DIABETES SERVICES DURING COVID-19
We know how important it is to manage your diabetes well during this time, and we are keen to support you as best we can.
You may like to read https://www.diabetes.org.uk/about_us/news/coronavirus-statistics which discusses the risks of coronavirus in people with diabetes.
Here follows updates and resources which we hope you will find useful. We have also provided information about how to manage diabetes in the event of illness.
Please contact the surgery if you have any questions or if your blood glucose levels are too low or too high, or you have concerns about your feet, such as skin changes, pain, or loss of sensation.
Request a phone call either by:
Calling the appointments line 01970 624855
Using e-consult.net (or click on link via Church Surgery website homepage). Click either on ‘I want general advice’, or ‘start a review’.
E-consult is highly recommended. It enables me to email you back and will be used increasingly by the practice.
We are reviewing all patient records (we have approximately 450 diabetic patients) and prioritising those with the greatest medical need to invite for blood testing. If you have not yet been contacted, there are several things you can do monitor your diabetes yourself.
FILL IN A BLOOD GLUCOSE DIARY
If you have never monitored your blood glucose before and do not have the equipment you can collect this from the surgery.
Come to the front door from 08.00-18.00 and use the intercom system and a member of staff will bring this out to you.
I would particularly encourage you to do this is your HbA1c was 58mmol/L or above at your last appointment.
Doing a blood glucose diary is an alternative to measuring HbA1c click here for more detailed information. Blood glucose diary
PURCHASE A HOME BLOOD PRESSURE MACHINE
Choose an upper arm cuff (not a wrist or finger one) ideally approved by the British and Irish Hypertension Society (BIHS).
We also have a small number of monitors we can loan out. Most people with diabetes should aim for a blood pressure reading below 140/80.
BRING US A URINE SAMPLE
We check your urine for ‘microalbuminurea’ (small proteins which indicate diabetic kidney damage) every year on the month of your birthday. If you have not yet had this checked this year, please bring one in a clear sample pot marked with your name and date of birthday and place it in an envelope marked diabetes urine test.
LEARN MORE ABOUT DIABETES
The excellent DESMOND structured education course is now available free online until September.
PLEASE sign up by emailing your name, postcode, GP surgery and NHS number to myDESMOND@uhl-tr.nhs.uk
www.bertieonline.org.uk/ (type 1 diabetes)
IMPROVE YOUR DIET AND PHYSICAL HEALTH
Most cases of type 2 diabetes are related to metabolic changes caused by weight around the middle of your body. Life style change is therefore the most effective treatment. All carbohydrates (e.g bread, potatoes, rice) are converted into sugar in the body. Reducing carbohydrates will therefore keep your blood glucose levels down, and also help with weight loss.
Low carb dietary information
Physical exercise and well-being resources
SICK DAY RULES: HOW TO MANAGE DIABETES IF YOU BECOME UNWELL
If you develop coronavirus symptoms or any other illness, it is likely that your blood glucose will increase even if you are eating less than usual.
If you already have access to blood glucose monitoring, increase the frequency of checking your blood glucose to every 2 to 4 hours. If you do not have access to blood glucose monitoring, look out for symptoms of high blood glucose. These include thirst, passing more urine than usual and tiredness.
Stay hydrated: drink at least ½ cup (100mls) of water every hour (you can also drink any other sugar-free drink).
Do not fast: maintain carbohydrate intake. If you are unable to eat or drink or are vomiting, replace meals with sugary fluids or ice cream.
Never stop insulin. Though you may need to adjust the dose. If your blood glucose is:
13-17mmol/l... increase insulin by 2 units
17-22mmol/l ...increase insulin by 4 units
>22mmol/l ...increase insulin by 6 units
(this is a general guide, seek advice if you are unsure or your glucose level persists >18mmol/l)
If you have type 1 diabetes, measure blood ketones. You should have equipment and know how to check for diabetic ketoacidosis. Contact the surgery asap if you do not. Seek urgent medical advice if ketones are >1.5mmol/l.
You may need to stop medications listed below. Restart your medicines as normal when you are well (normally after 24 to 48 hours of eating and drinking normally).
Metformin/sukkarto – dehydration can make it more likely that you will develop a serious side effect called lactic acidosis
Sulfonylureas (e.g gliclazide, ‘diamicron’) - if you are unable to eat or drink, it will be more likely that you develop low blood glucose (hypos). If you are eating and drinking normally and blood sugars are high continue to take sulfonylureas
SGLT2 inhibitors (e.g. dapagliflozin, empagliflozin) - dehydration can make it more likely that you will develop a serious side effect called ketoacidosis
ACE inhibitors (e.g ramipril, lisinopril, perindopril or others ending in ‘pril’) - these medicines are used for heart conditions, high blood pressure and for kidney protection. If you are dehydrated, these medicines can stop your kidneys working properly.
ARBs (e.g. losartan, candesartan, valsartan or others ending in ‘sartan’ - these medicines are used for heart conditions, high blood pressure and for kidney protection. If you are dehydrated, these medicines can stop your kidneys working properly.
Diuretics (e.g. bendroflumathiazide, indapamide, furosemide, bumetanide) - these medicines are used for excess fluid and high blood pressure and are sometimes called ‘water pills’. These medicines can make dehydration more likely.
NSAIDs (e.g. ibuprofen, naproxen) - these are anti-inflammatory pain killers. If you are dehydrated, these medicines can stop your kidneys working properly
If you are very unwell, unable to stay hydrated due to vomiting, or cannot control your blood glucose seek urgent medical attention. Call 111 out of hours.