Diabetes

What is Diabetes?

Diabetes (also referred to as diabetes mellitus) is a long-term condition where the amount of glucose (sugar) in the blood is too high. This happens when the pancreas does not produce any insulin, enough insulin or the body is resistant it. Insulin acts like a key to unlock the pathway to allow glucose to move from the blood into the cells to provide energy. Diabetes affects approximately 4.3million people in the UK. Approximately 8% of people with diabetes will have Type 1 and around 90% will have Type 2.

Type 1 Diabetes

Type 1 diabetes cannot be prevented. It is caused by a fault in the body’s immune response system, where the cells responsible for producing insulin are targeted and destroyed by mistake. People with type 1 diabetes will always require insulin therapy.

Type 2 Diabetes

Type 2 diabetes occurs when the pancreas is not producing enough insulin and/or the body resists to the action of insulin (insulin resistance).People with type 2 diabetes are usually managed with lifestyle advice and/or oral medications. Sometimes injectable therapies (including insulin) are required to help manage type 2 diabetes as it progresses. It is possible in some circumstances that you can get your diabetes into remission. This is achieved when your long-term blood sugar (HbA1c) is less than 48mmols for at least 3 months after stopping all diabetes medication.

Pre-Diabetes

This diagnosed when you have a HbA1c between 42- 47mmols. If your level is in this range it means that you are at higher risk of developing Type 2 diabetes. Please see the section on the Diabetes Prevention Programme (DPP)..

Children with Diabetes

Children with diabetes will be under the care of the Sheffield Children’s Hospital.

The Diabetes team specialise in working with children up to 16 years of age with all types of diabetes:

Type 1 diabetes
Type 2 diabetes
Cystic fibrosis related diabetes
Steroid -induced diabetes
Uncommon diabetes types such as maturity onset diabetes of the young (MODY)

Children’s diabetes services enquiries call 0114 271 7320 (8am – 4pm)

When families need to call the hospital for ‘out of hours’ diabetes advice, you should call the SCH switchboard on 0114 271 7000 and ask to be put through to the senior medical doctor on call.

Diabetes service - Sheffield Children’s NHS Foundation Trust

Young Persons Diabetes Service (16-20yrs)

The young persons diabetes clinic at the Northern General Hospital is held on the 1st and 3rd Wednesday afternoon of each month. For more information please click on the link below.

Transition to the young persons Diabetes service in Sheffield - Resource Library - Sheffield Children's NHS Foundation Trust

Steroid-Induced Diabetes/Hyperglycaemia (High Blood Sugar)

Steroids are artificial versions of hormones that are naturally produced by your body. They reduce inflammation in your body, and can help to treat conditions such as severe asthma/COPD, cystic fibrosis, arthritis, inflammatory bowel disease, other inflammatory conditions and are also used in some cancer treatments. These are not the same as anabolic steroids which increase body muscle mass.

Steroid-induced diabetes

Steroids can cause high blood glucose (sugar) levels. Some people who take steroids can develop (steroid-induced) diabetes. Sometimes dietary changes are enough to control the blood sugar. Other times additional medication is required. Steroid-induced diabetes may or may not resolve when the steroid medication stops.

Steroid-induced hyperglycaemia

Steroids can also cause a further increase in blood sugar levels for those who already have diabetes and medication may need to be adjusted to maintain good control.

If you are taking medium to high-dose, repeated courses or prolonged courses of steroids you should have access to blood sugar testing with a glucose monitor.

Please follow the link below for more information

Steroid-induced diabetes | Diabetes UK

Gestational Diabetes

If you have a history of Gestational Diabetes (diabetes in pregnancy) you are at increased risk of developing type 2 diabetes in the future. It is therefore important you have an annual blood test (HbA1c). You can book this blood test at the surgery, attend the drive through service at Longley or attend the Phlebotomy department at the Hallamshire or Northern General Hospitals.

You can take control of your risk of diabetes by moving more, improving your diet and maintaining a healthy weight longer term and the Diabetes Prevention Programme (DPP) can help with this. You can self-refer for this free NHS service and be seen online or in person. Please take a look at the website for more information https://healthieryou.reedwellbeing.com/gestational-diabetes/ (scan the QR code below) or chat to your nurse or GP at your next appointment.

It is important to remember that if you develop any signs or symptoms of diabetes, such as increased thirst, thrush infection, fatigue or passing lots of urine that you let your GP know promptly so they organise a test and support you.

GD QR code

Scan the QR code for more information on how NHS Healthier You can provide support after gestational diabetes or pre-diabetes through the Diabetes Prevention Programme.

How do I look after my Diabetes?

Your diabetes will be reviewed at the surgery at least once a year. Patients will need to book a 20 minute appointment for monitoring tests. This will include blood sampling, foot check, blood pressure and height and weight measurements. You will then need a follow-up appointment with the Practice Nurse to review the results, discuss your medication and to agree your ongoing management plan for your diabetes. Blood tests and other monitoring may be required more often to improve control or check levels after medication changes.

Some people will be offered referrals to other services that may also help manage and control their diabetes. This may mean that are seen in secondary care or in specialist community clinics.

What to expect from you diabetes review

During your annual diabetes review, the clinician will focus on the 9 key areas below, as well as other life style issues, to help you improve your diabetes control.

HbA1c

This is a blood test that shows your average blood sugar over a period of 3 months. Diabetes is diagnosed when you have two readings above 48mmols. The nurse will discuss your individual HbA1c target with you during your review.

Cholesterol

Your cholesterol level is checked by a blood test at least once a year. Depending on your result, your age and your type of diabetes, you may be offered a tablet called a statin. A statin helps to lower your cholesterol level and reduce your risk of having a cardiovascular event like a heart attack or a stroke. You can find more information on statin medication here.

Blood Pressure

If you have diabetes it is very important to keep your blood pressure in a healthy range to reduce your risk of complications. When your heart pumps it creates pressure in your blood vessels. The top number is the pumping pressure (systolic). The bottom number is the resting pressure (diastolic). Your blood pressure can vary throughout the day. At least half of heart attacks and strokes are associated with high blood pressure. It is also a major risk factor for chronic kidney disease, heart failure and dementia.

Kidney Function

Raised blood sugar levels can be damaging to the tiny blood network and filters in your kidneys. This is called nephropathy. Your kidney function should be monitored by a blood test at least once a year. This may need testing more often if your kidney function is altered or you are taking certain medications.

Urine ACR

High blood pressure and diabetes can also affect your kidney filters and sometimes causes protein to leak out into the urine. This is monitored at least once a year by a urine test called an ACR (Albumin Creatinine Ratio). Urine ACR Leaflet

These blood and urine tests allow problems to be recognised early and treated to reduce the risk of long-term complications.

Eye Screening

Diabetic eye screening is offered in a variety of locations throughout the city, including certain GP surgeries and hospitals. Sometimes additional clinics are offered more locally at the SWFC stadium.

All people aged 12 and over with diabetes (type 1 and 2) are offered eye screening. You will be invited again either after 12 months or 2 years depending on your eye screening result.

The only exceptions to routine eye screening are people with diabetic eye disease who are already under the care of an ophthalmology specialist.

The screening test usually takes around 30 minutes. On arrival some drops will put into your eyes to dilate your pupils so that photographs of the back of your eyes can be taken with a specialised camera. As it takes a little while for your eyes to return to normal after the test so you will not be able to drive for a few hours.

Diabetic eye screening does not replace regular eye examinations and it is important to attend both.

Diabetic eye screening - Sheffield Teaching Hospital

Diabetic eye screening - NHS - Includes explanation video of your eye screening appointment

Diabetic eye screening | Retinopathy | Diabetes UK

Diabetic eye screening: information leaflets - GOV.UK - Includes easy-read leaflets

Sheffield Teaching Hospitals - Diabetes - Includes video

Foot check

These tests are to make sure you have good circulation to your feet and to check for any signs of nerve damage (neuropathy). For further information about neuropathy you can click here. You will be offered a foot check at least once a year. The nurse will feel for your foot pulses and will sometimes use a special machine called a doppler to hear the foot pulses. The sensation in your feet will also be checked with a small instrument called a monofilament. You can see how a foot check is done by watching the video here.

It is also important that you check your own feet on a daily basis for any changes, breaks in the skin or signs of infection. You should contact the surgery promptly with any changes (call 111 if the surgery is closed). Here are some tips to keep your feet healthy:

Moisturise your feet daily to minimise the risk of hard and/or cracked skin as this can increase the risk of infection and development of foot ulcers.
Do not to moisturise between the toes or the toenails as this may encourage fungal infections.
It is not advisable to remove/cut off hard skin yourself or use corn plasters.
File your nails once a week instead of cutting your nails.
Any hard skin can be filed gently with an emery board.
Good supportive footwear is very important to reduce the risk of foot problems.

It is estimated that between 5-7% of people with diabetes will have a diabetic foot ulcer at some point in their lives. This risk can be reduced by keeping good control of your blood sugar and blood pressure, not smoking, checking your feet daily and seeking prompt medical attention with any changes.

Diabetes UK Foot Check Leaflet

If your feet are assessed to be higher risk, you will be offered a referral to the podiatry service, who are more specialised in foot care.

If you have an acute foot problem, such as an infection or an ulcer, then you may be referred directly to the foot clinic at the hospital.

Body Mass Index (BMI)

Keeping a healthy weight when you have diabetes helps to protect and reduce long-term risk for your heart, eyes kidneys and feet. A normal BMI in adults is 18.5 to 24.9 kg/m2. This range is a guide to indicate a healthy weight for your height. A BMI below 18.5 is considered to be underweight and a BMI above is considered to be overweight. You can calculate your own BMI by clicking the link here.

Smoking

https://sheffield.yorkshiresmokefree.nhs.uk/

Lifestyle

Additional blood tests

Other blood tests that are included in your annual review are a full blood count (FBC) , liver function test (LFT) and thyroid function test (TFT)

Courses and Referrals

MoreLife – you can refer yourself to this 12 week programme if you are an adult with a BMI above 25 or above 23.5 if you have a Black/Asian or other ethnicity. You can choose to do the programme face-to-face or online and it covers mindful eating, stress and emotional eating Home Page - Morelife UK

Move Well- Move More - Many people with health conditions find that being active helps them manage their condition and symptoms, as well as improving their general well-being. You can self-refer to this by clicking on the link below Move Well — Move More Sheffield

DESMOND course - is for people with Type 2 Diabetes (Diabetes Education and Self-Management for On-going and Newly diagnosed Diabetes) to increase your knowledge skills and confidence to manage your own diabetes https://publicdocuments.sth.nhs.uk/PIL4130.PDF

DAFNE Course - DAFNE stands for Dose Adjustment For Normal Eating. It aims to help adults with type 1 diabetes lead as normal a life as possible, whilst also maintaining blood glucose levels within healthy targets, to reduce the risk of long-term diabetes complications Home - DAFNE

WICKED Course - Working with Insulin, Carbohydrates, Ketones and Exercise to manage Diabetes. A structured education designed for young people with Type 1 diabetes. It aims to improve self-management skills and knowledge leading to better control of blood sugars and quality of life. This course would be accessed through the Young Persons Diabetes Services at Northern General Hospital.

Diabetes Prevention Programme – this programme lasts for 9 months and consists of fortnightly sessions for 4 sessions then monthly. It is offered to those with pre-diabetes or a history of diabetes in pregnancy (gestational diabetes). There are face-to-face or digital sessions. On-line tailoured sessions are also available if your vision or hearing is impaired or if you have a history of gestational diabetes. Please contact the practice if you would like to be referred. Please follow the link for further information.

https://healthieryou.reedwellbeing.com/about-the-programme/

Type 2 Diabetes Remission Programme research has shown that a 3-month specially formulated diet comprising of total diet replacement products including soups and shakes, followed by healthy lifestyle support helps people living with type 2 diabetes to lose weight, improve their blood sugar levels, reduce diabetes-related medication and, in almost half of participants, put their type 2 diabetes into remission.There is specific criteria that needs to be met before being accepted onto the programme. The products and the programme are FREE. You can check your eligibility from information in the link below. Please contact your practice if you woul dlike to be referred.

South Yorkshire: NHS Type 2 Diabetes Path to Remission - Momenta Newcastle

NHS Digital Weight Management Programme – this programme is available to adults with diabetes (Type 1 or Type 2) and/or hypertension (high blood pressure) with a raised BMI (body mass index). It is a an on-line behavioural and lifestyle programme over 12 weeks with three different levels of support which is allocated after assessment. Please contact the suregry if you would like to be considered for referral Bing Videos

NHS Weight Loss APP – this is a self-upload APP for adults. It can be used with a smart phone or computer and gives digital support with calorie counting, weight monitorinng and tracking activity with a flexible 12 week plan https://www.nhs.uk/better-health/lose-weight/

Carbsmart Course