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Signs and Symptoms
Local Guidance: Diagnosis of diabetes (requires either HbA1c or fasting blood glucose)
An accurate pathological diagnosis is essential to ensure the correct treatment pathway can be followed.
GHFT laboratories are unable to perform an HbA1c in a glucose specimen tube. This damages laboratory equipment. Use Greiner Vacuette EDTA tube.
This guidance aims to support people with diabetes and healthcare professionals involved in their care, to achieve optimal glycaemic control through the effective use of self-monitoring of blood glucose and Hba1c testing.
In summary, the use of BGL meters is variable throughout the county. We recommend that meters should only be given if there is good reason to do so. The results of BGL should be seen as a snapshot of the control but not as the long term trends that we should be using to help plan treatment regimes. At present there is no place for Libre meters to be prescribed on the NHS for people with Type 2 diabetes within Gloucestershire.
The aim of this position statement is to provide evidence-based guidance for Health Care Professionals working in primary, secondary care and the community in Gloucestershire, regarding the nutrition management of adults with Diabetes, Non-Diabetic Hyperglycaemia, and Metabolic Syndrome.
After careful review of the available evidence, there is no-one size-fits-all prescriptive approach to making food choices, and it is equally important that food choices are acceptable and enjoyable while also helping to achieve treatment goals, and improve health and quality of life.
Please follow the resource link below to view.
Prescribe glucose lowering medications if there is inadequately improved hyperglycemia with lifestyle modifications.
Every year all type 2 diabetic patients should have the following assessments:
The majority of women with diabetes who become pregnant give birth to healthy babies, BUT, diabetes increases the risk of complications both for the baby and the mother especially if the HbA1c is elevated. The chance of miscarriage is higher and the chance of the baby having a birth defect is doubled.
Effective care before pregnancy improves pregnancy outcomes in women with diabetes The National Institute for Health and Clinical Excellence (NICE) lists preconception care as a ‘key priority’ to improving pregnancy outcomes in women with diabetes. Contraception should be considered for all diabetic females in order to decrease risk of accidental pregnancy. Please consider contraception and type of contraception with your patient and her partner.
As a matter of urgency, once you are aware a patient is pregnant, if you haven’t already done so please inform the Specialist Diabetes Team within secondary care.
Due to increasing levels of obesity and inactive lifestyles improved identification and diagnosis of hyperglycaemia, we are diagnosing people with diabetes at a younger age than historically. This diagnosis is of Type 2 diabetes as patients do not present with typical Type 1 diabetes.
Complications may include:
Further guidance on complications can be accessed on the Diabetes UK website.
Guideline Info - Review date: December 2016
|Dr Alison Evans: Clinical Lead Diabetologist – GHNHSFT|
|Dr Ian Donald: Consultant in General Older Age Medicine - GHNHSFT|
|Dr Rob Estelrich: GPSI in Diabetes – GCS Community Diabetes Team|
|Dr Caroline Bennett: GCCG GP & Chair of Diabetes & Endocrinology Clinical Programme Group|
Please also see the ‘Clinician Education’ section to view a selection of podcasts by Dr Le Roux and Dr Donald on Diabetes and Frailty.