Please enter your login details

Guide to Diabetes

The Annual Review 

Please write your picture caption here

It is essential that your diabetes is reviewed yearly by your diabetes team. Appointments should be sent to you from your diabetes team, it is important that you do attend the clinics. This is to ensure that your treatment is correct and your target diabetes levels are being obtained between 4 - 7 mmol/l and to prevent the onset of diabetes complications.
 

Expect your diabetes to be reviewed yearly. It is important that your nurse or doctor reviews your diabetes and its treatment on a regular basis.

There are many ways that your doctor can check whether you are developing Diabetic Complications with your: Feet, Eyes, Heart, Kidneys, Circulation, and Nervous System. Therefore it is important that you have your yearly MOT / Annual Review.

 

What to expect from the Annual Review


It is essential that you attend your annual review appointment so that we can catch any potential problems early on hence It is very important that you attend. The following will be checked
 

  • Blood Tests: for your blood fats and HbA1c (which your long term diabetes check) and your kidneys
  • Blood Pressure Checks
  • Weight Measurement
  • Foot Check with the podiatrist including pulses and sensation
  • Eye check (with your optician or optometrist)
  • Urine test (You will be asked to bring a sample with you.)

 

Blood Tests: HbA1c or A1 blood test


The diabetes team will take a blood sample from your arm. During the life of a red blood cell (8-12 weeks) sugar sticks to part of it. This blood test gives an overview of the level of your blood sugars over the last 2-3 months. This will inform your diabetes team as to the level of your diabetes control.
 

HbA1c Target Level To show good diabetes control the HbA1c result should be between 6.5-7.5% where 7% is the ideal target.
 

Ways to reduce your HbA1c Always ask your diabetes team what your HbA1c result was, and by comparing it with previous results you will be able to monitor your progress. If your HbA1c is too high, your current diabetes treatment may need changing.

Download the  new Haemoglobin A1c Testing (HbA1c) information leaflet produced by the Department of Diabetes and Endocrinology and the Department of Ophthalmology Department 

 

Blood Fats ( Lipid) Cholesterol test)

 

Cholesterol is fat that circulates around the body in your blood. There two main types of blood fats these are:
 

  • Low Density Lipoproteins (LDL’s) “ bad Cholesterol” these are sticky and tend to build up as fatty deposits around the inside of blood vessels hence obstruct blood flow

 

  • High Density Lipoproteins (HDLs) “ good cholesterol” these help prevent fatty deposits and keep blood vessels free from obstructions.


Cholesterol Target Level: to reduce you risk of getting a heart attack the total cholesterol level should be below 5mmol/l Recent research has shown that a level nearer 3.5mmol/l may be better.


Having too much fat (bad cholesterol) in the blood can contribute towards developing heart diseases and stroke.
 

Ways To Reduce Your Lipid Levels:
 

Reduce weight and saturated (animal) fat intake; take regular physical activity; eat more fruit and vegetables, eat oily fish twice a week, limit alcohol intake, control glucose levels.

 

Blood pressure check


Blood pressure is the amount of outward pressure that your blood puts on the walls of your blood vessels. Thus a blood pressure check is the measurement of the pressure at which your heart pumps blood through you arteries.
 

There are two numbers, a systolic and diastolic: the systolic is the amount of pressure when your heart pumps the blood and is the higher value.

The diastolic is the amount of pressure when your heart is recovering before it pumps again, this is the lower value.
 

Target blood pressure the target is 140/80 mmHg or below.

If you have kidney problems then the target is 130/70mmHg
 

High blood pressure is an important contributor to conditions such as heart disease, stroke and kidney disease.
 

Ways to reduce your blood pressure : loose excess weight and keep it off, reduce salt intake and stress levels, stick to recommended alcohol intake, increase regular physical activity, stop smoking.

 

Weight Measurement


They may also take a waist circumference measurement to predict your risk.Carrying too much weight around your middle increases your risk of heart disease, affect BP and cholesterol and can make you insulin resistant. Your diabetes team will weigh and measure your height and check your Body Mass Index (BMI) to find out your health risk.
 

  • European men: 94cm or 37 inches at risk, 102cm or 40 inches High Risk
  • Asian Men 90cm or 36 inches at risk

  • European 80cm or 32inches at risk, 88cm or 35 inches high risk
  • Asian women: 80cm or 32inches at risk, 88cm or 35 inches high risk
     

If you are overweight, a 5-10% weight loss can reduce the risk of heart disease and stroke. E.g. if you weight 100 kg aims to lose 10kg. On the other hand being underweight is not healthy and can be due to poor diabetes control. Discuss this with your diabetes nurse/team. If needed you can request to be referred to dietician.
 

 

Eye tests/ Photographs
 

The Diabetic Eye Screening Service for Leicestershire and Rutland

This is a mobile screening unit that makes appointments with GP surgeries to attend yearly to perform retinal screening for the diabetes patients with in the surgery. You will be notified by your GP if you are needed to attend the mobile eye screening unit. (This will be at the GP surgery).

You will then see the diabetic retinal screener who will ask you some questions about your diabetes. They will then check your vision using an eye chart, and put drops into your eyes to dilate the pupils. These drops take 20 minutes to work and will slightly blur the vision for a few hours before returning to normal. Once your pupils have dilated your eyes will be photographed. a special camera is used with a flash, but it does not touch or hurt your eyes. It will take about 45 minutes.

It is important that you attend your appointment. If you cannot attend you must inform your GP practice so alternative arrangements can be made. You may not need to come if you attend a hospital eye clinic.

Remember to take any glasses that you have to every eye appointment.

Remember however if your vision is getting worse, this does not necessarily mean you have diabetic retinopathy. It may simply be a problem that can be corrected with glasses.

The photographs will be reviewed by trained retinal screener, under the supervision of an eye specialist. Both you and your GP will be notified of the results by post 1 month later.
If significant changes are found or the photographs are difficult to interpret, you will be asked to attend an eye outpatient clinic at the Leicester Royal Infirmary.

If you notice changes with your eyesight, you should contact your optician or eye clinic. 
Although your vision may be good, changes can be taking place in your retina that needs treatment, because most sight loss due to diabetes is preventable.
 

Feet Examinations


The sooner changes or problems are spotted, the more likely it is that they can be treated and prevented from getting worse. Your feet will be examined by your doctor, nurse or podiatrist (foot specialist)

They will check for pulses, cuts, bruises, marks and blisters. A sensory nerve examination can be carried out by your diabetes team.

In addition you should keep a close eye on yourself by checking your feet daily. If you notice anything unusual, such as unusual cuts, marks, discolouration or blisters on your feet, see your GP as soon as possible. If you think anything is wrong contact your clinic straight away. Download the Putting Feet First: Your Annual Foot Review
 

Kidney Function Test


The diabetes team will either check your urine to see if your kidneys are performing well, this will include protein presence.
 

Annual Check Up Rules


  • Have your blood pressure checked at least once a year.
  • Check your feet daily and visit a chiropodist (foot doctor) at least once a year.
  • Have your eyes checked at least once a year at your family optician with an optometrist. (Your eyes may be photographed)
  • Have your cholesterol measured at least once every three years

 


Why is it important to have all these checks?


 

  • It is necessary that you are examined and your diabetes is monitored professionally to prevent and detect any complications.
  • Attend Regular Clinics
  • In between appointments it is also important to continue to monitor your diabetes yourself. If you think anything is wrong contact your clinic straight away.
  • It is a good way to set your personal targets for losing weight giving up smoking and to review the changes you have made to help you manage your diabetes better and see how well you are progressing.
  • The sooner changes or problems are spotted, the more likely it is that they can be treated and prevented from getting worse.
  • It is also important that you attend your regular clinic appointments too. Make a note of any question or concerns that you may have so they can be answered at your next visit to the clinic. Maintain a healthy diet and give up smoking these can make a really positive impact.