My Diabetes: Information and Resource PackMy Diabetes:Information and Resource Pack Who is it for? This pack is for all people with diabetes in Surrey. Some people may already know

My Diabetes: Information and Resource Pack

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Contents

Section 1: General Information on Diabetes 5

1.1 What is Diabetes? 51.2 What Happens and What Causes It? 51.3 Myths about Diabetes 61.4 What are the Different Types of Diabetes? 61.5 Type 1 Diabetes 71.6 Type 2 Diabetes 8

Section 2:Management of Diabetes 9

2.1 What Can I Do? 92.2 Coping with Diabetes 102.3 Healthy Eating 122.4 Physical Activity and Lifestyle Changes 18 2.5 Medication for Diabetes 212.6 Measuring Your Blood Glucose Levels 252.7 What Care Should I Expect From the Health Service

for My Diabetes? 322.8 Prevention of Complications 36

Section 3: Living with Diabetes 42

3.1 Diabetes and Health 423.2 Diabetes and Employment 443.3 Driving and Insurance 453.4 Diabetes and Travel 483.5 Social Life 493.6 Diabetes and Fasting 513.7 Diabetes and Other Illness (Sick day rules) 52

Section 4:Who can offer me support? 53

4.1 Your Diabetes Service Providers 534.2 Other Services and Support 574.3 Other Services 594.4 Community Education 614.5 Appendix 61


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Personal InformationPlease complete your personal details below

Name

Address

Postcode

Email Address

Telephone no.

Mobile no.

Date of birth

First language

Next of kin name

Telephone no.

Your GP

Surgery address

Telephone no.

Diabetes specialist nurse

Telephone no.

Hospital ID no


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What is this pack for?

This pack is for you to keep. The aim of the pack is to:

• give you the information you need to be in control of your diabetes on aday to day basis,

• let you to know how and when to seek help from your health care team ifyou need to, and

• inform you of the different services and support that are available to you

• this booklet is for adults with diabetes.

The pack has been divided into 4 sections.

1. Basic information about diabetesThis section gives you an introduction to diabetes.

2. Management of diabetesThis section provides you with information on how to manage yourdiabetes through healthy diet, medication, physical activity and otherlifestyle choices, as well as how you cope mentally. There is also a sectionon what you should expect from your health care team and a checklist ofquestions to help you know what to ask.

3. Living with diabetesThis section provides you with information about aspects of living withdiabetes such as driving, travel and social life.

4. Who Can Offer Me Support?This section provides contact details of the diabetes service providers andother organisations that you might find useful.


Who is it for?

This pack is for all people with diabetes in Surrey. Some people may alreadyknow some of the information in this pack, for others it may all be new. Peoplewith Type 1 diabetes will need further information which will be provided onan individual basis usually by a hospital based team.

Who has written this booklet?

This booklet has been adapted by a multi-disciplinary team from Surrey. Theteam consists of a healthcare professionals and people with diabetes. Some ofthe information draws upon other publications.

Your comments

We do want to know what you think about this booklet as we will be updatingit in the future. Please fill out the form at the back of this booklet to let usknow what you think and if there are any improvements that we can make.

We hope that you find this booklet useful.

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Section 1: General Information on Diabetes

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1.1 What is Diabetes?

Diabetes, or to give its full name ‘Diabetes Mellitus’, is a common condition inwhich the amount of glucose (sugar) in the blood is too high because the bodyis not able to use it properly. Over 2.5 million people in the UK have diabetesand probably another half a million have the condition but do not know it, soyou are not alone. The main two types of diabetes are Type 1 and Type 2. Atpresent, diabetes cannot be cured. However, it can be controlled and you canlead a full and active life. Many patients with Type 2 diabetes have no symptomswhen they are diagnosed.

1.2 What Happens and What Causes It?

Diabetes is having too much glucose in the blood because the pancreas (a glandunderneath your stomach) cannot make enough effective insulin.

The starchy and sugary (carbohydrate) foods that we eat are changed intoglucose which passes into the blood. The glucose provides energy for the bodyto live and grow. Everyone has some glucose in their blood all the time.

Therefore glucose to the body is likepetrol to a car, it provides the energywe need to function. When you eatfood it passes through your digestivesystem where it is turned intoglucose. The glucose then enters intoyour blood stream. Insulin acts like akey allowing the glucose to get fromthe blood stream into the cells togive you energy.

With diabetes you either do notproduce enough insulin or theinsulin does not work properly. Theend result is that your blood glucoselevel is too high and this is whendiabetes is diagnosed. In Type 1there is no insulin produced.

This diagram shows what happens in people withdiabetes.

1. The stomach changes food into glucose whichenters the bloodstream.

2. The pancreas makes little or no insulin

3. Little glucose enters the body cells and glucosebuilds up in the bloodstream.


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1.3 Myths about Diabetes

There are many myths surrounding diabetes and it is important to be clear whatthese are so that you can inform people of the correct information relating toyour condition.

• You cannot get diabetes by eating too many sweets or by eating thewrong things, although if you become overweight and are physicallyinactive this can increase the risk of diabetes.

• There is no such thing as ‘mild diabetes or borderline’ diabetes. Diabetes isdetected through special blood tests. Uncontrolled or poorly controlleddiabetes can be a serious illness and lead to major health problems in thefuture.

• Stress does not cause diabetes, although it may make symptoms worse inpeople who already have the condition.

1.4 What are the Different Types of Diabetes?

There are two main types of diabetes: Type 1 and Type 2 diabetes.Both of these types have the same signs and symptoms.

What are the signs and symptoms of diabetes?You may have experienced some of these symptoms before but not necessarilyall of them. These are: -

• increased thirst,

• going to the loo all the time, especially at night,

• extreme tiredness or loss of energy,

• weight loss,

• recurring infections e.g. thrush, urine infections, skin infections, and

• blurred vision.


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1.5 Type 1 Diabetes

Type 1 diabetes develops when there is no production of insulin in the bodybecause all the cells in the pancreas that produce the insulin have beendestroyed. Nobody knows why this happens but it is thought it is triggered bya viral infection.

This type of diabetes develops quickly, usually over a few weeks and it mainlyaffects children or young adults. People with Type 1 diabetes have stoppedmaking insulin, therefore the body is unable to use the glucose that comes fromthe food they eat. They tend to lose weight very quickly because the body isactually being starved of the energy it needs. Their health will rapidlydeteriorate and they would die if insulin were not given.

However, because these symptoms of diabetes are so noticeable, they areusually diagnosed very quickly and treatment will be started immediately. Thesymptoms are quickly relieved once the diabetes is treated.

Type 1 diabetes is treated by:

• taking insulin injections,

• healthy eating, and

• taking regular physical activity.

Good control of Type 1 diabetes willreduce the chances of developing moreserious health problems.

They

t


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1.6 Type 2 Diabetes

Type 2 diabetes develops when the body is not able to produce enough insulinfor its needs, or when the body’s insulin does not work properly. It usuallyappears in people over the age of 40, but it can occur at a younger age. Type 2diabetes is becoming increasingly common in the UK.

There are many factors which make a person more at risk of developing Type2 diabetes. Those who:

• are overweight particularly if you are bigger round the waist/middle

• have a family history of diabetes,

• have had diabetes during pregnancy, or a history of delivering largebabies

• are 40 years of age or more (your risk increases as you get older),

• are of Asian (are 25 years of age or more), African or Caribbean descent,

• do little physical activity.

• have been previously diagnosed with Impaired Fasting Glycaemia orImpaired Glucose Tolerance.

• have a history of gout or polycystic ovary syndrome.

Type 2 diabetes develops slowly. Some people may not notice any symptoms atall and their diabetes is only picked up at a routine medical check up. You mayonly feel tired, so it is really easy to put the symptoms down to ‘getting older’or ‘overwork’.

How is Type 2 diabetes treated?Type 2 diabetes is treated by:

• healthy eating, maintaining a healthy weight

• regular physical activity

• tablets or insulin may be needed in addition to healthy eating andexercise.

It is important to recognise that your diabetes will change over time, andtherefore your treatment will need to change. This is not your fault but is dueto the progressive nature of Type 2 diabetes. If you currently treat your diabeteswith diet alone, you may need to start taking tablets in the future. If youalready take tablets, your dose may need to be increased and eventually youmay need insulin injections. It is impossible to put a time on these changes.

Section 2:Management of Diabetes

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2.1 What Can I Do?

Diabetes is a life-long condition which you need to take seriously. Managingyour diabetes well is a balancing act where you have to manage yourmedication (if you are taking any), with a healthy diet and physical activity.

Whether you have Type 1 or Type 2 diabetes, you should aim to eat a healthydiet and be as physically active as you can.

The management of diabetes mostimportantly involves self–care. Thefollowing sections will describe howyou can manage your diabetes (Type 1and Type 2) most effectively.

These sections are:

2.2 Coping with Diabetes

2.3 Healthy Eating

2.4 Physical Activity and LifestyleChanges

2.5 Medication

2.6 Checking your Diabetes Control

2.7 Understanding your DiabetesHealth Care Service

2.8 Prevention of Long TermComplications

Your GP, Practice Nurse and DiabetesSpecialist Team are here to support youwith this condition and to help you findways to continue living your life to thefull.

Healthy Diet

Med

icatio

n

Physical Activity


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2.2 Coping with Diabetes

It is a common reaction when you are first diagnosed to be shocked and thento feel a little lost. Some people are relieved that it is nothing worse, othersare fearful and some scared because they feel their life is out of control andthey cannot cope. It is not unusual to feel helpless and overwhelmed. All ofthese feelings are natural and family members may also be having similarfeelings.

Diabetes is your condition and although it would be nice for others to manageit, it is your responsibility to do so with the help and support of healthprofessionals, family and friends.

It takes time to come to terms with your condition and some people have aharder time than others. This means you may experience a number ofemotional changes; anger, sadness, fear, anxiety, or depression (more than justfeeling a bit low).

It is very common for people to feel depressed and anxious, but there are manyways you can help yourself. If the emotions you experience last more than amonth, have a chat with your GP.

Your GP may consider:

• referring you for extra support like psychological counselling, or puttingyou in touch with members of a diabetes self-help group, and/or

• prescribing you medication. You can discuss this with him/her.

Learning about your condition can help immensely by reducing your anxieties.Remember, no question is ‘silly’ and the more you know, the more able you willbe to control your condition. Understanding and discussing your condition withyour family, friends and other people with diabetes can help you understandand cope with your fears.

Your diabetes will not go away if you ignore it, but by controlling it andbuilding the lifestyle changes into your daily routine, you can have a long andfulfilling future.


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10 top tips from our patient representatives:

• Diabetes only restricts your life ifyou allow it to.

• Not every day will be a good day,so be prepared to be a bitflexible.

• You can only cope well if you areeducated in your condition:

- there is a lot of information outthere, you just have to find it,

- if you are not sure – ask,

- if you do not understand – ask,

- if you think something is wrong– tell someone and

- if it sounds wrong - query it.

• If you think you need a doctor – you need a doctor.

• Don’t take no for an answer, always ask why!

• Feeling depressed? Dry skin? Problems with your sexual relationship?These are side effects of diabetes and can be treated - talk to your GP.

• Build a relationship with your pharmacist – they are a wealth ofinformation.

• You don’t have to climb a mountain to exercise, you can walk to theshops or do some gardening! Two steps forward and one step back, isbetter than no steps at all.


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2.3 Healthy Eating

Healthy eating is important for everyone so all family members can eat thesame. Although people with diabetes do not need special foods your foodintake is key to helping you maintain good health. What and how much youeat directly affects your blood glucose levels. Maintaining your blood glucoselevel is a balancing act between your food intake, the amount of daily activityand any medication prescribed by your GP. It is not necessary to buy ‘diabetic’foods. Therefore diets for people with diabetes are designed to:

• keep your blood glucose at near to normal levels

• reduce your risk of developing heart disease or stroke

Your diet is individual to you but it is important that you:

• try to eat regular meals throughout the day

• aim to eat similar quantities of food at each meal each day

• ensure that each meal contains a starchy food such as rice, pasta, potato,chapati, bread or breakfast cereal.

• avoid sugary drinks and large quantities of sugary foods such as biscuits,cakes and desserts.

Starchy foods are our fuel foods. We need these foods for energy but both theamount and type is important. If you eat more of these foods than your bodyneeds, they can raise your blood glucose levels and you may gain weight.Starchy foods and sugars do not all affect the blood glucose levels in the sameway. The glycaemic index (GI) is a measure of how quickly individual foods areabsorbed into the bloodstream and raise the blood glucose levels. Low GI foodscause a slow steady rise in your blood glucose levels and help you to achievesteady blood glucose levelsbetween meals. They includepasta, noodles, new potatoes,basmati or quick cook rice,pulses vegetables such as peas,baked beans, kidney beans andlentils, oats/ porridge andwholegrain bread such asgranary, rye and chapati. Try toinclude them each day in yourdiet.


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It is advisable to have at least 5 portions of fruit or vegetable per day as it couldreduce the risk of heart disease, stroke and some cancers. People with diabetescan eat all fruits and vegetables. As fruit is naturally sweet, try to spread yourintake over the day to help keep your blood glucose levels stable and have oneportion at a time.

What Counts?

• Aim for a variety of fruit and vegetables

• Fresh, frozen, chilled, canned, or dried fruit and vegetables all count

• 100% fruit or vegetable juice counts once per day, even if more than oneportion is drunk

• Beans and pulses count once per day, even if more than one portion iseaten

• Potatoes and other starchy vegetables don’t count

• Fruit and vegetables in convenience foods – such as ready meals, pastasauces, soups and puddings – can contribute to 5 A DAY. But conveniencefoods can be high in added fat, sugar or salt – which should only be eatenin moderation – so check the labelling

How much is a portion?1 portion = 80g(approximately the amount that will fit into the palm of your hand)

Some common portions of fruit and vegetables are:

• 1 medium apple

• 2 kiwi fruit

• 3 heaped tablespoons of frozen peas

• 1 handful of chopped carrot sticks

• 2 small satsumas

• 2 broccoli florets

• small handful of grapes


Here are some tips to include more fruit and vegetables in your diet:

• Add dried fruit (1 tablespoon) to your cereal in the mornings

• Snack on sticks of raw vegetables with a dip

• Drink a small glass (100ml) of fruit juice each day with a meal

• Try to eat a piece of fruit with your lunch and evening meal as a dessert

• Serve at least 2 vegetables with your evening meal

• Add vegetables to your favourite dishes e.g. add peppers and cauliflowerto a curry dish or add peppers, carrots and mushrooms to a pasta dish.

• Incorporate beans or pulses into your cooking

• Add green or salad vegetables to your meals; these provide minerals andvitamins but will not affect your blood glucose levels

Meat chicken, fish, eggsHave smaller portions and choose low fat varieties. If you are vegetarian, pulses,legumes, soya and eggs are the recommended replacements.

Oily fish such as salmon, sardines or mackerel are a good source of omega-3fats which help maintain a healthy circulation; try to eat these once or twice aweek. Fresh but not canned tuna is also a good source.

For non fish eaters small amounts of omega-3 fats are found in sweet potato,dark green leafy vegetables and soya based foods. Unsalted nuts such aswalnuts, pecans, peanuts and almonds are another good source.

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Dessert: Fruit andyoghurt

Starchy food

Meat, chicken, fish,beans, pulses etc.

Vegetables

Suggersted servings atmain meals


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Dairy productsChoose low fat versions of milk, yoghurt and cheese as they have as muchcalcium but less fat than the regular. Aim to take about 3 portions a day – aportion being a glass of milk, a yoghurt or a small cube of cheese.

Suggested snacks between mealsHere are some ideas of the type of snacks you can eat between meals whichmeet the healthy eating guidelines for diabetes if you are not overweight:

• A piece of fruit

• A pot of plain or low sugar ‘diet’ fruit yoghurt/fromage frais

• 2 oat cakes

• 2 plain biscuits e.g. Rich Tea, malted milk, ginger nuts

• A slice of wholegrain bread with a low fat spread,

• A slice of fruit loaf

(If you are on insulin, always make sure you have snacks available if you areaway from home to take should you have a ‘hypo’ whilst out).

Foods to watch out for:-

Sugary foods

These raise the blood glucose levelsand they can also cause weight gain ifeaten in excessFor example sugar, jam, marmalade,syrup, honey, desserts, sweet cakes andbiscuits, sugar-coated cereals,chocolate, sweets, ice-cream, tinnedfruit in syrup, soft drinks and cordials.

• Avoid adding sugar or honey to drinks or food,

• Try to use low sugar alternatives e.g. Sweetex, Hermesetas, Splendaand Canderel,

• Check labels on ‘low fat’ food (eg. yoghurt) which can have a highsugar content: choose ‘diet’ ones instead


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Foods high in fat

A diet high in saturated fats increases your risk of heart problems andstroke. Foods that are high in fat promote weight gain and this may makeyour diabetes harder to control.

Here are some suggestions for reducing the total amount of fat in the diet:

• Choose low fat options when buying foods e.g. skimmed or semi-skimmed milk, reduced fat cheese

• When preparing food cut off fat and skin from meat

• Grate cheese rather than slicing it as less is used

• Use reduced fat spread sparingly on bread

• Choose cooking methods such as grilling, boiling, stewing, steamingor microwaving rather than frying

• Limit high fat snack foods such as crisps and nuts

• Beware of hidden fats in foods e.g. cakes, biscuits, crisps

• Limit processed meat, sausages, salami, gravies, sauces, saladdressings and mayonnaise.


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AlcoholThe recommended safe drinking allowance is up to 14 units a week for womenand 21 units for men and at least 2 alcohol free days per week.

Examples of units in a drink are:

• Pint of ordinary lager or bitter: 2 units

• Pint of strong lager or best bitter: 3 units

• Medium glass of wine (175ml): 2 units

• Single measure of spirits (25ml): 1 unit

Note:

• Alcohol can lower your blood glucose to an unsafe level. If you are oninsulin you are advised to have a starchy snack or meal before drinking

• All alcoholic drinks are high in calories and can lead to weight gain

• Diabetic or low sugar beers and lagers are often higher in alcohol whilelow alcohol beers or lager tend to be higher in sugar

• Avoid drinks that are high in sugar e.g. sweet sherry, sweet wine andliqueurs.

• Always use sugar free or diet mixers and soft drinks

• If you are on certain tablets or insulin, please remember to carry glucoseand make sure friends know that you have diabetes and what to do. It isalso advisable to carry some form of diabetes identification with you e.g. abracelet, ID card or an insulin passport.

There is a lot more to learn about healthy eating. Ask your doctor or nurse torefer you to a dietitian who can help you with your own personal healthyeating plan.


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2.4 Physical Activity and Lifestyle Changes

Why do I need to be physically active?Physical activity can be enjoyable and has many benefits such as helping you:

• Feel more relaxed andless stressed or anxious

• Sleep better

• Have more energy

• Lose weight

• Reduce the risk of heart disease and some cancers

• Control diabetes, high cholesterol levels, blood pressure,arthritis, osteoporosis and the risk of falls

• Increase your body’s sensitivity to insulin

• Maintain supple joints, balance and co-ordination

You could try:

• A brisk walk

• Taking the stairs instead of the lift

• Getting off the bus a stop earlier and walking the rest of the way

• Using a bicycle or walk instead of the using the car for short journeys

To promote good health, the current recommendations are to be active at alevel that increases your breathing rate and makes you feel warmer for 30minutes a day, five or more times a week. Most people are safe to do physicalactivity but if you are concerned or have certain health conditions such as heartdisease or asthma, please consult your GP.


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Types of activitiesBelow is a list of activities you might like to try. Libraries, town halls, schools,community centres, churches and the internet will have more information onthese and other activities in your area:

• Walking – as transport and for fun and at every given opportunity

• Housework and gardening

• Childcare – playing and transporting

• Cycling – as transport and for fun

• Aerobics, Zumba or a home exercise video

• Mobilisation, stretch and relaxation classes

• Bowling

• Swimming/aqua-aerobic classes

• Pilates or yoga

• T’ai chi

• Dancing

Any of the above, if done regularly, will benefit your health. Ideally a mixtureof activities will give you all round health and fitness gains. The most importantelement being the activities that make you slightly breathless (the ‘aerobic’types of activity)


Why should I give up smoking?

Giving up smoking is the most positive thing you can do for your diabetes andyour health in general. Smoking roughly doubles your risk of heart disease andincreases your risk of stroke.

If you are a smoker and want to quit, there are specialised people who can helpyou. In Surrey there are trained GPs and Practice Nurses, however you will needto phone first to find out who is your nearest trained advisor. This service isFREE of charge. They have the tools to help you kick the habit and breathe anew and healthy life.

There are effective treatments available to help you quit your addiction.Some of the services include:-

• nicotine replacement therapy and

• advice and consultation.

Surrey Smoking ServicesFor free advice, support and details of clinics to help you stop smokingTel: 0845 602 3608 – to:

• Increase your chances of stopping successfully with our help and support,

• Identify clinics in your local area,

• Prepare you for stopping,

• Access advice on treatment,

• Access ongoing support.

To find out more, call 0845 602 3608

It is worth it… it can save your life.

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2.5 Medication for Diabetes

There are many different types of medication to treat your diabetes. Your GPor Diabetes Team will recommend to you the most suitable medication regimefor your diabetes condition and lifestyle. You can discuss your medication withthem at any time.It is also important to learn about your medication, e.g:

• know the name of your medication,

• when to take it and how much to take,

• the action of the medication, and

• possible side effects (if any) and if it affects any other medication you aretaking.

a) Tablet treatment for your diabetesIf you have been prescribed tablets for your diabetes, it is because healthyeating alone will not control your blood glucose levels. However, you still needto follow a healthy diet and be physically active in order to manage yourdiabetes.

Some people need to take a combination of tablets to control their bloodglucose levels and some may need to take tablets and insulin. If this applies toyou, remember that needing tablets and insulin is a natural process of diabetes.

Taking your tabletsYour Health care Professional will advise you on when to take your tablets.It is important to remember the following:

• NEVER stop taking your tablets, without consulting your healthcareprofessional,

• for medication taken more than once a day; if you forget a dose by morethan 2 hours, do not take the missed dose. Take the next dose at thenormal prescribed time,

• if you are ill, DO NOT STOP taking your tablets, and

• if you are vomiting, contact your GP immediately.

By taking your tablets as instructed, you will be able to achieve better bloodglucose control and therefore reduce the risk of long term complications. If youexperience difficulty controlling your blood glucose or have unpleasant sideeffects at any time, speak to your GP or a member of your Diabetes Team.


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You should have the right treatment for you and therefore it is important thatyou stay in contact with your clinic and attend your appointments.

The main groups of medication available to treat diabetes are:1. Biguanides eg. Metformin (Glucophage®) Glucophage SR®

Action: Improve your body’s response to insulin and also stop it making too muchglucose. These are often used as the first line of treatment especially forpeople who are overweight.

When to take: Once, twice or three times a day with meals daily.Side effects: Upset stomach and wind, this can be overcome by starting on a low dose

and taken with or after food.

2. Sulphonylureas eg.Gliclazide (Diamicron®), Glipizide and Glibenclamide (Daonil®)Glimepiride (Amaryl®)

Action: Stimulates the pancreas to make more insulin and the body to use theinsulin more effectively.

When to take: Once or twice a day before meals as directed by your healthcareprofessional.

Side effects: Low blood glucose (hypoglycaemia) and possible weight gain.

3. Glitazones e.g. Pioglitazone (Actos®)Action: These tablets increase the action of your body’s insulin.When to take: Taken once a day.Side effects: Fluid retention and weight gain. These drugs should not normally be

prescribed to people with a history of heart disease or stroke.

4. Prandial glucose inhibiters e.g. Repaglinide (Prandlin®) and Nateglinide (Starlix®)Action: Helps your pancreas to produce the right amount of insulin after meals to

cope with the increase of glucose from your food.When to take: Taken directly before meals.Side effects: Upset stomach and wind.

5. DPP-4 Inhibitors e.g. Sitagliptin (Januvia®), Vildagliptin (Galvus®), Saxagliptin (Onglyza®),Linagliptin (Trajenta®)

Action: Works by blocking the action of an enzyme DPP-4, which destroys thehormone called incretin found in the gut.

When to take: Taken once or twice a day.Side effects: Nausea.

6. Incretin Mimetics e.g. Exenatide (Byetta®), Liraglutide (Victoza®), Lixisenatide (Lyxumia®)Action: Works by increasing a hormone called incretin found in the gut.When to take: Exenatide is usually injected twice a day up to an hour before food (usually

before breakfast and evening meal). Liraglutide is injected once daily.Side effects: Nausea and vomiting.

7. SGLT2 Inhibitors e.g. Dapagliflozin (Forxiga®)Action: Works with the kidney to selectively inhibit SGLT2 receptors, resulting in

the removal of excess glucose and its associated calories in the urine.When to take: Usually taken once daily.Side effects: Urinary tract infections, thrush and increased urine production.

If you are experiencing side effects which you find distressing or having anydifficulties with your medications please contact a member of your DiabetesCare Team.


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b) Insulin treatmentIf you have Type 1 diabetes then you must be treatedwith insulin injections and maintain both a healthydiet and regular exercise. Insulin cannot be taken intablet form, as the acids produced in the stomachwould destroy the insulin. However, insulin can becombined with certain diabetic tablets to control yourdiabetes. For people who have Type 2 diabetes,insulin may be recommended by your GP or DiabetesTeam.

Why do I need insulin?You have been prescribed insulin because you have Type 1 diabetes or becauseyour Type 2 diabetes is not being controlled well enough by tablets alone.

How do I start?Many people with diabetes (Type 1 and 2) are fearful at first of taking insulin.Discuss this with your GP, practice nurse or your diabetes specialist nurse whowill give you the information you need and put you at ease before you agreeto start insulin. All the possibilities will be discussed with you to enable you tomake an informed choice. You will be taught how to inject yourself with insulinand you will be supported with an ongoing education plan while you get usedto it. It is most common to take insulin twice or four times a day depending onyour lifestyle.

Below are some of the main discussions which you will have before andonce you have started the insulin.

• What type of insulin is going to fit in with my lifestyle?

• What insulin pen is best for me to use?

• How do I use the insulin pen?

• How do I store my insulin?

• How do I safely dispose of the needles?

For more information about insulin treatments discuss with your practicenurse or contact Diabetes UK for more information www.diabetes.org.ukTel 020 7424 1000 / Care line 0270 424 1030


You will be helped with your first injection by a diabetes specialist nurse, districtnurse or practice nurse.

Insulin is always started at very small doses whilst you get used to taking theinjections. Insulin doses will be increased very gradually (depending on yourblood glucose readings). This will occur under close supervision of a diabetesspecialist nurse.

The diabetes specialist nurse will also go into detail about the following:

• How to recognise and treat a low blood glucose (hypoglycaemia, page 29).

• What to do if you become ill (sick day rules, page 52).

• How often you should be reviewed at your diabetes clinic.

Where do I inject?Injections are given in fatty areas of the body i.e. stomach, thighs and buttocks.Insulin is NOT given into a vein. You will need to change the injection site everytime, as using the same place all the time can make the skin underneath lumpywhich may decrease/change the absorption of your insulin

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2.6 Measuring your blood glucose levels

Why is monitoring of blood glucose important?Good glycaemic control (blood glucose control) is a key goal in themanagement of diabetes. Evidence shows good glucose control delays theonset of and reduces the progression of complications such as heart, kidneyand eye disease.

There are two main ways that blood glucose levels can be assessed

1) Measuring Haemoglobin A1c (HbA1c)

2) Home blood glucose testing

What is Haemoglobin A1c (HbA1c) blood testing?HbA1c is a measure of how much glucose is attached to haemogloblin.Haemoglobin is a protein inside your red blood cells. The HbA1c result allowsyou and your Diabetes Care Team to see how well your diabetes has beencontrolled during the past 2 months.

a) Blood glucose testingYou may be advised to check your blood glucose levels with home monitoringequipment (glucometer). Learning how to test your blood glucose levels givesyou the information to help control your diabetes. Blood glucose testingenables you to see how well your body is responding to your medication, dietand activity levels.

There are various types of blood glucose meters available and your healthcareprofessional will be able to advise you as to the most suitable meter.


How often do I need to test my blood glucose levels?Monitoring your blood glucose may not necessarily be a lifelong requirementand will depend upon the treatment you receive. Your healthcare professionalwill advise you how and when to test your blood glucose. They will also adviseyou how long you need to continue with monitoring your glucose levels.

Testing your blood glucose

• Check you test strips are in date and use your meter according tomanufacturer’s instructions

• Wash your hands (preferably in warm water to encourage blood flow tofingertips) and use a new lancet each time

• The side of the fingertips is less painful and should be used

• Record your results and time of the test in a diary along with any changesin food, activity or medication

• Use a different finger each test

• See if you can understand why your blood glucose varies from day to dayand whether you can make any changes to improve your readings

• Speak to your healthcare professional if you think testing should beincreased.

CalibrationWhen you receive a new pack of test strips it is important to make sure themeter they use works with the new strips. This is known as calibration and isusually done by inserting the special “chip” in the pack of strips into the meteror by entering a code. If this is not done for every new pack of strips thereadings the meter gives will be inaccurate. Not all meters require calibration,check with the manufacturer if you are unsure.

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Situations when testing may need to be increased:

• Loss of diabetes control.

• Change in diabetes treatment.

• When you are ill.

• Driving, particularly long distances.

• If you feel hypoglycaemic.

• If you have lost some of your warning signs of hypoglycaemia.

• If you do strenuous exercise.

• If you are pregnant or breastfeeding

• If you are taking steroids

What should my blood glucose levels be?It is normal for your blood glucose to fluctuate throughout the day. Your bloodglucose will also rise after eating a meal. The best times to test are just beforea meal, or two hours after a meal.

Your blood glucose (glucose) readings should ideally be between 4-7 mmol/L(don’t worry about the mmol/L, just remember the 4-7) before meals. However,your Healthcare Professional will advise you what an acceptable blood glucoselevel should be for you, as well as how often you should test and how toperform the test accurately.


b) What if my blood glucose levels or HbA1c are too high? (Hyperglycaemia)Hyperglycaemia is a blood glucose level that is too high. This is a blood glucoselevel above the healthy range or acceptable level for you. Your GP or yourdiabetes specialist nurse will advise you what your acceptable blood glucoselevel is.

The symptoms of a high blood glucose level are:

• tiredness and loss of energy,

• increased thirst,

• passing urine more frequently, and

• susceptibility to infections.

How is it caused and what should I do?You can have high blood glucose levels for many reasons.

The main reasons are:

• eating large meals containing too much starchy or sugary carbohydratefoods,

• not having enough medication (insulin or tablets),

• less exercise taken than usual,

• emotional stress, and

• having an infection or fever.

The following may also help:

• do more frequent blood testing, and if these are too high contact your GPor diabetes specialist nurse,

• address your diet for example, e.g. am I eating too much sugary food?

• do more physical activity, e.g. go for a walk.

Without treatment you may become increasingly unwell. If your blood glucoselevels are consistently high, it is best to make an appointment to see your GPor diabetes specialist nurse to discuss what to do. Remember, long-term highblood glucose levels can also cause complications associated with diabetes.

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c) What if my blood glucose levels are too low? (Hypoglycaemia or ‘hypo’)If you require medication for your diabetes (insulin or some tablets), youcould experience hypoglycaemia. Hypoglycaemia or ‘hypo’ is a blood glucosethat is too low, that is below the healthy range for a blood glucose level (lessthan 4 mmol/L).

Hypoglycaemia does not occur when people control their diabetes with dietalone, or when the tablet used is Metformin.

What will I feel like?

A ‘HYPO’ HAPPENS SUDDENLY…

Below are some of the symptoms you may experience during a ‘hypo’. You mayexperience one or more of the symptoms.

• Excessive sweating,

• Shaking,

• Paleness,

• Headache,

• Hunger,

• Tingling of the lips and tongue,

• Pounding of the heart,

• Blurred vision,

• Lack of concentration, and

• Personality change – irritation and anger.

Your GP or diabetes specialist nursewill tell you if you are likely toexperience these, when you startyour diabetes medication.


Why does a hypo happen?You need to ask yourself why is it happening? These are some of thereasons:-

A low blood glucose can occur when:

• you have missed a meal, snack or are late for a meal,

• eating too little or dieting,

• you have done more physical activity than usual or restarted exercise aftera break,

• you have taken too much insulin or diabetes tablets,

• you have drunk alcohol without food,

• if the weather is hot, or

• if you are feeling very stressed.

What do I do to treat a low blood glucose/‘hypo’?Do not delay – take one of the following steps:

• You can use 5-7 glucose tablets (such as Dextrose). These are available fromany pharmacy, or 100mls of Lucozade

• If you do not have glucose tablets take something sugary, such as one of thefollowing:

- 3-4 teaspoons of sugar,

- 3-4 jelly babies,

- 4-6 wine gums,

- or 2 X 25g Glucogel.

If you do not feel better in 5-10 minutes or your blood glucose level is still lessthan 4 mmol/L, repeat one of the above.

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Once you are feeling better (usually after 5-10 minutes) or your bloodglucose is 4 mmol/L or higher, then have something to eat, such as:

• your next meal if due,

• 1 slice of bread,

• 1/3 pint of milk and a plain biscuit,

• a portion of fresh fruit,

It is important to never stop your diabetes medication if you have had a ‘hypo’.If you are having low blood glucose/’hypos’ regularly, you MUST go and seeyour GP or diabetes specialist nurse to review your treatment.

Glucose meter company helplines (for queries about your meter)

Roche 0800 701 000 (Aviva, Nano, Mobile and Expert meters)

Lifescan 0800 121 200 (One Touch, One Touch Ultra Easy)

Abbott 0500 467 466 (Freestyle Lite, Freestyle Insulinx and Optium)

Bayer 0845 600 6030 (Ascensia Contour, Breeze meters)

Menarini 0800 243667 (Glucomen LX)

Dime 01483-755133 (GlucoRx)

If you are unclear about why you are testing or if you feel this testing guidedoes not meet your needs, please discuss this with your diabetes healthcareprofessional.


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2.7 What Care Should I Expect From the Health Service for My Diabetes?

To achieve the best possible diabetes care, you needto work together with healthcare professionals asequal 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 isvery important as this appointment checks yourhealth and ensures that any problem can be treatedquickly. Some GPs will do this but sometimes your GPwill refer you to see doctors at other clinics as theymay 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 testingresults,

• your 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 Surrey,• your legs and feet should be examined to check your circulation and nerve

supply, and if necessary you should be referred to podiatrist/chiropodistregistered with the Health Professions Council,

• your weight should be recorded to make sure you are a healthy weight foryour height,

• any problems with erections or sex performance should be discussed,• 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.If you have not, you should discuss this with your GP.

For details of tests & meanings see appendix 1 on page 61.


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Structured Education Programmes on DiabetesThere are specialised education programmes available to support your diabetesself-management. People with Type 1 diabetes will be offered the BERTIEprogramme and people with Type 2 diabetes will be offered access to theConversation Map training programme. Please ask for details from yourDiabetes Care Team.

Your Diabetes Care TeamThe Diabetes Care Team is made up of a number of health care professionals,who you see, how often you will see the team will depend on the level of careyou require to control your diabetes and what your individual needs are.

The roles of the Team members are listed below. You will find their contactdetails in Section 4.

Meet your Diabetes Team

General Practititoners (GPs). Your GP has overall responsibility for the care youreceive, and most GPs run diabetes clinics.

Practice Nurse / Nurse Practitioner has a central role in providing nursing anddiabetes care. A practice nurse may be the person at the surgery who providesyou with most of your diabetes care with support from your GP if necessary.

Diabetes Specialist Nurses (DSNs) have specialist expertise in diabetes care andwork solely with people who have diabetes, giving advice, and providingeducation and training. Some Diabetes Specialist Nurses have undertakenadditional study and are able to prescribe medication.

Diabetologists/Endocrinologists are Consultants who specialise in diabetes,they are based at the following Hospital Diabetes Clinics: Dorking CommunityHospital, Dorking, East Surrey Hospital, Redhill and The John Kilner Unit, EpsomGeneral Hospital, Epsom.

Dietitians can give individual dietary advice. Everyone with diabetes is entitledto receive advice from a Dietitian registered with the Health ProfessionsCouncil. They may be available at your GP surgery, Hospital, or CommunityClinics.


Podiatrists Podiatrists- registered with the Health Professions Council; play animportant role in managing and preventing foot complications. They undertakeannual reviews of your circulation and sensation, informing you of the results.They offer advice and treatment on general foot care, footwear and theprevention of complications. Podiatry sessions are held in a variety of settings;community clinics, local health centres, GP practices and hospital clinics.

Optometrists are based in opticians, testing people’s eyesight and fittingglasses. Eye tests are free to people who have diabetes.

Pharmacists are based in all pharmacies/chemists. They will give you yourmedication supplies when you provide them with a prescription from your GP.

GPwSI these are GPs with a special interest in diabetes care, and who may alsowork in hospital based diabetes clinics.

Talking to Your Health Care ProfessionalHealth Care Professionals want you to take an active role in your healthcare.You and your Health Care Professional should work together in partnership toachieve your best possible level of health. An important part of this relationshipis good communication.

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Questions you may wish to ask your health professional.

About my condition. . . • What is my diagnosis?• What caused my condition?• Can my condition be treated?• How will this condition affect other health problems I have?• Should I watch for any particular symptoms and notify you if they occur?• What lifestyle changes should I make?

About my treatment. . . • What is the treatment for my condition?• When will the treatment start and how long will it last?• What are the benefits of this treatment and how successful is it?• What are the risks and side effects associated with this treatment?• Are there foods, drugs, or activities I should avoid while I am on this

treatment?• If your treatment includes taking a medication, what should I do if I miss a

dose?• Are other treatments available?

About my tests. . . • What kind of tests will I have?• What do you expect to find out from these tests?• When will I know the results?• Do I have to do anything special to prepare for any of my tests?• Will I need more tests later?

A few tips on communication.• If you do not understand your Health Care Professional’s responses, ask

questions until you do understand.• Take notes or get a family member or friend to come with you and take

notes, you could bring a tape recorder but you should ask if you can use itfirst.

• Ask your Health Care Professional to write down his or her instructions toyou.

• Ask your Health Care Professional for printed material about your condition.• If you still have trouble understanding your Health Care Professional – ask

where you can go for more information.• All members of your health care team, nurses, pharmacists, dietitians,

podiatrists, psychologists can be a good source of information, so talk tothem.


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2.8 Prevention of Complications

With treatment of your diabetes, your general health will improve and youshould also notice an improvement in your energy levels. It is important thatyou maintain good control of your diabetes, as continuing high blood glucoselevels can cause damage throughout the body.

Parts of the body that can be affected are your eyes, kidneys, heart and feet.These problems are discussed in more detail below. Evidence has shown thatpeople with Type 2 diabetes who look after and control their diabetes well,minimise their risk of developing diabetic complications (as shown in the UKProspective Diabetes Study). Therefore, there are very good reasons to takeyour diabetes seriously.

Your eyesDiabetes can lead to visual problems (in some cases blindness) due to cataractsand changes in the retina at the back of the eye (this is called retinopathy). Ifyour diabetes is well controlled, then you are less likely to have problems, orthey may be less serious.

Most loss of vision due to diabetes can be prevented, but it is vital that it isdiagnosed early. This can only be detected by a detailed examination of theeyes. Therefore regular annual eye examinations are extremely important, asyou may not realise that there is anything wrong with your eyes until it is toolate.

In Surrey the retinal screening service is organised by DRSSS using digitalcameras based at various sites around the county.

Your kidneysDiabetes can cause damage to the kidneys, which is known as renal disease ornephropathy. Your GP should check your blood pressure (high blood pressureincreases the risk of kidney damage) and kidney function regularly. This willtake place at your annual review. You will also be asked to produce a urinesample each year to check for ealy signs of damage to the kidneys caused bydiabetes (microalbuminuria). Sometimes medication may be suggested to helpprotect your kidneys.


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Your heartHaving diabetes puts you at a 25% higher risk of a heart attack or stroke thansomeone without diabetes. Evidence has shown that by keeping tight controlof your blood sugars, cholesterol level and blood pressure you can reduce thisrisk by up to 40%.

What is cardiovascular disease? (Heart and Blood Vessels)Your heart is a very hard working muscle which requires a good supply ofoxygen rich blood. This blood is delivered by the coronary arteries which sit onthe outside of the hearts surface. Over a period of years these arteries developa “plaque”, making them narrower - this is otherwise known as “heart disease”or “atheroma”. The speed in which these arteries become narrowed dependson many factors, known as Risk Factors.

These include:

• smoking,

• high saturated fat diet/raised cholesterol levels,

• lack of exercise / physical activity,

• hypertension (high blood pressure),

• diabetes.

It is thought that in people with diabetes, this plaque collects in the arteriesmore easily than in people who don’t have diabetes – increasing their“cardiovascular risk”. This is why it is very important to ensure yourcholesterol level and blood pressure are regularly checked and monitored,that you don’t smoke and that if you do you consider stopping and that youare physically active on a regular basis.

Medication may be suggested to help reduce your risk of cardiovasculardisease if blood pressure or cholesterol levels are too high. Eating fiveportions of fruit and vegetables a day and 1-2 portions of oily fish a weekprotects your heart.


Weight ManagementA combination of healthy eating, watching your portion sizes and regularphysical activity has been shown to be the most successful way of losing weight.

A common approach to weight loss is to go on a diet for a limited period oftime, however, permanent changes to your lifestyle are required for long-termsuccess.

If you need support or advice with weightmanagement, ask your health careprofessional to arrange a referral to adietitian.

Your feetDiabetes can lead to:

• nerve damage in the feet and legs resulting in a loss of sensation, pins andneedles or possible numbness and burning sensations. This is calledneuropathy.

• a reduced blood supply to the feet and legs resulting in cold, painful feet.

This means that injuries to the feet may go unnoticed, be slow to heal and canquickly become infected - you should seek help urgently from your GeneralPractitioner, Podiatrist, Nurse or Hospital Diabetes Clinic if there is any sign ofinfection such as pain/discomfort, inflammation, colour changes and orweeping.

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It is important that your feet are examined as part of your Annual Review(see page 32) each year so that any problems can be treated early. To preventproblems it is important that you care for your feet. The following informationshould help.

1. Wash feet daily with a mild soapand luke warm water.

2. Dry feet thoroughly especiallybetween the toes, using a soft towelor tissue.

3. For moist / sweaty skin swabbetween the toes with surgicalspirit.

4. If skin is dry use moisturising creambut avoid applying between toes.

5. When cutting toenails follow thecurve of the nail and avoid digginginto the corners. Do not cut nails tooshort.

6. Use a pair of nail nippers and filethe nails to avoid sharp edges.

7. For problem nails such as ingrownor thickened nails, or if you havepoor eyesight consult a Podiatristregistered with the healthprofessions council (HPC).

8. Corns and calluses should be dealtwith by a podiatrist. Do not userazor blades, corn plasters etc.However you may use a pumicestone to smooth hard skin andcorns.


9. Choose shoes with a fastening suchas laces to hold the foot in place.Wear closed in shoes with a deep,round toe box to allow plenty ofroom for the toes.

10.Have feet measured when buyingnew shoes. Always wear in newshoes gradually and avoid shoeswith seams to prevent rubs / blisters.

11.Avoid walking barefoot – alwayswear shoes / slippers outdoors andindoors to protect your feet.

12.Change socks daily. Wear socks orstockings which fit correctly and arein good repair.

13.Look at your feet every day. Checkbetween the toes and underneathyour feet, you may need to use amirror.

14.Things to look out for:• cuts, scratches, and blisters,• any change in colour (red, black,

blue, white),• sudden changes in temperature,• any discharge from a break or

crack in the skin,• any unusual swelling, and• painful areas.

15.Check shoes inside and out beforeputting them on for rough edges orforeign objects, which may irritatethe skin. You may not be able to feelthese if you have a loss of sensation.

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There may be times when you need to see a Podiatrist urgently because of aserious/acute problem.These can include:

• sudden onset of pain or swelling

• discharge/weeping or discoloured skin

• inflammation, blisters, in-growing toe nail or foot ulceration

• other high risk foot problems would include an area of callus that isdiscoloured as this may be hiding an ulcer underneath and requires prompttreatment.

Where can I go for Urgent foot problems?

Leatherhead Emergency Foot Clinic: Walk-in clinic on a Friday afternoon:1.30-4pm. You do not need a referral or an appointment and patients areseen in order of arrival. Please note routine treatment such as simple nailcutting is not provided. Address: Leatherhead Clinic, Poplar Road, Leatherhead, KT22 8SD.

Epsom Hospital, John Kilner Diabetes Unit: Patients already seen in the JohnKilner Unit can access this clinic by booking an appointment on 01372735444. The Podiatrist is there every Monday, Tuesday, Wednesday and FridayMorning.Address: Dorking Road, Epsom, Surrey KT18 7EG.

East Surrey Hospital: Patients registered with a GP within the East Surrey areacan self refer to the Podiatry Service by telephoning 01737 231622 (lines areopen between 10am-12pm & 2pm - 4pm daily). No drop-In clinics are run;appointments are required prior to treatment. Clinics are held daily, Mondaythrough Friday.Address: Canada Avenue, Redhill, Surrey RH1 5RH.

Section 3: Living With Diabetes

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Section 3: Living with Diabetes

Living with diabetes can have an impact on different areas of your life. Howyou feel about managing your diabetes and the demands of coping with itstreatment can feel too much at times. Talking through these worries withsomeone you can trust can be helpful, with a friend, a member of your familyor one of the healthcare professionals involved in your care. If you are underthe care of the Community Diabetes Team, they may ask whether you wouldlike to see someone from the Psychological Support Service who would be ableto provide specialist help and support.

3.1 Diabetes and Health

Concessions

• Everyone on medication for diabetes is eligible for free prescriptions. Askyour pharmacist or GP for an exemption certificate.

• You are eligible for a free flu vaccination which is available at your GP’ssurgery during October and November each year. It is stronglyrecommended that people with diabetes receive the flu vaccine.

• You are eligible for free eye checks and podiatry care as required andrecommended by your Diabetes Care Team.

• Pneumococcal Vaccination to help protect against pneumonia and usuallygiven free at your GP surgery.

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


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Pregnancy and diabetesPlanning for pregnancy needs a little extra care when you have diabetes.

• Ideally pregnancy should be planned. You should see your GP if you havediabetes treated with tablets or insulin, and plan to get pregnant.

• It is important that you make sure that your blood glucose levels are wellcontrolled before you conceive. High blood glucose, especially in the firstthree months of pregnancy, increases the risk of development problemsfor the foetus.

• The dose of folic acid used in pregnancy if you have diabetes is 5 mg oncea day. This is higher than the normal dose of folic acid recommended inpregnancy. This dose needs to be prescribed by your GP. Ideally you shouldstart folic acid when you are planning your pregnancy.

• A healthy diet is part of the on-going treatment for everyone withdiabetes but extra care may be needed to control weight increases duringpregnancy – remember, you are not eating for two! Discuss any foodcravings with your midwife or diabetes specialist nurse.

• Getting enough physical activity is very important. Your midwife ordiabetes specialist will discuss with you how you can include physicalactivity in your everyday life.

• By being prepared, following advice and by asking questions you will helpreduce the stress which may be experienced during pregnancy.

• If you are in any doubt about your pregnancy or diabetes treatment talkto your midwife or GP .

There are pre conception clinics held at Dorking Hospital, East Surrey Hospitaland The John Kilner Diabetes Unit and women considering pregnancy can askto be referred.

Operations and diabetesIf you are going to have an operation, you need to make sure your diabetes iswell controlled.


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3.2 Diabetes and Employment

Diabetes does not have to make a difference to your work. To prove this toyour employer your diabetes will need to be well controlled and you must beable to adjust your treatment to fit your working life. You may find you needspecific advice in relation to your particular job.

Discrimination in the workplaceUnfortunately there is still discrimination in the workplace based on prejudiceand lack of information. People with diabetes may be afforded protection bythe disability clauses of the 2010 Equality Act. This makes it illegal for employersto treat people with disabilities differently from other employees. Althoughmost people with diabetes do not consider themselves as disabled, diabetes iscovered under the Act. If you feel you are being discriminated against, youshould contact your union, phone Diabetes UK Careline or contact your localCitizens Advice Bureau (CAB).

Applying for a jobIf there is a health section on an application form, you should state that youhave diabetes. You might like to put ‘well controlled diabetes’ if this isappropriate. It is important to be honest with your employers in your form andat the interview, emphasise the positive aspects such as having to be aware oftime, following a healthy lifestyle and keeping to a regular routine.

Jobs where recruitment restrictions may apply include• Armed Forces,• Airline Pilot,• Cabin Crew with most airlines,• Sometimes jobs requiring a Group II Driving License,• Working offshore including work for big cruise liners,• Train driving,• Cab or taxi licenses - local practice varies.

In some of the occupations listed above, if you were already employed whenyou developed diabetes, it is sometimes possible to continue. It is important tocheck if you are changing from tablets to insulin.

If you have been diagnosed while you are still at work, let your manager andhuman resources department know. You may need to take time off work, tryto keep them informed of your progress. Tell your colleagues at work as it iseasier if people understand what has happened to you and they will give yousupport.

Discuss any employment concerns you have with your GP or diabetes specialistnurse.


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3.3 Driving and Insurance

Having diabetes may not prevent youdriving a car or a motorbike. As longas your diabetes is well controlledand your doctor says you are safe todrive, there is no reason why youcannot be issued with, or retain adriving license.

You must however inform the Driver and Vehicle Licensing Agency (DVLA) bylaw about your diabetes if you are treated with insulin or tablets. You do notneed to inform the DVLA if your diabetes is treated by diet alone. Drivinglicenses have to be reapplied for every 3 years. Further information is availableat the DVLA website http://www.dft.gov.uk/dvla/ You also need to inform yourinsurance company of your diabetes. At each renewal, update them on anychange in your condition or its treatment.

DVLA Advice – It’s the Law!

Carry your glucose meter and blood glucose strips with you and check yourblood glucose before driving (even on short journeys).On long journeys, you should test regularly (every 2 hours).

In each case if your blood glucose is 5.0mmol/l or less, take a snack beforedriving.

If it is less than 4.0mmol/l or you feel hypoglycaemic, do not drive.

If hypoglycaemia develops while driving, stop the vehicle as soon as possiblein a safe location, switch off the engine, remove the keys from the ignitionand move from the driver’s seat.

Always keep an emergency supply of fast-acting carbohydrate such asglucose tablets or sweets within easy reach in the vehicle.

Carry personal identification indicating that you have diabetes in case ofinjury in a road traffic accident.

Particular care should be taken during changes of insulin regimens, changesof lifestyle, exercise, travel and pregnancy.

Take regular meals, snacks and rest periods on long journeys. Always avoidalcohol.


Driving and diabetes FAQs

I’m on insulin. I haven’t got the time to test before driving. Do I really have to?Yes you do. Testing before driving is a DVLA requirement, even for shortjourneys. If there is an accident your meter could be checked to see when youlast tested. You could be prosecuted.

I’m not on insulin. Does any of this apply to me?If you are taking tablets such as gliclazide you could experience a low bloodglucose. If you have had symptoms of a hypo you should be testing before youdrive. People taking metformin alone do not need to test. Please check withyour doctor or diabetes nurse if you are unsure.

I don’t have hypos, so it doesn’t apply to me.If you are on insulin, or are taking some types of tablets, you must test. Inpractice everyone who is taking insulin will inevitably have a low bloodglucose occasionally.

I’m lucky - I don’t feel a hypo until my blood sugar is well below 4.0.This is NOT lucky. If you don’t have any symptoms until your blood glucose isvery low you have impaired hypoglycaemic awareness and should not bedriving! Talk to your doctor.

I often get a result under 4 that I wasn’t expecting when I do a routine test. Doesthat count?Yes it does. Frequent unexpected results below 4 mean that your warningsigns are poor and you should not be driving. Talk to your doctor.

What happens if I need help from someone else to get over a hypo?You should always contact your diabetes team promptly if this happens. If youhave more than one severe hypo (that is one needing help from someone else)in a 12 month period you must stop driving and inform the DVLA. If you havea vocational licence you must inform them after one severe hypo.

I had a bad hypo in the night and needed help to get over it. Where do I stand?Since 2011 the rules are the same for day and night time hypos needing helpfrom someone else.

I don’t have good waning signs of my hypos. Is there anything that I can do toget them back?Talk to your doctor. If you have been experiencing frequent low blood glucoselevels it may be possible to adjust your treatment so that your warning signsare gradually restored

I can’t give up my license. I need it for work, to take the children to school, forhospital appointments, or because I can’t walk far.We understand that driving is very important for many people but this is theLAW and is there to keep you, other road users and pedestrians safe.

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Other types of Insurance

Life AssuranceSome people with diabetes also have difficulties while trying to get life cover.It is important that you declare your diabetes when applying for a newassurance policy. Any life assurance policy you hold at the time of diagnosis isunaffected.

Travel insuranceInform your travel insurance company that you have diabetes and whatmedications you are taking. You will probably have to pay a higher premiumas most companies do not cover pre-existing conditions. Make sure you checkcarefully whatever policy you buy that it provides you with cover for yourcondition. For all types of insurance it is advisable to approach differentcompanies as quotes may vary considerably. Diabetes UK will also be able togive advice.


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3.4 Diabetes and Travel

If you are planning a holiday you needto go through this checklist to makesure you have a safe and happy holiday.

Medication

• Have enough medication for the whole of your trip and include extra in caseyou are delayed for a few days.

• Have the right vaccinations before you go, check with your practice nurseor GP. It is a good idea to have these done early as they may upset yourdiabetes control in the short term.

• Know what to do if you are travelling across time zones. Discuss this withyour GP or diabetes specialist nurse once you have booked your flights, sothey can advise you about your medicines.

• Carry your medication in your hand luggage to ensure that it arrives withyou. If there is more than one person travelling divide medication suppliesbetween you in case some are lost or damaged.

• If you are on insulin, you will need a letter from your GP or clinic verifyingthat you have diabetes so that you can explain at customs why you arecarrying syringes and needles.

• Insulin should be kept out of direct sunlight and kept cool. Cool bags areavailable, or find cool storage on your arrival. Insulin should not be allowedto freeze, hence the luggage hold is too cold. Insulin may be absorbed fasterin warmer climates so regular blood tests are important to avoid ‘hypos’. Itis a good idea to check beforehand with your accommodation where youcan store your medication.

Diet

• Carry some healthy snack foods in your case and also in your hand luggagefor long flights.

• It is usually better to avoid ‘special diabetic meals’ on the aircraft, as theseare often just low in carbohydrate as opposed to being a balanced meal.

• In terms of choosing food when abroad, try and stick to the same rules athome about healthy eating (see page 12).


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Feet

• Make sure that you have comfortable, well fitting shoes in case your feetswell in hot weather.

• Avoid going barefoot, particularly in the hot sand and sea. Make sure youdo not get sand in your shoes.

• Apply sunscreen to your feet to avoid sunburn

• If you develop a foot problem on holiday do not wait until your returnhome to seek medical attention

General

• Carry plenty of bottled water to ensure you drink safe water regularly.

• It is a good idea to know how to say, ‘I have diabetes’ in the language ofthe country you are going to. Carry your diabetes identity card with you.

• If you are taken ill while on holiday, never stop your insulin or tablets evenif you cannot take solid foods.

• It is a good idea to discuss any concerns you have about travelling withyour health care professional beforehand.

3.5 Social Life

Your social life should not alter much, you just need to plan and have acontingency for emergencies. You need to work with your diabetes and beaware of your daily needs. This means ensuring that you are well organised andwell prepared. It is not always easy to be spontaneous and gradually you willget used to what you can and cannot do without planning in advance. If youhave a car or are going out in a car, carry an emergency box (some glucosetablets, packet of biscuits or crackers, bottle of water, lucozade etc), that wayyou will always have a backup. If you carry a bag, take glucose tablets and somebiscuits.

Make sure you tell your friends and family about your diabetes and what yourneeds are. This will help them to look after you and be more considerate whenyou say, ‘I need to stop for something to eat’, or ‘I think I am having a hypo’.


Eating with friendsPeople can panic about what they can and cannot serve you. Reassure themthat your needs are similar to other people, you just have to be a bit morecareful. Ask your host what he/she is serving and explain your needs and thereasons behind them.

• Make sure you know what you are going to eat and when, so that you canplan your meals around it.

• Ensure that the meal will have enough starchy foods and that there willbe alternatives to some of the richer foods.

• Do not overindulge during the day if you know you will be eating a bigmeal in the evening.

• If the meal is late, make sure you have something to eat when you need it,even if you cannot then eat the whole of the meal provided.

• If you intend to drink alcohol ensure you test your blood before you go tobed.

Eating outEating out for the first time may concern you. Ask for advice from your Healthcare professional but don’t be put off.

Usually you can see themenu first - some goodrestaurants will send you amenu in advance and somehave them on their web site.Choose wisely and ask howlong until the meal will beserved once you give theorder. If necessary ask forsome starchy food (e.g.bread, potatoes, crackers) ifit is going to take too longand you cannot wait.

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3.6 Diabetes and Fasting

What if I want to fast and I have diabetes?There are times when you may need to fast for medical or religious reasons. Ifyou are fasting your diabetes treatment may need to be adjusted. You will needto discuss this with your GP or practice nurse.

What if my treatment is diet only?People with diabetes controlled by diet alone may fast.

What if I take tablets?If you take tablets for your diabetes you may fast but the timing of your tabletsmay change.

Taking your tablets• You should always take your tablets regularly.

• It is essential that you do not stop taking your diabetes medication.

• If you want to fast it is best to discuss this individually with your PracticeNurse or Diabetes Specialist Nurse.

What if I am on insulin?If you are on insulin then you need to be very careful if you decide to fast. It isimportant to contact your GP or Diabetes Specialist Nurse to discuss this withhim/her.

It is important that you see your GP or Diabetes Specialist Nurse before youchange your medication or insulin doses. You will also need to talk to adietitian about the dietary guidelines during fasting.


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3.7 Diabetes and other illness (Sick day rules)

When you become physically unwell, your body reacts by raising your bloodglucose levels, so worsening your diabetes control. Illnesses and infection thatcan upset your diabetes control include:• colds, bronchitis and flu,• vomiting and diarrhoea,• urinary infections (e.g. Cystitis), and• skin infections (e.g. boils, skin ulcers and inflamed cuts).

Below is a guide to help you through this challenging time.

1. Blood glucose testingMeasure your blood glucose levels more frequently when you are ill, asinfections/fevers will increase your blood glucose levels. You should aim to testat least 4 times per day.

2. MedicationIt is important at the time of illness not to stop taking your tablets or insulin.You need to get advice from your GP or Diabetes Team if any of the followingoccur:• if your blood glucose levels are high (greater than 13 mmol/L) you may

need your doses of tablets or insulin to be increased,• if your blood glucose levels are continuously high, you are vomiting and

are unable to keep anything down, or if you are unsure what to do,• if you are taking other medications e.g. blood pressure pills as these may

be affected by illness.

3. Food and DrinkDuring times of illness your appetite and fluid intake may be affected.Here are some tips to help speed your recovery:

• drink plenty of fluids, aim for five pints (3L) of unsweetened fluids a day.• if you cannot eat solid food, try to take in some carbohydrate in the form

of some easier to eat foods such as:- milk drinks,- soup,- ice-cream,- liquid replacement drinks,- drinking chocolate,- ordinary squash or fizzy drinks, or- yoghurt.

• if you are not hungry try eating small regular meals/snacks.

Section 4:Who Can Offer Me Support?

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4.1 Your Diabetes Service Providers are:-

Hospital Diabetes Clinics are held at;

Dorking HospitalHorsham RoadDorkingRH4 2AATelephone: 01306 646238Fax: 01306 883492Diabetes Nurse via outpatients 01306 646238 www.dorkinghealthcare.co.uk

John Kilner Diabetes UnitEpsom HospitalDorking RoadEpsomKT18 7EGMain Number: 01372 73 5444www.epsom-sthelier.nhs.uk/welcome/

East Surrey HospitalCanada AvenueRedhillSurreyRH1 5RH Main Number: 01737 768511Diabetes Nurses: 01737 231788www.surreyandsussex.nhs.uk/esh


Community Dietetic Service

Nutrition and Dietetic DeptRowan HouseEpsom General HospitalDorking Rd,EpsomKT18 7EGTel: 01372 735278Fax: 01372 735178

Department of Nutrition and Dietetics East Surrey HospitalCanada AvenueRedhill RH1 5RH Tel: 01737 768511 ext 6134

Retinal Screening Service

Diabetes Retinopathy Screening Service in Surrey (DRSSS)Surrey Community HealthFarnham HospitalHale RoadFarnhamSurreyGU9 9QLTel: 01483 408324Email: [email protected]

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Departments of Podiatry

Podiatry Department,Rowan HouseEpsom General HospitalDorking Road, Epsom KT18 7EGTel: 01372 735192Fax: 01372 735492

Podiatry ServiceEast Surrey HospitalCanada AvenueRedhillSurrey RH1 5RHTel: 01737 231622Fax: 01737 231775

PALS (Patient Advice and Liaison Service)

For general advice, information andguidance when you need help:-

General health care services provided outside of hospitalcall 0800 0525 270minicom service 0113 305 9494

For Hospital services in SurreyEast Surrey Hospital: 01737 768511 extensions 6922 or 6831 [email protected] Hospital: 01372 735243


Ambulance services

South East Coast Ambulance ServiceSurrey OfficeThe HorseshoeBansteadSurreySM7 2ASTel: 01737 353333Fax: 01737 370868http://www.secamb.nhs.uk

Sign Language, Braile, Interpreting & Deaf Services

Sign Language Interpreters/lip speaker & deaf services or note takers can bebooked by contacting:

Surrey Interpreting AgencyRentwood Resource CentreSchool LaneFetchamLeatherheadSurrey KT22 9JX Telephone: 01372 360718Textphone/Minicom: 01372 362471Fax: 01372 363239Email: [email protected]

This service can be booked by Health Care Professionals or service usersAn interpreting service is available from Diabetes UK Careline 0845 120 2960

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4.2 Other Services and Support

NHS DirectCALL: 0845 4647

This is a 24-hour nurse advice and health information service, providingconfidential information on:

• what to do if you or your family are feeling ill,

• particular health conditions, including diabetes,

• local healthcare services, such as doctors, dentists or late night openingpharmacies, and

• self-help and support organisations.

NHS Direct works hand in hand with other healthcare services provided bythe NHS, helping you make the right choice to meet your needs. Calls toNHS Direct are charged at local rates and for patient’s safety, all callsare recorded.

If you like to be more involved with diabetes service provision as arepresentative of those who use the service please contact:

Dr. Stewart TomlinsonMedwyn SurgeryReigate RoadDorkingSurrey RH4 1SD01306 882422

or

Dr Andreas Pitsiaeli Heathcote Medical CentreTadworth KT20 5TH01737 360 202


Diabetes UK

Diabetes UK is the largest charity devoted to diabetes. It offers many benefitsand services to members including educational events, a bi-monthly magazine,information about your diabetes care and about local groups. There is a specialDiabetes UK Care-line to help you with any questions you have about diabetes.It is open from 9am to 5pm Monday to Friday, telephone: 0845 120 2960 oremail: [email protected].

Diabetes UK10 ParkwayLondonNW1 7AATel 020 7424 1000/Careline 0845 120 2960www.diabetes.org.uk.

Surrey Downs Clinical Commissioning Group

Surrey Downs CCG Pascal PlaceRandalls Research ParkRandalls WayLeatherheadSurreyKT22 7TW

Tel: 01372 201700

www.surreydownsccg.nhs.uk

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4.3 Other Services

Mind

Offer a range of services and information including self-help and supportgroups, counselling, supported housing and employment.

Woking Mind Phone: 01483 766998 Email: [email protected] Contact: David Rye / Pauline Rogers Website: http://www.wokingmind.org.uk

Croydon MindPhone: 020 8668 2210 Email: [email protected] Website: http://www.mindincroydon.org.uk

Information for Mental Health

Surrey and Borders Partnership NHS Foundation Trust.

Provides resources and information about mental health for people in Surrey.

18 Mole Business Park Leatherhead Surrey KT22 7AD Tel: 01883 383838 http://www.sabp.nhs.uk/

Respond - Community Drug and Alcohol Team (East Surrey)

Tylney House 23 High Street Leatherhead SurreyKT22 8AB Tel: 01372 379739Fax: 01372 379525


Sharps Disposal Service

Elmbridge Borough CouncilWill collect free of charge upon request from local residentsContact Environmental Care DivisionTel: 01372 474775Email: [email protected]

Reigate & Banstead Borough CouncilProvide free domestic collection on Tuesday or Thursdays from local residents.Sharps collected from resident must be in “sharps boxes” which are availableon prescription from the GP. Replacement sharps bins will be provided uponcollection.Contact Neighbourhood ServicesEarlswood DepotHorley RoadRedhillRH1 6PNTel: 01737 276775Email: [email protected]

Epsom & Ewell Borough CouncilSharps for diabetic waste collection are free of charge once a year per resident.A replacement bin is provided upon collection.Tel: 01372 732000Email: [email protected] (ask for sharps collection orenvironmental department)

Mole Valley District Council (MVDC)Free sharps collections from domestic properties on Mondays.Resident to contact MVDC a few days priorTel: General services dept on 01306 885 001

Tandridge District CouncilWill NOT collect any sharps from local residents. Please contact your GP for localarrangements.

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Albumin Creatinine Ratio(ACR)A urine test which detectsif kidneys are beingdamaged – also calledmicroalbuminuria

Blood Glucose level(B.G or B.S)The amount of glucose(sugar in your blood) aimfor 4-7 measured inmmols/L.

Blood Pressure (BP)A measure of the effortthe heart has to make tocirculate blood around thebody

Body Mass Index (BMI)Indicator of obesity.Healthy range: 20 - 25

CataractsCloudiness and thickeningof the lens of the eye

Cholesterol (Chol)A type of fat in the blood.Too much increases therisk of heart disease

HbA1cA blood test whichmeasures the averagelevel of blood glucose overthe last 2 months

HyperglycaemiaHigh Blood Glucose

HypoglycaemiaLow Blood Glucose

IncretinThis is a hormone found inthe gut which helps thebody produce more insulinwhen needed as well asreducing the amount ofglucose produced by theliver. At times, in somepeople with diabetes theliver can over produceglucose.

KetonesToxin produced by thebreakdown of fat whenthe body can not useglucose. May indicateillness or lack of insulin,found by testing blood orurine – Requires action

Liver Function Tests (LFTs)A blood test to check yourliver function

Oral hypoglycaemicagents (OHAs)Tablets that lower theblood glucose

ProteinUrine protein is checked totest for damage to thekidneys. Protein is alsofound when someone hasa urinary tract infection

RetinopathyDamage to the back of theeye (retina)

Triglyceride (Trigs)A type of fat in the blood.A high level may indicatean increased risk of heartdisease

Urea & CreatinineBlood test to detect anychange in kidney function

Visual Acuity (VA’s)A simple eye test to checkdistance vision (NOT inplace of you visiting youroptician annually)

Terms & Meanings

4.4 Community Education

Citizens Advice BureauAdvice on various issues, such as: debt, welfare, benefits, immigration,employment, consumer, housing, health, education and much more.

Reigate & Banstead : 08444 111 444Caterham & Warlingham : 01883 344777Leatherhead and Dorking: 08444 111 444Epsom & Ewell: 08444 111 444

4.5 Appendix


My Notes

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My Diabetes Pack – your comments

Thank you for giving us your feedback. We want to know what you thinkso that we can make this pack as useful as possible to people with diabetes.We will take into consideration your comments and update the pack inthe future.

Please circle/underline the appropriate answer.

1. How useful have you found:

a) My Diabetes: Information and Resource Pack?

Not useful Useful Very useful

b) The Handheld Record?

Not useful Useful Very useful

2. Were there any sections that you did not understand?

a) My Diabetes: Information and Resource Pack

No Yes

If yes, which part/s?

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b) The Handheld Record

No Yes

If yes, which part/s?

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3. Do you have any suggestions for improvements in the future?

a) My Diabetes: Information and Resource Pack

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b) Handheld Record

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4. Do you carry your The Handheld Record to your appointments?

Yes No Sometimes

5. Do you have any other comments?

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Thank you for your time.

Please send your comments to:Dr Stewart TomlinsonMedwyn SurgeryReigate RoadDorkingSurreyRH4 1SD

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Documents

My Diabetes: Information and Resource PackMy Diabetes:Information and Resource Pack Who is it for? This pack is for all people with diabetes in Surrey. Some people may already know