What Care Should I Expect From the Health Service

To achieve the best possible diabetes care, you need to work together with healthcare professionals as equal members of your diabetes care team. Everyone who has diabetes should have a full check. You are entitled to have a full check up every year, this is called an annual review. The annual review is very important as this appointment checks your health and ensures that any problem can be treated quickly. Some GPs will do this but sometimes your GP will refer you to see doctors at other clinics as they may not provide this service for you.
At this annual review:

• your blood should be tested to measure long-term diabetes control, this is called HbA1c,
• you should discuss your diabetes control, including your home blood glucose testing results,
• our blood pressure should be taken,
• your kidney function should be tested, this involves taking a urine test and a blood test,
• your cholesterol levels in your blood may be checked, this involves taking a blood test,
• you should be offered Digital Retinal Screening at one of the various camera sites in the city,
• your legs and feet should be examined to check your circulation and nerve supply, and if necessary you should be referred to a state registered chiropodist/podiatrist,
• your weight should be recorded to make sure you are a healthy weight for your height,
• your injection sites should be examined if you are on insulin, and
• you should have the opportunity to discuss how you are coping at work and at home.

Education sessions

Once diagnosed with Type 2 diabetes, you may be invited to attend an education session. Please ask your GP or Practice nurse for more details. People with Type 1 diabetes will receive ongoing education with a member of the Diabetes Specialist Team.

Referral

In some cases your GP may refer you to other members of the Diabetes Team. Who you see and how often will depend on the level of care your GP can provide and what your specific needs are. The roles of the Team members are listed below.

Your GP has overall responsibility for the care you receive, and most GPs run diabetes clinics.

Practice Nurse / Nurse Practitioner play a central role in providing diabetes care. A practice nurse may be the person at the surgery who provides you with most of your diabetes care with support from your GP if necessary. However, not all have specialist knowledge in diabetes. Diabetes Specialist Nurses (DSNs) have special expertise in diabetes and work solely with people with diabetes, giving advice and training. Some may be able to alter your medication.

Concessions

• Everyone on medication for diabetes is eligible for to free prescriptions. Ask your pharmacist or GP for an exemption certificate.
• You are eligable for a free flu vaccination which is available at your GP’s surgery during October and November each year. It is strongly recommended people with diabetes receive the flu vaccine.
• You are eligable for free chiropody and eye checks annually.

Dental Care

It is important that you tell your dentist that you have diabetes. As gum disease is more common in people with diabetes, regular dental checks and early treatment are essential as dental infections may disturb your diabetes balance. Dental treatment may upset your diabetes control temporarily, particularly if you find visits to the dentist stressful. There are no concessions for people with diabetes for dental care.

Planning for pregnancy needs a little extra care when you have diabetes

• Ideally pregnancy should be planned. You should be referred to the Diabetes Centre if you have diabetes treated with tablets or insulin, and plan to get pregnant.
• It is important that you make sure that your blood glucose levels are well controlled before you conceive. High blood glucose, especially in the first three months of pregnancy, increases the risk of development problems for the foetus.
• The dose of folic acid used in pregnancy if you have diabetes is 5 mg once a day. This is higher than the normal dose of folic acid recommended in pregnancy. This dose needs to be prescribed by your GP. Ideally you should start folic acid when you are planning your pregnancy.
• A healthy diet is part of the on-going treatment for everyone with diabetes but extra care may be needed to control weight increases during pregnancy – remember, you are not eating for two! Discuss any food cravings with your midwife or diabetes specialist nurse.
• Getting enough exercise is very important. Your midwife or diabetes specialist will discuss with you how you can include exercise in your everyday life.
• By being prepared, following advice and by asking questions you will help reduce the stress which may be experienced during pregnancy.
• If you are in any doubt about your pregnancy or diabetes treatment talk to your midwife or diabetes specialist, both nurse and doctor. There are pre conception clinics held at both LGI and St James’s hospitals and women considering pregnancy should ask to be referred.
• If you are going to have an operation, you need to make sure your diabetes is well controlled.