Tag Archives: diabetes
Long Term Conditions – Self Management Programme for Ealing!
The letter reprinted:
Mrs Diane Mellitus
6, Sweetwater Drive,
Andover B4 1LL
Dear Dr Down
Thank you for your letter and concern. I am so sorry that I have not been to see you but I have been so busy with decorating and doing jobs around the house and my sister has been ill and my mother was taken into hospital. Also, I couldn’t get an appointment for two weeks to see you and when I go to the surgery I have to wait so long and I just haven’t got the time to wait around. As much as anything I was worried I might pick up something whilst I was waiting that I might pass on to my mother or sister.
Anyway, I have made an appointment next week to have my bloods taken and the following week I have made an appointment to see the nurse and one to see you.
Thank you once again for your concern.
Dr Brenda Patricia Down,
Andover, B4 UD1
March 20th 2015
Mrs Diane Mellitus
6, Sweetwater Drive,
Andover B4 1LL
I am writing to you as I am very worried that I have not seen you in surgery for sometime and your last blood tests were not good and showed that your diabetes is poorly controlled. I know that if you come to see me, together we can improve the situation considerably.
The problem is that, although you may not feel too bad, if your blood sugar is high for a long time your body is slowly becoming damaged. Gradually, the large blood vessels in your body will become clogged. As a result, you are more likely to have a heart attack, stroke or have difficulty walking without severe leg pain. It also effects the small blood vessels and this effects your eyes causing cataracts or damage to the back of your eyes and it may effect your kidneys. The high sugar effects the nerves, especially in your feet and hands, so that you can’t feel things properly.
I know you love sewing gifts for your family, but if your eyesight gets worse and you can’t do much with your fingers you will really miss making all those lovely gifts. They so rely on you to do repairs and it won’t be that long before the grandchildren will be on the way! I also know how independent you are and how you like to get out and about.
Do you know that I saw a diabetic patient last week who has lost such a lot of weight and has been walking the new dog each day. I could not believe how his blood sugars have improved, his blood pressure has come down and his cholesterol is normal, which means I have been able to stop nearly all of his tablets. He is so happy that he will look better in his swimming trunks and with the money he has saved on quitting smoking he has decided to take his wife on a Caribbean cruise!
Please make an appointment soon so that we can get to grips with controlling your diabetes as it is not only me who is worried about you, but your family must also be concerned and I know you are so important to them.
Dr B.P. Down
PS Did you manage to get to that meeting with Right Start to learn more about diabetes? If you want to look up to find out more about Diabetes try http://www.diabetes.org.uk it is a really good website.
During the last week I have been aware of 4 patients who have been sent fines for out of date prescription exemption certificates
If you suffer from one of the specified medical conditions you are eligible to hold a valid medical exemption certificate.
Medical exemption certificates are issued on application to people who have:
a permanent fistula (for example caecostomy, colostomy, laryngostomy or ileostomy) requiring continuous surgical dressing or requiring an appliance
a form of hypoadrenalism (for example Addison’s disease) for which specific substitution therapy is essential
diabetes insipidus or other forms of hypopituitarism
diabetes mellitus, except where treatment is by diet alone
myxoedema (that is, hypothyroidism requiring thyroid hormone replacement)
epilepsy requiring continuous anticonvulsive therapy
a continuing physical disability which means the person cannot go out without the help of another person.
(Temporary disabilities do not count even if they last for several months)
Or are undergoing treatment for cancer:
including the effects of cancer, or the effects of current or previous cancer treatment.
When you visit the pharmacist it is important you show the certificate when handing in the prescription. The pharmacist wil then indicate in the appropriate place that they have seen the certificate. If this box is not completed there is strong possibility that the business prescribing authorities will check their records and if the certificate is out of date you will be issued a fine.
The letters I have seen show the fine is £50 for not possessing an up to date certificate.
This can be appealed and may be waived if you are receiving income support.
How to apply for a medical exemption certificate
To apply for a medical exemption certificate ask your doctor for an FP92A form. Your GP, hospital or service doctor will sign the form to confirm that your statement is correct. You will also be given a pre-paid envelope. At your GP’s discretion, a member of the practice who has access to your medical records can also sign the form.
Your certificate will be valid from one month before the date that the NHS Business Authrority receives the application form.
The MedEx lasts for five years and then needs to be renewed. You may receive a reminder that your certificate needs to be renewed. If you don’t receive a reminder, it is your responsibility to ensure that it is renewed.
The certificate covers all prescription charges. Further details can be obtained from the following website:-
if you want more information about prescription costs including pre-payment certificates if is available on the following website:-
Ealing Borough has one of the highest uptakes of free NHS Health Checks in the country. That means residents are reducing their risk of developing heart disease, stroke, diabetes and kidney disease.
If you are aged between 40 – 74years old , have not had a health check in the last five years and have not already been diagnosed with certain conditions you will be invited for a Free NHS Health Check. The checks only take 20 minutes and hopefully will give you peace of mind and good advice on staying well.
Even if you feel perfectly well and lead a healthy life style it is worth having it. Some conditions do not have early symptoms. It is estimated that 850,000 people are unaware that they have type 2 diabetes. I remember when I first joined the practise on simple urine screening I picked up 19 asymptomatic diabetics in 6 months including a 19 year old young man.
We as GP’s are increasingly aware that people need to be educated as to what is a healthy weight, the safe levels of alcohol aswell as the importance or regular exercise. If after discussing your results you are found to be at risk of getting one of these diseases your healthcare professional can offer support to help lower the risks.
For more information visit www.nhs.uk/nhshealthcheck
Those of you who have read one of my previous blogs may remember Sam, an 18yr old boy who came in nervously with his sister as he had been complaining of genital irritation which turned out to be thrush, which is a known presentation of diabetes especially in men.
He had no other symptoms but his urine contained glucose. When I told Sam he had diabetes his reply was, ” Am I going to die?” My reply was “I hope not as that means I am not a very good doctor. However, I suggest that you must not smoke and night’s out with the lads heavy drinking is not for you!” He replied,”Oh that’s good I don’t smoke and I am not fond of drinking I only drink an occasional lager”
I arranged for him to attend the diabetic clinic to be initiated on insulin as he was clearly a Type 1 diabetic.
Sam remains well still in the same job, although thinking of joining the fire service, married with 2 children, fit as a fiddle. Diabetes does not dominate his life, he has never been in hospital,continues taking insulin and sees his doctor every 6 months for regular check ups. That how the majority of diabetics live – they can have a lager or a bar of chocolate occasionally and can become organ donors and he will be assessed on his ability to be a firefighter and will not be turned down because he has diabetes.
Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.
Who typically gets Type 1 diabetes?
Type 1 diabetes accounts for about 10 per cent of all adults with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially y in childhood. It is the most common type of diabetes found in childhood. Type 1 diabetes can’t be prevented. The body’s immune system destroys the insulin-producing cells, and nobody quite understands why.
The vast majority of children with diabetes have Type 1 diabetes, but an increasing number are now developing Type 2 diabetes.
Notwithstanding, there are those for one reason or another develop complications but for the most part the majority of people like Sam lead a normal life.
The rest of those patients who I picked up with glucose in the urine were older.
I particularly remember Diane, who was a 55yr old teacher very overweight, and admitted she did very little exercise. She had come to surgery feeling tired and stressed but a routine urine showed glucose. I tried to suggest that she lost weight and even suggested Bariatric surgery but she was very negative, claiming she had tried every diet and didn’t have time for exercise. As time went by she was treated for hypertension and needed to have several types of diabetic medication and the diabetes was still not satisfactorily controlled and she was not only was her weight increasing but she was developing angina. Probably dreading hearing the same old advice – diet and exercise and the suggestion of insulin she started not turning up for her appointments. At the beginning or each year we audit our patients to review those that have not been checked and her name appeared and we then ask the receptionists or nurse to phone them to make an appointment. She did make an appointment and her blood tests showed her blood glucose was running very high. When I saw her she said that her job was now becoming so stressful that she was considering early retirement and that she was now prepared to have Bariatric surgery and look seriously at her health. I was thrilled it was worth waiting for that moment. She went on to have surgery and with the support of the multidisciplinary team of dietitian, psychologist and surgeon she became motivated to eat a healthier diet, exercise and gradually as the weeks went by she stopped one medication after another. She was transformed she looked more attractive, she was happier, free from both her diabetic and blood pressure medication and the angina settled. She was now retired and set to enjoy life outside London and as she came to say goodbye she said, “Why hadn’t I done this earlier?”
Who typically gets Type 2 diabetes?
Type 2 diabetes usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin are often required.
In Type 2 diabetes there is not enough insulin (or the insulin isn’t working properly), so the cells are only partially unlocked and glucose builds up in the blood.
In today’s press:-
More than one in three adults in England are on the cusp of developing type-2 diabetes, new research suggests.
If nothing is done to stop the trend, there will be a steep surge in this form of diabetes within the next few years, the authors of a report published in the British Medical Journal Open said.
People are classed as having borderline diabetes, also known as pre-diabetes, when they have blood glucose levels at the very high end of the ‘normal’ range. Those with the condition are at high risk of developing diabetes and its associated complications.
Their study found that in 2011, the number of people diagnosed with pre-diabetes tripled from 11.6 per cent in 2003 to 35.3 per cent.
We now regularly screen patients not just for urine glucose but for blood glucose in an attempt to prevent the onset of diabetes.
It is now reported that 80% of Type 2 diabetes can be prevented by diet and exercise alone
As I reflected it made me realise the enormous strides that have been made in medicine since I have been qualified regarding diabetes, firstly being able to diagnose it so easily with a simple dipstick and more accurate blood tests to recognise pre-diabetes as well as having the proven knowledge that leading a healthy lifestyle can prevent the onset. However, sadly many people don’t take heed of this and don’t eat healthily and live a life of a couch potato running a great risk of developing Type 2 diabetes.
I remember my first job as a surgical house officer there were always some patients on the ward with chronic leg ulcers, and those who had poor lower limb circulation both as a result of diabetes and who were on the surgical ward and inevitably ended up having an amputation. Many of these patients also had poor eyesight due to cataracts or diabetic retinal damage, others had had heart attacks or strokes and it was a concern whether they would able to cope with anaesthetic and had to have the surgery with a spinal block. Most of these diabetics went on to develop kidney failure but were considered unsuitable candidates for renal dialysis because of there array of other complications. They had to have peritoneal dialysis – a cumbersome way of ridding the body of liquid waste. It involved pouring large volumes of fluid into the abdomen and then flushing the fluid out. When I was a GP visiting these patients, who were discharged home for it to be carried out by the District nurse on a regular basis, sometimes daily, I remember having to squeeze past these piled up boxes in the hallway. There prognosis was poor and they often developed severe infections or went into end-stage kidney failure and died at in there 50’s. Hence, it is not surprising that many people fear this condition and feel it will alter their life.
Diets at that time consisted of large amounts of fat and sugar: the day started with a greasy cooked breakfast, puddings were a must and afternoon tea was accompanied by a selection of home-made cakes. Although exercise was part of a daily routine the television began to limit how much people did and more people bought cars, public transport improved but everyone continued with the same diet.
In 2001 Diabetes Prevention Program (DPP),a large trial was carried which was scheduled to last 4years comparing a group of people who were supervised strictly to adhere to exercise and a healthy diet and a group who were not educated but the trial had to be abandoned after 3 years because it was so clear that a highly significant number were developing diabetes in the non-educated group and it was considered non-ethical not to educate everybody.
Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5-7 percent of their body weight.
It is reported that 80% of Type 2 diabetes can be prevented by diet and exercise alone
You can check your risk of developing diabetes by clicking on the link below:-
It is possible to delay the onset of Type 2 diabetes by lifestyle intervention.
Before you develop symptoms:-
If you are interested to learn more about diabetes and how to manage it you may be interested to download a monitoring diary or view a short video using the link below:- “https://www.diabetesmatters.co.uk/what-is-diabetes#.UgstikAWTu0
If treatment doesn’t effectively control high blood sugar levels, it leaves a person with diabetes more vulnerable to infections. Over time it can also damage the small blood vessels and nerves throughout the body, including the smaller vessels at the back of the eye, which can result in blindness, and the kidneys, leading to kidney failure.
For further support and information:-
This is a useful App for all diabetics
Diabetes Manager by patient.co.uk
We are keen for patients to take an interest in monitoring and understanding all aspects of their Diabetes. When you attend surgery for your review please bring your iPhone or iPad to load up the relevant information. If you don’t have either of these we will supply you with handheld written record of information.
Look out for further information about Diabetes
The blue circle is the global symbol for diabetes, introduced by the International Diabetes Federation with the aim of giving diabetes a common identity, supporting existing efforts to raise awareness of diabetes and placing the diabetes epidemic firmly in the public spotlight.
A healthy diet is one that helps maintain or improve general health. It is thought to be important for lowering health risks, such as obesity, heart disease, diabetes, hypertension and cancer. A healthy diet involves consuming primarily fruits, vegetables, and whole grains to satisfy caloric requirements, provide the body with essential nutrients, phytochemicals, and fibre, and provide adequate water intake. A healthy diet supports energy needs and provides for human nutrition without exposure to toxicity or excessive weight gain from consuming excessive amounts.
I think it is a good idea that we all stop and think about what we are eating. Many of us make numerous excuses not to eat properly – we haven’t time, we can’t afford to, we don’t like healthy foods, they don’t agree with me……….but at the end of the day.
WE ARE WHAT WE EAT!
If we take time to plan our eating perhaps 30-40 minutes each week all these excuses would disappear. It is so important that we stock our kitchen carefully. I know if there are only biscuits in the surgery then that is what I eat but if I organise myself I can snack and can eat very healthily with not much effort. Reading the news today I was saddened to read of children’s food ignorance. http://www.bbc.co.uk/news/education-Cheese comes from plants and fish fingers are made of chicken, according to a significant number of children questioned on their knowledge of where food comes from.
The British Nutrition Foundation (BNF) included more than 27,500 children in the research and found that nearly a third (29%) of primary school children think that cheese comes from plants, and nearly one in five (18%) primary school children said that fish fingers comes from chicken.The survey also found that one in 10 secondary school children believe that tomatoes grow under the ground. The largest of its kind, the study was conducted as part of the BNF’s Healthy Eating Week, which is launched on Monday by The Princess Royal.More than 3,000 schools are participating in the week-long event, during which more than 1.2 million children will learn about healthy eating, cooking and where food come from. Roy Ballam, education programme manager at the BNF, said the high numbers of schools taking part shows there is an understanding of how important it is to encourage healthy eating. And so it goes on…….Most of us are aware what we should be eating and most supermarket produce relevant literature and children in school are taught formally about healthy food but despite that they remain ignorant. To find out more about healthy eating refer to the section in nhs choices http://www.nhs.uk/Livewell/healthy-eating/Pages/Healthyeating.aspx.
Meals should be a social time to sit together to discuss the day, share each others concerns and as well as enjoy each others company. All members of the household whatever their age can help to prepare a meal and young teenagers ( before they want to opt out) can prepare a meal perhaps in the style of ‘come dine with me’ adding points for healthy eating. It is all great practice if they leave home to go to University and learning to budget and cook healthily. Growing your own vegetables and herbs whether in a planter on a balcony or windowsill or finding a patch in the garden is very pleasing. The supermarkets all seem to sell packets of seeds very cheaply and it so rewarding to eat your own. We are lucky to have a ‘Farmers Market’ in West Ealing on Saturday morning and look out for another one in Green Lanes, Hanwell.Healthy eating is an investment for future health and well being.
Written by Dr Jacqueline Bayer