High Risk of Diabetes

Each year in the UK, 5% to 10% of people diagnosed with pre-diabetes go on to develop type 2 diabetes. People with pre-diabetes will often have no symptoms, but have an increased risk of diabetes and heart disease.

What is Pre-diabetes?

Pre-diabetes is also called Impaired Glucose Tolerance. Like diabetes, pre-diabetes is a condition where the amount of glucose (sugar) in the blood is too high and the body cannot use it properly. The glucose levels are not high enough at this stage to be diagnosed with diabetes.

In pre-diabetes, the pancreas (an organ in the body) does not produce enough insulin or the insulin that is produced doesn’t work properly. Insulin is a hormone in the blood which lowers and controls blood glucose level. This is often the result of carrying extra fat around the waist area.

Either a fasting plasma glucose test or an HbA1c test may be used to diagnose type 2 diabetes or prediabetes.

The following results indicate the presence of prediabetes:

  • Fasting plasma glucose: 6.0 mmol/L to 6.9 mmol/L
  • HbA1c: 42 to 47 mmol/mol (6.0 to 6.4%)
diabetes
http://www.diabetes.co.uk/pre-diabetes.html

Is there a cure for Pre-diabetes?

The good news is that cases of pre-diabetes that are identified early on can be reversed, preventing them from progressing into full-blown type 2 diabetes.

There are no medications which can treat or cure pre-diabetes. The only way of reducing your risk of diabetes is through lifestyle changes. This includes:

  • increasing activity levels,
  • eating a healthy and balanced diet
  • maintaining a healthy weight.

If you would like support please make an appointment with our Nurse or Healthcare assistant for a review. Also visit One You Hounslow who can help you eat well, move more, stop smoking or drink less. 

Changes to podiatry services for diabetics

Nail cutting for people with Diabetes – Information for patients

The Royal College of Podiatry diabetes-and-your-feet-a5-24pp advise that there is no reason why people with diabetes at low risk of developing foot complications cannot cut their own toenails. If you have Diabetes, can reach your toenails and can see well enough, you can cut your own toenails.

If you cannot reach your toenails or see well enough to see them, a relative or a carer should be able to help you with this. If this is not possible Age UK in Hounslow provides an affordable nail cutting service. Please contact;

http://www.ageuk.org.uk/hounslow/contact-us/

Telephone 020 8560 6969

If you DO NOT have nerve damage/and or reduce blood supply this is how to

take care of your own nails

DO’s

 Cut them every 6-8weeks when they have grown beyond your toes

 Get a pair of nail clippers and an emery board from your pharmacy

 Trim your nails following the shape of you toe

 Use the emery board to take off rough edges

DON’T

 Don’t use anything sharp to clean down the side and edges of nails. This can damage the nail or cause an ingrowing toenail

 Cutting down the sides of nails or cutting them very short can damage them

 If you have an ingrowing toenail or you think you have a nail infection (easily broken, thick or discoloured nails), don’t try treating it yourself. See your podiatrist, nurse or GP.

How do I know if I have damage to my nerves and/or reduce blood flow?

 Damage to the nerves causes changes in your feet such as pain, less sweating, numbness, hard skin, feet may look hot and red to the touch.

If this is the case, please contact your GP so as yo can be referred to diabetic service.

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New Move Away from Pre-Diabetes Programme

People with pre-diabetes will often have no symptoms, but have an increased risk of diabetes and heart disease. Patients belonging to Feltham and Great West Road Localities can access a special service and reduce the risk of developing diabetes.

What is Pre-diabetes?

Pre-diabetes is also called Impaired Glucose Tolerance. Like diabetes, pre-diabetes is a condition where the amount of glucose (sugar) in the blood is too high and the body cannot use it properly. The glucose levels are not high enough at this stage to be diagnosed with diabetes.

In pre-diabetes, the pancreas (an organ in the body) does not produce enough insulin or the insulin that is produced doesn’t work properly. Insulin is a hormone in the blood which lowers and controls blood glucose level. This is often the result of carrying extra fat around the waist area.

Is there a cure for Pre-diabetes?

There are no medications which can treat or cure pre-diabetes.

The only way of reducing your risk of diabetes is through lifestyle changes. This includes increasing activity levels, eating a healthy, balanced diet & maintaining a healthy weight.

What is the ‘Move Away from Pre-diabetes’ programme?

The programme is fun, motivating and an excellent opportunity for you to learn more about nutrition and making healthy changes to your lifestyle.

The service aims to help you achieve:

  • healthy weight
  • healthy eating
  • more active lifestyle
  • improved blood pressure, blood glucose & cholesterol

You can download the patient leaflet here.

MAP Patient leaflet (hounslow)

MAP

New Diabetic Service for Hounslow CCG

Dr Delgado Raquel, diabetic lead for Hounslow CCG presented to new diabetic service commissioned and it’s impact on the locality. DM

3 types of services will be commissioned for practices. This can be delivered either by the practice or locality level. If necessary, neighboring localities can provide services. There may be flexible delivery of service, where resources within the locality. Eg delivery of level 2 requires 2 clinicians, and premises. If one practice cannot deliver this, we may be able to clinicians from 2 practices and run the service from where there is clinical space available. We will also be supported to explore new ways provide consultations eg email, phone and online. The key outcomes are improved diabetic care, identifying diabetic care, improving access and upskilling primary care and patients.

3 types of service will be commissioned.

  • High risk of diabetes
  • Level 1 – managing type 2 diabetics
  • Level 2 – Initiating insulin.

Key Outcomes

  • Address variation of care across CCG and practices.
  • Early identification and prevention. Reduces the consequent complications.
  • Better management of 9 care processes,
  • NWL diabetes education programme
  • Diabetes dashboard, will be available which allows comparing across practice, locality, CCG and NWL.
  • New diabetes community service.
  • Systm One OOH templates (yellow means that you have to input data).
  • Local diabetes education courses for clinicians. Doctors and nurses. These will be available, more information will be available shortly.

High Risk

  • Register, XaZLG code. Gestational diabetes and abnormal glucose test.
  • Annual BP, HbA1c, Lipids, smoking, BMI, Lifesytle intervention / referral.
  • High risk

Level 1 diabetes.

  • Refer to structured education programme
  • Annual 9 care processes including ACR and retinal screening (which are not included in QoF)
  • Annual review with 30m appointment.
  • Hypoglycaemia recording frequency and management.
  • Following CCWHE guidelines Diabetes for BP, Lipids, HbA1c insulin and glucose strips.
  • Care planning including housebound patients.
  • Copy of care plan given to patient.
  • Patient satisfaction survey.
  • Discharge from secondary care suitable patients.

Level 2

  • Insulin and GLP-1 Initiation and optimization and insulin education.
  • Need to have 2 accredited clinicians.
  • Annual accredited re-fresher course.
  • Adhere to prescribing guidelines.
  • Face to face appointments, telephone, email.
  • Dietician and DSN from the community service.
  • Referral to insulin education programme.
  • Min network population of 30,000.
  • Can have up to 3 sites for a locality.
  • Patient will be seen 11 times.

New diabetic service will have:

  • New diabetic service has dieticians, DSN, podiatrist, clinical psychologist linked to each locality.
  • It will be a flexible service.
  • Email and telephone access to all clinicians.
  • Joint clinics with diabetologist, Diabetic specialist nurse and dieticians.
  • Joint visits for housebound patients.
  • Larger choice of education programmes for patients and clinicians.

The Flu Vaccination 2014

The flu jab

Flu vaccination by injection, commonly known as the “flu jab” is available every year on the NHS to protect adults (and some children) at risk of flu and its complications.

Flu can be unpleasant, but if you are otherwise healthy it will usually clear up on its own within a week.

However, flu can be more severe in certain people, such as:

  • anyone over the age of 65
  • pregnant women
  • children and adults with an underlying health condition (particularly long-term heart or respiratory disease)
  • children and adults with weakened immune systems

Anyone in these risk groups is more likely to develop potentially serious complications of flu, such as pneumonia (a lung infection), so it’s recommended that they have a flu vaccine every year to protect them.

The flu vaccine is given free on the NHS as an annual injection to:

  • adults over the age of 18 at risk of flu (including everyone over 65)
  • children aged six months to two years at risk of flu

Find out more about who should have the flu jab.

Flu nasal spray vaccination

The flu vaccine is given as an annual nasal spray to:

  • children aged two to 17 years at a particular risk of flu
  • healthy children aged two, three and four years old

Read more about the flu nasal spray for children.

How the flu jab helps

Studies have shown that the flu jab does work and will help prevent you getting the flu. It won’t stop all flu viruses and the level of protection may vary between people, so it’s not a 100% guarantee that you’ll be flu-free, but if you do get flu after vaccination it’s likely to be milder and shorter-lived than it would otherwise have been.

There is also evidence to suggest that the flu jab can reduce your risk of having a stroke.

Over time, protection from the injected flu vaccine gradually decreases and flu strains often change. So new flu vaccines are produced each year which is why people advised to have the flu jab need it every year too.

Read more about how the flu jab works.

Flu jab side effects

Serious side effects of the injected flu vaccine are very rare. You may have a slight temperature and aching muscles for a couple of days after having the jab, and your arm may be a bit sore where you were injected.

Read more about the side effects of the flu jab.

When to have a flu jab

The best time to have a flu vaccine is in the autumn, from the beginning of October to early November, but don’t worry if you’ve missed it, you can have the vaccine later in winter if there are stocks left.

The flu jab for 2014/15

Each year, the viruses that are most likely to cause flu are identified in advance and vaccines are made to match them as closely as possible. The vaccines are recommended by the World Health Organization (WHO).

The 2014/15 vaccine protects against three types of flu virus. This year’s flu jab protects against:

  • H1N1 – the strain of flu that caused the swine flu pandemic in 2009
  • H3N2 – a strain of flu that can infect birds and mammals and was active in 2011
  • B/Massachusetts/2 – a strain of flu that was active in 2012

The nasal spray flu vaccine offers protection against four strains of virus, as it includes a virus strain that was active in 2008.

Is there anyone who shouldn’t have the flu jab?

Most adults can have the injected flu vaccine, but you should avoid it if you have had aserious allergic reaction to a flu jab in the past.

Read more about who shouldn’t have the flu vaccine.

You can find out more by reading the answers to the most common questions that people haveabout the flu vaccine.