Diabetes mellitus (sugar diabetes) is a very common condition affecting 1 in 40 of Eastcote patients. It occurs when the body does not produce enough insulin to regulate the level of sugar in the blood. There are two main types of diabetes. In one type the body’s pancreas gland does not produce insulin at all and patients are totally reliant on insulin injections. This type of diabetes can affect any age but tends to affect children and adolescents more and has a rapid onset of symptoms. In the other type of diabetes the pancreas either produces too little insulin or patients are resistant to the action of their insulin. The second group who are in the majority, tend to be adults rather than children or adolescents, and are managed on diet, diet and tablets or diet and insulin. This second type has a slow onset and may be picked up on a routine screen with the person being unaware of any symptoms.

Diabetes can cause complications

Irrespective of the type of diabetes, complications both long and short term are just as likely to occur. All diabetics have an increased risk of heart disease, kidney problems, eye damage which could lead to blindness, and damage to nerves and blood vessels (especially in the feet), which can lead to ulcers and other foot complaints. However in the majority of patients, if diabetes is well controlled and efficiently monitored, most of these complications can be detected in the early stages and stabilised or prevented. At the onset, or during periods when the diabetes is unstable, more regular check ups are required. Otherwise a patient may be happy to be assessed once a year at the annual diabetic clinic (the minimum requirement established by the British Diabetic Association).

Annual diabetic check

At The Devonshire Lodge Practice, a system exists whereby all diabetic patients are invited to attend the diabetic clinic at least annually. Sisters Nicholson or Rusk will perform preliminary tests and arrange blood tests and referrals to chiropody. It is important that an annual optician or ophthalmology appointment is carried out. See below.

The diabetic clinic at present involves seeing a nurse (Sister Nicholson or Rusk) and a GP (Dr Brewerton). The nurses role is to briefly establish any problems the patient might be experiencing, regarding diet, control of diabetes, record weight, blood pressure, check blood sugar levels, assess feet and visual acuity (eye sight). It is intended to be an opportunity for the diabetic to ask any questions, express any concerns they may have not necessary related to the issues listed.

Diet

There is not a dietician on site at the time of the clinic, although you can be referred to one at either Hillingdon or Mount Vernon Hospital. We can provide guidance and leaflets about the changes that you might need to make to your diet. Often reviewing diet can help improve blood sugars and so improve general health - perhaps ‘less damaging’ foods can be suggested that are still acceptable to the persons diet that they were unaware of. Are you eating the wrong margarine?  Is it high in poly-unsaturates or mono-unsaturates?  Do you know what you should be eating more of? The dietician can be a good source of information. Use this resource to your advantage.

Chiropody

Patients can be referred for chiropody treatment at Eastcote Health Centre. Domiciliary visits can also be arranged for if you are house bound. If you are attending your own chiropodist privately, make sure they are registered. The most common problem to occur with the feet is damage to the nerves, this in turns reduces sensitivity and so allows for injuries to go unnoticed or appear superficial (as they may not cause much discomfort). It is recommended that your feet are inspected by a chiropodist annually, not waiting until damage occurs to your feet. General leaflets recommending daily care for your feet are available from the nurses - these include advice regarding footwear, not walking barefoot, daily cleaning and inspection of feet, and emphasizes asking advice on any injuries however minor they may appear.

Blood Pressure

Blood pressure must be checked annually as a minimum requirement. Diabetics are more at risk of cardiac problems and renal ( kidney) disease. However if slight changes are detected early, they can often be very successfully treated. Whether you are diabetic or not, you are generally not aware of raised blood pressure, until you develop angina, or have your heart attack or stroke- we would rather asses your blood pressure regularly and try to prevent such problems occurring.

Blood Tests

Blood tests are also important to monitor annually. Changes in HbA1c levels indicate how well maintained the blood sugar level is. This will have a direct impact on all the other systems. Should the blood sugars be showing a trend towards increasing, possible changes to diet or treatment can be discussed, reaching a regime acceptable to both parties and a clear understanding for any changes. It is also a good opportunity to discuss methods of monitoring diabetes, whether by urine or blood test, and you will find the best method suited to you. There are many different blood sugar monitoring meters and testing strips being developed, and we will be happy to discuss which is best for you.

Eye Checks

Annual eye checks are extremely important in diabetic follow up. Visual problems are extremely common in diabetes but very treatable, especially if caught early. Again the most effective treatment is at the very early states of retinal damage when you are unaware of any visual problems. You will receive an invitation to attend one of the clinics provided by the Medical Retinal Screening service at least once a year. During this examination a photograph wil be taken of the retina at the back of the eye. Some opticians still provide this service but if you choose this method of screening, you may be charged a fee.

There is a list of accredited opticians in the area available from this link. This simply means that the opticians have shown further interest in the care of diabetes and have undergone additional training to show they have achieved the desired level of competence. Other opticians may be of a similar standard, but if they have not attended the necessary course, may not be delivering the care you need.

 We appreciate the clinic may not be convenient to you, but we hope we have explained the need for routine checks. If you are unable to attend the clinic at the usual time, please either phone, call in to arrange a more suitable time. Please do not ignore your invitation for annual review. As a result of a recent audit, we are aware that many people have problems with the clinic time, and hope to soon offer mini clinics with the nurses at different times. The list of accredited optometrists is available here- we do not mind who you choose to monitor your eyes, as long as they are cared for! If you are house bound, ring and request a home visit.

More information

There are many resources where you can obtain further information.

All can be contacted by post or telephone but if you have access to the Internet, you can obtain information there. Some useful addresses are shown below

Your own GP Practice Website

                                    www.devonshirelodge.co.uk

                     Email:         prescriptions@gp-e86006.nhs.uk

DIABETES UK

10, Queen Ann Street, London. W1G 9LH
A great place to obtain information about Diabetes care in the United Kingdom

                    Tel: 020 7323 7531
                    Website:               www.diabetes.org.uk

DIABETES UK Careline

                    Tel: 020 7462 2732
                    Textphone: 020 7462 2757
                    Email:             careline@diabetes.org.uk