Download Jeffrey Kelson Centre Diabetes and Endocrinology

The North West London Hospitals NHS
NHS Trust
Central Middlesex Hospital
Jeffrey Kelson Centre
For
Diabetes and Endocrinology
Diabetes Basics: Information
1
The Jeffrey Kelson Centre For Diabetes
Endocrinology was established in 1989/1990 by
Dr Stuart McHardy Young
and
It is a Multidisciplinary team of:
Administrator: Mrs L Pontello
Doctors:
Consultants Endocrinologist: Dr D Darko
Consultants Endocrinologist: Dr W M Kong
Honorary Consultant Endocrinologist: Dr S McHardy Young
Community Consultant Endocrinologist: Dr D Devendra
Associate Specialist: Dr C Kirollos
Two Specialist Registrars
Podiatry service for moderate/severe foot problems;
Senior Podiatrist: Mrs G Todd, Podiatrist: Mrs R Shah
Diabetes Specialist Nurses:
Sr E Barry, Sr U Drubra,
And Community DSNs , Sr N Patel, Sr J Anthony, Sr L Odiga,
Dietitians:
Mrs T Thompson , Community dietitian Ms H. Davies
Secretaries:
Miss J Wilson, Mrs T Larkin-Hinds, Mrs K Taylor
Clerks/Receptionists:
Mrs K Chandegra, Mrs M Golding,
Clinic Nurses:
Mrs C Gamble, Mrs T Palmer
Other corroborative teams include:
Renal, Midwifery, Clinical Pathology, Metabolic Syndrome, Orthopaedic, Vascular
Paediatrics and Radiology.
GRATITUDE
JKC staff and patients appreciate the generous donations of the family and friends of Mr
Ronald Humphrey, & Mr Gary Sheil who funded the printing of this booklet.
Gratitude to Sr Sharon McCarthy who initiated these leaflets in 2002, which are now
updated by JKC team
2
Index:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Diabetes Management Check List
What do you know about Diabetes?
Diet Myths
Fat in your diet
Alcohol
Glycaemic Index
Exercise and Activity
Physical Activity Targets
Eye Screening
Cataracts
Foot Care
Driving
Illness
Holidays
Diabetes Management
Diabetes Results and Targets
Blood Sugar Results
Diabetes UK
Diabetes Education Groups
Hypos
3
4
1- Diabetes Management
List:
Referred
1- Initial Consultation:
2- BP
3- Foot Examination
4- Optometrist / Eye check up
5- Blood test:
HBA1c
U&Es
Full lipid profile (?fasting)
FBG
LFT & Ca++
TFTs
6- Urine test: For Albumin creatinine ratio
7- Dietary advice
8- Diabetes Specialist nurse advice
9- Diabetes education leaflets
9- Smoking cessation
10- Home blood testing
11- Review
12- Diabetes Education Groups
5
Check
Yes
No
2- What do you know about…..
Diabetes
Main points
1
Diabetes occurs when the amount of glucose in
the blood is too high
2
The pancreas is not producing enough insulin or it
is not being used properly
3
There are two types of diabetes.
Type 1 and 2
4
Main symptoms include: tiredness, feeling thirsty,
passing more urine.
5
Diabetes can be treated successfully
There are approximately 2 million people in Great Britain with diabetes,
so you are not on your own.
Diabetes occurs when the amount of glucose (sugar) in the blood is too
high because the pancreas is unable to produce enough insulin or the
insulin it produces is not used properly by the body.
6
When the blood glucose rises, normally the insulin helps the glucose to
enter the cells and be used by the body for energy. This does not
happen in diabetes causing tiredness.







The main symptoms of diabetes are:
extreme tiredness
passing a lot of urine especially at night
increased thirst
weight loss
blurred vision
Yet, some may have no symptoms and their blood sugar would
be found to be high during a routine blood test.
There are two types of diabetes known as Type 1 and Type 2.
Type 1 develops when the pancreas stops producing insulin. This type is
more common in people under 40 and children. It is treated with insulin
injections and diet.
Type 2 develops when the pancreas is not producing enough insulin or
the insulin it produces is not used properly by the body. This type is more
common in people over 40. It is treated by diet alone, or a combination of
diet, tablets and insulin injections.
Those most at risk of developing Type 2 diabetes are:





people with a family history of diabetes
people over 40 years old
people who are overweight
people of Asian or Afro-Caribbean origin
women who had a baby weighing more than 9 pounds or 4 Kgm..
Although diabetes cannot be cured, it can be treated very
successfully. Ask for other leaflets available in this series to help you find
out more.
7
3- Diet Myths
main points
1
2
3
4
5
Diabetes is not caused by eating too
much sugar
You can eat bananas and grapes!
Starchy foods should be eaten with
each meal
Foods labelled
‘diabetic’ or ‘suitable for diabetics’
should be avoided.
A healthy diet is a low sugar diet, not
a ‘no sugar’ diet
8
Diabetes is not caused by eating too much sugar.
Diabetes develops because not enough insulin is being made by the
body. If you become overweight or obese by eating too much generally,
your chance of developing diabetes increases.
If you have diabetes, you can eat bananas and grapes.
All fruit and vegetables are good for people with diabetes. They are high
in vitamins and fibre and low in calories. They are ideal as snacks. Aim
to eat 2-3 fruits –spread out over the day, and 2-3 vegetable portions
each day.
If you have diabetes, you can eat starchy food such as bread and
rice.
Starchy food such as wholegrain bread, boiled potatoes, rice and pasta,
beans, oats and wholegrain breakfast cereals should make up the main
part of the meal, along with vegetables and fruit.
People with diabetes should avoid foods labelled ‘For diabetics’.
These foods are often high in fat and calories, are expensive and can
have a laxative effect. The diet for people with diabetes is a healthy diet
based on real food and therefore special diabetic foods are not
recommended.
People with diabetes must avoid foods with high sugar contents.
It is important to limit the amount of sugar and sugary foods you eat, but
it is not necessary to avoid sugar altogether. Many savoury foods such
as soups and baked beans contain some sugar and that’s OK. As long
as your diet follows healthy eating guidelines then the occasional sweet
food eaten after a meal will not make a big difference to your diabetes
control. However, you should not add sugar to foods or beverages and
always have sugar-free squashes and fizzy drinks.
9
4- Fat in your diet
main points
1
2
Cut down the total amount of fat
in your diet
Cut down on saturated fats
And replace with small amounts
of monounsaturated or
polyunsaturated fats.
REMEMBER – ALL FATS
AND OILS ARE HIGH IN
CALORIES AND SHOULD
BE TAKEN IN SMALL
QUANTITIES.
Some fat is essential for health, but we eat far more than we need. There
are 2 main problems with eating too much fat:

Too much ‘saturated’ fat increases the risk of heart disease

Fat is high in calories and can cause excess weight
10
So it is important for people with type 2 diabetes, and especially those
who are overweight to reduce the amount of fat in their diet and think
about the types of fat they use.
There are 3 main types of fat:
*Saturated fat – mainly from butter, ghee, coconut cream, palm oil,
pastry, full fat dairy foods and fatty meat
*Polyunsaturated fat – mainly from corn oil, sunflower oil and
margarines made from these oils and oily fish
*Monounsaturated fat – mainly from olive oil, rapeseed oil, peanut
(groundnut) oil and margarines made from these oils, avocados and
almonds.
Too much saturated fat increases the level of cholesterol in the blood.
This excess cholesterol can cause blockage of the arteries leading to
heart disease or stroke.
The advice is to cut down on saturated fats and partially replace
with a mixture of the other two types.
Monounsaturated fats have been shown to have an advantage when it
comes to controlling cholesterol levels.
Why?
Did you know we have ‘good’ and ‘bad’ cholesterol?. It’s like two- way
traffic, the good cholesterol (HDL), returns excess cholesterol to the liver
to be broken down. If there is excess ‘bad’ (LDL) cholesterol (caused by
too much saturated fat) this is taken up by the blood vessel wall and may
eventually cause blockage and heart attack.
Monounsaturated fats and oils lower ‘bad’ cholesterol levels and
increase ‘good’ cholesterol levels, so are recommended in small
quantities.
11
5- Alcohol
main points
1
2
3
4
Alcohol can be enjoyed in moderation
2 units a day for women
3 units a day for men
2-3 alcohol free days per week
Alcohol can cause your blood sugar
to go too low.
5
Avoid very sweet wines and drinks
6
Do not buy special ‘diabetic’ beers
12
Alcohol can be an enjoyable part of your social activities and is not
a problem in moderation, though it may have some effect on your blood
glucose.
Alcohol can be measured in units. The following measures all provide
one unit of alcohol:




Half a pint of ordinary strength beer, lager or cider
1 small glass of wine
1 pub measure of spirits
1 small glass of sherry
Healthy limits of alcohol intake are 2 units a day for women and 3 units a
day for men, with 2-3 days each week without alcohol. Saving up all your
units and drinking them once a week is not recommended.
Remember:
 Avoid very sweet sherries, sweet wine, port and liqueurs
 Use diet or sugar free mixers with spirits
 There is no need to buy special ‘diabetic’ beers
Do not drink on an empty stomach. Eat before or with any alcohol,
as it can cause a low blood sugar
Alcohol is high in calories so if you are concerned about your weight try
the following:
 Add soda water to wine to make a spritzer
 Drink half pints rather than pints
 Alternate diet or sugar free drinks with an alcoholic drink
 Supply water as an alternative to alcohol when entertaining
13
6- Glycaemic Index
main points
1
Eat regular meals based on
starchy
Carbohydrate
2
Choose slowly absorbed
starchy foods more often
3
Have fruit and/or vegetables
with each meal
4
Cut down on sugar and sugary
foods
Better known as the difference between slowly and quickly absorbed
carbohydrate. Slowly absorbed carbohydrate helps to stabilise blood
glucose levels and prevents the ‘highs’ and the ‘lows’.
14
Carbohydrate
The term ‘carbohydrate’ includes both sugary and starchy foods.
Starchy foods are the key to healthy eating. They are filling, low in fat
and full of vitamins and minerals.
Sugar and sugary foods, on the other hand, contain very few useful
nutrients and if eaten in excess, raise blood glucose levels and
contribute to weight gain.
Fibre
One of the reasons some foods have a lower glycaemic index is the
presence of fibre. Eating starchy foods which contain more fibre, or
having high fibre foods (such as vegetables or) with your starchy foods,
slows down the digestion and therefore the absorption of glucose.
Slowly absorbed starchy foods:
Wholegrain bread (bread with ‘bits’),
Fruit bread and pitta bread
Pasta – all kinds
Basmati or ‘easy cook’ rice
Green banana and yam
Oat based cereals eg porridge
Peas, beans and lentils/dal
Barley
Some starchy foods, not mentioned above, such as potatoes, are still an
important part of your diet. Make sure you eat them with high fibre foods
such as vegetables, salad or beans.
It is the combination of foods you eat that is important. The main part of
your meal should be the starchy food, with a good helping of vegetables
and/or salad and a smaller portion of meat, fish, chicken or vegetarian
alternative
15
7- Exercise and Activity
main points
1
2
Regular, moderate activity will
improve diabetes control
Aim to do 30 minutes of moderate
activity, such as brisk walking,
Five times a week
3
Discuss any planned new activity with
your diabetes team
4
Be aware of the risk of hypos and
seek advice.
Being active is good for all of us but it is especially important if you have
diabetes. Any increase in activity is better than none as long as you do
something you enjoy and do it regularly.
Some of the benefits:

Regulates glucose levels
Strengthens the heart
16
 Improves blood circulation
 Lowers blood pressure
The recommended amount of exercise is 30 minutes of moderate
activity 5 or more times a week. That means moving about enough to
make you feel warm and slightly out of breath but not too breathless to
talk. The 30 minutes can be spread over the day as 2x15 minutes or
3x10 minutes if preferred.
Try to include more activity in your daily routine. Take every opportunity
to walk, e.g. leave the car behind for short journeys, get off the bus a
stop earlier, use stairs more often, go for a walk during lunch break.
On a regular basis, try to do activities you enjoy – dancing, swimming,
cycling, sports, yoga, keep fit classes, gardening, DIY, Car Washing,
window or cupboard cleaning. Remember, build up slowly if you have
done very little exercise before.
Exercise screening
Activities such as walking should not present any difficulties, but discuss
any planned new activity with your diabetes team, who will be able to
advise you of any limitations or precautions.
Hypoglycaemia
As you exercise you use up the glucose in your blood and are more at
risk of hypos (ie. very low blood sugar).
If you are on diet alone, Metformin or Glucobay, there is very little risk of
hypo.
If you are taking other diabetic tablets or Insulin, you need to take care to
avoid hypos. Do not miss meals or snacks – you may need to take extra
starchy food before or after the activity. Discuss this with your diabetes
team.
17
8- Physical Activity Facilities and
Targets
Brent Leisure Centres:
 Bridge park
 Charters
 Vale Farm
In Harrow:
 Harrow Leisure centre
 Hatch end swimming pool
Exercise classes:
Leaflets for current dates and venues, are available at Jeffrey Kelson
Centre, Willesden and Wembley Centres for Health and Care,
Please ask the Diabetes Specialist Nurse and the Dietitian.
Or Ring:
 Thea 020 8453 2482
 Doug 020 8903 1728
 Tamara 020 8450 1016
Guided Health walks in Brent (all walks are FREE):
- Available from Brent Sports Services on
020 8937 3707
- or visit website:
www.brent.gov.uk/sports
Set yourself some targets, build up slowly and check your progress
See next page:
18
Target achieved (tick)
Day
10 min
15 min
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
19
20 min
30min
9- Eye screening
main points
1
Regular eye checks identify any
problems early.
2
Eye tests are free for people with
diabetes.
3
4
Do not drive after your pupils have
been dilated until your vision returns
to normal.
The better your diabetes is controlled
the less likely you are to develop
retinopathy.
Diabetes may cause changes in the retina at the back of your eyes,
which can become serious.
Regular checks will identify problems at an early stage
so that treatment can be given to prevent loss of vision
20
One of the complications of diabetes is the possibility of diabetic eye
disease, which if left unchecked, can progress to blindness. It is very
important that everyone with diabetes should have their eyes checked on
a regular basis (at least once a year), even if they do not feel they have
any problems with their eyes. Such precautionary checking of eyes is
called Retinal Screening. The aim of retinal screening is to pick up
diabetic eye disease so that appropriate treatment can be offered early
to try to prevent blindness.
Brent Primary Care Trust, has introduced a new service called “Digital
photography” to check for early signs of diabetic eye disease. This
involves having some drops put in the eyes and then a photograph of the
back of the eye is taken. This method is recommended by the National
Screening Committee and is safe, quick and uncomplicated.
In Brent there are also trained or accredited opticians that offer retinal
screening for people with diabetes. (Lists are available). The optician
uses instruments such as ophthalmoscope or Slit lamp, which shines a
bright light into the eye to check your retina and some, may also have
photographs taken of the back of the eye.
By either method, you will have a sight test first and then your pupils will
be dilated with eye drops. These may cause blurred vision for about two
hours, so you should not drive afterwards, until your vision returns to
normal. You may find sunglasses helpful until the effects of the drops
have worn off.
If you are found to have diabetic eye disease (retinopathy), you will be
sent an appointment for the eye clinic and be seen by an ophthalmologist
(eye doctor).
The better your diabetes is controlled, the less likely you are to develop
retinopathy. In 9 out of 10 people there are no serious diabetic eye
damage; hence a further check up would be once yearly.
REMEMBER: A regular eye check up every year is never a waste of time
and will give you the best chance of avoiding future problems with your
eyes.
21
10- Cataracts
main points
1
Cataract affects the lens of the eye.
2
Cataract causes the lens to become
cloudy.
3
Treatment is by an operation to replace
the cloudy lens.
4
There is very little pain associated with
the operation.
5
In the majority of cases vision is
improved.
22
A cataract is a condition affecting the lens of the eye. The lens is situated
inside the eye behind the pupil. Its normal function is to ensure we see a
clear image.
A cataract is said to be present when the lens, which is normally clear,
becomes cloudy. This restricts the amount of light that is able to enter
the eye, causing blurred vision and often dazzle and glare.
The cause of cataracts is most commonly related to old age. This can
occur in both eyes, although one eye may be worse than the other.
Cataracts also are more common in people with diabetes and may
present earlier.
Usually cataracts develop gradually and can often go unnoticed at first.
As they develop, vision becomes worse and everyday activities become
more difficult.
The only way a cataract can be treated is by an operation to remove the
cloudy lens.
An artificial lens implant is inserted into the eye to replace the cataract.
The operation is normally carried out with a local anaesthetic. (you stay
awake). Most people have surgery as a day case. One eye is operated
on at a time.
There is very little pain associated with this operation although eyes may
be sensitive to light for a few days.
In the majority of cases the vision is improved.
Every effort is made to match the strength of the implant lens with the
eye. However, best vision may not be achieved until glasses are
prescribed.
23
11- Foot Care
main points
1
Look at your feet everyday
2
Finding and treating problems quickly
will decrease any risk of foot ulcers
3
Having less feeling in your feet is the
most common cause of injury
4
Remember the safety points
To prevent foot problems, people with diabetes must be committed to
actively looking at and protecting their feet each day.
Check between toes and try to use a mirror to see difficult areas, if
necessary ask a family member or friend to help


Improves glucose sensitivity
Keeps joints mobile
24
You are looking for:

Sores, cuts, bruises or injury

any colour change, swelling, warmth or redness

calluses or changes in the shape of your feet
Finding and quickly treating all foot problems will decrease the risk
of foot ulcers.
If you find any problem with your feet, call your diabetes team.
You are at more risk of developing foot ulcers if you have any of the
following risk factors.

Loss of feeling in your feet

Pain in legs while walking

Changes in the shape of your foot

Previous foot ulcers
Having less feeling is the most common cause of injury to your feet.
Painless injuries often can lead to foot ulcers.
Poorly fitting shoes can also quickly lead to problems.
Safety Points:
Protect your feet with proper footwear and before you put on your shoes
check the inside for rough lining or loose objects.
Be careful not to use anything hot on your feet.
If your feet are dry and cracked, use the moisturising cream recommended by
your diabetes team.
25
12- Driving
main points
1
2
3
You can hold a driving licence
You must inform DVLA if you are
treated with tablets or insulin
You can not hold a PSV or HGV
licence if you are treated with
insulin
4
You must inform your insurance
company
5
Stop the car if you feel hypo as
soon as safely possible
6
Always carry glucose tablets and
food with you
26
Car and motorbike licences can be held by people with diabetes. You
must by law notify the Driving Vehicle Licensing Authority (DVLA) if
your diabetes is treated with tablets or insulin but not if it is treated
with diet alone.
If your diabetes is treated with tablets you will be issued with a full
licence but you must let DVLA know if any problems or complications
occur or if you start to take insulin.
If you are treated with insulin, the license may be issued for one, two,
or three years depending on your general health. The licence renewal
form will be automatically sent before the expiry date.
If you are treated with insulin you will not be allowed to hold a large
goods vehicle, or a passenger carrying vehicle licence. There is also a
restriction on any vehicle over 3.5 tons and minibuses over nine seats
including the driver.
Driving and Hypos
Always carry glucose and food in the car. If you feel hypo when driving,
stop the car as soon as safely possible. Remove the keys from the
ignition and move in to the passenger seat.
Do not start driving again until you have eaten and it is safe to do so.
Car Insurance
You must inform your insurance company of your diabetes and ensure
your policy covers you.
27
13- Illness
main points
1
2
3
Never stop your insulin or tablets
Always seek help if you are
worried
Replace your normal food with
suggestions if you cannot eat
Eg: milk yogurt, build up etc.
4
Try to eat little and often
5
Drink plenty of sugar free fluid
6
Monitor blood sugar regularly
28
If you get an illness such as ‘flu or diarrhoea and vomiting, it may upset
your diabetes control. This may cause a rise in blood sugar levels even
though you may be eating less food or not eating at all. Because of this,
it is important to continue with your tablets or insulin.
If you take insulin injections never stop your insulin, you may need
to increase the dose
If you take tablets and are unable to keep them down, consult you
doctor.
Try to continue eating your normal foods. If your appetite is poor, you
can replace the meals with the following suggestions:




Build up, Complan
Milk pudding or custard (made with sugar)
Ordinary yoghurt
Drinking chocolate, Ovaltine or Horlicks
If you are being sick (ie vomiting), replace foods with drinks. Here are
some suggestions.
 Lucozade plus water.
 sugary fizzy drinks,
 hot drinks with some sugar in them.

Warning: . It is important to take them in small amounts. These
foods/drinks have more sugar in them, than is recommended for normal
health, as they are absorbed more quickly.
If you are constantly being sick for 6-8 hours, or more than 2 meal times,
consult your doctor.
As well as this:



Drink plenty of sugar-free fluid
Test you blood sugar before each meal and before bed-time
Always seek help if you are worried
29
14- Holidays
main points
1
Take medical insurance
2
Carry identification
3
4
5
Carry equipment and medication
with you
If travelling across time zones,
discuss this with your diabetes
team
Diabetes UK have more specific
information about travel
30
People with diabetes are able to enjoy holidays and travel abroad in the
same way as everyone else, but you may need to take some extra
preparations.
Insurance
Make sure you do not travel abroad without medical insurance. Check
the policy and make sure is does not exclude ‘pre-existing’ conditions.
Diabetes UK can also advise you on travel insurance.
If you are travelling across time zones, you may need to adjust your
insulin or tablet doses. Discuss this with your Diabetes team before you
go.
Carry your equipment in your hand luggage so that it does not get
separated from you. Do not put insulin in the hold of an aeroplane as
it may freeze and become unusable.
Insulin should be kept cool and out of direct sunlight. A cool bag is useful
for this.
You should take a diabetes identity card and twice as much medication
and equipment you think you will need. This will allow for any delays or
mishaps during travel. It is also a good idea to take a supply of food and
drinks with you.
Diabetes UK has information sheets about the availability of medication
and equipment in other countries. You may like to contact them about
this on 020 7323 1531.
When travelling, don’t aim for perfect control. The main thing is to enjoy
your holiday.
31
15- Diabetes Management
Management profile: helps you to keep track of your diabetes.
The profile will make it easy for you to review your entire, up-to-date
management plan at any time.
Work with your doctor, diabetes specialist nurse, pharmacist and
educator to fill and update these sections.
Name
Tel no.
Appointment
GP
Specialist Dr
Specialist
Nurse
Dietitian
Podiatrist
Pharmacist
Others
Medications:
Name
dose
Times taken
32
Repeat
16- Frequency of Blood sugar testing: ______per day or week
When to test your Blood sugar: Fasting or 2 hours after meals.
Targets Blood Sugar: Fasting ____________________mmol/l
2 hours after meals_____________________ mmol/l
Optimum eating time:
Breakfast
Snack
Time
Lunch
Snack
Dinner
snack
16- Diabetes Results and targets
Results
Goals
HBA1c
BP
Weight
BMI
Cholesterol
Smoking
Exercise
Eye Test
33
Targets
17- Blood Sugar results
Breakfast
Before
Lunch
After
Before
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
34
Dinner
After
Before
Bedtime
after
Night
17- Blood Sugar results
Breakfast
Before
Lunch
After
Before
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
35
Dinner
After
Before
Bedtime
after
Night
17- Blood Sugar results
Breakfast
Before
Lunch
After
Before
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
36
Dinner
After
Before
Bedtime
after
Night
17- Blood Sugar results
Breakfast
Before
Lunch
After
Before
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
37
Dinner
After
Before
Bedtime
after
Night
17- Blood Sugar results
Breakfast
Before
Lunch
After
Before
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
38
Dinner
After
Before
Bedtime
after
Night
18- Diabetes UK
main points
1
Diabetes UK is dedicated to helping
people with diabetes
2
Diabetes UK produce a magazine called
Balance
3
Diabetes UK have trained advisors
available on the telephone
4
Diabetes UK can be contacted by phone,
fax, email and letter
5
Address:
10 Park Way, London
NW1 7AA
Tel: 020 7424 1000
Fax: 020 7424 1001
www.diabetes.org.uk
[email protected]
‘Diabetes UK Careline’. Phone:
0845 120 2960
39
Diabetes services:
 A- Access community input already available
eg education and exercise classes, nurses
and GP facilities.
 E- Ensure consultation and education
objectives are met.
 I- Investigations & Test results explained.
 O- Once objective is reached, discharge back
to G.P. Diabetes care.
 U- Utilize community facilities continuously
i.e. Education & Exercise groups.
For Various Diabetes Educational courses:
(short, Comprehensive, DAFNE, DESMOND)
Information available from JKC, Diabetes Specialist Nurses
and Dietitians; or directly from:
Mr Sala Salih
Education Co-ordinator
Monks Park Primary Care Centre
Wembley, HA9 6JE
Tel: 8453 5964
Fax: 8453 5972
Email: [email protected]
40
A hypoglycaemic reaction or ‘HYPO’ happens
when your blood sugar falls too low (below 4).
Symptoms:
Symptoms vary from one person to another. You may
feel faint, light headed, giddy, sweaty, shaky, confused or
agitated. Your vision may become blurred or you may slur
your speech e.g. symptoms of drunkenness and
aggression. Other symptoms experienced are headache,
dry mouth, tingling lips or fingers, and palpitations.
Hypo’s may be caused by:

A delayed meal

Missing a meal

Not eating enough carbohydrate foods

Exercising more than usual

Taking too much insulin or diabetic tablets

Drinking alcohol without food

Hot weather
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1.
Immediately have some quickly absorbed sugary food or drink
e.g.
(note – chocolate, biscuits and milk are NOT quickly absorbed)

OR
4-5 Lucozade or Dextrosol tablets
4-5 Soft sweets e.g. Jelly babies
OR
120 ml/1/3 of small bottle of lucozade original
OR
185 ml/½ can/ 1 teacup coca cola or fizzy drink (NOT diet)
OR
small carton (200-250ml) any fruit juice
This gives you enough glucose to bring your blood glucose level
to 7 or 8 (not too high), within 10 minutes
Then - if it is likely to be more than an hour before your next
meal, eat something more substantial to stop you going low
again e.g.








A small, healthy sandwich, try wholegrain or pumpernickel bread.
2 – 3 Plain biscuits
Slice of wholegrain toast
Low fat yoghurt
Portion of fruit
Oat cake
Glass of low fat milk
Oat based cereal bar
Central Middlesex Hospital
Dietetics Department
August 2005
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