NEVER neglect diabetes

Over 200,000 people in Ireland have been diagnosed with Type 2 Diabetes. Being diagnosed with this lifelong condition can be a bit of a shock, but life settles into a routine after a while. You concentrate on having a healthy balanced diet, regular exercise, taking your medication if it’s been prescribed – but are you being diligent enough on the regular check-up front?

Having diabetes can mean daily checks at home, particularly glucose-(sugar-)level checks, and keeping a diary related to this, but there are several check-ups that you should be having on a regular basis to stay as well as possible.

It’s all about management of the condition, says Clair Naughton, nurse specialist with Diabetes Ireland. “The aim of diabetes management on a daily basis is to keep people’s blood-sugar levels as normal as someone who doesn’t have diabetes. This involves having a healthy, balanced diet, taking regular exercise and watching your weight. Medications may be prescribed, and you might be advised to check your blood-glucose levels at home using a special meter.”

The goal of diabetes management is to prevent the chronic complications that can be associated with diabetes, she says. “These include eye disease, foot problems, kidney disease and cardiovascular disease that could trigger heart attack or stroke.

“People should have certain health checks done once a year to screen for the complications of diabetes, such as annual eye screening, foot assessment, blood tests and blood pressure measurement. The aim of these checks is to identify complications of diabetes in the early stages, so they can be treated and prevented from getting worse.”

NO SYMPTOMS UNTIL WELL ADVANCED

The fact that you won’t have symptoms of any of these developing complications – like eye, foot, kidney and heart disease – makes it all the more important to get the checks done regularly, she adds.

“Complications come on slowly. Most people don’t develop symptoms until something is very advanced but, luckily, not everyone gets complications. Complications are associated with high blood-sugar levels over long periods – years and years of undiagnosed or poorly controlled diabetes.”

Others factors that can contribute to the development of complications are uncontrolled blood pressure, cholesterol and smoking.

Regular screening (having the required regular check-ups) can prevent complications. “If a person attends for eye screening and we see early signs of damage to their eyes, for example, there can be interventions to prevent eye disease getting worse.

“Everyone with diabetes should have their eyes photographed each year. This test is available free to everyone with diabetes as part of the national screening service called Diabetic Retina.”

Another example (of silent symptoms) is kidney disease. “A person wouldn’t know they have kidney problems unless they get urine and blood tests done at their diabetes appointments.”

KEEP THE FOCUS ON FEET

Looking after your feet is very important also, but feet don’t necessarily have to be checked by a podiatrist or chiropodist, she says.

“Your GP or practice nurse could have a look also. It’s a non-invasive, simple check where they very quickly check a person’s circulation by checking pulses in the feet and sensation by using a little plastic filament on the sole of the foot.

“Following a foot assessment, the person should go away knowing that their sensation and circulation is normal or not normal or whether they are at higher risk of developing foot problems. They should also be really aware of protecting their feet at home, such as washing their feet, drying them well, checking feet daily to look for any broken skin and not walking barefoot, for example,” she says.

BLOOD PRESSURE AND CHOLESTEROL CHECKS

Having blood pressure and cholesterol levels checked regularly is vital also. “Diabetes is a risk factor for heart disease, so everyone should have their cholesterol and their blood pressure checked to make sure they are within normal limits. Again it’s about prevention,” says Clair.

Remember that smoking isn’t a good idea if you have diabetes. “Smoking is not good for anyone’s health, but smoking when you have diabetes increases the chances of developing the complications of diabetes,” she states.

While you may or may not have to test your blood sugar levels at home, depending on your doctor’s instructions, a four-to-six monthly HbA1C blood test, done at your GP surgery, every four months is very important.

“This HbA1C blood test will reflect the last three to four months of your blood glucose readings and give a good indication of whether your diabetes is being well controlled or not. You don’t have to fast for it, and the advice is to have this check-up three times a year.” CL

A stern warning from the doctor

Dr Tony O’Sullivan, a Dublin-based GP who has Type 1 Diabetes and is a regular spokesperson for Diabetes Ireland, says: “People who are not getting regular check-ups are at risk of developing complications, because it’s not a condition that stands still.

“Type 2 Diabetes gradually gets worse over time – something many people don’t realise. So even if you are following the plan – eating the right things, getting lots of regular exercise, taking the relevant tablets that you are prescribed – your sugar levels will still gradually rise.

“That’s why it’s absolutely essential that we get people back to see us on a regular basis and at least twice a year. And step up their treatment if things are not going as well as we’d like. They may need more insulin or more tablets.”

Dr O’Sullivan believes it is a challenge for GPs and hospitals to keep a good eye on those with diabetes type 2. “We need to monitor who is coming for check-ups and who isn’t and chase people up if they don’t come.

“We would all have cases of people who got diabetes and didn’t really follow up with check-ups and who maybe after a mere 10 years developed serious complications like loss of vision, lost toes or kidney failure.”

There is nothing to gain from hiding Type 2 diabetes or ignoring it, he adds. “People sometimes don’t want to take tablets because they feel pretty fine but while a sugar level of around 10, 11 or 12 is not high enough to cause symptoms – like getting up at night to go to the toilet or feeling thirsty – it is high enough to cause long-term complications.

The person could feel fine until things start to happen, so the only way to manage diabetes is with those regular reviews.”

TOP TIPS TO HELP MANAGE YOUR DIABETES

Get help

ONLINE INFO – EASY TO SEE

Diabetes Ireland has an online module at www.diabetes.ie for those newly-diagnosed with Type 2 Diabetes, called Diabetes Smart.

This module explains what diabetes is, healthy eating and the importance of regular physical activity, medications and complications.

“Sometimes a booklet can put people off,” Clair says, “but this easy to use module explains about diabetes management and there is an annual review form you can print off too.”

CARE IN THE COMMUNITY

An increase in the number of people with Type 2 diabetes has led to changes in the way that care for people with Type 2 diabetes is delivered. In the past, they would have attended for hospital appointments, but the majority of people with the condition now have their diabetes managed by their GP and practice nurse with support from diabetes nurse specialists, dietitians and podiatrists in the community.

That’s because, in 2015, the HSE Cycle of Care Initiative was launched.

This initiative entitles people with Type 2 diabetes who have a medical card or GP visit cards to have a full, structured review of their diabetes by their GP and practice nurse twice a year (at participating GP practices).This does not exclude people from attending a diabetes clinic in the hospital, where necessary.

When you go for your annual check-up, many topics will be discussed: healthy eating, exercise, weight management, driving guidelines, flu vaccine and eye checks, for example. “The support is there, so the person knows they are doing everything they should do,” she states.

Don’t forget that if you have diabetes you are entitled to get your medication free via the Long Term Illness Scheme. “You will be given a book to present at the pharmacy where you can get your medication on an ongoing basis,” Clair explains.