare team to assess how well your diabetes is being managed. You might choose to record your results in a diary, use a computer software package provided by your meter manufacturer or use the Diabetes UK Tracker smartphone app. If you have Type 1 or Type 2 diabetes, or are caring for someone who does and you own an Apple or Android smartphone – you can download the free Diabetes UK Tracker app. The app is designed to be quick and simple to use, taking the daily chore out of logging levels such as blood glucose, carbohydrates and calories. The app was designed by a team that included user experience professionals, clinical specialists and people with diabetes, to help you manage your condition.

Urine testing

Urine testing involves holding a test strip under a stream of urine for a few seconds and comparing the colour change on the strip, after a set amount of time, with the chart on the strip container. If you have been advised to test your urine for glucose it is best to test it in the morning before your breakfast. Empty your bladder when you get up, then test a sample passed 30 minutes later. Tests done at this time should be negative. You can also test two to three hours after a meal, when your blood glucose will have been at its highest.

• Urine testing gives a less accurate picture of your blood glucose than blood testing, but your doctor may still feel that it is suitable for you. It is less accurate because there is usually no glucose in your urine unless the glucose levels have risen to 10mmol/l or above, which is considered quite high.


• Also, it does not give you an indication of what your blood glucose level is at the time you test, because the urine you are testing may have been produced several hours before you test.


• Urine tests also cannot tell you if your blood glucose is too low – which is important for people on insulin or certain tablets.


• Some people get glucose in their urine at lower levels. They are said to have a 'low renal threshold' for glucose. Older people may develop a high renal threshold, when glucose does not appear in the urine until the level in the blood is much higher than 10mmol/l. High or low renal thresholds will cause confusion if you are monitoring your diabetes with urine tests.


• Because urine testing involves comparing a colour change on the urine testing strip, it is not suitable if you are visually impaired

HbA1c (Glycated haemoglobin) and fructosamine

At least once a year, your doctor should check your long-term diabetes control by taking a blood sample from your arm.

HbA1c

The most common test is the HbA1c test, which indicates your blood glucose levels for the previous two to three months. The HbA1c measures the amount of glucose that is being carried by the red blood cells in the body.

HbA1c targets

For most adults with diabetes, the HbA1c target is below 48 mmol/mol, since evidence shows that this can reduce the risk of developing complications, such as nerve damage, eye disease, kidney disease and heart disease. Individuals at risk of severe hypoglycaemia should aim for an HbA1c of less than 58 mmol/mol. However, any reduction in HbA1c levels (and therefore, any improvement in control), is still considered to have beneficial effects on the onset and progression of complications.

HbA1c results

You will now be getting used to seeing your HbA1c results reported using the IFCC (International Federation of Clinical Chemistry) reference measurement procedure of mmol/mol.

(%)	(mmol/mol)
6.0	42
6.5	48
7.0	53
7.5	58
8.0	64
9.0	75

 

To help you with the transition from the percentage system you were used to a converter:

Here the link

Fructosamine test

If your red blood cells are affected by, for example, anaemia, sickle cell anaemia or thalassaemia (all of which involve a lack of or abnormal type of haemoglobin – the oxygen-carrying part) then your doctor may carry out a blood test for fructosamine. Fructosamine gives an average result for the previous 14 to 21 days. If you normally have a fructosamine test, discuss your individual target with your doctor.

Blood pressure (hypertension)

Blood pressure is a measurement of the force of blood flow inside your arteries. Your blood pressure is stated as two figures, e.g.130/80mmHg (millimetres of mercury). The first figure is known as the systolic pressure and relates to the pressure as the heart contracts and pushes blood through the arteries. The other figure is the diastolic pressure measured when the heart relaxes to refill with blood.

• For someone without diabetes the blood pressure should be no higher than 140/85 but when you have diabetes (or if you have had a heart attack, stroke or coronary heart disease) your blood pressure should be no higher than 130/80.


• It is important to have your blood pressure checked at least once a year as part of your annual review for diabetes. This helps to ensure that it is in the target range and not increasing your risk of developing diabetes complications.

Note:
Your healthcare team will help you to aim towards a target level of 130/80mmHg or less. High blood pressure usually has no signs or symptoms – occasionally people with very high blood pressure say they experience headaches – so the only way to know if you have high blood pressure is to have yours measured. High blood pressure can lead to heart attack, stroke or kidney failure. If your blood vessels are narrowed or clogged, extra strain is put on your heart as it has to work harder to pump blood around your body.

Causes of high blood pressure

For most people, there may be no single cause for their high blood pressure. It is not known exactly what causes it, but we do know that lifestyle can affect your risk of developing it. You are at a higher risk if:

• you are older


• have a family history of high blood pressure


• are of African or Caribbean origin


• eat a lot of salt


• are overweight


• do not take much exercise


• smoke


• drink large amounts of alcohol


• are very stressed.

Blood fats (lipids)

Lipids are the cholesterol and triglycerides in your blood. Cholesterol is a type of fat found in all of us. You may be familiar with the term blood cholesterol, but what you may not know is that not all cholesterol is bad. Some of it, HDL (high density lipoprotein), can actually protect against heart disease. Low levels of this protective HDL cholesterol increase your risk of cardiovascular disease (CVD). However, LDL (low density lipoprotein) cholesterol is the bad form of cholesterol in the blood. It is high levels of this type that are linked with an increased risk of heart disease. Triglycerides are another type of fat in the blood. If you have raised cholesterol and raised triglycerides you have an increased risk of CVD.

• Your total cholesterol level should be below 4.0mmol/l.


• LDL levels should be less than 2.0mmol/l.


• HDL levels should be 1.0mmol/l or above in men and 1.2mmol/l or above in women.


• Triglyceride levels should be 1.7mmol/l or less.

If you do not know your lipid levels, ask your healthcare team to arrange a simple blood test for you.

 

 

 

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