Long Term Conditions

Diabetes

Our aim is to provide a service that encourages partnership in decision-making, supports you in managing your diabetes and helps you to adopt and maintain a healthy lifestyle.

Diabetes care at the Medical Centre
We hold at least one morning and one afternoon diabetic clinic each week.  The days vary so it is important to make an appointment with one of our receptionists.

Introduction
Being diagnosed with diabetes can be a stressful and worrying time.  We hope that this information will help you understand a little more about your condition and the care that we provide you with.

Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly. Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chapattis, yams and plantain, from sugar and other sweet foods, and from the liver which makes glucose.

Insulin is vital for life. It is a hormone produced by the pancreas, which helps the glucose to enter the cells where it is used as fuel by the body. The main symptoms of untreated diabetes are increased thirst, going to the toilet all the time – especially at night, extreme tiredness, weight loss, genital itching or regular episodes of thrush, and blurred vision. 

For more information visit:  Diabetes UK

Types of Diabetes
There are two main types of diabetes. These are:

• Type 1 diabetes, also known as insulin dependent diabetes.  Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. It is treated by insulin injections and diet with regular exercise recommended.
• Type 2 diabetes, also known as non insulin dependent diabetes.  Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). This type of diabetes usually appears in people over the age of 40, though often appears before the age of 40 in South Asian and African-Caribbean people. It is treated by diet and exercise alone or by diet, exercise and tablets or by diet, exercise and insulin injections.

Keeping healthy
To keep well and healthy, everyone with diabetes needs good and regular healthcare.  The early detection, treatment and continued control of your diabetes is very important as this will reduce your chances of developing the serious health problems (complications) linked to diabetes, such as heart disease, kidney disease and blindness.

There is a lot that can be done to reduce the severity of any complications from this disease.

Diabetes care – your diabetes care team, who does what?
To achieve the best possible diabetes care, you need to work together with healthcare professionals as equal members of your diabetes care team.

Here at the Medical Centre that team is made up of:

Diabetic Clinic Manager:  Carol Cooper
Specialist Diabetic GP:  Dr Hickson
Specialist Diabetic Practice Nurse:  Linda Sterry
Practice Nurse with special interist in diabetes: Jacqui Harrison
Specialist Diabetes Nurse (District Nursing): Sharon Rogers
Healthcare Assistants:  Donna Middleton, Jenny Burgess, Hayley Boddington
Dietician:  Janet Penfound

It is essential that you understand your diabetes as well as possible so that you are an effective member of this team.    Please feel free to contact Carol Cooper, our Diabetic Clinic Manager, on the phone on 01908 611767 or via email if you have any queries at all:  carol.cooper@mkpct.nhs.uk

Diabetes – your annual review – what does it involve?
We recognise that living with diabetes becomes a lifelong learning process, whether you have just been diagnosed or had diabetes for some time.  Monitoring your health when you have diabetes is crucial to preventing some of the complications associated with diabetes.  This involves knowing your blood glucose, blood pressure and blood fat levels as well as the condition of your feet and getting your eyes screened for retinopathy

We have redesigned the care we give to our patients with diabetes and invite all our patients with diabetes to attend an annual diabetic review at the Medical Centre.

How does the Annual Review Work?
Stage One
A double appointment in the morning with the Health Care Assistant in preparation for your annual diabetic check.

At this appointment the following tests which are recommended yearly will be carried out.  We will then send you the results prior to your review appointment in order to assist you in planning for your review.

Laboratory tests and investigations

• Blood glucose control: an HbA1c blood test will measure your long-term blood glucose control. The range to aim for should be 6.5 per cent or below. 
• Kidney function: urine and blood tests to check for protein will show that your kidneys are working correctly. There should not be any protein in your urine.
• Blood fats (lipids, cholesterol and triglyceride levels): a blood test that measures your blood fat levels. A total cholesterol of below 4.0mmol/l or less and a fasting triglyceride of 1.7mmol/l or below are accepted as national target ranges.*
• *Please note all normal and good ranges will vary from person to person — it is meant to be a guide so you know what to aim towards. If you have any questions, ask your diabetes care team.

Physical examinations

• Weight is often calculated as a Body Mass Index (BMI) which expresses adult weight in relation to height. Waist measurement is also an important indicator of increased risk and is a part of this check.  From this you will be advised if you need to lose weight to better control your diabetes.
• Legs and feet will be examined to check your skin, circulation and nerve supply. If necessary, you should be referred to a state registered chiropodist/podiatrist.
• Blood pressure will be taken. You should aim for your blood pressure to be at or less than 130/80. If it is at higher levels discuss why your blood pressure may be high at your annual review appointment. Keeping your blood pressure down has been proven to be beneficial for people with diabetes (UKPDS research trails). 

Stage Two
An appointment for an ‘annual review’ with Linda or Jacqui, our diabetic nurses.  This should be made for three weeks after your preparation appointment in order for us to have time to send you results and relevant information.

• This review will enable us to work together to review every aspect of your care in order to support you in living the healthiest life possible thus reducing complications.  There will be time to discuss:
• Your general wellbeing; how you are coping with your diabetes at home, work, school or college.
• Your current treatment, your diabetes control, including your home monitoring results and hypos and any problems you may be having.
• You should feel free to raise issues that may be concerning you such as: discussion about smoking, alcohol consumption, stress, sexual problems, physical activity and healthy eating issues. Effective diabetes care is normally achieved by team work, between you and your diabetes care team. Looking after your diabetes and changing your lifestyle to fit in with the demands of diabetes is hard work, but you’re worth it.
• You will not always get your care right; none of us does, but we are here to support you. Ask questions and request more information especially if you are uncertain or worried about your diabetes and/or treatment. Remember the most important person in the team is you.
• Whilst we are in the process of getting this new system up and running we recognise that a few of you will be invited to our clinic around the same time as you are seen at the hospital diabetic clinic.  We apologise if this happens to you, but do ask that you come and have your appointments as above.  Our hospital diabetic consultant, Dr Ali, has asked us to ensure that you have this annual review as an important part of your care.

Footcare

•  It is important that people with diabetes of all ages spend a few minutes each day inspecting their feet.  This can prevent problems developing.  Use a mirror or ask a relative or friend to do this if you have difficulty inspecting your feet by yourself.
• Wash feet daily in warm not hot water and ensure that they are dried thoroughly especially between the toes.  Apply a moisturising cream when feet are dry.  Rub this cream well into the skin.  Breaks in the skin should be covered with a dry sterile dressing.  Healing takes longer in diabetics.
• Change socks and tights or stockings daily.  Make sure they are the correct size for your feet.  Check inside shoes for any sharp objects.  Always ensure that shoes are a comfortable fit.  It is important to have your feet measured and fitted when buying new shoes.  Buy shoes in the afternoon as feet swell during the day.  Court shoes and slip-on shoes should be avoided.  Lace-up shoes or shoes with a bar or buckle are more suitable.
• Cut and file toe nails regularly, follow the natural line of the end of the toe.  Do not cut down the sides of the nail.  Do not use sharp instruments on your feet; never use corn plasters.
• Corns and callus are caused by pressure from footwear or misshapen joints.  These need to be filed regularly and if problems arise visit an NHS Podiatry Clinic.
• Avoid direct heat or hot water bottles next to the feet.
• Although most people with diabetes are not likely to have serious problems with their feet, foot care is important to prevent problems arising.
• Sometimes the nerve supply to the feet can be affected.  Because of this it may be difficult to recognise heat or cold or the sensation of touch on the skin.
• If your feeling is impaired in this way you may not notice small cuts or damaged skin.  Shoe fitting also needs extra attention.
• Sometimes the blood supply to the feet can be impaired.  This can mean that infections may occur more easily and could take longer to heal.  Maintaining good skin quality is important in presenting infection.
• Your feet will be checked by our specially trained HCA's or specialist nurses at your diabetic appointment.  Please feel free to speak to her about any concerns you may have.  Our aim is to help you have the best foot health possible. 

Diabetes in Pregnancy
If you become pregnant while you have diabetes or develop diabetes during pregnancy we will work closely with you and your midwife to support you in having a positive, healthy pregnancy.  You will be referred for specialist hospital care, under the care of Dr Ali.  It is important to have regular checks to reduce problems from abnormal blood glucose levels, and you may need to have insulin.

Diet
A dietician, Janet Penfound, is based at the Medical Centre. Appointments can be arranged by your doctor or at reception.  For more information visit BBC Health – Nutrition

Your responsibilities
The following list of responsibilities is given to help you play your part in your own diabetes care.

It is your responsibility:

• To take as much control of your diabetes on a day-to-day basis as you can. The more you know about your own diabetes, the easier this will become.
• To learn about and practice self-care which should include dietary education, exercise and monitoring blood glucose levels.
• To examine your feet regularly or have someone check them.
• To know how to manage your diabetes and when to ask for help if you are ill, e.g. chest infection, flu or diarrhoea and vomiting.
• To know when, where and how to contact your diabetes care team.
• To build the diabetes advice discussed with you into your daily life.
• To talk regularly with your diabetes care team and ask questions you may have.
• To make a list of points to raise at appointments, if you find it helpful.
• To attend your scheduled appointments and inform the diabetes care team if you are unable to do so.

Diabetes Insulin Initiation Capability
We now have a Diabetes Insulin Initiation Capability.  Please see the following Patient Information Leaflets on:

Starting on insulin therapy

Hypoglycaemia or low blood sugars

Asthma  

Asthma remains a serious illness and if you are at all concerned that your asthma is getting worse you should ask for an emergency appointment with your doctor or nurse. Please make it clear to reception staff that you are asthmatic when you phone.

Two of our practice nurses have specialist asthma qualifications. They run clinics in order that asthma may be assessed, advice offered, queries answered and correct treatment ensured.

Patients on asthma medication should be seen at least once a year in the asthma clinic for a check up with the nurse.

The following factsheets, available from Patient UK give information and advice on a variety of asthma related topics:

What is asthma; who does it affect?
Management of Adult Asthma
Management of Childhood Asthma
Medicines inside inhalers; types of inhaler devices
Peak Flow Meter

Further information:
NHS Direct Index of conditions

Asthma UK- an independent UK charity dedicated to conquering asthma.  It funds research, offers help and advice, and campaigns for a better deal for people with asthma

Asthma UK - All about Asthma

Cardiac Monitoring Clinic

We offer an annual appointment to patients with established heart disease.

The purpose of this clinic is to support you in managing your heart condition and to ensure that the quality of your health remains at its best. It has been proven that correct management of people with cardiovascular disease will reduce the risks of death, heart attacks and admission to hospital.

At the clinic we will review risk factors, discuss lifestyle changes, review medications and arm you with the knowledge you need to manage your condition.

Two weeks prior to your appointment you will need to have a blood test. This will mean that your cholesterol and other blood tests will be available for discussion at the clinic.

The cardiac monitoring clinic also sees patients who have a high risk of heart disease, but have not actually had a heart attack. They do this through a once off appointment in the clinic and then with support via the practice nursing clinic with any ongoing lifestyle issues. To access this clinic you need to be referred by your GP or practice nurse.

For further information
If you are interested in accessing further information on heart disease and how to manage it the British Heart Foundation offers a wealth of information to help you.

Cardiac Risk Calculator- This will help you to calculate your risk of heart disease, but cannot be used if you have already had a cardiac event (Heart attack/Stroke)

Milton Keynes Community Cardiac Group

This is a charity based scheme offering support for those who have suffered from a heart attack, angina, heart bypass or other hear problems.

They have facilities for members to exercise in a safe environment with trained staff.  For information please visit their website: www.mkcardiacgroup.org

High Blood Pressure (Hypertension)

Our aim is to provide a service that encourages partnership in decision-making, in order to support you managing your high blood pressure.   If you have high blood pressure, this higher pressure puts extra strain on your heart and blood vessels. Over time, this extra strain increases your risk of a heart attack or stroke.  High blood pressure can also cause heart and kidney disease, and is closely linked to some forms of dementia.

What is Blood Pressure?

Put simply, blood pressure is the pressure of blood in your arteries.

Your heart is your body’s main pump and it pushes blood through your arteries by contracting and relaxing. When it contracts, it forces blood through your arteries and pushes the pressure of the blood to the highest point – the systolic pressure. When your heart relaxes between beats, your blood pressure is at its lowest – its diasystolic pressure.  The two pressures are written as two numbers, with the higher pressure first.

High blood pressure usually has no signs or symptoms, so the only way to know if you have high blood pressure is to have yours measured. However, a single high reading does not necessarily mean you have high blood pressure. Many things can affect your blood pressure through the day, so your doctor or nurse will take a number of blood pressure readings to check if it stays high over time.

You can find out more about high blood pressure, its treatment and the role you can play in reducing it at  the Blood Pressure Association website

High blood pressure readings explained

You probably have high blood pressure (hypertension) if your blood pressure readings are consistently 140 over 90, or higher, over a number of weeks.

You may also have high blood pressure if just one of the numbers is higher than it should be over a number of weeks. In other words:

• If the top number is 140 or more (regardless of the bottom number) this may be high blood pressure.
• If the bottom number is 90 or more (regardless of the top number) this may be high blood pressure.

What can you do to reduce your blood pressure ?

We do know that your lifestyle can affect your risk of developing it. You are at a higher risk if:

There are some factors that increase your risk of developing high blood pressure, which you cannot control. These include:

• Age: as you get older, the effects of an unhealthy lifestyle can build up and your blood pressure can increase.
• Ethnic origin: people from African-Caribbean and South Asian communities are at greater risk than other people of high blood pressure.
• Family history: you are at greater risk if your parents have, or have had, high blood pressure.
• Some people may have high blood pressure that is linked to another medical condition, such as kidney problems. For these people treating the medical problem may lower their blood pressure back to normal.

Care at Newport Pagnell Medical Centre

Your doctor will then refer you to one of our practice nurses who will work with you to achieve optimum control.  They will monitor your blood pressure and see you regularly.  During this time you will need to return every couple of weeks for a blood test and for your medication to be adjusted.  It is common to find that one medicine on its own is not enough, and your doctor will then add another blood pressure medicine until control is gained.  Each time your medicine is increased or you have another one added you need to make an appointment for a blood test to check if your high blood pressure has affected your body and its organs. The results of these tests will help your doctor to choose the best medicines.

Your diet, exercise levels and weight have a real effect on your BP. Being the right weight lowers BP because your heart doesn't have to work so hard. If you have high blood pressure, you can start lowering it today by eating more healthily (reduce salt intake, eat more fruit and vegetables) and being more active. Even a little, regular extra exercise helps.  Keeping to healthy alcohol limits will lower your blood pressure.  If we work together and control your BP your chances of having a heart attack or stroke will be greatly reduced.

Once your blood pressure is controlled you will be asked to have a blood pressure check six months later, and then,  if all is well, to return yearly in the month of your birthday for an annual review with a practice nurse.

At the annual review working together we’ll produce a care plan for the following year, capturing what you intend to do to stay healthy and reduce risk and any help you need to do that.

Prior to your annual check you need to have a blood test taken. 
It is our responsibility to:  

It is your responsibility:

• To learn about and practice self-care which should include healthy eating and exercise. 
• To build the hypertension advice discussed with you into your daily life.
• To take your medication, once you have discussed and understood the need, as directed.
• To make a list of points to be raised at appointments, if you find it helpful.
• To attend your scheduled appointments and inform the Medical Centre if you are unable to do so.

Recording your progress

Download this form to record your blood pressure, pulse, blood test results and medications you are taking, including changes.  Please bring a copy to your appointments.

Blood pressure self monitoring

Also attached is a blood pressure calculator that will help calculate the average readings when using your own monitor.

Frequently Asked Questions

Are there specific days when it is better to have blood taken eg blood clinic? 
No any day up till 3pm

How soon are the results of a blood test available?  
Some are immediate (e.g. cholesterol) and some that have to be sent away for analysis?  They do vary but a few days is the norm

Should urine samples be the first in the morning? 
No it doesn’t matter

Are sample bottles available at the desk?
Yes

Are the results of urine tests available immediately?
Again can the results of some tests be available immediately but others need to be sent away for analysis? You are right.  Some are done immediately some sent away

When medication is being introduced to control BP how often should you have urine and blood tests eg every month? 
Two weeks after every change

How soon after you have had  blood and urine  tests should you make an appointment?  
1 week should be OK

Who should this appointment be with, doctor or nurse?  
As part of your care when you are first diagnosed with hypertension you will have a named nurse who will manage your care.  She will refer you back to your GP if and when you need extra medication, and you will then continue seeing her until you are stable.  Then you will return six months later for a blood pressure check and if all is well then yearly in the month of your birthday with any practice nurse.

When medication is being introduced to control BP do you need to repeat both urine and blood tests?
You need to repeat your blood tests each time new medication is introduced.