Type 2 Diabetes - A primary health care checklist

Keeping blood pressure levels close to normal can reduce the risk of some of the complications of Type 2 diabetes so people with diabetes usually have their blood pressure checked at least once per year, more frequently if it is not controlled.

You can find out more about blood pressure checks and treatment by asking your health care team the following:

1.  What blood pressure levels are you aiming for?
2. How often will my blood pressure be tested?
3. What else can we do to control my blood pressure?

One of the key tests of diabetes control is the result of a blood test for HbA1C levels which indicate the average blood glucose (sugar) levels over the past 2-3 months.

The target HbA1C level for each person with diabetes varies and is decided in discussion with the healthcare team.

HbA1c levels are usually checked at least every 3 to 6 months but may be tested more frequently if there are concerns about the level of diabetes control.

You can find out more about your diabetes control and how it will be monitored by asking your health care team the following:

a) What target HbA1C reading am I aiming for?
b) What is the result of my HbA1C test and what does it say about my diabetes control?
c) When and how often will my diabetes control be tested?

People with Type 2 diabetes have a higher risk of developing eye complications known as retinopathy. Retinopathy involves damage to the seeing part/back/ retina of the eye due to abnormal effects on the small blood vessels there.

For this reason, people with Type 2 diabetes have regular eye screening which are different from normal sight tests and specifically look for early signs of damage caused by diabetes.

Checks for retinopathy should be performed around the time Type 2 diabetes is diagnosed and then at least once a year from then on. If there are signs that damage may be developing, more checks or a referral to an eye specialist will be recommended.

The NHS information site explains more about diabetic retinopathy.

Preventing foot problems is a priority for people with diabetes and you should have regular foot checks by a specialist, doctor or nurse.

You can usually expect to have a foot check:
a) when diabetes is diagnosed and at least once a year after that
b) if you think you have a problem with your feet
c) if you have to go into hospital for any reason, and if you have any foot problems during the hospital stay.

If a check shows that you have a moderate or high risk of having a foot problem related to your diabetes, you should be referred to see another healthcare professional in the foot protection service.

You can find out more about foot problems by asking your health care team
a) What did the foot check show?
b) What is my risk of developing a foot problem and how have you worked this out?
c) What should I do if I am worried about a foot problem?
d) What is the best way to look after my feet and what types of footwear, socks or insoles would you advise?
e) How often should I have a foot check?

Some foot problems are considered serious because they might lead to an amputation or life-threatening illness. Typical examples include conditions like:
a) foot ulcers which are causing illnesses like a fever or blood poisoning (sepsis)
b) problems with the blood supply to the foot
c) severe foot or bone infections

These problems need urgent care and people with diabetes suffering from serious foot problem should be sent to hospital immediately so that they can be assessed and treated straight away.

Learning about diabetes and how to control it is an essential part of diabetes care.

All of the regular health checks are opportunities to find out more about Diabetes but the NHS also funds specialised courses which explain how to control it. These courses are usually done in groups and are available to adults with type 2 diabetes and/or their family members or carers.

There are numerous information sites and leaflets about Type 2 diabetes (see below).

If someone with diabetes suffers an infection then their blood sugars are likely to increase even if they are eating less than usual. So it is essential to check glucose levels more frequently, stay well hydrated and understand what to eat and how to manage different types of medication including diabetes meds.

NHS England has developed a set of sick day rules to help people with diabetes manage their condition during infections such as COVID – see the sick day rules here

People with Diabetes- should be offered:
a) Annual flu vaccine (new injection every year usually autumn)
b) Pneumococcal vaccine (once only injection at any time of year)
c) COVID vaccine at intervals determined by evolving national policies

Diabetes is recognised to increase the risk of developing pneumococcal infections and complications of influenza such as pneumonia or bronchitis.