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| Diabetes care – who does what? |
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Reviewed by Professor Ian Campbell, consultant physician
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Diabetes is a common condition and medical services in the UK
are well geared to care for people who have it. But this means there's a lot of
information to take in when you're first diagnosed – so use our guide to find
out about the health professionals you'll meet.
The team
1. Yourself
The actions you take in day-to-day living, the lifestyle
choices you make and how you get on with your prescribed treatment are all
important parts of your care.
The more comfortable you are with understanding the different
aspects of
diabetes and the
basics of how to manage it, the less likely you are to have problems.
2. Primary care team
For many people with diabetes, your primary care team will
provide all the help and advice you need.
GPs are used to monitoring diabetes, but general practice is a
vast area of medicine and it’s impossible to be an expert in
everything.
Some GPs do have a special interest in diabetes, and in some
practices this GP will take the lead in the practice's arrangements for
diabetes care.
Newly diagnosed people with diabetes and those needing
treatment adjustments will usually be seen at the local diabetes
clinic.
Children and younger
Type 1 diabetics tend
to be managed by hospital-based teams in diabetes centres.
The extended primary care team is quite a large group of
people. They may not be housed within the same building as your GP (practice
nurses almost always will be), but they are essential to the smooth delivery of
care.
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Practice nurse: has often completed extra
training in diabetes care and does much of the routine checking and health
promotion.
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Health visitor: a nurse who's completed
extra training. Carries out a similar role to the practice nurse, but tends to
see people in their own homes more often.
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District nurse: often pays morning visits to
people who need help with their
insulin injections or
blood glucose
checks.
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Podiatrist/chiropodist: carries out formal
foot checks every year, and more often if necessary. Regular foot checks should
be part of your routine if you have diabetes.
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Dietician: advises on a suitable diet to
help control diabetes and reduce your chance of long-term complications. Will
also help if you need to lose weight as part of your treatment.
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Pharmacist: advises on medicines. Can help
decide the best treatment plan for a person with diabetes - who may also have
other conditions that need medication. Arrangements for pharmacist input vary
and they are not always considered part of the primary care team.
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Optometrist: looks for the signs of
diabetic eye disease.
Often has more sophisticated equipment than a GP, and many use special cameras
that can photograph the retina (back of the eye). You should get your eyes
checked once a year.
3. Hospital team
All regions have a specialist referral centre for diabetes.
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Consultants: one or two consultants will
oversee the clinical aspects of diabetes, attending to newly diagnosed patients
and advising GPs on changes to treatment. More junior members of their team
will also take part in the same process. Specialist registrars (SpRs) are
experienced doctors in training who are heading towards a career in
hospital-based medicine.
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Diabetes specialist nurse: often the most
important source of information for all the practical aspects of diabetes -
from which needle fits which pen, to how to go about adjusting medication for a
ski trip. Much of this knowledge from experience never finds its way into
textbooks. They provide a bridge between hospital care and the community, so
will work closely with primary care teams.
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Ophthalmologist: a hospital specialist in
eye disease. Becomes involved if any treatment is required for diabetic eye
disease.
Standards for care
In the 1980s European health officials and diabetes associations
put together the St Vincent Declaration that set out aims and standards for
diabetes care.
In the UK, the Department of Health has set clear goals for
diabetes care - a full list of which can be found on its website.
When first diagnosed with diabetes, you should be given:
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a full medical examination
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information about your diabetes, including treatment, from a
suitably trained nurse
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dietary advice from a state registered dietician
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information about how diabetes will affect your work and other
areas of your life
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details of support groups who have detailed knowledge of
diabetes and its accompanying issues.
If you need insulin or tablets to control diabetes, the team
should make sure you:
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know how to carry out insulin injections or deal with
medication
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have adequate supplies of equipment
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know what
hypos are and how to
manage them.
Once your diabetes is under control, you should have at least an
annual review by a doctor experienced in treating diabetes, as well as easy
access to advice when you need it.
Your annual review
Diabetes is monitored through routine check-ups by your doctor
and annual check-ups at the hospital. The purpose of the annual review is to
determine if treatment is satisfactory and to look out for any evidence of
longer-term complications such as eye,
kidney or foot
problems, and to check for evidence of
high blood
pressure.
You should have the following things checked at least once a
year:
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Good advice
These checklists are just reminders of the essentials that
mustn't be overlooked.
In practice, diabetes care is a person-friendly
experience.
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weight
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blood pressure
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vision and eyes
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legs and feet
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urine for protein
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HbA1C levels in blood, ie your long-term control of blood
sugar
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insulin sites, if part of treatment.
As part of your review, your doctor should ask you how you're
managing, and discuss any issues, fears or uncertainties you have.
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Based on a text by Dr Dan Rutherford, GP
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Last updated 12.09.2008
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