Information, resources and self referral.
As part of your diabetes care it is important to be up to date with guidance and information to help you look after yourself and manage the condition.
These brief pages highlight useful areas and links for people with type 2 diabetes.
Please review the contents to see what applies to you and how you can self refer to services.
Once you have been diagnosed it is advisable to learn more about what diabetes is and how to manage it.
https://www.diabetes.org.uk/diabetes-the-basics
Self management and a healthy lifestyle is very important in keeping good control and reducing complications (which includes eye, kidney, foot, heart, and other vascular disease).
You will be invited to an education programme (diabetes2gether) run be the specialist community team which we strongly recommend that you attend. (You can also self refer to this)
Medication that is often started with new type 2 diabetes includes - Metformin (to reduce sugar levels) and Atorvastatin (to control cholesterol), a Gliflozin is started once these medications are tolerated.
Diet and Lifestyle
https://www.diabetes.co.uk/lifestyle-changes-for-type2-diabetes.html
Diabetes can sometimes be reversed by diet
(you should not start a very low carbohydrate or calorie diet without consulting your clinician first, especially if on certain medication like Flozin or those that can significantly reduce you blood sugar levels)
https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/meal-plans/low-carb
Low carbohydrate meal planner
It is important to attend annual eye screening when invited
Foot care is import to avoid complications
https://trenddiabetes.online/wp-content/uploads/2021/08/A5_Foot_TREND.pdf
Medication adjustment when unwell ‘sick day rules’
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness
METFORMIN
This medication gently reduces blood sugar levels and reduces vascular risk (heart attacks etc). It can cause loose bowels which can be reduced by altering the dose or formulation in discussion with you clinician. Unexplained change in bowels should alway be discussed with your doctor in case of a more serious cause.
Metformin should be stopped whilst you are unwell as part of the ‘sick day rules’.
If you are on Metformin as the only sugar reducing diabetes medication then you do not need to routinely check blood sugar levels yourself.
The starting dose is 500mg once daily with the main meal increasing every few weeks until on 1000mg taken twice daily with meals.
https://www.nhs.uk/medicines/metformin/
STATINS
Most people with diabetes will be offered statins at some point to reduce vascular (heart attack, artery blockage) risk.
The main side effect can be muscle aches (if more than mild the medication should be stopped whilst you seek medical advice)
Atorvastatin 20mg is usually prescribed and taken in the evening (and not with grapefruit juice)
https://www.nhs.uk/conditions/statins/
A liver blood test is needed before starting then within 3 months and then at 12 month.
GLIFLOZINS
The benefits for gliflozin medications include - lowering glucose as well as weight, blood pressure and vascular risk (like heart attacks, strokes and heart failure which can be reduced by around 20%)
The main side effects are passing more urine (as peeing out more sugar). This can sometimes lead to increased risk of urine infections and genital infection (reduced by rinsing after passing urine and keeping well hydrated is advised).
If unwell on a gliflozin medication then you should stop it (in line with ‘sick day rules’). You should have blood ketone level tested urgently as part of the medical assessment (as there is a very low risk 1 in 10,000 of ketosis even when the blood sugar level is not elevated).
Further details of rare possible side effects are listed on the link below.
https://www.nhs.uk/medicines/dapagliflozin/side-effects-of-dapagliflozin/
Examples of gliflozins with further information below.
www.nhs.uk/medicines/dapagliflozin/
www.nhs.uk/medicines/empagliflozin/
Patient leaflet
SGLT2 INHIBITORS AND DIABETIC KETOACIDOSIS IN TYPE 2 DIABETES
BLOOD PRESSURE MEDICATION & ACE INHIBITORS
You may be advised to start an ‘ACE inhibitor’ (or ARB) medication if either your blood pressure is raised or if your kidneys are leaking protein (raised ACR level).
Before starting this medication you will need a kidney blood test done and also again after you are on a stable dose. It is advisable to have your own home blood pressure meter so that you can adjust the dose to keep your blood pressure below your target level (usually under 140/80). Blood pressure should not go too low so that you feel dizzy and not be lower than around 110\70.
If you are starting lisinopril (an ACE inhibitor) then the initial dose is 2.5mg increasing weekly until you are on 10mg. Once you have reached your target blood pressure you need to book a C&E blood test and send in an average of your blood pressure readings as well as your current dose. If your repeat blood test is satisfactory then your medication will be put on repeat for you to continue ordering. If not getting to target then contact the clinical pharmacist at the practice.
The main side effect of lisinopril is a dry cough and if this is more than very minor you should discuss this with the clinical pharmacist so an alternative (usually losartan ‘ARB’) can be tried instead.
You can read further about lisinopril and losartan below
https://www.nhs.uk/medicines/lisinopril/
https://www.nhs.uk/medicines/losartan/
GLP1RA drugs
There is a national shortage of these drugs likely until well into 2024
Please see the guidance on the link below
Information about other diabetes medication can be found at Diabetes UK
https://www.diabetes.org.uk/diabetes-the-basics/diabetes-treatments
WHY IS IT IMPORTANT TO TREAT TO TARGET
This is because a raised glucose level over a period of time is toxic to eyes, nerves and blood vessels. A raised level increases infection risk as well as symptoms of thirst and passing more urine.
WHAT SHOULD MY TREATMENT TARGET BE?
……it depends…..
Targets are personalised, but in general if you are young and fit then you should aim for very good control to reduce the risk of complications as even a slightly raised glucose over time will give an eye risk.
Targets should be discussed with your clinician so that they are tailored to your situation.
If you are recently diagnosed then it is important to get good control soon. The longer the glucose is raised, the more you are ‘clocking up’ risk. If you get to good control soon and stay in range, then the complication risks are delayed and less. If control is not gained or maintained soon then the raised risk for this period stays with you and is not diluted over time (legacy effect).
What are the complications due to high glucose levels?
Eye disease and loss of sight, erectile dysfunction, heart attacks, heart failure, strokes, foot ulcers, reduced blood supply to feet, kidney disease, reduced nerve function with poor sensation or leg pains, increased infections are examples.
FINGER PRICK BLOOD GLUCOSE TESTING
It is important to have a working blood sugar testing kit if on medication that can significantly lower blood sugar such as injectable medications, insulin and sulphanylurea drugs (like gliclazide).
Blood sugar levels should be checked when unwell, if the level might be low (‘hypo’) and at times relevant to driving.
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving#test
Blood sugar test record list/grid
https://www.diabetes.org.uk/resources-s3/2017-09/Blood%20Sugar%20Monitoring%20card%20-%20new.pdf
(Useful to fill out and take the last 2 week of readings to your diabetes review - suggest daily morning fasting and in addition one at a different point each day)
CONTINUOUS BLOOD MONITORING
Any diabetic can request a ‘one off’ free trial of a continuous glucose meter sensor see below
https://www.freestyle.abbott/uk-en/getting-started/sampling.html#form
This can help inform you how different foods and activity will change your blood glucose readings and help you to make lifestyle adjustments to gradually improve this.
If you have any problems with the sensor / technology or want a reader please contact the company using the support tab or freephone 0800 1701177 Email adchelpuk@abbott.com
A smart phone needs android 8 or IOS 14.5 for Apple devices.
For start guidance please see the web support guide below.
https://www.freestyle.abbott/uk-en/getting-started/firstuse.html
We recommend that you keep up to date with the DVLA government driving rules and test your blood sugar levels (if on certain medication) as advised.
When you must notify the DVLA
https://www.gov.uk/government/publications/information-for-drivers-with-diabetes
Information about driving and diabetes
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving/driving-licence
You can self refer to a free diabetes education programme
(Diabetes2gether if recently diagnosed and Diabetes4ward if some years since diagnosis)
https://www.oxfordhealth.nhs.uk/community-diabetes/
Web based structured education programme for new diabetics or if wanting a refresher
For exercise based health activities you can self refer to
https://www.getoxfordshireactive.org/
You can self refer for weight management
https://www.achieveoxfordshire.org.uk/services
Help to reduce and stop smoking is available by contacting
https://www.stopforlifeoxon.org/
Text STOPOXON to 60777