Diabetes is a key topic for us at Blackheath. As a disease it is becoming more common, and there are now over twice as many diabetics than there were 10-15 years ago.
As a practice we aim to diagnose diabetes as early as possible, and to ensure that our patients with diabetes receive the best possible care and advice.
Why is diabetes important?
Diabetes is associated with a significant increase in the risk of developing heart disease (heart attacks & angina), stroke, blocked leg arteries (leading to a risk of amputation), severe eye problems, and serious kidney problems.
Diabetes can affect the eyesight, forcing some to stop driving. It is the leading cause of blindness in the UK.
Diagnosing diabetes as early as possible and managing it effectively helps to reduce the risk of developing these important complications.
Diagnosing diabetes as early as possible
The preferred screening test is a blood test.
We check for diabetes on most blood tests done in the practice. Additionally, our computer system
calculates the patient's QDiabetes risk score during consultations, and prompts the clinician
if a diabetes check is appropriate.
For more information about QDiabetes, please see
this link.
If a screening test comes back abnormal, patients will be invited to have further tests.
The most important thing most people can do to reduce their risk of developing diabetes is to lose weight - most of our diabetics are overweight at the time of diagnosis. Taking more exercise is also important - a 20 minute walk as briskly as you can at least three days weekly at the very least.
Optimising care of known diabetics
Maximising diabetes care is important for many reasons:
- To reduce the risk of premature death.
- To reduce the risk of vascular disease. Diabetes is associated with a higher risk of heart disease and peripheral vascular disease. The heart disease can include angina and heart attacks. Peripheral vascular disease can limit the patient's ability to walk any distance, and in bad cases, can lead to lower limb amputation.
- To avoid eyesight problems that might stop the patient driving, or cause blindness.
- To make sure the patient is fit for whatever else life throws their way. Patients with poorly controlled diabetes can be declared "unfit for surgery". For most operations, the HbA1c test result needs to be less than 65 mmol/mol. Some operations require this result to be less than 50. Being declared "Not fit for surgery is quite a challenging and stressful event. Do you know your latest HbA1c number?
- To reduce the risk of peripheral neuropathy (where the patient cannot feel things with their hands and feet).
- To protect the kidneys and reduce the risk of renal impairment, and in bad cases, kidney failure.
We will..
- Advise you about what you can do to help your diabetes. The fundamental advice is:
Lose Weight and Take More Exercise. - If you smoke, it is very advisable to stop. Smoking and diabetes is not a good mix. We can refer you to the local smoking cessation service to help you dump the weed before it dumps you.
- Refer you to other specialists such as:
- Dietician who can help you work what changes you need to make to your diet
- Optician (must be from a list of accredited opticians)
- Podiatrist - to advise on foot care
- Community-based diabetic liaison nurse (where appropriate)
- Although most diabetic care is delivered in the practice, more complicated patients will be referred to a hospital-based consultant diabetologist when necessary.
- Advise you to have blood tests at regular intervals. We will also advise annual urine tests (ACR) to check your kidney function.
If you use a mobile 'phone, please give us the number and we can 'text' you when reviews are due. - Prescribe whatever is needed to optimise your diabetic care. Prescriptions often include medications to help your cholesterol and your blood pressure which both have to be strictly managed.
Most maturity-onset diabetics are managed with tablet medication; sometimes, GLP1 injections are added to the treatment plan. Some do require insulin therapy.
Diabetes requires significant patient involvement to ensure best management.
We see it all in the practice, from the patients who do not modify what they eat, require more and
more drugs for their worsening diabetes, and develop diabetic complications, to those who really
take the bull by the horns, modify their diet, take more exercise, and require fewer or no drugs.
Those that lose weight, take more exercise to the best of their ability, and switch to a low
carbohydrate diet significantly reduce their risk of developing complications.