Frequently asked questions
l Health Care Professionals l
l Diabetes l
Q1) I am a Brent GP, How do I update myself with diabetes?
Q2) My patient is a poor complier with medications what would you suggest I do next?
Q3) I found the guidelines very comprehensive and detailed, I was looking for something simple to help me in treating diabetes.
Q4) Who do I refer to the Intermediatary Care Team?
Q5) Who should I refer to secondary care?
l Dietetics l
Q6) Where can my patients see a Dietitian and how soon should they be seen after diagnosis?
Q7) Do you have Diabetes resources specific for ethnic groups?
Q8) Do we currently offer any weight management services?
l Podiatry l
Q9) What should I do at an annual foot care review?
Q10) Who do I refer to the Intermediatary Care Team?
Q11) Who should I refer to secondary care?
l Patients l
l Diabetes l
Q1) I hate doing blood glucose monitoring using the finger prick testing, is there another method I can use?
Q2) Why is my GP not referring me to the hospital for diabetes advise?
Q3) How do I speak to another patient with Diabetes regarding their experiences?
l Dietetics l
Q4) Can I still have some sugar in my Diet?
Q5) Are there any fruits that I can’t eat?
Q6) Can I eat Rice, Potatoes or Bread?
l Podiatry l
Q7) How does diabetes affect the feet?
Q8) Should I care for my feet myself?
Q9) What should I do if I have an injury?
Health Care Professionals;
Diabetes;
Q1) I am a Brent GP, How do I update myself with diabetes?
A1) The Diabetes Team will be holding joint educational update sessions with the cardiology team.
There are Diabetes courses organised externally e.g. Bradford Diploma course and the Certificate in Diabetes Care, organised by Warwick University. These courses will need to be funded by the individual or cluster group.
The Locality commissioning board can commission sessions for the cluster.
Q2) My patient is a poor complier with medications what would you suggest I do next?
A2)
- Find out reasons why; if elderly, does your patient have memory problems?
- Is your patient suffering from side effects of their prescribed medication.
- Is your patient depressed, and could they benefit from counselling
- Involve other members of the family
- Use of a Dosette Box filed by the pharmacist or a family member.
- Contact Social Services or other agencies for further assessment.
Q3) I found the guidelines very comprehensive and detailed, I was looking for something simple to help me in treating diabetes.
A3) Look at the pathways for the Treatment of Type 2 Diabetes and also microalbinurea treatment.
Develop local guidelines with other surgeries in your cluster group.
Share best Practice.
Q4) Who do I refer to the Intermediatry Care Team?
The types of patients that should be referred to the DSN’s are;
- Poorly controlled patients who require maximisation of their insulin therapy.
- Those patients on maximum oral therapy requiring Insulin initiation.
- Those patients discharged from hospital and require short term follow up.
- Those patients requiring rapid advise and support.
- Patients who are newly diagnosed and require referral to the Group Education Sessions.
- Diabetic women requiring Pre conceptual care
Referrals should be made using the Long Term Conditions Centre-Diabetes form and can be posted to Monks Park Primary Care Centre, HA9 6JE, faxed to 0208 453 5972or emailed to gm.e.bre-pct.diabetes@nhs.net.
Nurse Led clinics are held in all localities;
Kilburn Kilburn Square clinic
Wembley Wembley Centre for Health & Care
Willesden Willesden Centre for Health and Care
Kingsbury Chalkhill Health Centre
Harlesden Monks Park Primary Care Centre
Q5) Who should I refer to secondary care?
The types of patients that should be referred to Secondary Care are;
- Those patients who have Diabetes complications
- Gestational Diabetes
- Children with Type 1 DM
- Adults with Type 1 Diabetes.
top
Dietetics;
Q6) Where can my patients see a Dietitian and how soon should they be seen after diagnosis?
A4) Long Term Conditions Centre-Diabetes (LTCC-Diabetes) currently refers patients directly to the Dietitians at the Wembley or Willesden Diabetes MDT clinics. If you have a Dietitian who visits your practice this should still remain your initial referral route.
Standards suggest that a patient with diabetes should have access to a Dietitian within 4 weeks of diagnosis.
Click here for first line diet advice which is available to all practices for use whilst patient is on the waiting list.
Q7) Do you have resources specific for ethnic groups?
A5) We have resources on diabetes, healthy eating and weight loss in Guajarati, Urdu, Punjabi, Bengali, Somalian, and Arabic. We are always working in conjunction with communities to produce new resources and update our existing resources.
Q8) Do we currently offer any weight management services?
A6) At present we offer one to one weight management services in our Diabetic MDT clinic at Willesden or Wembley. These sessions are based on a specific package of care to enable the patient to get the most out of the time. Anti-obesity medication will also be recommended where necessary. It is also hoped in the future to run Diabetes specific weight management groups.
For further information please refer to the Brent Diabetes Care Pathway or alternatively you can call or e-mail:
Helen Davies, Diabetes Specialist Dietitian
Helen.Davies@brentpct.nhs.uk
Wembley - 020 8795 6690
Salma Butt, Ethnic Health Dietitian for Diabetes/CHD
Salma.Butt@brentpct.nhs.uk
Wembley - 020 8795 6691
Main office contact: 020 8796 6363
Fax: 020 8795 6360
top
Podiatry;
Q9) What should I do at an annual foot care review?
A7) According to the National Service Framework for Diabetes all patients need to have a circulation check and neurological assessment annually. In Brent the locally adopted policy can be found in the Brent Diabetes Care Pathway and consists of palpation of pulses, a visual inspection as well as a test with a calibrated 10gram monofilament.
Based on the foot screen the patient can be categorised at grade 0 and does not podiatry input. General footcare and footwear advice should be given. If you feel the patient will benefit from further education you can refer them for the diabetes education course which consists of a podiatry session.
In the Diabetes care pathway a section exists on grading. Anyone graded by yourself as At risk / Grade 1 or above needs to be referred to a podiatrist at which point a further detailed assessment of their vascular and neurological status can be made. Based on the assessment an appropriate package of care will be offered to the patient.
Q10) Who do I refer to the Intermediatary Care Team?
A8) Currently there are two clinical podiatry sites – Wembley and Willesden that are part of the Diabetes Intermediatary Care Pathway. Both these sites are run by the Senior Community Diabetes Specialist Podiatrist Rakhee Shah. Specialist facilities as well as medical staff exist to deal with:
a. Most minor wounds. A referral should be made on the normal podiatry referral form. Please mark these for the urgent attention of Rakhee Shah, stating clearly the details of the wound and diabetes status. These can be posted or preferably faxed to:
Willesden Podiatry: 0208 438 7101
Wembley Podiatry: 0208 795 6018
b. High risk patients that have previously had ulcerations, amputations, managed Charcot’s arthropathy, foot deformity and neuroischaemic changes.
Strong communication channels exist between Secondary care, Intermediatary care as well as Community care and patients will be referred for care accordingly based on a clinical assessment.
Q11) Who should I refer to secondary care?
A9) The Chief Podiatrist, Gaytree Todd provides the intensive podiatry treatment for any acute ischaemia, gangrene, cellulitis, acute infection, new and sudden deformity – Charcot’s arthropathy and has access to a range of specialist facilities such as bone scans and consultants too. Patients here can be fast tracked to a range of other medical teams including the vascular team should it be felt necessary.
Referrals here should be made on the podiatry referral form detailing the problem can be posted to:
Gaytree Todd
Chief Podiatrist
Jeffrey Kelson Center
2nd Floor
BeCad
Or preferably faxed to:
0208 453 2415.
For any further information please refer to the Brent Diabetes Care pathway or alternatively you can call or email:
Rakhee Shah
Rakhee.shah@brentpct.nhs.uk
Wembley – 0208 795 6033
Willesden – 0208 438 7093
Mobile – 07973 82 77 55
Gaytree Todd
Gaytree.todd@nwlh.nhs.uk
Jeffrey Kelson – 0208 453 2607
Mobile – 07772 257888
top
Patients;
Diabetes;
Q1) I hate doing blood glucose monitoring using the finger prick testing, is there another method I can use?
A1) There are glucometers available that offer alternate site testing such as the forearms.
Q2) Why is my GP not referring me to the hospital for diabetes advise?
A2) Your GP does not need to refer you to the hospital for care if your diabetes is stable and you do not have any Diabetic complications. The following should be referred to the hospital; Gestational diabetes , Type 1, children, Unstable Diabetes, or Diabetics who have complications.
Your GP can refer you to Brent Single Point of Access at any time for advise about your diabetes management.
Q3) How do I speak to another patient with Diabetes regarding their experiences?
A3) Brent Primary Care Trust currently runs Diabetes Educational Group sessions for patients and carers with DM. As well as the educational component, you will meet and be able to share experiences with other members of the group.
There is also a Diabetes Support Group run by Gloria Travers, (0208 901 1150) which is held at Chalkhill Tenant’s Hall on the last Wednesday of every month. There is different guest speakers talking about all aspects of Diabetes management, and participants get the opportunity to ask questions, talk to other diabetes patients, and make new friends.
Diabetes UK which is the charity for diabetic patients also has local groups which meet regularly and offer support to diabetics, check out their Website (www.diabetes.org.uk) to see if there is a local group in your area that meets regularly.
top
Dietetics;
Q4) Can I still have some sugar in my Diet?
A4) Yes – The new guidelines produced by Diabetes UK, allow people with diabetes to have some sugar in their diet. Foods high in sugar like cakes and desserts, tend to be high in fat and calories, so should be limited as part of a healthy diet and especially if your trying to lose weight. Foods that contain a bit of sugar or foods that you eat in small amounts, e.g. sauces, jams, ready meals and yoghurts will not affect your diabetes control.
Q5) Are there any fruits that I can’t eat?
A5) No. All fruits are good for you; they contain natural fruit sugars, which don’t increase your blood glucose in comparison to refined sugars. Fruits are a good source of fibre and vitamins. Aim for at least 3 portions of fruit a day. An example of a portion would be: 1 medium banana or apple, a slice of melon, 2 small plums, a handful of grapes or half a mango.
Q6) Can I eat Rice, Potatoes or Bread?
A6) Yes, Starchy foods such as bread, pasta, chapattis, potatoes and cereals are part of a healthy balanced diet. Ideally each mealtime should include some form of starchy food, as this will help you to control your blood glucose levels. All varieties are fine, but try to include more wholegrain and low glycaemic index options.
Why low glycaemic index? When eaten, Low Glycaemic Index starchy foods are digested and broken down to glucose at a slower rate. The glucose from these foods is therefore release into the blood at a slower rate. This slow release of glucose helps to control blood glucose levels. Examples: fruit and vegetables, pulses, oats, granary bread.
top
Podiatry;
Q7) How does diabetes affect the feet?
A7) Poorly controlled diabetes can lead to nerve damage which results in the change of shape of the feet as well as a reduction in the skin quality and a loss of sensation. Due to the loss of sensation any trauma that might occur eg tight fitting shoes causing a blister, might not be felt and could therefore be left and lead to more serious problems such as ulceration.
Uncontrolled diabetes can also cause damage to the arteries which leads to a restriction in the blood supply reaching the feet. Therefore injuries can heal slower and very quickly become infected if not monitored closely. The feet can feel cold and change in colour too. Your G/P or Nurse will monitor for signs of these at your annual reviews and if any problems are detected you will be referred to the podiatrist for further assessment.
Q8) Should I care for my feet myself?
A8) People with diabetes need to be actively looking at there feet daily. Check in-between the toes as well as the bottom part of the feet. If you find this difficult ask a family member or use a mirror. Wash feet daily and dry well as well as apply moisturising cream. Wear low heeled shoes with laces or velcro straps with plenty of room in the toe areas and good shock absorbing sole. When buying shoes ask for your feet to be measured before. Examine your shoes for small stones rough lining or cracks before putting your feet in as all these can cause injuries.
In addition you can cut the nails straight across so all edges can be seen and then file them round with an emery board. Don’t probe down the sides. For thicker nails apply the same principle but file them on the top too to keep them flat. If you have any reduced sensation or circulation in your feet your podiatrist will advise you more accordingly
If you have any calluses or corns – see the help of a Podiatrist never attempt to use a razor blade scissors or corn cures to treat them. Walking barefoot makes you more prone to injuries so always wear a good pair of protective slippers. You must take precautions when dealing with heat and cold – never sit too close a heater, don’t put your feet directly onto a hot water bottle and before stepping into a bath check the temperature with your elbow beforehand. Smoking accelerates damage to nerves and arteries so seek the assistance of the smoking cessation team to give up.
Q9) What should I do if I have an injury?
A9) Any cuts need to be cleansed and then dressed with a dry dressing. It you see an increase in redness, yellowy discharge or swelling or feel an increase in temperature then you need to seek the help of a medical professional.
top |
