In the UK, current 2022 NHS diabetes diet advice is that there is no special diet for people with diabetes.

Many people with diabetes focus on the carbohydrate content of their meals and prefer a low-carb diet for tight blood glucose level control.

The NHS (and

Diabetes UK
) recommend a healthy, balanced diet that is low in fat, sugar and salt and contain a high level of fresh fruit and vegetables.

This guide reviews the diet advice the NHS gives to people with diabetes and discusses to what degree the advice is sensible.

What does the NHS advise?

The NHS provides the following diet advice for people with diabetes:


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[148]</sup>

• Eat plenty of starchy
  
  carbohydrates
  with a
  
  low glycemic index
  (low GI)
• Increase the amount of fibre in your diet
• Eat plenty of fruit and vegetables – at least 5 portions per day
• Cut down on fat and saturated fat in particular
• Choose foods with unsaturated fat instead – such as vegetable oils, reduced fat spreads, oily fish and avocados
• Choose low-fat dairy products
• Choose lean meat – such as skinless chicken
• Avoid fatty or processed meat
• Eat fish at least twice a week and ensure you have oily fish at least once a week
• Eggs and beans are other good sources of protein
• Cook food by grilling, baking, poaching or steaming instead of frying or roasting
• Avoid fatty or sugary snacks – such as crisps, cakes, biscuits and pastries
• Eat snacks such as fruit, unsalted nuts and low-fat yoghurts
• Cut down on sugar
• Eat less salt – have less than 6g of salt (2.4g of sodium) per day
• Cut down on alcohol
• 
  Don’t skip breakfast
• Keep hydrated – aim to drink between 1.6 and 2 litres of fluid each day

Is the NHS advice sensible?

Whilst a number of these points are undoubtedly sensible, some of the recommendations have been criticised by patients and some leading UK healthcare professionals.

The following points are sensible:

• Eat plenty of vegetables
• Have sufficient fibre in your diet
• Cut down on sugar
• Cut down on processed meat
• Eat fish regularly
• Cut down on energy dense, processed food – such as crisps, cakes, biscuits and pastries
• Cut down on alcohol
• Cut down on salty processed foods

However, some of the recommendations may inadvertently lead to poorer diet choices.

The recommendations for people with diabetes to eat plenty of starchy carbohydrate and avoid fat from meat and dairy could lead to poorer blood glucose control, particularly in people with

type 2 diabetes

Having said that, the NHS has certified the Low Carb Program to provide structured education and weight management support to people with type 2 diabetes.

Should I base meals upon starchy carbohydrate?

The NHS advises people, including those with diabetes, to base meals around food with starchy carbohydrate such as:

• Potatoes
• Cereals
• Pasta
• Rice
• Bread

The problem with this advice is that even starchy carbohydrates with a low GI can have a pronounced effect in raising blood glucose levels.

Starchy carbohydrate may be problematic for many people with type 2 diabetes as carbohydrate requires greater insulin production than fat or protein does. Research studies have shown that greater insulin production increases the effect of insulin resistance.

By advising people with insulin resistance and type 2 diabetes to base their meals around carbohydrate, the NHS diet advice increases the underlying problem of

insulin resistance

People with type 1 diabetes may find that having meals based on starchy carbohydrate helps them to better estimate insulin doses. By contrast, some people with type 1 diabetes have reported better success by following a low carbohydrate diet. Adjusting to a low carbohydrate will require care and dedication and the support of your diabetes health team.

• Read more about the debate around
  
  NHS carbohydrate advice

Should I eat less saturated fat?

The problem with the NHS’s recommendation to eat less saturated fat is that it makes no distinction between different sources of saturated fat.

Saturated fat should be regarded as a healthy form of

fat

as long as it comes from natural sources

such as:

• 
  Meat
  (unprocessed)
• 
  Fish
• 
  Dairy
• Olives and olive oil
• 
  Nuts
  (unsalted) and nut oils
• Seeds
• Avocados

Rather than condemning saturated fat, the NHS should instead advise people to cut down on ‘processed sources of fat’, which include:

• Cakes
• Biscuits
• Crisps
• Chops
• Pastries

Note that many of these foods are high in calories because they are packed with vegetable oil.

Research into fat in the news

• Fats found in Nordic diet play ‘significant’ role in health
• Altering diet plan and circadian clock affects vital fat tissue

Should I eat low-fat products?

Whilst the NHS has taken great trouble to coerce the public to buy low-fat dairy, research studies have shown eating full fat dairy to be just as healthy, if not more healthy.

A notable point about products labelled as low-fat is that many of them have added sugar, salt or other unnatural additives to replace the fat.

Should I eat fruit?

As long as not eaten in excess,

fruit
is a healthy part of the diet.

Caution should, however, be taken with fruit juice as it has a high sugar content and raises blood glucose levels very quickly.

It is better to eat whole fruit instead of fruit juice as whole fruit contains more fibre which helps to slow down the impact on

blood glucose levels

Should I follow the NHS diet advice?

A number of leading healthcare professionals admit that the diet recommendations for people with diabetes are flawed, particularly in regard to people with prediabetes and type 2 diabetes.

One diet which has found common ground for agreement, between the NHS and the healthcare professionals that have criticised the NHS diet, is the

Mediterranean diet

The agreement is undoubtedly a result of the Mediterranean diet being based upon fresh, unprocessed food, includes natural sources of fat and is a flexible diet to follow.

Insulin dosing errors in hospital should be rare but have been found to be more prevalent than many would expect.

Insulin overdoses can lead to severe

hypoglycemia

which can have serious health implications including coma and death.

Signs of insulin overdose

Hypoglycemia will result from an insulin overdose if the dosing error is identified too late. Symptoms of hypoglycemia in patients may include:

• Pale skin and lips
• Staring eyes
• Confusion
• Slurred speech
• Irritability or aggression
• Fitting
• Loss of consciousness or
  
  coma
  

How can insulin dosing errors occur?

• Misreading handwriting – ‘2U rapid insulin’ may get misread as ’20 rapid insulin’ which would result in a massive overdose.
• Using the wrong syringe for an
  
  insulin injection
  
  Using a syringe with the wrong unit gradations could result in a severe overdose.
• Using the wrong syringe, such as an intravenous syringe, to measure out insulin for an intravenous drip.
• Injecting the wrong type of insulin – for example injecting short acting insulin instead of intermediate insulin.

How common are insulin overdoses by the NHS?

In 2010, The National Patient Safety Agency (NPSA) reported that over 3,800 insulin dosing errors had been reported within a five year period between August 2004 and August 2009.

At least 20 of these reports resulted from an intravenous syringe being used instead of an insulin syringe.

When the report was published, the NPSA provided insulin safety guidelines to reduce the risks of insulin dosing errors and NHS Diabetes developed an e-learning course for healthcare professionals to safely administer insulin.

Insulin safety guidelines

The following is a summary of NPSA’s insulin safety guidance:

• Insulin doses should only be administered with an insulin syringe or an
  
  insulin pen
  

• Insulin doses for IV infusion are measured out with an insulin syringe.
• Never use abbreviations for units such as ‘U’ or ‘IU’ as these can easily be misread.
• A training programme should be undertaken by all healthcare professionals that prescribe, prepare or administer insulin.
• Hospital staff have access to adequate supplies of insulin syringes.

What can I do to prevent insulin overdose in hospital?

Whilst the figures show that overdoses are not as rare as we’d all hopen, the number of injections performed properly in hospitals far outweighs the number of mistakes and so patients should not be unduly worried.

If you have any queries about insulin doses, hospital staff should be able to answer your queries. In some cases, it may be possible for you to self manage your own diabetes during your hospital stay.

• Read more about
  
  diabetes care in hospital
  

The National Institute for Health and Care Excellence (NICE) currently state that there isn’t insufficient evidence showing continuous glucose monitoring (CGM) to be cost-effective enough to recommend widely.

However, NICE recommends that

CGM

is considered in a number of specific situations which we will outline in this guide.

CGM usage may become widespread if use of the technology if data can show that it is effective in improving blood glucose control, reducing episodes of

hypoglycemia

, particularly severe hypoglycemia, and shows evidence of being cost effective in meeting these aims.

Continuous glucose monitoring access in adults

CGM may be considered appropriate under the following situations:

• If having more than one
  
  severe hypo
  
  a year that’s brought on by no obviously preventable cause.
• A complete loss of
  
  hypo awareness
  

• Frequent episodes of problematic hypos occurring without symptoms.
• If an extreme
  
  fear of hypoglycemia
  
  is causing problems or distress.
• If unable to achieve an
  
  HbA1c
  
  of under 75 mmol/mol (9%) despite testing blood sugar levels at least 10 a day.

CGM use can be applied if the following factors also apply:


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• The intended user of the CGM is willing both to commit to using the CGM at least 70 per cent of the time and keep it regularly calibrated.
• The user is on
  
  multiple daily injections
  
  or
  
  insulin pump therapy
  

• The health team providing the CGM has the expertise to advise on effective use of the CGM.

CGM access for children

NICE advises that CGMs with alarms are offered to children if any of the following circumstances apply:


^[171]

• Experiencing frequent episodes of severe hypoglycemia.
• If hypo unawareness is leading to seizures or anxiety.
• If a child with diabetes is
  
  unable to recognise symptoms of a hypo
  
  or unable to adequately communicate the symptoms they have in order to prompt hypo treatment.

CGM access in pregnancy

CGM use may be considered for pregnant women who are on insulin if:


^[172]

• Problematic severe hypos are occurring.
• CGM could
  
  help improve poor blood glucose control
  

• CGM can provide useful information towards minimising too high or low blood glucose levels.

If CGMs are used, there should be support available to help with analysing and interpreting results and trends.

Access to CGM sensor augmented insulin pumps

In February 2016, NICE published guidance on ‘Integrated sensor-augmented pump therapy systems for managing blood glucose levels’.

Integrated sensor-augmented pumps are insulin pumps that can communicate directly with CGM sensors. Whilst there are a few insulin pumps that allow CGM integration, NICE state that it is only the

Medtronic MiniMed Paradigm Veo

that has shown enough evidence to date of being sufficiently cost effective.

A key reason why the MiniMed Paradigm Veo has been recommended is that it has a feature known as Low Glucose Suspend which switches off insulin delivery whilst blood glucose levels are too low.

The diagnostic guidance recommends that people with

type 1 diabetes

that are on insulin pump therapy are considered for the CGM integrated pump technology if:

• They experience regular unpredictable hypos despite having good blood glucose control (an HbA1c of no more than 48 mmol/mol or 6.5%).

The guidance also states that the CGM technology should only be provided if the following conditions apply:


^[173]

• The insulin pump company collects, analyses and publishes data on the use of the MiniMed Paradigm Veo system.
• Use of the system is overseen by a health team with expertise of both insulin pump therapy and continuous glucose monitoring.
• If CGM sensors are used at least 70 per cent of the time.
• The user adequately understands how to use the technology.
• The user agrees to use the system whilst undergoing a
  
  structured diabetes education program
  

The

NHS

advises people with diabetes to follow a low-fat diet and get roughly half of their daily calories from carbohydrate.

Additionally, if someone with diabetes intends to

lose weight

, the NHS suggests following a starchy carbohydrate-based low-calorie diet as the best method.

This has courted a certain amount of

controversy

as the high carbohydrate intake typically leads to increased difficulty in managing blood sugar levels.

Whilst the

low-fat

diet has long been defended by healthcare professionals, more recently, prominent doctors have openly questioned the effectiveness of the low-fat diet for people with diabetes in particular.

NHS advice to eat high carbohydrate diets

Since the 1980s, the NHS has been advising people with diabetes to eat a low-fat diet based around starchy carbohydrate. The advice since then has been to have roughly half of our energy coming from carbohydrate, which typically means having 200-300g of carbohydrate per day.

The decision to base diets around this much carbohydrate

was not supported by high quality research

and the diet has been criticised by a number of high profile doctors in recent years.

Criticisms of the NHS diet advice

Significant criticisms of the NHS diet are that it encourages weight gain, leads to

high blood glucose levels

and a dependence on medication that increases over time; leading people putting on stronger medication as they get older.

Over time, this can have follow-on effects such as decreasing people’s mobility, increasing the risk of medication side effects, increasing the likelihood of

diabetes complications

occurring and increasing the risk of additional health conditions and frailty developing.

Since the low-fat dietary guidelines were introduced, rates of type 2 diabetes have risen sharply and whilst this does not show that the low-fat diet is itself to blame for this, the low-fat diet does not seem to have helped matters.

Advantages of low-carb diets

Until recently, medical experts would cite a lack of evidence for why low-carb diets were not being recommended or considered to help diabetes control.

In recent years, there have been a growing number of well-run clinical trials that have consistently shown low-carb diets to at least as effective as low-fat calorie restricted diets in terms of weight loss and

significantly better in terms of blood glucose control

Another key advantage of low-carb diets is that they allow people to

reduce their dependence on medication

and therefore avoid unpleasant, and potentially damaging, side effects of diabetes drugs.

Challenging the dietary guidelines

A group of 12 leading doctors formed a charity, the

Public Health Collaboration (PHC)

, that is dedicated towards challenging the current dietary guidelines.

As type 2 diabetes is one of the leading health conditions in adults, dietary changes to

prevent type 2 diabetes

is a primary focus for the PHC.

One of the doctors involved with the PHC is GP Dr David Unwin. At his practice,

Dr Unwin has encouraged patients to tackle diabetes

by reducing high carbohydrate intake down to a healthier, low-carb level.

The strategy has had significant success and enabled many of his patients to reduce or come off their diabetes medication.

We are proud to note that Dr Unwin’s approach was initially inspired by hearing of the great success members of the

Diabetes.co.uk Forum

were having in controlling their diabetes through low-carb diets.

People with long-term health conditions, such as diabetes, should be offered the chance to have a care plan put together to meet their individual needs.

A care plan can help you to take charge of the care you are receiving and ensures both you and your doctor are working towards the same goals.

What is a diabetes care plan?

The NHS describes a care plan as an agreement between you and the healthcare professional who oversees your diabetes to help you

manage your diabetes

Putting your diabetic care plan together

When putting together a care plan you’ll be asked about the goals you hope or expect to achieve.

The goals could include keeping your

HbA1c below a certain value

, to fit half an hour’s activity into each day or could be to quite smoking.

To help you achieve your goals, you may need help from the NHS such as to receive certain support services.

Measures such as these will be documented as part of your care plan.

What will a care plan typically contain?

• Goals or targets to aim towards
• Support services you may require
• The medication you are taking
• 
  A diet plan
  
• An exercise plan
• Emergency contact numbers –such as your GP out of hours service or a next of kin contact number in case they need to be contacted in an emergency

How do I arrange to have a care plan developed?

If you wish to have a care plan developed,

speak to your GP

or the specialist responsible for your diabetes care.

Depending on your own individual diabetes care needs, your healthcare team can vary considerably in size.

This team will assist you in your diabetes management.

At a very minimum your health team may just be your GP, however you should have access to a range of specialists as and when you need them.

GP – general practitioner

Your GP (general practitioner) is your first point of contact who will be kept updated of any changes in your care and is responsible for prescribing any medicines and supplies you need.

• Read more
  
  about your GP
  
  

Consultant or diabetologist

Depending on the set up at your medical centre, you may or may not have regular access to a consultant or diabetologist, however, you should have access to one if you have specialist questions that needs a consultant’s advice.

Diabetes specialist nurse – DSN

Diabetes specialist nurses, as the name suggests, are nurses with specialist knowledge of diabetes.

Diabetes specialist nurses

play a role in helping and supporting people with diabetes in managing their condition.

Practice nurse

Practice nurses play a key and varied role in medical centres.

Practice nurses are trained to deal with a wide range of tasks from treating injuries to

performing blood tests

and vaccinations.

Pharmacist

Pharmacists receive specialist training in a wide variety of medical conditions, medications and treatments. If you have questions about your

medication

, such as side effects, your pharmacist can advise you.

Optometrist and opthalmologist

Optometrists and opthalmologists are both eye specialists and can help with your retinopathy screening and other

eye conditions

such as

glaucoma

and

cataracts

The difference between the two is that an ophthalmologist is likely to have a deeper specialist knowledge and will be responsible for any eye surgery that may be needed.

Podiatrist

Not everyone with diabetes will see a podiatrist as

basic foot checks

can be performed by other healthcare staff. If you need to see a specialist for your feet, it will be a podiatrist that you see.

Dietitian

A

dietitian

is a specialist in food and nutrition who can help to advise you on the content and structure of your diet.

Read more about a

diabetes diet

Psychologist

If you are having emotional or psychological issues that are affecting your life, you should have access to see a psychologist who will be able to give you support.

• 
  Diabetes and emotions
  

Other specialist consultants

If you

develop complications

, you may need to see a specialist in the relevant area of care.

To help ensure that your care is appropriate, you can ask for a

care plan

to be drawn up either before your visit or during it.

Generally the transition from children’s (pediatric) diabetes care to adult

diabetes care

will take place between the ages of 16 and 18.

However, there is no set age and the transition from pedriatric to adult care should take place when you are ready.

How will I know when I’ll be switched to adult care?

Before the change takes place, you should be informed of when the transition will take place and you should be given the chance to ask any questions or voice any concerns you may have.

How different is adult care to children’s care?

Teenagers may often find that they need to take more ownership of their diabetes when they progress to adult care.

In paediatric care, the doctors and nurses will typically spend more time making sure you’ve got to grips with everything.

This should still happen in adult care but you may need to be more proactive in asking questions.

What if I am finding the transition difficult?

If you at all isolated or have difficulty expressing yourself to a new doctor or consultant, you can contact a doctor or nurse at your old clinic who should be able to give you advice for handling the change.

What can I expect from the transition from the children’s to adult clinic?

The transition should not be an abrupt change. In an ideal situation you will go through a transition clinic but this won’t always be available.

You should be given a clear idea of any increase in your own responsibilities and be notified in writing of any other differences in your care such as how often your clinics or care reviews will be, where they will take place and which health staff you will see for your reviews.

Availability of blood glucose testing strips is a particular issue for people with type 2 diabetes, but can also be an issue for people with other

types of diabetes

as well.

Self monitoring of blood glucose (SMBG) can be very beneficial for people with all types of diabetes and can help to reduce the risk of developing

diabetic complications.

Research into cost effectiveness

A number of research studies have been conducted to assess whether self-monitoring for

blood glucose

is cost effective for the NHS.

The studies have found self-monitoring has not been effective at improving blood glucose control in cases where patients have either not known how to interpret their results or have not been themselves committed to self testing.

However, many people with

type 2 diabetes

see self monitoring of their blood glucose as an essential part of their diabetes management and their self-testing has lead to a vast improvement in their blood glucose control.

NICE recommendations

The National Institute for Health and Clinical Excellence (NICE) recommends that self-monitoring should be available for people on diabetes medication to help provide information to

avoid hypoglycaemia

, to assess fluctuations in blood glucose, to cope with periods of illness and to ensure against accidents during dangerous activities such as driving or operating certain machinery.

In line with this, those who are prescribed self-monitoring equipment should be assessed at least as often as annually on the appropriate frequency of their testing and whether self-monitoring is benefitting the patient.

Can PCTs declare blanket bans on prescribing test strips?

Each PCT should consider each case for self testing individually. The government has responded to issues by underlining that PCTs should not impose blanket bans on test strip availability.

What can I do if my test strips have been withdrawn or reduced?

If your availability to blood glucose testing strips has been restricted, you should arrange to discuss the decision with your health care team. Ask your GP or health team why they have withdrawn or reduced your

test strips.

• If they say that self testing has not had an impact on your results, you may ask for further education to help support your home testing.
• If cost cutting is cited as the reason you may ask for a copy of the policy that sets out the cost cutting guidelines.

Making a claim against the restriction of testing supplies

Your healthcare team may not be aware of the importance of self monitoring to you. Outline how self testing benefits you.

The following examples may help to improve your chances of being prescribed more test strips:

• I experience hypoglycemia
• Testing has improved my post meal blood sugar levels -cite examples
• Since
  
  testing my HbA1c
  
  has improved by X%
• 
  I regularly drive
  
• I regularly need to operate dangerous machinery

Making a complaint

If you have discussed your case with your

healthcare team

and have been unhappy with the reasons for restricting your access to testing supplies, you may wish to complain. A formal complaint may be sent to the following organisations:

• 
  England:
  
  Patient Advice and Liason Service (PALS)
• 
  Scotland:
  
  Your Local health Board
• 
  Wales:
  
  Your Community Health Council
• 
  Northern Ireland:
  
  The Patient and Client Council

It is generally advised to make the complaint in writing, either by letter or email or both.

Should your complaint not be resolved to your liking, you may take your case to the Public Service Ombudsman.

On 13 October 2011, the government released a new paper, ‘

Healthy lives, healthy people: a call to action on obesity



^[11]


‘ their strategy to address the nation’s rising levels of obesity.

Health Secretary, Andrew Lansley’s foreword offers an overview of how the government will look to tackle the issue:

“Past efforts have not succeeded in turning the tide.

We need a new way of looking at the issue – and new approaches to tackling it together.”

Who have the Government been working with?

The Government has enlisted the help of:

• Academic and clinical experts
• Health charities
• NHS practitioners
• The wider public sector involved in front-line work
• Key players in the food industry
• Key players in the physical activity sector

A key report that informs the new paper is the Government Office for Science’s 2007 ‘

Foresight report’

^[12]

Targets for the call to action on obesity

The following targets have been set, which the Health Secretary describes as “truly stretching ambitions”:

• A sustained downward trend in the level of excess weight
  
  in children
  
  by 2020
• A downward trend in the
  
  level of excess weight
  
  averaged across all adults by 2020

Government view on an overweight Britain

The government appears to place the principle cause of weight gain on our calorie intake.

Mr Lansley states:

“We need to be honest with ourselves and recognise that we need to make some changes to control our weight. Increasing physical activity is important but, for most of us who are overweight and obese, eating and drinking less is key to weight loss.”

The Health Secretary accepts that busy lifestyles of the 21st century can make it harder to

make healthy choices

How does the government plan to reduce obesity?

The government will rely on local government to play the lead role in developing and implementing strategies and these will be supported with “high quality data and evidence of ‘what works’”.

Change4Life will continue to play a strong part in communicating the importance of healthy lifestyles.

A key initiative being launched is to urge business to take a leading role to reduce calorie intake. The target is to collectively reduce the national energy intake by 5 billion calories a day.

Will there be a fat tax in the UK as a result?

Calls for a ‘fat tax’, similar to one recently brought in by Denmark which taxes any food with a saturated fat content of over 2.3%, have been rejected.

Criticisms of the report

Professor Philip James, of the International Association for the Study of Obesity, was vocal in his displeasure with the report, labelling the plans as pathetic, stating:

“It is not simply a question of personal responsibility. There is an environmental problem in terms of the food system we have.”

Taking in too many calories?

A criticism that can be made is that the report does not so well address why people may be taking in too many calories.

A potential reason is the lack of good quality food available within people’s budget.

Cheaper food tends to be more calorific but lower in vital vitamins and minerals and therefore people can feel ‘unsatisfied’ without knowing why and therefore prone to eat more to fill the need.

One could argue that the government should focus more on ensuring the food industry provides

fresher and nutrient rich foods

in place of much of the prepared foods that currently line many of our supermarket aisles.

To ensure we stay healthy, as people with diabetes, we should undergo a number of important health checks each year.

Some of the checks are ones which we should receive at least once each year and others are dependent on specific circumstances.

Essential diabetes health checks

The following health checks are ones which all people with diabetes should receive once a year. The one exception to this rule is children under 12 years old.

Blood glucose control check – HbA1c test

This may be carried out either via a blood sample taken from your arm, or if it is the only blood check, via a finger prick test.

• 
  HbA1c test
  

Blood lipid check – cholesterol test

This test requires a blood sample from your arm.

• 
  Cholesterol screening
  

Blood samples will usually require you to arrange for the blood test to be taken at least a couple of weeks before your annual diabetic care review.

Check with your health team if you need more information about the process.

Kidney function check

Two different tests are carried out to check for kidney problems.

For the first check, a urine sample is needed. Ideally you should bring your urine sample with you to your diabetic care review.

The urine test looks for the presence of protein in the urine. No protein in the urine is a good sign.

The second check is done via a blood sample which checks the glomerular filtration rate of the kidneys; in other words, how well the kidneys are functioning.

• 
  Kidney screening
  

Blood pressure check

Your blood pressure will usually be measured at your clinic or diabetic care review. The test is not complicated but you will need to be in a rested state whilst your blood pressure is being checked to prevent the reading being higher than it should be.

People’s blood pressure can rise in a short space of time and the doctor or nurse may need to repeat the test if a high reading is recorded.

• 
  Blood pressure screening
  

Retinopathy screening

Each year you should be offered a retinopathy screening check. The check involves having a photograph taken of your retina at the back of your eye. The retinopathy check may be carried out at a hospital or at an opticians. Your doctor or local retinopathy service should inform you of where you can have your retinopathy test performed.

Check with your health team whether you need to book yourself in for a test or whether the booking will be done on your behalf.

• 
  Diabetic retinopathy screening
  

Foot examinations

As with all of the above, feet checks should be performed at least once a year. At the foot check, the doctor or nurse will look for signs of damage to the skin (such as cuts, burns, blisters or ulcers), will check your circulation and test the level of feeling in your feet for any signs of

neuropathy (nerve damage)

Weight checks

You should have your weight checked at each diabetic care review or clinic, even if you’re a healthy weight. If you are overweight, you should have your waist measured as well.

• 
  Diabetes and BMI
  

Additional diabetes health checks

In addition to the essential health checks above, a number of additional health checks should be performed where relevant.

An individual diabetes care plan

A diabetes care plan should be to set up targets that are appropriate for you along with listing any personal needs to help you manage your diabetes and health.

• Read more about a
  
  diabetes care plan
  
  

Diabetes education

People with diabetes should be offered the opportunity to join a diabetes education course.

• 
  Diabetes education courses
  

Paediatric care

Children should receive specialist paediatric care and receive adequate support when they move into adult care.

• 
  Paediatric to adult transitional care
  

Pregnancy care

If you are planning on having a baby, it is important that you receive specialist care to help you keep tight control of your diabetes through your pregnancy.

• 
  Diabetes and pregnancy
  

Support to quit smoking

Because the combination of smoking and diabetes significantly raises the chance of complications such as heart disease and stroke, people with diabetes who are looking to quit smoking should receive advice and support to help.

• 
  Diabetes and smoking
  

Psychological support

People with diabetes have a higher chance of needing psychological support and this should be provided by your health team where needed.

• 
  Diabetes and depression
  

Access to medical specialists

People with diabetes should be given access to a range of specialists, such as dietitians and podiatrists, as and when needed to help manage diabetes and any related conditions or complications.

• 
  Diabetes healthcare team
  

Care in hospital

People with diabetes admitted to hospital should expect high quality care and should have appropriate access to specialists.

• Read more about
  
  diabetes care in hospital
  

As someone with diabetes, you will likely need to visit your doctor and healthcare team on at least a semi-regular basis. It’s essential to maintain a good relationship with your healthcare team.

Also remember that your doctor will have their own limitations and always maintain a good level of composure and self restraint.

Plan ahead of diabetes appointments

It is well worth planning ahead of an appointment what you wish to discuss and how best to get the message across. Writing down in advance what you wish to talk about can sometimes be particularly useful, especially if you sometimes find it difficult to explain things ‘on the spot’.

If what you wish to discuss is relevant to your

blood glucose control

, take along with you a record of your recent blood glucose test history.

How do I get more time to talk about diabetes with my doctors?

Doctors tend to be very busy and face a lot of pressure on their time. Some

GPs

may even have only a set amount of time they can give to each patient per appointment.

If you think you’ll need more time, try to book a ‘double appointment’ but be prepared to justify why the extra time is needed.

If a double appointment is not available, pick the most important things to discuss this time round and arrange another appointment later to discuss the other matters.

Planning ahead can help you make the most of your time with the doctor. If there is more than one issue to raise, let your doctor know at the start of the appointment how many things you wish to address. This way, if there is not time to discuss all points, your doctor will likely be more willing to arrange a follow up appointment in the near future to address the remaining points.

Do your own diabetes research

Thanks to the internet, many people have the chance to read up on subjects before visiting their doctor.

Be wary of appearing to lecture your doctor though. If you feel that the advice of your doctor goes against your own

diabetes research

you may wish to ask them why they are recommending their line of advice.

You may not agree with their reasoning one hundred per cent but it’ll at the very least help you to better understand where your doctor is coming from.

As a basic rule of thumb, the more respect you give to your doctor, the more respect you will likely get back.

What if my doctor doesn’t seem to understand my diabetes?

No doctor is perfect. Doctors carry with them an awful lot of specialist knowledge but it’ll always be true that some doctors will understand and be able to

explain diabetes

better than others. It’s often worthwhile asking your doctor why they have given some advice or why they have prescribed a certain medicine or routine.

If you feel that the doctor is not able to address your problem adequately you may wish to ask if you could be referred to a specialist, such as a diabetologist (diabetic consultant), to address a particular matter. If, despite your best efforts, you and your doctor can’t see eye to eye, you can request to see a different doctor.

Keeping calm at your doctor’s appointment

Diabetes is most probably a big deal to you and if your doctor isn’t giving your condition the time or care you feel it deserves, it can be very frustrating. If you’ve waited half an hour or more to see your doctor, only to see him or her for 5 minutes it can be even more so. Accept that the outcome may not entirely meet your expectations and be ready to ask appropriate questions if things don’t go entirely the way you’d hoped.

Try to bring an open mind to the appointment. You needn’t accept everything at face value but it will help you to consider other avenues of thought. If despite your best efforts you feel that you’re not getting a reasonable level of care, there are ways in which you can make a complaint.

How can I make a complaint about the care I receive?

If you have a complaint to make, you should bring the issue up with your own healthcare provider.

Start by asking them what their complaints procedure is and follow the complaints guidelines.

It may be tempting to have a rant but a complaint that states the facts without too much hyperbole will tend to fare better.

If your care provider is unable to resolve the complaint, you can raise a formal complaint. You can advice on making a complaint from the following bodies:

• 
  England:
  
  Patient Advice and Liason Service (PALS)
• 
  Scotland:
  
  Your Local health Board
• 
  Wales:
  
  Your Community Health Council
• 
  Northern Ireland:
  
  The Patient and Client Council

If your complaint is still not resolved, you may wish to take your case to the Public Service Ombudsman.

Why was I not told that before? It’s a question many of us with diabetes have asked ourselves at some point.

The amount of information about diabetes we’re given can vary quite substantially from one doctor to another and there are some key points about diabetes that patients are commonly not made aware of.

We look at 7 key nuggets of

information

that are commonly neglected by our GPs and other members of our

diabetes health team

Medication side effects

Before you are

prescribed a new medication

, your doctor should make you aware of the side effects or at least direct you to read the side effects in the patient information leaflet, enclosed with the medication, before starting treatment.

However, it is not uncommon for doctors to omit this and, as a result, some of the side effects of medications may come as a surprise.

Some examples of what people have noted as side effects they wish they’d been made aware of before starting treatment include:

• 
  Statins can sometimes bring on muscle aches
  
  , memory loss and increased blood glucose levels
• 
  Sulphonylureas can, in some cases, cause severe hypoglycemia
  
• Some blood pressure medications, such as ACE (angiotensin-converting-enzyme) inhibitors and ARAs (angiotensin-II receptor antagonists), may reduce kidney function
• Most antidepressive medications have weight gain as a side effect
• Many medications can lead to decreased sex drive or increase the risk of impotence

Type 2 diabetes need not be progressive

Many medical textbooks list

type 2 diabetes

as a progressive disease so it is not a surprise that many doctors inform their patients that their type 2 diabetes will steadily get worse over time. Some doctors may even go so far as telling patients that they will inevitably require insulin within a few years.

Whilst in many cases type 2 diabetes does indeed grow in severity over the years, a significant number of clinical studies have shown that the symptoms and severity and

type 2 diabetes can be reversed to a significant extent

Losing weight, taking more physical activity and adopting a

very low calorie

or

low carbohydrate diet

have all been shown to be effective ways to reduce dependence on diabetes medication and to reduce or eliminate symptoms of hyperglycemia.

Whilst type 2 diabetes certainly can progress, with adequate support and commitment, patients can hold back the progression of diabetes.

The benefits of low carb

The NHS advises people with diabetes to maintain a relatively

low fat diet

and many doctors and dietitians advise people with diabetes to consume plenty of starchy carbohydrate at each meal.

What very few health practitioners tell diabetes patients is that low carbohydrate diets have been shown to be significantly more effective than low fat diets towards helping people to achieve improved diabetes control in all of the main types of diabetes.

In addition, research has also shown low carb diets to be more effective at achieving weight loss and more effective at achieving improved markers of heart health than low fat diets.

Carbohydrate is not the only nutrient that raises blood glucose levels

All people with diabetes that are put on insulin are told that they need to be aware

how carbohydrate affects their blood glucose levels

Very few patients, however, are made aware that protein and even fat, to some extent, can raise blood sugar levels. Whilst the blood glucose raising of effect of protein and fat is significantly less than the effect of carbohydrate, many people on insulin, particularly those with type 1 diabetes, can often be left puzzled why blood sugar levels may be surprisingly high a few hours after having a

protein

or fat based meal.

If you are experiencing high blood glucose between 3 and 6 hours after a high protein or high fat meal, it is worth considering the effects that protein and

fat as a possible cause

Discuss your results with your health team if you need more help in understanding your blood glucose results.

There are other types of diabetes

Most people in the UK will be diagnosed as type 1 diabetes, type 2 diabetes or gestational diabetes. However, there are other types of diabetes which are sometimes overlooked.

The International Diabetes Federation (IDF) notes that a form of type 1 diabetes that develops in adults, known as

Latent Autoimmune Diabetes of Adulthood (LADA)

, is estimated to occur in 10% of adults diagnosed with diabetes between the ages of 30 and 50.

Another form of diabetes which may sometimes go overlooked by doctors is

diabetes MODY

, a form of diabetes caused by a single genetic mutation. There are a number of different forms of MODY and in some cases people with MODY may be incorrectly diagnosed as having either type 1 or type 2 diabetes.

If there is significant doubt over which type of diabetes you have, your doctor can perform specific diagnostic tests to confirm your diabetes type.

Sometimes exercise can raise blood sugar levels

All people with diabetes should be told that exercise can help with lowering blood glucose levels. Whilst this is usually true, it is not so often mentioned that some forms of

exercise can actually result in a rise in blood sugar levels for some patients

We should stress that exercise is beneficial for health but it is useful to be aware of when exercise can lead to a rise in sugar levels particularly if unexpected highs following exercise lead to confusion over how best to control your sugar levels.

One of the main causes of high sugar levels following exercise is if you do short bursts of exercise, for example sprinting.

A short burst of exercise can, in many people, cause the body to release stored glucose from the liver into the bloodstream in anticipation of further exercise. If you intend to exercise for an extended period of time, this raise in blood sugar can be helpful, however, if you only take part in a short duration of exercise, the rise in sugar levels will not be so helpful.

So, if you have previously been confused as to why high sugar levels occur following exercise, the above explanation may provide an answer.

If you are frequently getting higher than intended sugar levels after short bursts of exercise, consider extending your exercise to include a

period of lower intensity exercise such as walking or jogging

There are other forms of metformin available

Metformin is the most commonly prescribed drug for treating type 2 diabetes

Side effects within the first few weeks of taking metformin are common and metformin’s reputation for causing flatulence, particularly when patients start taking the drug, has seen the medication become nicknamed ‘metfartin’ amongst many members of the diabetes patient community.

Whilst the side effects will usually wear off to a large extent in most people, in other people, uncomfortable side effects may persist over a longer term.

For these people, an alternative form of metformin, called extended release metformin, can prescribed. Extended release metformin has benefits in that the side effects are less pronounced than with regular metformin.

If you’re wondering why doctors don’t tell many patients that the extended release version exists, it’s because this version is more expensive than the regular version.

Having diabetes can make us more susceptible to certain health issues and so people with diabetes qualify for free sight tests and, if your diabetes is treated with medication, no prescription charges.

To qualify for free prescriptions, you need to apply for a medical exemption certificate. Ask your doctor for an FP92A application form.

You’ll need to renew your certificate every five years, and if you claim free prescriptions but don’t have a valid certificate, you could be facing a penalty charge of up to £100.

If your diabetes is controlled by diet alone, you’re not eligible for a medical exemption certificate. If you’re on a low incomen, you may qualify for free prescriptions and help with other health costs through the NHS Low Income Scheme.

You can find out more at

nhsbsa.nhs.uk/healthcosts

Alternatively, anyone can buy a prescription prepayment certificate, which could save you money if you need to pay regular prescription charges. Visit

www.nhsbsa.nhs.uk/ppc

Prescription costs

People with diabetes that are treated with medication qualify for free prescriptions. If you take medication for your diabetes, apply for a Medical Exemption (MedEx) Certificate which will make you exempt from paying prescription charges.

If you are not on

diabetic medication

, you may still be eligible for free prescriptions if you:

• Are under 16 years old
• Are 60 or over
• Are
  
  pregnant
  
  or have given birth within the last 12 months
• Hold a war pensioner exemption certificate
• Hold a valid prescription prepayment certificate
• Are named on a valid HC2 certificate

You may also be eligible for free prescriptions if you or your partner receive any of the following

benefits

:

• Income support
• Income-based jobseeker’s allowance
• Pension Credit Guarantee Credit
• Tax credits – if certain conditions are met

Read more about

free prescriptions for people with diabetes

Free NHS sight tests

Diabetes is known to

affect the eyes

and so all people diagnosed with diabetes are eligible for free sight tests on the NHS.

You may need to bring proof that you are eligible for a free eye test. Proof you have diabetes can include a repeat prescription card or an out-patient appointment card.

Optical vouchers

Optical vouchers help towards costs for glasses and contact lenses. People with diabetes do not automatically qualify for optical vouchers but you may be eligible if you:

• Are under 16 years old
• Are 16, 17 or 18 and are in full time education
• Require complex lenses
• Are named on a valid HC2 certificate

Or if you are included amongst the following entitlements:

• Income support
• Income-based jobseeker’s allowance
• Income-related Employment and Support
• Allowance
• Pension Credit Guarantee Credit
• Tax credits – if certain conditions are met

NHS dental care

Whilst diabetes is recognised as increasing the risk of

dental health issues

, people with diabetes don’t automatically qualify for help towards dental treatment. However, there are other factors which could allow you to receive help towards dental treatment on the NHS, which include:

• If you are under 18
• If you are 18 and in full time education
• If you are pregnant or have
  
  had a baby
  
  within the last 12 months
• Are named on a valid HC2 certificate
• Are named on a valid HC3 certificate

You may also qualify for help towards dental costs if you are included amongst any of the following:

• Income support
• Income-based jobseeker’s allowance
• Pension Credit Guarantee Credit
• Tax credits – if certain conditions are met

All people with diabetes should undergo a diabetes care review at least once annually. Your diabetic review will allow your doctors to monitor your health.

They will also use your annual review to assess aspects such as your long term

blood glucose control

, cholesterol levels and

blood pressure

Some people, such as those newly diagnosed,

children

, or those with complications present may have a diabetic review more often than annually.

At your annual diabetic review

At your annual diabetes care review the doctor or nurse will:

• Take your height and weight (to check if you are under or overweight)
• Take your blood pressure
• Review your blood glucose control
• Review your
  
  HbA1c
  
  and cholesterol levels
• Discuss any issues you have with your diabetes or health in general
• Advise any change in regimen, lifestyle or medication – including any side effects

People who take

insulin

should also have their injection or

infusion sites

checked.

You may also be asked whether you are suffering from depression or

sexual dysfunction

, as these tend to be more common in people with diabetes.

Your health results

It can be helpful to know what results you should be aiming for. For this reason we have put together a page to cover the targets you should be aiming for.

• Read more about
  
  diabetes health guidelines
  

Eye and foot examinations

Diabetes retinopathy

screening and having your feet examined are part of your annual review, however, you may need to book separate appointments for these depending on how your practice organises these.

Your general eyesight should be checked either at your annual review or as part of your retinopathy screening appointment.

For more information on retinopathy screening and foot examinations, see our

diabetes health screening

pages.

What will I need to bring/prepare?

You will usually need to book a blood test appointment about a couple of weeks prior to the annual review.

The blood test will be used to check your HbA1c result as well as your cholesterol. For the cholesterol test to be effective,

you may need to fast before the blood test is taken

If you are on insulin, check whether you need to fast and if so, how you should prevent hypos from occurring.

• If your blood test is a fasting one, set a reminder not to eat for 8 hours before the test

Ask you healthcare team if you have queries about fasting for the blood test.

• A pen and something to note down your results and discussion on

Remember to bring a pen and either notepad or download and print out our diabetes annual review record sheet.

• 
  Download the diabetes annual review record sheet
  
  – PDF
• 
  Download the diabetes annual review record sheet
  
  – Excel

• Your latest blood glucose results (if self testing)

This could be your

blood glucose monitoring diary

or a print out. Your doctor will often wish to view at least a month or two of results.

• A urine sample

You should have been provided with a sample bottle at a previous appointment. If not you can pick one up beforehand. Some practices may enable you to provide a sample at the practice/clinic but it’s best not to assume this will be the case.

• Keep your feet clean

It probably goes without saying but, if you are

having your feet checked

at your annual review, try to make sure your feet are clean.

• Prepare a list of questions or topics to discuss

Do you have questions about your medication? Are you suffering any side effects? Would you like to discuss how to

avoid hypos

or ask why your blood sugars are high at a particular time of day. Your annual care review gives you the chance to discuss these areas.

Making the most of your diabetes care review

Your annual diabetes review is a great opportunity to ask about different aspects of your diabetes regime and control.

People with

type 2 diabetes

will also have the chance to ask about medications and people with type 1 have the chance to discuss going onto a different regimen, such as insulin pump therapy.

You can also discuss the possibility of taking an

educational course

such as:

• 
  DAFNE
  
• 
  DESMOND
  
• 
  X-PERT
  

Be sure to ask your doctor if anything they have said is unclear.

Do you understand why you are being advised to take a medication? Did your doctor explain the cholesterol results clearly enough?

If there’s anything you forgot to ask at your review, don’t be afraid to ask straight after; your doctor should be happy to help.

If you’re admitted to hospital, either for a planned visit such as surgery or for an emergency, you should expect to receive good quality care during your stay.

To help ensure that your care is appropriate, you can ask for a care plan to be drawn up either before your visit or during it.

Managing your diabetes in hospital

Depending on the circumstances, you may be able to manage your diabetes.

A diabetes care plan should be drawn up to help with how your diabetes is managed during your hospital stay.

The care plan will outline the care you can expect to receive, how

high and low blood glucose needs to managed

, any dietary requirements that need to be taken into account, whether you’d like to involve a relative or carer and whether you have any requirements based on cultural or religious needs.

Will I be able to use my medication and diabetes equipment in hospital?

In some cases you will be able to administer your own diabetes treatment.

The hospital team may decide to temporarily change your treatment routine whilst you are in hospital however.

Typical changes may include putting people who normally take tablets onto insulin.

People taking insulin may have their dosages altered during their stay to prevent the chance of

hypoglycemia

Will the hospital be able to cope with my dietary needs?

The food in hospital should be able to meet a number of dietary requirements, such as vegetarian and vegan.

If you are used to eating a

low carb diet

, you may need to make some compromises but the hospital should provide a variety of options which should help.

Some people with diabetes may wish to receive snacks at specific times, which the hospital should be able to accommodate. You should have access to see an NHS dietitian during your stay if required.

Formalities when leaving hospital

When you leave hospital at the end of your stay, you should be given a ‘discharge letter’ and a copy will be sent to your GP as well.

If you need a follow up appointment, this should be clearly communicated to you so you know where to go, when to go and what you may need for the appointment.

Diabetes control after your stay

If your treatment or dosages have been different during your stay in hospital, you may need to more closely manage your diabetes in the first few days after leaving hospital, to ensure your control becomes steady again.

Diabetes in the UK is often treated entirely by the National Health Service. The NHS provides structured care for people with diabetes of every type and at every stage.

Diabetes is a complex condition and therefore NHS

diabetes care
must be similarly complex.

Many people with diabetes are not aware of NHS diabetes care services, initiatives in their area, and the support available.

NHS and Diabetes

Diabetes and Your Doctor

>Help with Health Costs

Annual Care Review

Diabetes Care in Hospital

Diabetes Health Checks

Diabetes Care in Hospital

Pediatric to Adult Care

Blood Glucose Test Strips

An increasing number of people are choosing private health insurance. The below is a series of guides to going private, the potential benefits and costs.

Guides on private healthcare:

Going Private

Private Health Insurance

This section has been created to provide a central platform for our visitors to browse NHS diabetes services, locally and nationally.

• It is estimated that 10% of the NHS budget is spent on diabetes, equating to £286 a second
  
  
  ^[1]
  

The
NHS
faces serious difficulties in dealing with diabetes care, from

pre-diabetes
to

blood glucose
management to trying to avoid the complications of diabetes. With millions of people with diabetes in the UK, diabetes places a great strain on NHS resources.

NHS diabetes spending

Estimates indicate that the NHS spends some 9% of total hospital expenditure on treating diabetes and diabetes complications.

Furthermore, an estimated 10% of NHS hospital beds are occupied by people with diabetes.

A report entitled ‘Diabetes in the NHS’ estimated a total cost of £3.5 billion per annum, over £9.6 million each day.

• Read more about the
  
  cost of diabetes to the NHS

With over 100,000 people with diabetes being diagnosed each year, it is easy to see how these health costs could spiral.

How does the NHS deal with diabetes?

Most NHS diabetes care is handled by multidisciplinary teams.

The NHS has brought diabetes care closer to home and started to involve technology in handling diabetes. As well as a consultant diabetologist, an NHS team may include Diabetes Specialist Nurses, dietitians and podiatrists.

If you would like to add an NHS initiative or service, please

contact us

Healthier You NHS Diabetes Prevention Programme

The Healthier You programme was launched in 2016 by NHS England and Diabetes UK.

While type 1 diabetes cannot be prevented, the risk of developing type 2 diabetes can be reduced through healthy lifestyle interventions.

Those who are identified as being at an increased risk of type 2 diabetes can be referred to the Healthier You programme.

Delivered over the course of 9 months, the evidence-based lifestyle change programme provides support covering all the foundations of good diabetes control, including weight management, healthy eating and physical exercise.

When referred to the programme, you have the option to chose between a face-to-face group service or digital service. Both cover the same aspects of type 2 diabetes prevention and management but are delivered in different ways.

The face-to-face group is typically provided in a physical setting with tailored support. However, due to the COVID-19 pandemic the service has been offered over the phone or through a group video conference.

On the digital pathway you are given support through the use of technology, including:

• Online peer support groups
• Wearable activity trackers that monitor your daily exercise
• Applications that allow you to access health coaches
• Electronic goal setting and monitoring