Download What is diabetes? - Bristol Community Health

Diabetes
Information
Pack
Acknowledgements
This pack has been designed for people newly diagnosed with
Type 2 diabetes and supports the “Living with Diabetes”
education course. It is also used to support people with Type 2
diabetes who attend our Understanding Insulin education course.
It has been produced by Bristol Community Health in conjunction
with Bristol Clinical Commissioning Group, North Somerset
Community Partnership, and South Gloucestershire Clinical
Commissioning Group. We are grateful to all health professionals
and the people with diabetes who have helped to develop it. We
would also like to thank Diabetes UK for their contribution of
images to this pack and their ongoing support.
Jargon busting
There are full explanations for any wording marked in bold
throughout the pack in the “jargon buster” section. This can be
found on page 48.
Contents
Section
Page Number
1. Introduction
 How to contact Diabetes Education
1.1. Just been diagnosed with diabetes?
1
4
5
 What is diabetes?
6
 What’s the difference between Type 1 & Type 2
diabetes?
7
 Type 1 diabetes
7
 Type 2 diabetes
8
 Is there anything else I should know?
8
o Driving
8
o Motor Insurance
10
o Prescriptions
10
o NHS Eyesight Tests
10
o Employment
10
o Pregnancy
11
 You and your healthcare team
11
o You
11
o Why are you so important?
11
o Your healthcare team
12
o Doctor
13
o Practice Nurse
13
o Diabetes Specialist Nurse
13
o Dietitian
13
o Podiatrist
13
o Retinal Screening
14
o Pharmacist
15
2. Staying in Control
15
2.1. Lifestyle
15
 Healthy Eating
15
 Balanced Eating
16
 Fats
19
 Salt
20
 Food Labels
20
 Diabetes UK Foodstore
22
 Alcohol
22
 Keeping Active
24
 Weight Management
27
 Waist Circumference Measurements
30
 Smoking
31
 Eyes
31
 Feet and foot care
33
 General foot care
35
2.2. Blood tests
36
 Blood glucose
36
 Cholesterol
37
 Blood Pressure
38
 Kidney Function
38
2.3. Annual Review Checklist
 15 Healthcare essentials
3. About your medications
39
39
40
3.1.Treatments for people with Type 2 diabetes 40
3.2 Types of medications for diabetes
41
3.3. How to treat low blood glucose levels
(Hypoglycaemia)
43
4. What should I do if I am ill?
46
Jargon Buster
48
Contact information
59
Help improve services
69
Feedback
70
Disclaimer
71
Notes pages
72
We have left some pages blank for you to make your own
notes
Appendix – Insulin
76-83
Note: (This appendix is only issued for people with diabetes on
Insulin)
1. Introduction
You have been given this folder because you have been
recently diagnosed with diabetes or because you are
attending one of our education courses. You may have been
feeling unwell recently, in which case it may have come as a
relief to find out what was wrong. On the other hand, you
may not have been suffering from any symptoms, or even
realised that anything was wrong - in which case the
diagnosis may have come as quite a shock to you.
Although diabetes cannot yet be cured, it can be successfully
managed through a variety of treatments, in most cases
allowing you to continue to work, travel, have a family and enjoy
an active life.
Diabetes is different from most other medical conditions in that
you, the person with diabetes, have an active role in managing
the condition. Your healthcare team may prescribe and give
you advice and support on how to manage your diabetes, but
the daily choices will really be down to you.
This information pack provides a great starting point. It contains
some information about diabetes, how to take care of yourself,
your local healthcare team, and where to obtain further
information and support. The best way to learn about diabetes
is to attend one of our local ‘Living with Diabetes’ education
courses. This free one day course has been developed by a
group of healthcare professionals. Run by a Nurse and a
Dietitian, it is designed to provide you with more information to
support you to take control of your life with diabetes. All those
invited will have been recently diagnosed with Type 2 diabetes.
The purpose of the ‘Living with Diabetes’ course is for you to:
 have the opportunity to gain the skills and
knowledge needed to live a healthy life with
diabetes
 explore lifestyle choices that will help keep
you well in the future
 find out about the local groups that are
offering support in a variety of settings e.g.
walking groups, diabetes support groups etc.
 meet with other people recently diagnosed
with Type 2 diabetes and share your
experiences
We’ve had really positive feedback from people who have
attended our courses. Here is what some of them had to say….
“A very friendly and
informative course,
easy to follow &
well planned. Other
peoples experience
and pointers also
very useful”
“A very well planned
day. Good presentation.
The tutors worked well
together and gave me
room to ask questions
and answered all my
questions with patience
and understanding.”
“I feel that today has
been very beneficial
to me and my wife
in managing my
diabetes”
“Very interesting
course, very helpful
with dietary needs
and well put across
by the teachers.
Also good to share
& discuss with
other people with
different stages of
diabetes”
A referral form should have been sent to the Diabetes Education
office for you to attend one of our education courses. However, if
this has not happened you may self refer. Our contact details can
be found overleaf or at the back of this folder under Bristol
Community Health on page 59.
If English is not your first language or you would
like this information in another format, please contact
the Diabetes Education Office on 0117 9598970 as
we have a range of other information that you may
prefer. You can also contact us by e-mail at:
[email protected] We also have a range of
videos in different languages, please go to the
following link to view these
http://briscomhealth.org.uk/patients-and-carers/selfmanagement-information-people-with-diabetes/
If you are able to access the internet you may wish to look at our
wide range of video clips (http://briscomhealth.org.uk/patientsand-carers/self-management-information-people-withdiabetes/) or the Diabetes UK website which provides information
for people living with diabetes - www.diabetes.org.uk
How to contact Diabetes Education
If you would like to contact us you can do so in the following
ways:
 Tel: 0117 9598970, Fax 0117 9598971
 E mail: [email protected]
 Write to us at:
Diabetes & Nutrition Services,
John Milton Clinic,
Crow Lane,
Henbury,
Bristol BS10 7DP
1.1 Just diagnosed with diabetes?
If you have just been diagnosed with diabetes, it is likely that
you will have many questions and queries and that you will be
experiencing a range of emotions.
At first it may feel like being on an emotional roller coaster.
You may be surprised that you have been diagnosed with a
lifelong condition, especially if you have not noticed any
symptoms. Or you may feel relieved that you have finally found
out what is wrong after feeling unwell.
People often feel angry or sometimes guilty. Some people
grieve for their former health and this can lead to feelings of
sadness or depression. Understandably you may be anxious
about what the future will hold and this is perfectly natural.
Understanding diabetes and accepting that it will be with you
for the rest of your life takes time.
It is important to remember that people with diabetes can, in
general, continue with their day to day life and take part in
activities previously enjoyed. Looking after yourself and
learning how to live with your diabetes will give you the best
chance of doing this. We discuss this on the ‘Living with
Diabetes’ course.
Your Practice Nurse, GP and other members of the diabetes
team are there to advise and help you live with diabetes. YOU
are the most important member of the diabetes team so we
strongly encourage you to attend the course to learn as much
as you can, particularly as people with diabetes are at greater
risk of developing heart disease and stroke, changes in their
eyes, feet, kidneys, and blood vessels. These complications
are more likely to happen if your blood glucose, blood
pressure, and cholesterol levels are not well controlled.
Some of the simple ways to keep yourself healthy are:





making healthy food choices
being more active
maintaining a normal weight and losing weight if overweight
not smoking
attending regular appointments at your diabetes clinic
Your diabetes team will discuss the most appropriate targets
and treatment for you to keep yourself as healthy as possible.
This should be agreed and recorded in your Personalised
Diabetes Care Plan, and reviewed regularly. So do remember
to take it along to all your health related appointments. This
booklet can be found in the back pocket of this folder.
What is diabetes?
Diabetes is a common condition which can affect both adults
and children. Diabetes occurs when the pancreas, a gland
near the stomach, fails to produce enough insulin. Insulin
helps to control the level of glucose in the blood by converting
the glucose from food that we eat into energy.
The main problem in diabetes is that there is not enough, or a
complete lack of insulin produced and so the blood glucose
level rises. Often the glucose will spill over from the blood
stream into the urine where it can be detected.
Symptoms of diabetes can include increased thirst, passing
urine more often (especially at night), tiredness, weight loss,
thrush and blurred vision. However, some people may not
experience any symptoms.
Reproduced with kind permission of Diabetes UK
What’s the difference between Type 1 and Type 2
diabetes?
Type 1 diabetes
In Type 1 diabetes, the body stops producing insulin. It
usually develops in childhood and young adults, although it
can occur at any age.
The management of Type 1 diabetes requires treatment with
insulin, combined with healthy eating and exercise.
Type 2 diabetes
In Type 2 diabetes, the body still produces some insulin, but
often it is not enough for the body’s needs and usually this
insulin is not used effectively (insulin resistance).
Over three-quarters of people with diabetes have Type 2
diabetes. There is a strong link between this type of diabetes
and being overweight, although 20% of people with Type 2 are
of normal weight.
Those people most at risk of developing Type 2 diabetes
include:

those with a family history of diabetes

those of Asian or African-Caribbean origin

those who are overweight

women who have had a baby weighing over 4kgs or 8.8 lbs
or were diagnosed with gestational diabetes during
pregnancy
The main treatment is always healthy eating and activity.
People with Type 2 diabetes may need a combination of
treatments to manage their diabetes effectively such as tablets
or insulin.
Is there anything else I should know?
Driving
Having diabetes does not mean you
need to give up driving but there are important points you need
to consider, if in doubt speak to your GP/Practice Nurse or
DVLA. This list is not exhaustive and depends on licence
category, but as a general rule you should notify DVLA if:
 you require treatment with insulin OR if you take other
medications for your diabetes and have suffered from more than
one disabling hypo in the last 12 months or if you are at high risk
of developing disabling hypoglycaemia (see page 42).
 you require laser treatment to both eyes for retinopathy (see
page 30).
 if both eyes are affected by other eye problems.
 you develop problems with the circulation or sensation in the legs
which make it necessary for you to drive certain types of vehicles
only e.g. automatic or modified vehicles (this must also be noted
on the licence).
 an existing medical condition deteriorates or you develop any
other condition which may affect safe driving at any time in the
future
 If you are in any doubt as to whether your diabetes may affect
your licence.
 If you drive Group 2 vehicles (LGV/PCV) you should seek specific
advice as other restrictions may apply.
Remember, if you drive, you must ensure you discuss and
understand your hypo risk, monitoring and treatment with your
GP/Practice Nurse/Diabetes team
Driving regulations can change so keep yourself up to date via
the DVLA (see page 62 for contact details).
Motor Insurance
We recommend that you inform your motor insurance
company in writing of your diagnosis to ensure that they will
cover you in the event of a claim. Some companies may try to
increase your premiums, but many won’t, so by shopping
around you can usually obtain a reasonable quotation.
Prescriptions
People taking tablets or insulin for
their diabetes are exempt from all
prescription charges. You can obtain
a form (FP92a) from your GP or
Practice Nurse.
If you are not exempt from prescription charges, you may wish
to consider obtaining a “prepayment certificate”. This
exemption or prepayment certificate should then be shown to
the pharmacist when you collect your prescription.
NHS Eyesight Tests
NHS eyesight tests are free to people with diabetes, but you
will have to pay for glasses.
Employment
If you have any concerns about your
employment due to your diabetes you can
access information via the Diabetes UK’s
Advocacy Service, your local Citizens’ Advice Bureau or the
Equality and Human Rights Commission (see Page 62).
The only employer where a blanket ban on recruiting people
with diabetes applies is the Armed Forces (Equality Act (2010)
exemption).
Pregnancy
If you are a woman of child bearing age and are considering
starting a family, prior to conception, you should discuss this
with your nurse/GP to ensure you are given the right advice
and monitoring for a healthy pregnancy.
You and your healthcare team
You
You are the most important member of the diabetes team.
Healthcare professionals can give you information, offer advice
and prescribe medication but it is up to you to build these into
your life.
Remember, ask to be referred to the ‘Living with Diabetes’
course so that you can learn more about managing your
condition. You will find more information on this course on the
Bristol Community Health website at:
www.briscomhealth.org.uk/ under ‘Our Services’ - select
Diabetes & Nutrition Service and look up Diabetes Education.
Your daily diabetes management will be the core of your
diabetes care. If you have any questions about your diabetes
management then please ask your diabetes healthcare team
for further information.
Why are you so important?
It is possible that you may only see each member of your
healthcare team for a few hours in total each year.
Consequently it is vitally important that you understand your
condition, what to do if you are having any difficulties and how
to access the right help at the appropriate time. It is also
important that you prepare for the appointments that you do
have and make sure that you write down, if necessary, any
questions that you need answered. Remember to make full use
of your Care Plan (at the back of the folder). If there is anything
that you are concerned about or there appear to be changes,
make sure that you contact your relevant healthcare
professional. Most of all ensure you have the knowledge to
look after yourself.
Your healthcare team
Your diabetes healthcare team will usually include any of the
following people:
Doctor
This is usually your GP but it may also be a consultant at the
hospital, or sometimes both. They will carry out regular
medical checks and refer you to other specialists as needed.
Practice Nurse
Your Practice Nurse is often the key contact person for your
routine diabetes care, this will be either the Treatment Room
Nurse, Practice Nurse or a District Nurse.
Diabetes Specialist Nurse (DSN)
A Diabetes Specialist Nurse is a nurse who works
exclusively with people living with diabetes. Your GP or
Practice Nurse may refer you to see a Diabetes Specialist
Nurse.
Dietitian
A registered healthcare professional who specialises in how
food and drink can affect health and disease. They will discuss
your diet in detail with you and help you identify dietary targets,
based on the healthy eating guidelines, appropriate for you
All people with diabetes should receive dietary advice from a
Dietitian. Appointments are provided free by the NHS and can
be arranged from a referral through your GP or other
healthcare professional.
Podiatrist
A Podiatrist, previously known as a chiropodist, is a
healthcare professional who specialises in feet. If you are
referred to see one, he or she will check your feet and offer
advice about how to look after them.
An annual foot assessment is part of the routine diabetes care
carried out by your Practice Nurse or GP. If necessary, you will
be referred to a Podiatrist, which is provided free by the NHS.
If you choose to see a Podiatrist privately, we recommend
you see one who is registered with the Health & Care
Professions Council (www.hcpc-uk.org)
Retinal Screening
The Bristol and Weston Diabetic Eye Screening Programme is
part of the National Diabetic Eye Screening Programme and is
provided locally by Bristol Community Health. We offer annual
eye screening for people with diabetes aged 12 and over who
live in Bristol, North Somerset and South Gloucestershire.
Screening is provided at local GP practices in majority of
cases. As soon as a diagnosis of diabetes has been made,
your GP will inform the screening programme and you will
automatically be invited for eye screening.
Diabetic Eye Screening is not to be confused with your usual
eye examination that you have with your optometrist. Both are
equally important to attend.
For further information please see the Eyes section on page
……or visit:
www.briscomhealth.org.uk/our-services/diabetic-eyescreening/
Pharmacist
A pharmacist (chemist) will provide you with the medicines
prescribed by your GP. They will be able to provide you with
advice on how best to use or take any medication.
It is advisable to try to use the same pharmacy (one that is
convenient to you), so the staff get to know you and
understand your needs. Ask them how you can get the best
out of their service, particularly for dealing with repeat
prescriptions.
If you buy any other medicines, such as for headaches or for
flu, then do tell the pharmacy staff that you have diabetes and
the medications you are currently taking.
2. Staying in Control
In this section you will find lots of information to help
empower you to self-manage your diabetes. In this way
you can really reduce the risk of problems occurring
which may pose a threat to your long term health.
2.1 Lifestyle
Healthy Eating
You may be thinking that all you want to know is what you can
and can’t eat now that you have diabetes.
You will be pleased to know there is no need to follow a
special ‘diabetic’ diet, prepare special meals, or completely cut
out all the foods you enjoy. There is also no need to buy
special ‘diabetic’ foods (they are often expensive, high in fat
and calories, and can have a laxative effect!)
The healthy diet for people with diabetes is the same as the
healthy diet recommended for everyone. So you should be
able to enjoy a wide variety of different foods, in moderation as
part of a well-balanced diet while keeping your blood glucose,
blood pressure and cholesterol levels under control.
Balanced Eating
To get the balance of what we eat right we need to make sure
meals and snacks are based mostly on the two larger food
groups – fruits and vegetables and high fibre starchy foods.
Moderate amounts of meat, fish and poultry (or vegetarian
alternatives) and dairy products are also important. Fats, salt
and sugar should be eaten in the smallest amounts.
You could use this picture of a plate as a daily/weekly guide to
making balanced, healthy meals
Picture reproduced with kind permission of the Food Standards Agency
The following guidelines may also help if you have identified
that you need to make some small changes to what you
normally eat and drink now:
 eat regular meals across the day
 remember to include some starchy carbohydrate at each meal
 eat less fat, especially saturated fat
S
ome more small changes you can make:
 cut down on sugar, sweet foods and sugary drinks
 Aim to have at least 5 portions* of fruit and vegetables or salad
each day, the more variety the better
 eat oily fish regularly
 cut down on salt
 drink alcohol in moderation
 eat the right amount of food to maintain a healthy weight
 avoid overcooking vegetables – which can destroy the
vitamin/mineral content
 spread fruit portions throughout the day – due to the natural sugar
content
…and don’t forget to balance this with increased physical activity
* examples of a portion size include: one apple, one pear, one
small banana, one orange, slice of melon or a small handful of
grapes. Two satsumas/kiwi or a cupful of berries. A small bowl of
salad. A small glass of unsweetened fruit juice. 2-3 heaped
tablespoons of vegetables or pulses.
Here are some practical tips that other people have found helpful in
making permanent changes to their eating habits.
Old habits
Forming new habits
Missing
meals
Eat regular meals – i.e. breakfast, lunch,
and evening meal. Meals don’t have to be
large and spreading your food across the
day will help keep blood glucose levels
steady
Eating when
bored
Figure out when this is likely to happen
and try to do something else rather than
eat e.g. go for a walk, listen to music,
work on a hobby, phone a friend etc.
Eating when
watching TV
or relaxing
Try to avoid doing anything else when
eating – eat only while at the table, at
meal times or planned snack times
Eating
everything
on your
plate
Eat slowly and chew thoroughly. Make
meal times a relaxing experience and
enjoy the flavour and taste of the food
you are eating. You don’t HAVE to eat
everything on your plate if you are
already feeling satisfied
Eating large
portions
Try using a smaller plate and/or serving up
smaller portions of food
Eating treat
foods
regularly
Treat yourself with things other than food
e.g. flowers, music, a magazine, taking
time out for yourself etc.
Eating fried
food
Grill, casserole, microwave or bake foods
instead
For some people, a few changes to the types of foods eaten or
the portions sizes at main meals may be all that is required.
You can visit the Diabetes UK website www.diabetes.org.uk
for more information.
If you would like more specific advice tailored to your own
lifestyle and favourite foods, then please ask to see a Dietitian
via your GP Surgery.
Fats
We all need to be careful about the amount of fat that we eat
as a high fat diet may increase our risk of heart disease and
strokes. This is particularly important for people who have
diabetes. High fat foods are also high in calories, so should be
reduced if you want to lose weight.
We all need some fat in our diet, but it is important that we
have the right sort. Saturated fats and partially hydrogenated
vegetable fats tend to raise our blood cholesterol and should
ideally be restricted. However, unsaturated fats, particularly
monounsaturated fats and fish oils offer some health benefits
so should be included in our diet in small amounts.
Fats to limit or
reduce








Butter/hard margarine
Suet
Creamed coconut
Crème fraiche
Meat fats/sausages
Pasties
Dairy fats including
whole milk, full fat
cheese, hydrogenated
vegetable oil
Fats to choose
instead

 Margarines labelled in
“high
monounsaturates” e.g.
olive or rapeseed
 Olive oil
 Soya oil
 Oily fish e.g. sardines,
mackerel, pilchards,
salmon including
tinned
 Nuts and seeds
Salt
Reducing your intake of salt is recommended due to the link
between salt intake and high blood pressure. Try these tips to
help you cut down:
 use herbs, spices, onion or garlic to give your food added flavour
(watch out for added salt in ready-made spice mixes though)
 cut down on packet and processed foods such as noodles,
instant rice/couscous, stock cubes, crisps, salted nuts and yeast
extracts all of which are high in salt
 avoid adding salt to your cooking – train your taste buds to have
less salt
 avoid low-salt alternatives
Food Labels
It isn’t always easy to make sense of food labels;
If you find food labelling confusing as a general rule:
This is high per (per 100g)
More than 17.5 fat
More than 5g saturated fat
More than 22.5g sugars
More than 1.5g salt
More than 0.6g sodium
This is low per (100g)
3g fat or less
1.5g saturated fat or less
5g sugars or less
0.3g salt or less
0.1g sodium or less
There are 4 places to find information about nutrition on
packaged goods.
Nutrition Labelling
All food and drink manufacturers have to provide information
about the amount of energy, fat, saturated fat, carbohydrate,
sugar, protein and salt per 100 g/ml in their product. They
sometimes also include information per portion. The RI is the
reference intake for an average adult. This information is a
guide only as people’s nutritional needs vary.
You can see whether a
product is high/medium or low
in fat, saturated fat/sugar/salt
by comparing it to the table on
the other page.
Front of pack labelling
These labels are usually but not always displayed on products;
depending upon the manufacturer. When they are displayed
they include information about the amount of energy, fat,
saturated fat, sugar and salt in the product. Front of pack
labelling is useful to compare products, to see which one is
healthier. However do be aware that the manufacturer’s
portion size may be different to yours.
Some manufacturers also use traffic light colours to help you
understand whether a product is high, medium or low in fats,
sugar or salt.
Red means high – watch how often you have these foods and
aim to eat in smaller quantities or
occasionally.
Amber means medium – okay to have
some of the time but the best choice is
green
Green is low – this is the healthiest choice.
Ingredients List
All of the ingredients in a product are listed in descending
order of weight. The front of pack and nutrition labels are
helpful to see at a glance how much of each nutrient is in a
portion/100g but it doesn’t tell you where these nutrients come
from. A breakfast cereal or yoghurt may be high in sugar but it
is not clear whether it’s from the natural sugar in fruit or milk or
an added sugar unless you check the ingredients list. If low fat
milk products or fruit are listed in the first few ingredients it is
often a healthy choice.
Nutrition and health claims
Nutrition and health claims are based on science and can be
trusted, however they are sometimes misleading. For example
a product can be labelled as ‘reduced fat’ but still be a high fat
product or a food may be labelled as ‘light’ or ‘lite’ this must be
at least a third lower in a typical value (e.g. calories or fat) than
the standard product. However, it may not be lower when
compared to another brand. Use the front of pack or nutrition
labels to find out more.
Diabetes UK Foodstore
This can be found at www.storetour.co.uk . The website
provides help on shopping, nutritional information on foods,
and will guide you as to how balanced your diet is and can
help with menu planning.
Alcohol
You do not have to give up alcohol just because you have
diabetes. Everyone is advised that if they drink alcohol to do
so in moderation. Aim to keep within the recommended limits
of 3-4 units/day for men and 2-3 units per day for women. You
should also try to have at least two alcohol free days per week.
What is a unit of alcohol?
 one small glass (100ml) of wine (10% ABV) (ABV = alcohol by
volume)
 half a pint of beer/lager/cider (3.6% ABV)
 one pub measure (25ml) of spirits (40% ABV)
Remember to choose slimline/low calorie mixers with spirits.
Alcohol is high in calories and if you are trying to lose weight it
may be worth considering reducing your average weekly
intake.
If you are taking tablets or insulin to help treat your diabetes
then it is important to discuss
drinking alcohol with your Practice
Nurse or GP. Alcohol can reduce
blood glucose levels for several
hours after drinking and may
increase the risk of blood
glucose levels dropping too low.
You may be advised to check your
blood glucose levels before
going to bed and having a snack if it’s low. Never drink alcohol
on an empty stomach.
Keeping Active
If you have diabetes it is also recommended
that you keep active. Active people are
better able to manage their weight, and also
have less risk of high blood pressure,
heart disease and stroke.
Being physically active and moving more is important for
people with diabetes because it:
 helps lower blood glucose levels
 can lower blood pressure and cholesterol
levels
 keeps the heart fit
 helps with weight management
 makes you feel good
 keeps you active and more able to perform
every day tasks
1. Adults should try to be active daily. This means over a week,
about 2½ hours of moderate intensity activity. Try to do this by
doing 10 minutes or more during each day or try 30 minutes at
least 5 days a week.
2. Or you can get the same results by doing 75 minutes (1hr 15
minutes) of vigorous intensity activity spread across the week
or combinations of moderate and vigorous intensity activity.
3. Adults should also try physical activity to improve muscle
strength on at least two days a week.
Examples of physical activity that meet the guidelines:
Moderate intensity physical activities will cause you to get
warmer and breathe harder and you heart will beat faster, but
you should still be able to carry on a conversation. Examples
include:
 Brisk walking
 Cycling
 Gentle swimming
Vigorous intensity physical activities will cause you to get
warmer and breathe much harder and your heart will beat
rapidly, making it more difficult to carry on a conversation.
Examples include:
 Running
 Sports such as swimming or football
Physical activities that strengthen muscles involve using body
weight or working against a resistance. This should involve
using all the major muscle groups. Examples include:
 Exercising with weights
 Carrying or moving heavy loads such as groceries
It is also recommended that you try to minimise the amount of
time spent sitting down. You could do this by making simple
changes to your day which can make a big difference.
For example why not:
 set your phone/timer so you remember to stand every 20
minutes to boost your metabolism
 choose the stairs at work or when shopping
 use the car or bus less often and walk or cycle instead (this
could include walking part of the way)
 turn off the TV or computer at home and find ways to be more
active, e.g. cleaning/ walking to the shops
 try to stand instead of sitting more often
The important thing to remember is that if you are not very
active right now start off gently and build up your fitness
gradually. Speak to you Practice Nurse or GP if you are
unsure of your limits. Even if you are unable to do the exercise
mentioned it is recommended that you start just by moving
more.
What stops
me?
Lack of time
Too many
aches and
pains
Too tired
What can I do about this?
Add physical activity to your daily routine
e.g. walk or cycle to work or the local shops,
take the stairs at work, get off at an earlier
bus stop and walk the extra distance etc.
Make sure you start off slowly and do some
gentle warm-up stretches beforehand.
Find an activity you can do now and add
other activities over time
Plan activity for a time of day when you
know you will feel more like being active.
Becoming more active can actually increase
your energy levels!
Lack of
motivation
Holidays or
working away
Do an activity that you enjoy and if possible
invite a friend or family member to exercise
with you to make it more fun
Create opportunities to be active on holiday
e.g. taking a walking-tour or cycle tour when
visiting a new city, use the hotel pool etc.
When working away from home, use the
exercise facilities available at the place you
are staying or seek out local venues etc.
Also remember if you take insulin or tablets for diabetes you
may need to adjust this or take an extra snack if you are doing
more physical activity so speak to your Dietitian or Practice
Nurse.
Health Trainers are available at many GP surgeries and can
offer one to one advice on choosing an activity programme
that is right for you. Ask at your surgery as they may be able to
refer you to Active Choices which is a
scheme with a 12 week tailor made
package of exercise sessions, especially
for people with or at risk of developing
health problems.
Weight Management
One of the key goals for a healthy heart and good diabetes
control is to achieve and maintain a healthy weight. This is
best done by making healthy food choices and keeping active
over the long term.
At your annual diabetes assessment your GP and/or Practice
Nurse will measure your height and weight. Your body shape
is then assessed by measuring your waist circumference (WC)
and overall level of body fat by calculating your Body Mass
Index (BMI).
If your BMI is 25 or more (23.1 for South Asians) you should
think about losing weight because being overweight or obese can
increase your risk of health problems, such as:




heart disease
Stroke
some types of cancer
high blood pressure (hypertension)
 kidney disease
For most adults, an ideal BMI is in the range 18.5 to 24.9.
If your BMI is 25 or more, you’re over the ideal weight for your
height:
 25 to 29.9 is overweight (23.1 for South Asian)
 30 to 39.9 is obese
 40 or more is very obese
Healthcare professionals use the words obese and obesity as
clinical terms to indicate your increased risk of health
problems. They do not use these terms to describe what you
look like. If you are unsure of your BMI you can ask at your
surgery next time you visit.
Checking your waist circumference, will show you the amount
of weight you carry around your waist. If you need to lose
weight, reducing your waist measurement will help to improve
blood glucose control and reduce your risk of developing
some diabetes complications.
To measure your waist, you need to find the bottom of your
ribs and the top of your hips. Measure around your middle at a
point mid-way between these (for many people this will be the
tummy button).
Weight Management schemes
You can receive 12 weeks of free vouchers for Slimming
World or WeightWatchers to help you lose weight.
We ask that you commit to attending the group for 12 weeks. It
has been proven that weight loss results are much better when
you receive weekly support and advice. The sessions only
take 90 minutes a week.
To check if you are eligible or to find out more see your GP,
Practice Nurse or healthcare assistant at your GP surgery to
ask them to refer you. Or call us on 0117 922 2921 Email
[email protected]
Weight Management Service
Community Specialist Weight Management Dietitians support
adults over 16 to lose weight to help improve their health.
We offer patients the option of 1 to 1 or group support at
different locations throughout Bristol. Patients receive a
combination of nutrition advice and support with increasing
physical activity and changing behaviour to lead a healthier
lifestyle. We work with patients over a 6-12 month period both
to achieve a healthy weight and maintain it in the long
term. Our service currently supports patients with conditions
such as impaired fasting glucose, diabetes, obstructive sleep
apnoea, osteoarthritis and chronic obstructive pulmonary
disease to improve their health by losing 5-10% of their body
weight.
You can be referred by your GP or another health
professional, or you can contact us directly. Our service is
available to individuals who have a BMI of 28 or more together
with another medical condition, or who have a BMI of 30 or
over with no other medical problems.
Contact:
Weight Management Dietitians Greenway Community
Practice, Greystoke Avenue, Southmead
Bristol BS10 6AF
Tel: 0117 959 8935 or 0117 959 8921
Waist circumference measurements:



White and African-Caribbean men should be below 94cm
(37 inches)
Asian men should be below 90cm (35 inches)
White, African-Caribbean and Asian women should be
below 80cm (31.5 inches)
Being overweight or obese has a
direct effect on your diabetes and in
fact may or may not have been part
of the reason why you developed
diabetes in the first place. You may
have heard of ‘apple’ and ‘pear’ body
shapes? In general, the ‘apple’ shaped bodies, where a
person carries their weight mostly around the middle, often
causes ‘insulin resistance’. This is when your body is
resistant to the body’s natural insulin production, and
therefore your blood glucose control gets worse.
In Summary
This may help you to decide whether you need to start losing
weight to help you to manage your diabetes or discuss this
further with your GP or Practice Nurse. You can also ask to be
referred to a Dietitian for individual advice and support.
Smoking
Smoking is harmful for everyone, and
even more so if you have diabetes. It
increases your risk of having a heart
attack or a stroke.
Most practices now run smoking cessation clinics where
support and advice is given. A wide range of nicotine
replacement therapies are available. Even if you have tried to
give up before, we would strongly recommend you seek
support to stop smoking. You can contact your local
‘Smokefree’ service (see page 69) or ask at your surgery.
Eyes
Retinopathy
All people with diabetes are at risk of developing diabetic
retinopathy. Diabetic retinopathy is caused when diabetes
affects the small blood vessels in the retina, the part of the
eye that acts rather like a film in a camera. Diabetic
retinopathy can affect your sight and is still a significant cause
of blindness in the working population.
What should people with diabetes do to care for their
eyes?
The best way to care for your eyes is to achieve good blood
glucose control. This can reduce the risk of you developing
diabetic retinopathy and slow the rate at which it happens.
However, some people may still go on to develop sight
threatening retinopathy despite their best efforts.
Diabetic retinopathy does not usually cause a loss of sight
until it has reached an advanced stage. Even sight-threatening
retinopathy that is close to affecting your sight may not cause
symptoms. Therefore it is important that people with diabetes
aged 12 years and over attend an annual eye screening
appointment. Screening is an effective way of detecting
diabetic retinopathy as early as possible.
The Bristol and Weston Diabetic Eye Screening
Service
The Bristol and Weston
Diabetic Eye Screening
Service provides annual
eye screening for all
people with diabetes
living in Bristol, North
Somerset and South
Gloucestershire . Screening usually takes place at a person’s
GP surgery. Each appointment will be with a trained screener
and will last around 30 to 45 minutes.
The screening service will visit GP surgeries at least twice a
year and you will automatically be sent an invitation to one of
these clinics. If you have just been diagnosed with diabetes,
you may be invited for a first appointment at a central location,
such as the Bristol Eye Hospital.
It is important not to confuse your eye screening appointment
with the general eye tests you have with your optician.
Screening does not replace your regular eye examinations. It
is important to attend both.
What treatment will be given?
If you have mild diabetic retinopathy then you will not usually
require any treatment other than controlling any other risk
factors (for example, blood pressure, glucose and
cholesterol levels). More advanced retinopathy may require
laser treatment or other therapies. Laser treatment works well
to prevent worsening of retinopathy and so prevents loss of
vision, but cannot restore vision that is already lost. The
treatment is not usually painful, and vision, in most cases,
returns to its previous level after a few hours.
Feet/Foot care
Uncontrolled diabetes can affect the feet in a number of ways:
 Nerves can become damaged which can lead to limited or
heightened sensation (Neuropathy)
 Blood flow to the feet can be reduced (Ischaemia)
 Your foot shape can change
 Your skin can become dry
Any of these complications can increase your risk of
developing foot attack. This means that you could develop an
ulcer (a wound that is slow to heal). This can increase your
risk of infection and ultimately amputation.
You should expect to receive a foot check every year by your
GP / Practice Nurse team. If you develop any complications
you will be referred to your local Podiatry (Chiropody) team
which can help and advise you to prevent any of these serious
complications occurring.
We highly recommend that you attend these appointments and
the health care professional can fill in your care plan (at the
back of the folder).
To prevent foot problems it is recommended that you:
 Have your feet checked annually as part of your annual
assessment and ask what your “risk of a foot attack is”
 See a Podiatrist (Chiropodist), Practice Nurse or GP for advice
if you notice changes to your feet, your nails are ingrowing/causing you a problem or you develop corns/callus on
your feet
If at anytime you think you have a foot problem or have any
concerns, contact your GP, Practice Nurse or a Podiatrist as
soon as possible.
General Foot Care
Daily: check your feet using a mirror if necessary. You are looking for:
 Callus (areas of thick hard skin)
 A wound on your foot
 Changes in colour, swelling, heat or redness
 Breaks in the skin
 Changes in shape/texture of your feet
Should you notice any of these it is important to get your feet
checked quickly. Please contact your health care professional to
give you some advice, especially if you have developed
neuropathy (decreased sensation) or ischaemia (lack of blood
flow)
You are advised to:
 Wash your feet regularly and dry carefully between your toes
 Cut or file your nails straight across (do not cut down the sides)
preferable after a bath when the nails are soft. Avoid cutting your
nails too short.
 Avoid walking without footwear / slippers
 Wear shoes / slippers that fit well and have your feet measured
regularly
 Check inside your shoes for rough lining or loose objects before
putting them on
 Be careful not to burn your feet
o Check the bath temperature before getting in
o Avoid the use of hot water bottles / electric blankets or
remove / switch off before getting into bed
o Use sunblock on your feet if wearing sandals outdoors
 If your feet are dry or cracked, use a moisturising cream daily (avoid
putting between your toes)
2.2 Blood tests
Now that you have diabetes
you will be asked to have
regular blood tests. This is
because blood glucose,
cholesterol and blood
pressure can all have a
significant impact on your
diabetes if they are not well controlled. The frequency with
which they will be checked will vary according to the test
results, your medications and general health.
Blood Glucose
Blood glucose control is very important for people with
diabetes. For people on particular treatments home blood
glucose testing can help to manage your diabetes but this is
not necessary for most people newly diagnosed. If you are
home testing then you will have been given your own targets.
Average target range is 4-7mmol/l before meals or up to
8.5 mmol/l 2 hours after meals or before bed. Your diabetes
team can help you develop a routine for testing that meets
your individual needs.
Whether home testing or not, as part of your annual diabetes
checks you will have your blood glucose levels checked by a
blood test called HbA1c. This test measures your average
blood glucose level over the previous three months. A result
of 48 – 58mmol/mol is desirable to reduce the risk of health
problems associated with diabetes. However, you may agree
an individual target suitable for you with your GP or Practice
Nurse which should be recorded in your Care Plan (at the back
of this folder)
Lipids -These are the cholesterol of triglycerides in your blood
Cholesterol
Cholesterol relates to the amount of ‘fats’ in your blood and is
known to speed up the blocking of arteries in your heart. There
are a number of different measures of cholesterol in the
blood.
 Total cholesterol measures all the cholesterol in your
blood and can increase your risk of heart disease and stroke
Low density cholesterol (LDL) increases your risk of
cholesterol build up in your arteries, increasing your risk of
heart disease
High density cholesterol (HDL) helps protect against
heart disease
 Triglycerides are a measure of the fat circulating in your
blood.
The levels of cholesterol will be tested annually in your blood.
For the ranges you are looking to achieve consult your Care
Plan (at the back of the folder)
Non HDL cholesterol
Your non-HDL cholesterol is your total cholesterol minus your
HDL (good) cholesterol.
Non HDL range
<2.5
<3.5
<3.6
Blood Pressure
Blood pressure tells you how hard your heart has to work to
move blood around the body. Having high blood pressure
can increase your risk of developing heart disease, stroke and
kidney disease. Your blood pressure will be checked by your
Practice Nurse as part of your annual checks. Aim for your
blood pressure to be less than 140/80 mm/Hg (or the
individual target you have been given). If it is higher your GP
may prescribe medications to lower it, which is proven to be
beneficial for people with diabetes.
Kidney Function
Kidneys can be affected by a number of things including blood
pressure and medication. As a general rule, at least once a
year, your blood will be tested for kidney function. In addition
you will be asked for a urine sample to check for protein which
can be an indication of possible kidney problems.
2.3. Annual Review Checklist
In summary here is a list of the care you should be provided
with that has been put together by Diabetes UK. The full listing
can be obtained by visiting the website: www.diabetes.org.uk
15 Healthcare Essentials
Diabetes UK has named them the “15 Healthcare Essentials”
and they are:
1 Have your blood glucose levels measured at least once a
year
2 Have your blood pressure measured and recorded at least
once a year
3 Have your blood fats (cholesterol) measured every year
4 Have your eyes screened for signs of retinopathy every year
5 Have your legs and feet checked – the skin, circulation and
nerve supply of your legs and feet should be examined
annually
6 Have your kidney functions monitored annually
7 Have your weight checked and have your waist measured to
see if you need to lose weight
8 Get support if you are a smoker including advice and
support on how to quit
9 Receive care planning to meet your individual needs – you
live with diabetes every day so you should have a say in every
aspect of your care
10
Attend an education course to help you understand and
manage your diabetes
11
Receive paediatric care if you are a child or young
person
12
Receive high quality care if admitted to hospital,
regardless of whether the stay is because of your diabetes
13
Get information and specialist care if you are
planning to have a baby as your diabetes control has to be
a lot tighter and monitored very closely
14
See specialist diabetes healthcare professionals to
help you manage your diabetes
15
Get emotional and psychological support, if you feel
you need it as living with a long term condition can be
difficult
3. About Your Medications
3.1 . Treatments for people with Type 2 diabetes
The first line of treatment for people
with Type 2 diabetes will always be to
eat a healthy diet and to keep active. If
your GP or Practice Nurse find that this
is not enough to keep your blood
glucose levels normal you may also need to take medication.
There are several kinds of medication for people with Type 2
diabetes which may be prescribed on their own or in
combination. This may include medication for your blood
pressure and/or cholesterol.
If you are prescribed any medication you are advised to make
sure that you find out the following information from your GP or
Practice Nurse:






What the medication is called?
What the medication is prescribed for?
How much should you take?
When should you take it?
Possible side effects?
What you should do/who to contact if you have any problems
It is also advisable to keep a copy of your latest prescription in
your wallet/purse and in your Care Plan (at the back of this
folder).
3.2 Types of medications for diabetes
Metformin is usually the first tablet advised if your blood
glucose level is not controlled by a healthy diet and activity. It
is often used for people who are overweight because it
generally does not result in weight gain and can reduce the risk
of complications such as a heart attack or stroke. On its own it
cannot make your blood glucose level go too low.
Sulphonylureas – there are several types of sulphonylurea
drugs which include Gliclazide, Glimepiride and Glipizide. They
tend to be used if you cannot take Metformin or if you are not
overweight. They work by encouraging the pancreas to work
and make more insulin to help lower the blood glucose levels.
Because sulphonylureas boost your level of insulin,
hypoglycaemia (blood glucose less than 4mmol/l) is a possible
complication. However, this is an uncommon problem, and
unlikely to happen if you have regular meals and avoid missing
or taking late meals and avoid too much alcohol. Your GP or
Practice Nurse should discuss hypoglycaemia with you and
provide advice if necessary on checking your blood glucose
levels and how to treat hypoglycaemia (see Page 42).
Other medications used in Type 2 diabetes
Other medication used in Type 2 diabetes include
Pioglitazone, DPP4’s (Sitagliptin, Saxagliptin, Linagliptin,
Vildagliptin, Alogliptin), GLP-1’s (Lixisenatide, Exenatide
Liraglatide and Dulagutide) and SGLT2’s, Canagliflozin,
Dapagliflozin, Emphghtlozin and Acarbose.
Insulin
For some people with Type 2 diabetes insulin injections may
be required to keep blood glucose levels under control. It is rare
for someone newly diagnosed with Type 2 diabetes to
commence on insulin. If you have been prescribed with insulin
please ask your Practice Nurse to issue you with the Insulin
Appendix to add to this folder. You should also be referred to
our ‘Understanding Insulin’ course to learn about using Insulin.
Alternatively, you can request a copy of the Appendix and/or a
course referral form from the Diabetes Education Services –
see our contact details under Bristol Community Health in the
contact details at the back of this folder.
3.3 How to treat very low blood glucose
levels (Hypoglycaemia)
If you are newly diagnosed and are managing your diabetes
with diet and activity or taking Metformin you are not usually at
risk of low blood glucose levels. When you have Type 2
diabetes, your blood glucose levels are only able to drop too
low, i.e. below 4 mmol/l, if you are taking certain tablets or are
on insulin therapy. This is known as hypoglycaemia or
‘hypo’.
The symptoms associated with very low blood glucose levels
vary for individuals, but may include
Early signs
 Sweating & shaking
 Trembling
 Hunger & headaches
 Blurred vision
 Tingling lips
 Palpitations
Later signs
 Anxiety & irritability
 Forgetfulness & confusion
 Drowsiness
 Odd behaviour
 Speech difficulty
 Lack of co-ordination
 Unconsciousness
A ‘Hypo’ can be caused by the following:
too much insulin / too many tablets
delayed or missed meal or snack
not enough food - especially carbohydrate containing food such
as bread, rice, pasta, potatoes etc..
unplanned or strenuous activity
drinking too much alcohol or alcohol without food
Who is likely to experience a hypo? – anyone taking insulin or
some types of oral hypoglycaemic medication
What can be done to prevent a ‘Hypo’?:
 Eat regular meals including starchy carbohydrates e.g pasta, rice,
potatoes or cereals
 Have an extra snack or reduce your insulin when you do more
activity
 Plan ahead, you may need something to eat if a meal is delayed
 Check blood glucose levels before and after exercise
 If you have had alcohol have a starchy carbohydrate snack before
bedtime
If you do feel any of the symptoms mentioned or if you do have
a blood glucose level less than 4 mmol/l then you should:
1. Take 20 grams of rapidly digested sugar, for example:
 100ml of Lucozade ‘original’ (approx 1/3 small bottle or
1/2 glass)
 5-6 glucose tablets
 150ml (approx 1/2 can) of ordinary fizzy drink (not ‘diet’)
 200ml (small carton) orange juice
 4 Large jelly babies
 7 Large jelly beans
 2 tubes of glucogel
Note: chocolate, biscuits or milk will not bring your blood
glucose levels up quickly enough.
2. Check your blood glucose level again after 10 minutes. If it
remains below 4 mmol/l take another 20 grams of rapidly
digested sugar (as above) and test again in 10 minutes. It is
important that you don’t have too much sugar at this time as
otherwise your blood glucose levels can swing up too high.
3. When your blood glucose levels return to normal you
should have something more substantial to eat within 30
minutes e.g. sandwich, cereal with fruit and yoghurt, your next
normal meal etc. This will prevent your blood glucose levels
dropping again.
NB: It is best to check whether your blood glucose levels are
actually too low before taking something sugary. Some people
experience the symptoms described above, along with an
increased thirst and the need to pass urine more often, when
their blood glucose levels have gone too high!
If you are taking tablets or insulin to treat your diabetes and
find you often have results less than 4 mmol/l then you need to
contact your GP or Practice Nurse to discuss this with them as
soon as possible. Depending on the problem, you may require
a change in your medication.
4. What should I do if I am ill?
For people with diabetes not taking insulin
Any illness may cause your blood glucose to rise. So when
you are ill your blood glucose level tends to go up. This may
happen even if are not eating or are vomiting.
Conditions that may upset your diabetes include:
 the common cold or flu
 diarrhoea and vomiting
 urine or chest infections
 leg or foot ulcers
 other infections, for example tooth abscesses, boils
Signs that the illness is affecting your diabetes include:
high blood glucose levels
excessive thirst
passing large amounts of urine, especially at night
It is important that you:
do not ignore these signs
do not stop your medication
monitor your blood glucose levels more often
try to eat normally but if unable to then try fluids or soft
drink plenty of water or sugar-free fluids
foods
It is recommended that everyone with diabetes has the flu
vaccination. This is free and is usually available from your GP
surgery in the autumn. Please discuss this with your Practice
Nurse or GP.
Golden Rules
1. Never ignore the warning signs that your blood glucose levels may be
high. Contact your GP or Practice Nurse if you feel unwell
2. Continue taking your prescribed medication (unless otherwise
advised by your Medical Professional i.e. vomiting +GLP1/SGLT2)
3. If you usually test your blood glucose levels at home, it is advisable
that you do so more often during an illness
4. Drink plenty of water or sugar-free fluids
5.Try to eat your normal diet. If you cannot, try nourishing foods that are
easy to eat e.g. soups, soft foods like cottage pie with mashed potato,
milky drinks or puddings etc.
Low blood glucose levels
If you experience blood glucose levels lower than normal (or
hypos) you should contact your GP surgery or Practice Nurse
for advice on reducing your medications.
When to call for help
If your blood glucose level stays above 17 mmol/l for more than 24
hours
If you are vomiting and can’t keep fluids down
If you are worried or don’t know what to do
If in doubt contact your GP or Practice Nurse
Jargon buster
The following are explanations of commonly used terms you
may encounter in managing your diabetes. Remember always
ask for an explanation if you come across terms or phrases of
which you are uncertain.
A1c
The simple name for the HbA1c test –
see HbA1c.
Albumin
A blood protein that can leak into the
urine – if it’s there, it can be a sign of
kidney problems
Angina
A condition caused by problems with the
arteries carrying blood to the heart; the
person has short periods of chest pain
and a feeling of constriction or tightening
Aspartame
A low-calorie artificial sweetener. Brand
names include Nutrasweet and
Canderel
Basal insulin
The background insulin needed to
control the normal levels of glucose in
the blood between meals and at night
Beta Blockers
A class of drugs which reduce high
blood pressure
Blood glucose
levels
The amount or concentration of glucose
(sugar) in the blood. UK measurement is
millimoles per litre (mmols/l)
Blood glucose
meters
Electronic devices which can measure
your blood glucose levels
Blood pressure
When your heart beats, it pumps blood
round your body to give it the energy
and oxygen it needs. As the blood
moves, it pushes against the sides of
the blood vessels. The strength of this
pushing is your blood pressure.
Body mass index A measure of a person’s weight in
(BMI)
relation to their height, showing if they
are overweight or underweight
There are a number of BMI ‘ready
reckoners’ that can be found on the
internet which will calculate your BMI for
you.
e.g.
British Heart Foundation www. bhf.org.
uk/bmi
Height Weight Chart
www.nhs.uk/Livewell/healthy-living
Even some of the high street stores and
large chemists and slimming clubs have
some.
Alternatively your surgery or local leisure
centre will help work it out for you.
Carbohydrate
foods
A class of food which includes both
starches and sugars in foods such as
bread, potatoes, rice, pasta, beans, fruit,
milk, and also sugars in processed food
Chiropodist
See podiatrist
Cholesterol
Cholesterol is a fatty substance known
as a lipid and is vital for the normal
functioning of the body. It is mainly
made by the liver but can also be found
in some foods we eat. High levels of
cholesterol in the blood is known to
speed up the blocking of blood vessels
CVA
Cerebral Vascular Accident – See
Stroke
Diabetes
(Gestational)
Diabetes occurring in pregnancy.
Usually blood glucose levels return to
normal after the birth
Diabetes
Specialist Nurse
(DSN)
A nurse who works exclusively with
people living with diabetes
Diabetologist
A doctor who has specialist knowledge
about diabetes and its management
Dietitian
A registered health professional who
has specialist knowledge about eating
and the effects of different foods and
drinks on the body. Dietitians have to be
registered with the Health & Care
Professions Council www.hcpcheck.org
Digestion
The process in which food is broken
down in the gut into smaller molecules,
which are then absorbed into the
bloodstream. The whole process takes
place in the digestive system which
begins at the mouth and ends at the
anus
Dilated eyes
Eyes which have had special drops put
in them to make the pupil bigger so that
each eye can be examined
Energy
The strength and stamina needed for
everyday activities. The energy in food
is measured in kilocalories or kilojoules
Erectile
dysfunction
Often known as impotence, where a
man cannot have sex because he
cannot get or keep a full erection
Fat
A nutrient in foods: includes all solid
fats as well as oils, e.g. butter, lard, oil,
margarine
Fibre
Fibre is the indigestible part of food.
Good sources of fibre are wholegrain
cereals, bread, brown rice, pasta and
oats. There is also some fibre in fruit
and vegetables especially the skin.
Fibre absorbs a lot of water and ensures
faeces are soft and easy to pass out of
the body
Fructose
One of the sugars occurring naturally in
fruit and honey. It can affect blood
glucose levels when eaten in large
amounts
Gastroparesis
Where the stomach contents do not
empty properly into the intestine
Glucose
Comes from the digestion of
carbohydrates (starches and sugar) and
is absorbed into the bloodstream, where
it circulates and is used for energy
Glycaemic index
A measure of how quickly a food is
broken down into glucose when a food
is digested
HbA1c test
This is a blood test that gives an
indication of how well the blood glucose
level has been controlled over the
previous six weeks. It measures the
amount of glucose attached to the
haemoglobin in your blood
Health & Care
Regulates health, psychological and
Professions
Council
social work professionals
Heart attack
Where part of the heart is permanently
damaged because one of the heart
arteries is blocked and blood has been
unable to get through to the heart
muscle. Also known as Myocardial
Infarction (MI)
Hydrogenated
fats
Fats and oils that have been hardened
during the manufacturing process. They
affect the body in a similar way to
saturated fats
Hyperglycaemia
(Hyper)
Blood glucose levels which are above
target
Hypertension
High blood pressure (e.g. more than
140/80)
Hypoglycaemic
(Hypo)
Blood glucose levels which are low
(below 4 mmols/l)
Insulin
A hormone produced by the pancreas
which is essential for regulating the
levels of glucose (sugar) in the blood
Insulin resistance In Type 2 diabetes the body produces
some insulin but the body’s cells are
unable to use it efficiently
Ketoacidosis
A condition where the person has raised
blood glucose levels and is dehydrated
so that a metabolic acidosis develops
(where the body’s natural acid–base
balance becomes disturbed)
Ketones
Ketones are the acid breakdown
products of fats in the body that occur in
people with Type 1 diabetes when blood
glucose levels are high
Ketostix
Ketostix are a brand of urine strips to
test for ketones
MI
Myocardial Infarction – see Heart Attack
Minerals
The body needs minerals to grow,
control body processes e.g.
transmission of nerve impulses and they
form an essential part of body fluids.
Some minerals are required in relatively
large amounts e.g. calcium, iron,
sulphur, phosphorus, potassium and
chlorine. Others are required in minute
amounts e.g. iodine, manganese, zinc
and fluoride. They are found in certain
foods and drinks
Monounsaturated Found mainly in olive oil, rapeseed oil,
Fats and Oils
nut oil, avocados and spreads made
from these fats. This is the best sort of
fat to include in your diet
Multidisciplinary
A team of different types of health
team
professionals who work together to
make sure that people have the care
they need, at the time they need it; for
diabetes, these are known as diabetes
care teams
Nephrologist
A doctor who has specialised in
diagnosing and treating kidney
conditions
Nephropathy
Damage to the kidneys
Neuropathy
Damage to the nerves
Nicotine
replacement
therapies
A substitute for nicotine, which is an
addictive drug in cigarettes. They can
take the form of patches, chewing gum,
nasal sprays or inhalers
Omega 3 fatty
acids
Found within oily fish such as pilchards,
mackerel, salmon sardines, nuts and
seeds (especially linseeds) Can protect
the heart and blood vessels from
damage
Opthalmologist
A doctor who has specialised in
diagnosing and treating eye conditions
Pancreas
A gland behind the stomach which
produces insulin and other hormones
Podiatrist
A health professional who looks after
people’s feet. Also known as
Chiropodist. If you choose to see a
podiatrist privately we recommend you
see a podiatrist who is registered with
the Health & Care Professions Council
www.hcpc-uk.org
Polyunsaturated
Fats
Found mainly in fish, nuts, seeds and
leafy green vegetables. Examples
include omega 3 and 6 fatty acids.
Omega 3 can help protect against heart
disease
Retina
The light sensitive area at the back of
the eye
Retinopathy
Damage at the back of the eye (retina)
Saturated fats
Saturated fats are predominantly found
in fats that are solid at room
temperature. e.g. animal fats and dairy
produce, coconut oil, palm oil. Eating too
much can contribute to heart disease
Smoking
cessation clinics
A clinic led by a trained advisor to help
you find ways to stop smoking
Stroke
Where the blood stops getting through
to an area of the brain, which may cause
weakness in one part of the body. Also
known as CVA – Cerebral Vascular
Accident
Thrush
A fungal infection. It can cause creamy
white patches and extreme itching and
soreness, usually in the genitals or
mouth. Repeated attacks may be
triggered by excessively high glucose
levels in the urine
Trans fats
Have been strongly linked to an
increased risk of coronary heart disease.
They are commonly found within highly
processed, high fat foods such as
cakes, biscuits, pastries and take-away
foods
Triglyceride
Are the circulating levels of fat in the
blood. Higher than normal levels are
associated with an increased risk of
heart disease, strokes and other
circulatory diseases
Ulcer
An open sore or crater that may be hard
to heal; in diabetes, one of the aims is to
stop ulcers from developing particularly
on the feet.
Feet are at risk of developing ulcers
particularly if diabetes has reduced the
blood flow to the feet or if the nerve
endings have been damaged resulting in
a loss of feeling to the feet
Vitamins
Vitamins are a group of different
chemical substances. The body
requires only small amounts of each
vitamin but as it cannot make most of
them itself they must be supplied by
food. Vitamins are needed to help the
body grow, to maintain the body and to
control metabolic reactions in cells
Contact Information
Below is a list of organisations that offer support and information for
people with diabetes.
Name and what they do
Contact details
Bristol Community Health
Provides a wide range of
community healthcare services
commissioned by the NHS in
and around Bristol. Our services
cover a diverse range of
specialist clinical care, from
dermatology nursing to district
nursing, physiotherapy to
podiatry, walk-in centres to
wound care and much more.
One of the services is the
Diabetes & Nutrition Service,
which provides information
about the different education
courses for patients with both
Type 1 and Type 2 diabetes,
that are provided across Bristol
can be found on the website, or
by contacting the team. They
can also provide information in
different formats. The Service
also provides advice and
Website:
www.briscomhealth.org.uk/
Under ‘Our Services’ Select
Diabetes and Nutrition
Service
Tel: 0117 9598970
E mail: [email protected]
support to adult patients and
carers locally within the
community, via one-to-one
counselling and group
education. The service is
accessed via a written referral
from any health care
professional in accordance with
specific referral criteria.
British Heart Foundation
(BHF)
Website: www.bhf.org.uk
A national charity fighting heart
and circulatory disease. The
BHF funds research, education
and life-saving equipment.
British Hypertension Society
A national charity with the aim of
sharing cutting-edge research in Website: www.bhsoc.org
order to understand the origin of
high blood pressure and
improve its treatment.
British Dietetic Association
(The Association of UK
Dietitians)
The Association of UK
Dietetics
www.bda.uk.com
National Contact
information
Diabetes UK is a national charity Diabetes UK, 10 Parkway,
for people living with diabetes.
London, NW1 7AA
Their website has a wealth of
Tel: 0345 1232399
useful information, plus
(Mon – Fri 9am-7pm)
documents that you can
Fax: 020 7424 1001
download. You can also
Website:
purchase items such as recipe
www.diabetes.org.uk
books from them and subscribe
E mail; [email protected]
to their newsletters.
Diabetes UK
See also Local Support Section
for local groups.
Diabetes UK Careline
This is a facility set up by
Diabetes UK for any concerns,
questions or feelings you may
have about living with diabetes.
You are able to contact them by
e mail or telephone. The
telephone number is charged at
local rates and the lines are
open Monday to Friday 9am 5pm
Diabetes UK Store Tour
Tel: 0345 123 2399
E mail:
[email protected]
Diabetes UK Careline
Macleod House
10 Parkway
London
NW1 7AA
This is a Diabetes UK website
which provides information on
food regarding shopping, food
labeling, and menu planning.
Website: www.storetour.co.uk
DVLA
You can contact the DVLA
Tel: 0300 790 6801
(Monday to Friday, 8am to 7pm
www.gov.uk
and between 8am to 2pm on a
Saturday). Please remember to
quote your full name, date of
birth and/or driver number (if
known), when telephoning. They
will then send the appropriate
medical questionnaire.
Employment
Useful links and contact
numbers with regard to
employment information.
Diabetes UK’s Advocacy
Service 0345 1232399 (MonFri 9am-7pm)
Citizens Advice Bureau :
www.citizensadvice.org.uk
Tel: 03444 111 444
TextRelay users should call
03444 111 445
Human Rights Commission:
www.equalityhumanrights.com
Everyone Active
The Exercise Referral scheme
provides a 12 week tailor made
package of exercise sessions,
especially for people with, or at
risk of developing health
problems. Participants will work
with their fully qualified
instructors to develop an activity
programme suitable to their
conditions. To access the
scheme, you need the support
of a GP or other healthcare
professional. Once a referral
form is received, they will
contact you with the time and
date of your first appointment.
There are fees for the scheme
The independent champion for
people who use health and/or
social care services.
They collect stories about using
services, look for themes and
give feedback to providers and
commissioners.
They provide information and
signpost to health and wellbeing
services with Well Aware
Tel: 07825 033741
www.everyoneactive.com
e mail:
alistairmacfarlane@everyone
active.com
Bristol:
www.healthwatchbristol.co.uk
email:
[email protected]
Tel: 0117 2690400
The Care Forum
The Vassall Centre
Gill Avenue
Bristol BS16 2QQ
(www.wellaware.org.uk))
They offer advocacy services
and support if you wish to
complain about health and
social care services.
Health and Care Professions
Council
www.hcpc-uk.org
Park House,
184 Kennington Park Road,
London, SE11 4BU
Tel: 0845 300 6184
Link Age Bristol
This is a local website that gives
details of lots of local activities
by area such as arts & crafts,
walking groups, cinema groups,
and in addition services such as
foot care all for the over 55’s.
www.linkagebristol.org.uk
Tel: 0117 3533042
Email:
admin@linkagewestofengland
.org.uk
Local Library
Your local library can be a very
useful source of information for
local activities and events.
Local Support
Bristol Diabetes Support Network
A network of local groups for
Website:
www.diabetesbristol.org.uk
people with diabetes, their
friends and families in the Bristol
area. In partnership with Bristol
Community Health, Bristol
Clinical Commissioning Group
and Diabetes UK. Each group
meets every other month.
http://facebook.com/groups/
diabetesukbristol
Tel: 0117 930 9986
[email protected]
Bristol Central meets at venues
around the city from around
contact: [email protected]
17.45 – 19.45. Please check the
website or Facebook page.
Bristol East meets at the
Beechwood Club, Beechwood
Road, Fishponds BS16 3TR
around 14.00 -16.00
Bristol South meets at Knowle
West Health Park, Downton
Road, Bristol BS4 1WH from
18.30 – 20.30
contact: [email protected]
contact: [email protected]
Bristol West Meets at Westbury
on Trym Primary Care Surgery, contact:
Westbury Hill Westbury on Trym [email protected]
Bristol BS9 3AA. 14.00- 16.00
NHS 111
An online/telephone health
service offering you advice and
information. The telephone lines
Website: www.nhs.uk search
for 111
Telephone: 111
are open 24 hours a day for any
health related enquiry.
NHS Choices - Live Well
www.nhs.uk/livewell
Healthy eating/exercise
information
Search Healthy
eating/exercise for information
Podiatry
If you think you have a problem
with your feet you can be
referred by your GP or contact
the podiatry teams for advice.
Bristol: Knowle Clinic,
Broadfield Road, Bristol BS4
2UH
Tel: 0117 9190275
Prepayment Certificates
If you pay for your prescriptions
you may find it more beneficial
to purchase a prepayment
certificate. You can obtain the
details via your pharmacy, by
telephone from the “prepayment
certificate issue office” and you
can organise payments over the
phone or apply on line.
Website www.nhsbsa.nhs.uk
- select prescription
certificates
Retinal Screening
Website
Or via www.gov.uk (type in
prescription prepayment)
Tel: 0300 3301341
www.briscomhealth.org.uk/ou
If you would like any further
information regarding Retinal
Screening, please contact the
Bristol and Weston Diabetic Eye
Screening Service
r-services select Diabetic Eye
Screening
Tel: 0117 342 0888
E mail:
BRCH.BristolDESPAppointments@n
hs.net
Stopping Smoking
Bristol
Provides free support if you
want to stop smoking.
Smokefree Bristol, Public
Health, 3rd Floor, Clifton Wing,
Brunel House, St George’s
Road, Bristol, BS1 5UY.
Website:
www.smokefreebristol.com
Tel: 0117 9222255
Travel
Diabetes UK has information
sheets about the availability of
medication and equipment in
other countries.
Insulin travel wallets can be
purchased from a company
called “FRIO” that keep insulin
Tel: 0345 1232399
Website:
www.diabetes.org.uk (type in
travel, select travel & diabetes
UK)
cool and safe whilst travelling.
Tel: 01437 741700
Also available to purchase at the
Website: www.friouk.com
Diabetes UK website.
Well aware
Information on health and
wellbeing services, support
organisations, activities and
groups in Bristol, South
Gloucestershire, Bath & North
East Somerset, North Somerset
and Somerset
www.wellaware.org.uk
Tel: 0808 808 5252
Information Services at The
Care Forum, The Vassall
Centre, Gill Avenue,
Fishponds, Bristol BS16 2QQ.
Help Improve Services
Your local NHS wants to improve services for people with
diabetes.
One of the ways they do this is to work with people with
diabetes to find out from them how they feel services can be
improved. We have people who take part in specific working
groups, and we run focus groups to get feedback.
If you would like to be involved in any of this work please
contact:
Matthew Areskog – Public Involvement Manager
Tel:
0117 900 2638
E-mail:
[email protected]
Address:
Bristol Community Health
South Plaza, Marlborough Street
Bristol, BS1 3NX
Feedback
We welcome your comments and feedback on how to improve
this document and our education programmes. You can
contact the Diabetes Education team at:
[email protected] or
Diabetes Education Manager
Bristol Community Health
John Milton Clinic
Crow Lane
Henbury
BS10 7DP
Tel: 0117 9598970
Any complaints should be put in writing to the Diabetes
Education Manager at the above address.
Disclaimer
Bristol Community Health provides all information contained
within this information pack in good faith and makes every effort
to ensure that the information provided is accurate, informed by
specialist expertise, and is up to date. The material within this
folder is for information only and is not intended to be used for
diagnosis, treatment, or as a substitute for medical advice.
Always see your GP, Practice Nurse or member of your
Diabetes Team if you have any healthcare questions or
concerns.
Bristol Community Health is not responsible for the contents or
reliability of other websites or organisations and does not
necessarily endorse the views expressed by them. Bristol
Community Health may be listed on other organisations’
websites or in their publications however such listings should not
necessarily be taken as an endorsement of these organisations
by Bristol Community Health. We cannot guarantee that other
organisations’ website page links will work all of the time and we
have no control over the availability of linked pages.
Material produced in this folder may only be reproduced by
written permission of Bristol Community Health.
All other material reproduced in this document is by permission
from the copyright holders and may only be reproduced by
permission from them.
© Bristol Community Health January 2016
Notes Pages
Notes Pages