Type 2 Diabetes - Patients' Pathway

A guide designed to help newly diagnosed patients understand their care plan.

Diagnosis

If you have recently been diagnosed with Type 2 diabetes, it may have come as quite a shock or as a relief, if you have been feeling unwell. You may have other family members with the condition and been aware of the symptoms. Not everyone will have symptoms as some cases of diabetes are found through screening blood tests. Your GP or practice nurse will have informed you of the diagnosis and explained about the elevated level of glucose in your blood and why this occurs. They may have also discussed ways to modify your diet and increase your level of activity to help to reduce the level of glucose in the blood and you will have been given some leaflets with more information.

You are probably feeling quite unsure of what will happen next. This leaflet will try to explain what you can do yourself and how you will be cared for, in order to keep the diabetes under control, and enable you to lead a normal and active life.

General practices do not all manage diabetes in exactly the same way. This information describes how it is done at Wyndham House Surgery where Trish Brown, senior practice nurse who has undertaken extensive training in diabetes, will provide much of your care. All the GPs have an interest in diabetes, working together to provide a high quality service.

Your first appointment will be with your practice nurse to have further blood tests. These should include: -

HbA1C ( this test measures the average glucose level over the past 3 months)
Cholesterol level; which is very important to assess the risk of heart disease, (This may be done in the morning before you have eaten using a 'fasting sample').
Full Blood Count, Thyroid , Liver and Kidney function tests, which are usually done to exclude other health problems.
Your practice nurse will check your blood pressure, weight and height and discuss the results with you. She will ask you about your smoking and alcohol.
She will ask you about your smoking and alcohol intake. You should be given a leaflet about diet and exercise and 'Understanding Diabetes', a leaflet produced by Diabetes UK ; a charitable organization, which helps people with diabetes (see address is at the end of this leaflet).
You will be asked to bring an early morning specimen of urine with you at your next appointment.

Initial Review

You will be advised to book another appointment, which will be with your practice nurse first, and then a combined appointment with the GP. It will take about half an hour.

The results of your blood tests will be discussed with you, as you may need to have medication to improve the glucose levels in your blood.
You may also need medications to reduce your blood pressure and cholesterol levels. It is not uncommon to have several different blood pressure medications. Good blood pressure control will reduce the risk of heart disease and strokes.
Most people with Type 2 Diabetes are prescribed a low dose of Aspirin to keep the blood less 'sticky', which reduces the risk of forming clots.
It often takes several appointments to get the diabetes, blood pressure and cholesterol well controlled so please be patient.
You will also have a foot examination. Your nurse will check the shape of your feet and assess the circulation and sensation level. She will also look at your footwear and give you advice. You may need referral to a State Registered Chiropodist (Podiatrist), for regular foot care.
Your eyes will be examined. Your vision will be tested using your normal distance glasses if worn. Some eye drops are then used to enlarge the pupil so that the retina at the back of the eye can be examined. The drops will prevent you from being able to drive for a few hours and may cause discomfort if the day is bright. Dark glasses are helpful, and arrangements made to have a lift or take the bus.
Some goals will be discussed with you for your self-management plan and advice on when you should be seen next.

Self Monitoring

Your practice nurse may teach you how to monitor the glucose levels in your blood, when to test and how to interpret the results. If blood testing is suggested, you may be given a meter or advised which one would be most suitable to purchase.

Education

At the time of your diagnosis, you may begin to feel swamped with new information and have some questions. To ease this situation, group education programmes have been developed. These are arranged at regular intervals in different locations in Mid Devon: - Okehampton, Mortonhampstead, Crediton, Tiverton, Hemyock and Cullompton.

Your practice nurse will give you details of dates and venues nearest to where you live. The sessions are run by the community diabetes specialist nurse and will give you an opportunity to meet some key people who will advise you on some very important aspects of diabetes.

The first session explains about the disease process and the importance of a healthy diet and activity; it runs for about two hours and partners and carers are most welcome.

The second session looks at the risk to your heart and the importance of not smoking and having good blood pressure and cholesterol control to reduce those risks. It also explains about how diabetes can affect the feet, kidneys, blood circulation, nerves and the eyes and how with the correct treatment, management and regular screening, the risks can also be reduced.

Education sessions are very important and you should attend them if at all possible, but if you cannot, your practice nurse will try to help you as far as her time permits. The Education Sessions should give you knowledge and help to empower you to ask questions from the health care team and ensure that you are getting the best care possible.

Diabetes medications

Type 2 Diabetes is usually treated by diet and exercise initially, but after some time most people will need to take tablets, some will even require insulin to keep their blood glucose levels under control. No one can predict the speed of this progress, which is why you need to be seen at regular intervals to monitor the situation.

Annual Review

Each year you will have an Annual Review. You will have the blood test taken 2 weeks beforehand and take with you an early morning specimen of urine. The blood test does not need to be fasting and will for glucose, HbA1C, cholesterol, kidney and sometimes-liver function.

The annual review appointment takes about half an hour and will be with your practice nurse first and then a combined appointment with your GP. If you are testing your blood it is important to bring your records with you to show the practice nurse.
Your vision will be tested followed by eye drops to enlarge the pupil to aid examination by your GP.
The results of your blood and urine tests will be discussed with you, also your treatment to ensure that you are taking it correctly and not getting any side effects or problems.
Your blood pressure, weight and height will be measured.
Your feet and footwear examined.
The annual Review is a good time to ask questions and agree some goals for your self-management plan for the coming year.

Specialist Advice

If your practice team is concerned about any aspect of your care, they have speedy access to a diabetes specialist. This system has been designed to address problems with diabetes itself, but also particular problems, which sometimes occur with feet, eyes, kidneys etc. The specialist appointments are usually at the Diabetes and Vascular Health Centre at the RD& E Hospital Wonford, but sometimes at community hospitals. Your practice team will continue with your care, supported with the advice from the specialist.

Follow- Up

Most patients should be monitored again after 6 months. This is usually done with the practice nurse using a 15-minute appointment. It will involve a blood test for HbA1C. Your blood pressure and weight will be measured. Again your home monitoring record is always useful. Some patients need to be seen more regularly and your practice nurse will always tell you when to make your next appointment.

You can always see your GP or practice nurse between these appointments if you are having any problems.

It is important to keep your appointments even if you are feeling well.

Retinal Screening

Every two years you will be invited to have a retinal photograph. This usually takes place at the Health Centre and is exactly like the retinal examination, but a photograph is taken with a digital camera. This will be examined by the ophthalmologist and then stored in your notes as a record. The digital photographs can be enlarged to show a lot more detail than the regular eye examination.

Vaccinations

All people with Diabetes are advised to have an annual Influenza and a ten yearly Pneumonia vaccination.

Help lines

You can contact your GP or Practice Nurse during normal working hours

At Wyndham House Surgery 01392 860034

The Diabetes and Vascular Health Centre day time help line number is 01392 402281

You can call GP out of hours service Devon Doctors on Call 01392 824600

A message with this number will be given out by calling your own surgery out of normal working hours.

NHS Direct 08454647

Novo Nordisk Help line 0845 600 5055 for people using their insulin products

5.30 pm -11pm Mon to Fri and 8.30 am - 11pm Weekends and Public Holidays

For information about membership, leaflets, etc: -

Diabetes UK , 10 Parkway, London NW1 7AA (Telephone 020 7424 1000)

For help and advice - Careline -Tel: 0845 120 2960
Website www.diabetes.org.uk
Email : info@diabetes.org.uk

Local website with a page specifically for patients www.devondiabetes.org.uk and information about the diabetes UK Exeter and district Voluntary Group, including dates, venues and subjects of meetings.