Most people with Type 1 diabetes attend a hospital diabetes clinic. People with Type 2 diabetes will mostly attend their GP, but some may need to attend the hospital diabetes clinic or both.
While attending your clinic appointment, you will be able to discuss any problems you may have with your medication and we can also provide specialist advice on diet, exercise and other lifestyle issues associated with your diabetes. You will usually be seen by a Diabetes Specialist Nurse (DSN) and in some cases you may also be seen by a Diabetologist who visits every 4 months from Glasgow. We have an excellent care link set up with Greater Glasgow & Clyde which can offer advice and support at any time via the DSNs. Young people with Diabetes have direct access to this support out with normal working hours.
If you visit one of our clinics, blood samples maybe taken and tested for:
Haemoglobin A1c (HbA1c). This is done at every visit and tells how well controlled your diabetes has been over the previous 3 months. Good control means an HbA1c of 48 – 58mmol/mol. This is equivalent to an average blood glucose of between 6 and 10 before meals. The blood sample is taken using a finger prick test. It is processed while you wait and takes about 6 minutes. This allows the Diabetes Specialist Nurse to decide if any changes to your treatment are required. All the Diebetes Specialist Nurses are able to prescribe and make any necessary changes to your medication, you do not need to see your GP as well.
Renal Function. This is checked yearly and tells us how well your kidneys are working.
Cholesterol. This tells how much ‘good fat' and ‘bad fat' is in your blood. It is checked yearly or more often if it is high.
You will also be asked to bring along a urine sample that has been collected first thing in the morning. This is tested for:
- Protein (called microalbumin). High levels of microalbumin are associated with a greater risk of developing some complications of diabetes and with high blood pressure. This can be helped with tablets called ‘ACE Inhibitors'.
At your first visit your height is measured.
At every visit your weight and blood pressure are checked.
If you are a person with diabetes and are over 12 years old you will have the opportunity to have your eyes checked (screened) each year. As part of the national screening programme, a free annual invitation for eye screening will be sent to you.
Even if your eyes are examined by your local optometrist or GP you will still be sent an invitation to have your eyes screened. Everyone with diabetes runs the risk of developing diabetic retinopathy, a condition that may cause blindness or serious damage to your eyesight. In its early stages, diabetic retinopathy does not have any obvious symptoms so you may not realise you are developing this condition, this is the stage when treatment is most effective.
Diabetic Retinopathy
Picture of Diabetic Retinopathy
Having your eyes screened is the ONLY way to detect the condition in its early stages, therefore it is very important that you attend your annual eye screening appointment.Diabetic retinopathy causes damage to the blood vessels at the back of the eye and is the most common cause of blindness among people with diabetes. Poor control of blood glucose and blood pressure increases your risk of developing diabetic retinopathy.
Your Screening Appointment
You will be sent an invitation letter inviting you to phone Robert Doig Opticians to make an appointment at a time that is convenient for you. If you do not telephone within a certain time, a reminder will be automatically sent to you. After 3 weeks, you will be sent a final reminder to make an appointment. If, after 3 weeks you have still not made an appointment, a letter will be sent to your GP advising them that you have not made an appointment to have your eyes screened. You will be invited again in 12 months.
Most appointments take about ten minutes, during which, your vision will be checked and a photograph will be taken of your eyes. It may be necessary to put eye drops into your eyes in order to dilate your pupils. This may be required to obtain a good photograph of your eyes, in which case your appointment will take longer than usual (around 30 minutes). Around a quarter of people need eye drops, so you should come prepared for this. If eye drops are used, you may become temporarily sensitive to bright light, so you may wish to bring sunglasses. If you have not needed eye drops in the past, it is less likely you will need them in the future. Eye drops may also cause you to have blurred vision for several hours – therefore it is not advisable to drive after an appointment and you should make alternative arrangements for getting home safely. Sometimes the quality of the photograph is not good enough to examine accurately. In this case you will be asked to stay for a further examination using equipment called a slit lamp which uses a slightly brighter light. This examination is completely painless but we need to put eye drops into your eyes to dilate your pupils.
If you are unable to leave your home to attend your screening appointment, your GP can request that the Eye Screening Team visits you in your own home to carry out the test.
Your Screening Results
After your appointment, your photographs will be examined for signs of retinopathy. Your results will be sent to you within 20 working days of your screening appointment and your GP will have access to an electronic copy. If you have registered on the www.mydiabetesmyway.scot.nhs.uk website then you will also be able to see your retinal photograph along with all your other diabetes related results. If you have not registered yet then you can do so easily by clicking here.
If significant diabetic retinopathy is found in your photograph, referral for specialist opinion and possible treatment at an eye clinic will be automatically arranged if necessary. You will be informed of this in your result letter. The hospital eye clinic will then contact you with an appointment.
Please be aware that if you have any problems or concerns related to your feet health, you can access the NHS Western Isles Podiatry Department website for further information and advice or on how to contact them. Visit: www.wihb.scot.nhs.uk/our-services-podiatry
Holiday Foot Care
Going on holiday can cause foot problems, so follow these simple precautions to ensure a trouble-free time.
The Journey
Long journeys on trains, buses and planes can make your feet swell. Walk up and down the aisle every half hour – the exercise will help keep the swelling down. Make sure your shoes don't become too tight.
Footwear
If you normally wear hospital supplied shoes, wear them on holiday too. Remember that changing over to ordinary shoes could cause an ulcer – and ruin your holiday.
Avoid walking barefoot. On the beach, and in the sea, wear plastic sandals.
Sunburn
Avoid sunburn to your feet and legs. Use a sun screen with a high protection factor – or keep covered.
Foot Care
If your skin gets very dry in the hot weather, you may need to apply more moisturising cream than usual. Pay special attention to your heels – dry skin here cracks easily.
First Aid
Take small sterile dressings, antiseptic and adhesive tape on holiday. Clean any small blisters, cuts or grazes thoroughly then apply a sterile dressing.
Foot Check
Examine your feet daily for sores, swelling and colour changes. If any of these problems develop, then visit the local state registered podiatrist or doctor.
Remember: delays in seeking treatment may make foot problems worse. Seek early treatment for all holiday foot problems.
Foot Screening for People with Diabetes
Diabetes can have an effect on the blood and nerve supply, which can lead to complications in the leg and foot. This can slow down the healing process in the body and reduce the sensation to pain, temperature and pressure. Not everyone will develop these problems, but ALL people with diabetes should follow the same rules of foot care to prevent problems developing.
Maintaining good blood sugar and weight control is very important, as is avoiding smoking.
Your Annual Foot Check
As part of your ongoing diabetes care you will receive a formal check of your feet at least once a year. This includes checking the pulses and feeling in your feet. This will be undertaken by whoever is providing your diabetes care and may be a doctor, nurse or podiatrist. This will allow them to calculate your risk of developing a foot ulcer in the future which could be low, medium or high. You can ask your GP, nurse or podiatrist to tell you what your risk score is and they will provide you with a leaflet specially written for that risk category.
Inspect Your Feet Daily
- Look especially in between your toes and around your heels.
- If you cannot bend over, ask a friend or relative to help, or put a mirror on the ground.
- Be aware of any blisters, breaks in the skin, pain or any signs of infection such as swelling, heat or redness.
Tell your Diabetes team or Podiatrist about any changes in your feet.
Free leaflets are available to view/download from Diabetes UK. Click here to view.
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- LAST REVIEWED ON: January 11, 2023