Enfield Diabetes Support Group
in collaboration with
LIVING WITH DIABETES
Issue 4 – November 2013
ENFIELD DIABETES SUPPORT GROUP
A LOCAL DIABETES SUPPORT GROUP IN THE AREA FOR
THOSE WITH DIABETES, THEIR FAMILY AND CARERS
WOULD YOU LIKE SUPPORT/COULD YOU GIVE SUPPORT?
MONTHLY MEETINGS ARE HELD ON A TUESDAY AT:
THE DIABETES CENTRE
CHASE FARM HOSPITAL
THE RIDGEWAY
ENFIELD EN2 8JL
FROM 7.30 pm TO 9.00 pm
GUEST SPEAKERS WILL TALK ON ALL ASPECTS OF
DIABETES CARE AND OTHER RELATED ISSUES
EVERYONE IS WELCOME
FOR MORE INFORMATION CALL:
RUTH – 020 8386 4416 or
DAVID – 020 8245 0948
edsg@blueyonder.co.uk
THIS GROUP IS RUN BY PEOPLE WITH DIABETES
FOR PEOPLE WITH DIABETES
Issue 4 – November 2013
© No part of this publication may be reproduced in any form without the permission of Enfield PCT/NHS
Enfield/ECS – 2006 onwards
1
FOREWORD
The aim of the booklet is to help those with diabetes, their family and their
carers to be better informed, know what questions to ask and know where to
go for help.
This booklet has been produced by people with diabetes from the Enfield
Diabetes Support Group in collaboration with the Enfield Community Services
Diabetes Team. This book was originally endorsed by the three Enfield MP’s
– Joan Ryan, David Burrowes and Andrew Love and continues to be
endorsed by the current MP’s, David Burrowes, Andrew Love and Nick de
Bois.
In order to manage your diabetes well, you will need to learn more about what
diabetes is, how it is treated and what YOU can do to help yourself.
Do not try to take in all the information in this booklet at once but read it when
you need it.
Remember – you are not alone in having diabetes.
Enfield MP’s - correct at time of going to press
Enfield Community Services is responsible for providing NHS services in the London Borough
of Enfield and is hosted by Barnet, Enfield and Haringey Mental Health Trust.
Issue 4 – November 2013
© No part of this publication may be reproduced in any form without the permission of Enfield PCT/NHS
Enfield/ECS – 2006 onwards
2
CONTENTS
TOPIC
PAGE NUMBER
Useful contact numbers
Introduction
Explanation of diabetes terms
What is diabetes?
Who is most at risk of developing diabetes?
Questions you might want to ask
Coping with diabetes
The importance of your regular diabetes check-ups
Getting the most out of your annual review
Regular check-ups
Some medications used in the treatment of diabetes
Taking insulin
Your diet
Physical activity
Smoking
Health Trainer Service
Foot care
Controlling your blood pressure
Taking care of your heart
Blood glucose monitoring
What does my HbA1c (Glycated haemoglobin) mean?
Hypoglycaemia
Hyperglycaemia
Feasting and fasting
Eating with friends
Eating out
Social life
Feeling unwell
Driving and diabetes
Motor Insurance
Travel
Entitlements
Dental care
Personal insurance
Employment
Job application
What to tell an employer
5
6
7
8
9
10
11
12
13
14
15
17
18
21
23
23
24
26
27
28
31
32
33
34
35
35
35
36
37
38
39
41
41
41
42
43
43
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Enfield/ECS – 2006 onwards
3
Complications of diabetes
Eyes – Retinopathy
Eyes – Cataracts
Hardening/Furring of arteries
Kidney problems – Nephropathy
Nerve damage – Neuropathy
Foot ulceration
Sexual health for men
Sexual health for women
Contraception
HRT – (Hormone Replacement Therapy)
Thrush
Cystitis
Index
Additional information sources
44
44
45
45
46
46
47
47
49
49
50
50
50
51
54
Diabetes UK is an independent, registered charity and is
the largest charity devoted to the care and treatment of
diabetes. Diabetes UK is committed to providing education and support to all
people with diabetes.
Members of Diabetes UK receive a bi-monthly magazine packed with news,
celebrity interviews, lifestyle features and recipes. Membership also helps to
fund research that aims to find a cure for diabetes.
Diabetes UK produces a wide range of books, magazines and leaflets on
everything from cooking to travel – all aiming to help people live with diabetes.
Telephone 0800 585 088 for a free catalogue.
A considerable amount of the information included in this booklet is attributed
to Diabetes UK.
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
4
USEFUL CONTACT NUMBERS
ORGANISATION
TELEPHONE
WEBSITE/EMAIL
ACUTE HOSPITALS
Barnet & Chase Farm
North Middlesex
University Hospital
Royal Free
Whittington
University College
Hospital
0845 1114000
020 8887 2000
www.bcf.nhs.uk
www.northmid.nhs.uk
020 7794 0500
020 7272 3070
0845 1555 000
www.royalfree.nhs.uk
www.whittington.nhs.uk
www.uclh.nhs.uk
LOCAL INFORMATION
Community Dietetics
Diabetes Nursing Team
Enfield Diabetes Support
Group
Enfield & Haringey Quit
Smoking Service
Heart Throbs - Joan Firth
Citizens Advice Bureau
Edmonton GP led walk in
service
Health Trainers
020 8375 2973
020 8344 3184
020 8386 4416
020 8245 0948
0800 085 6258
www.enfield.nhs.uk
www.enfield.nhs.uk
edsg@blueyonder.co.uk
01992 718155
020 8375 4175
020 8887 8355
www.heart-throbs.org.uk
www.quitsmoking.uk.com
www.edmontongpledwalkinservice.nhs.uk
NATIONAL INFORMATION
Best Treatments
Department of Health
Food Standards Agency
N/A
N/A
N/A
Diabetes UK
Diabetes UK Support and
Careline
DVLA - Driving Licence
enquiries
Vehicle enquiries
NHS Direct
NICE - National Institute
for Clinical Excellence
020 7424 1000
0345 123 2399
0300 790 6801
0300 790 6802
0845 4647
N/A
www.besttreatments.co.uk
www.dh.gov.uk
www.food.gov.uk
www.salt.gov.uk
www.eatwell.gov.uk
www.diabetes.org.uk
www.direct.gov.uk/motoring
www.nhsdirect.nhs.uk
www.nice.org.uk
PLEASE NOTE – THESE DETAILS ARE CORRECT AT TIME OF PRINTING
AND SOME DETAILS MAY CHANGE
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Enfield/ECS – 2006 onwards
5
INTRODUCTION
HOW THIS INFORMATION BOOKLET HELPS YOU
This information booklet is for you, your family and for
your carers. It contains useful information about diabetes
care and how to maintain good health.
Diabetes cannot yet be cured but it can be treated
successfully.
No one really knows why some people develop diabetes. Diabetes affects
around 3 million people in the UK and Ireland so you are not alone. In most
cases it will not interfere with your family, work or social life. You will be able
to continue with your daily activities and will be able to participate fully in an
active home, family and work life if you work together with the people who are
there to support you e.g. consultant, diabetes nurse, dietitian, doctor, optician
and podiatrist.
In order to manage your diabetes well, you will need to learn more about what
diabetes is, how it is treated and what YOU can do to help yourself.
Do not try to take in all the information in this booklet at once but read it when
you need it.
REMEMBER
YOU PLAY THE MOST IMPORTANT PART IN YOUR OWN TREATMENT
AND YOUR HEALTHCARE TEAM IS THERE TO HELP

Taking responsibility for your diabetes on a day-to-day basis can
dramatically improve your general health and well being

Poorly managed diabetes can lead to complications

Please do not ignore your diabetes
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Enfield/ECS – 2006 onwards
6
EXPLANATION OF DIABETES TERMS
Type 1 Diabetes
This used to be known as insulin dependent diabetes
mellitus and is caused by a total lack of insulin.
Type 2 Diabetes
This used to be known as non insulin dependent
diabetes mellitus. Type 2 diabetes is the most common
type. The body can still make some insulin but not
enough. The insulin it does make does not work
properly.
Blood Glucose
Levels
This is the amount of glucose found in your blood
sample when tested. It is measured in millimols per litre
of blood – shown as mmols/l.
Normal blood glucose levels in people without diabetes
are between 4 and 6.5 mmols/l.
HbA1c or Glycated
Haemoglobin
This is your long-term blood glucose level.
It is measured as a percentage or in mmols/mol. It
should ideally be around 48 mmols/mol or 53 mmols/mol
depending on your age and duration of diabetes
Hyperglycaemia
This is the medical term for high blood glucose (hyper).
Hypoglycaemia
This is the medical term for low blood glucose (hypo).
Insulin
This is a hormone produced by the beta cells of the
pancreas. It helps the body to control blood glucose
levels and to control energy production.
Nephropathy
This is a complication that results from damage to the
blood vessels in the kidney.
Neuropathy
This is a complication that results from damage to the
nerves and mainly affects the feet.
Retinopathy
This is a complication that results from damage to blood
vessels that are in the back of the eye and can lead to
blindness.
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7
WHAT IS DIABETES?
Diabetes is a condition in which the body loses its ability to convert glucose
into energy. This is because the hormone insulin (a chemical messenger) is
either not being produced in sufficient quantity or cannot work efficiently.
Insulin is manufactured in the pancreas and is responsible for controlling the
amount of glucose in your bloodstream.
When the glucose levels in the bloodstream rise after eating, the pancreas
(situated behind the stomach) releases insulin. Insulin helps glucose enter
the cells of your body where it stays until it is needed for energy. Without
enough insulin, the level of glucose in your bloodstream rises and becomes
too high.
Glucose comes from the digestion of food and drink that have higher amounts
of carbohydrate (starch). Examples are potatoes, rice, pasta, bread, sweet
foods like cakes, biscuits and desserts as well as sugary drinks.
When blood glucose levels are too high, you can develop some of the
following symptoms:







Thirst/dry mouth
Tiredness
Passing large amounts of urine
Blurred vision
Weight loss
Itchiness (skin and genitals)
Cramps
You may not have experienced any of these symptoms at all.
There are two types of diabetes

Type 1 diabetes. Type 1 diabetes develops when the insulin producing
cells of the pancreas have been destroyed. Nobody knows for sure why
these cells have been damaged but the most likely cause is an abnormal
reaction of the body to the cells. This may be triggered by a viral or other
infection. This type of diabetes generally affects younger people.

Type 2 diabetes. Type 2 diabetes used to be called ‘maturity onset’
diabetes because it usually appears in middle aged or elderly people. It is
becoming more common in younger people. The main causes are that the
body no longer responds normally to its own insulin and/or the body does
not produce enough insulin. Being overweight is often a trigger to this type
of diabetes.
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Enfield/ECS – 2006 onwards
8
WHO IS MOST AT RISK OF DEVELOPING TYPE 2 DIABETES?
People most at risk of developing diabetes are:

Those with a family history of diabetes

People who
children

Women who developed diabetes
pregnant (gestational diabetes)

More common in those over 40

People of African/ Caribbean, Mediterranean or Asian origin have been
found to be more susceptible to the onset of diabetes
are
overweight,
including
when
Type 2 diabetes is often wrongly described as ‘mild’ diabetes.
All types of
appropriately.
diabetes
should
be
taken
seriously and
treated
TREATMENTS
A suitable healthy diet and physical activity are both very important in
managing diabetes. Some people will need tablets to improve their blood
glucose levels, others will need to have insulin injections or a combination of
both.
Recently new treatments for people of type 2 diabetes have been developed.
These include injections (Incretin mimetics or GLP-1 Agonists) and tablets
(DPP4 inhibitors, Gliptins and SGLT-2 inhibitors). These are explained in the
section on page 16.
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Enfield/ECS – 2006 onwards
9
? QUESTIONS YOU MIGHT WANT TO ASK WHEN DIAGNOSED ?
About my condition
What is my diagnosis?
What caused my condition?
Can my condition be treated?
Is there a cure for diabetes?
How will diabetes affect other health problems I have?
Should I watch for any particular symptoms and notify you if they occur?
What lifestyle changes should I make?
About my treatment
What is the treatment for diabetes?
When will the treatment start?
What are the benefits of this treatment and how successful is it?
What are the risks and side effects associated with this treatment?
Are there any foods, drugs or activities I should avoid?
Are there any other treatments?
About the tests
What kinds of tests will I have?
What do you expect to find from these tests?
When will I know the results?
Do I have to do anything special to prepare for any of the tests?
Will I need more tests later?
OTHER QUESTIONS YOU MIGHT HAVE AT ANY TIME
How can I find out more about my diabetes and access structured education?
Can I stop taking the insulin?
Will the pain in my feet get better?
Can I eat out?
Can I drink alcohol?
How do I cope on holiday?
If I need insulin by injection, will I change from having type 2 diabetes to type
1 diabetes?
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Enfield/ECS – 2006 onwards
10
COPING WITH DIABETES
Diabetes is your condition and although it would be nice for others to manage
it, it is your responsibility to do so with the help and support of your health
care team, family and friends.
When first diagnosed it is quite common to feel shocked and perhaps a little
lost. Some people can accept the diagnosis and others are fearful and scared
because they feel that their life is out of control and they cannot cope. It is not
unusual to feel helpless and overwhelmed or resentful. It will take time to
come to terms with your condition and some people have a harder time than
others. You may experience a number of emotional changes, for example,
anger, sadness, fear, anxiety or depression (more than feeling a bit low).
However, there are many ways you can help yourself but if the emotions you
are experiencing last more than a month, talk to your GP.
If you feel you need support you can contact the Enfield Diabetes
Support Group – details are on pages 1 and 55.
Educating yourself about diabetes can help immensely in reducing your
anxieties. Structured education sessions are available in Enfield and these
can be delivered in different ways. For example, Conversation Maps for type
2 diabetes and DAFNE and BERTIE for type 1 diabetes. Your healthcare
team will be able to give you more details.
Diabetes UK has an excellent support and care line team. Telephone 0345
1232399. (Calls to this number are charged at local rates). Remember, no
question is silly and the more you know, the more successful you will be at
managing your diabetes. Understanding and discussing your condition with
your family, friends and other people with diabetes can help you bring your
fears into perspective.
TIPS









Diabetes only restricts your life if you allow it
Not every day will be a good day so be prepared to be a bit flexible
You can only cope well if you understand your condition
If you are not sure about anything or don’t understand what you have been
told – ask
If you think something sounds wrong – query it
Don’t take ‘no’ for an answer – always ask ‘why’
Build a relationship with your pharmacist - they are a wealth of information
Your health professionals will want you to change your life style. Work
with them
Physical activity can be just walking to the shops or doing some gardening
If you find you are not coping with your diabetes, phone your surgery for
advice.
11 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
THE IMPORTANCE OF YOUR REGULAR DIABETES CHECK-UP
(ANNUAL REVIEW)
Your healthcare professional, regardless of whether you are seen by your GP,
Diabetes Nurse or a Hospital Consultant should ensure that you are reviewed
at least once every year. Your diabetes care plan will be discussed with you.
These check-ups should include the following:















Long term blood glucose control (HbA1c)
Weight
Blood Pressure
Cholesterol levels
How you are coping and the impact that diabetes is
having on your life
Smoking cessation advice
Eye sight/vision test (not with dilated pupils)
Retinopathy screening (digital photograph with dilated
pupils)
Urine testing for kidney function
Feet (pulses, sensation and general foot health)
Your diet and eating habits should be discussed
Your current treatment/medication should be discussed
Your current physical activity programme should be discussed
Your injection sites checked if insulin treated
Contraception advice given if appropriate
At these check-ups you will be assessed on how well your diet, medication
and lifestyle are controlling your blood glucose levels. In order to ensure that
your blood glucose levels are staying as close to normal as possible, your
healthcare professional may find it necessary to do any of the following:




Suggest improvements to your diet
Change your physical activity programme
Start you on tablets
Change your medication e.g. dosage, type of tablet or add insulin
If it is felt that you need to start new medication or insulin therapy, help and
support will be available before, during and after the change.
If you require an injectable therapy, you will be referred to the Enfield
Community Services Diabetes Team
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Enfield/ECS – 2006 onwards
12
GETTING THE MOST OUT OF YOUR YEARLY CHECK-UP
(ANNUAL REVIEW)
Your yearly check-up is extremely important to you and is your opportunity to
find out how well you are doing. It is a good idea to write down your questions
on a piece of paper prior to your appointment with your healthcare
professional. You can also discuss any worries, fears or anxieties that you
have. Your yearly check-up also enables the healthcare professional to
ensure that they are providing the most appropriate care for you.
Here is a suggested checklist:






Have you had the blood tests taken as requested by your doctor or nurse?
Have you brought along a fresh specimen of urine in a clean specimen
pot? This should always be the first sample you pass when you get up.
(The sample pot is available from your surgery, Health Centre or Diabetes
Centre that you attend)
Have you had a diabetes retinopathy screening examination? (This test is
a digital photograph taken after your pupils have been dilated with eye
drops)
A list of your current medication
Bring your home blood glucose record diary (if you are recording your
blood glucose at home)
Bring your personal diabetes care plan/record with you if you have one
Here are some questions that you may wish to think about prior to your
check-up:





Are you experiencing any side effects from your medication?
Are you experiencing any of the following health problems:
Chest pain, shortness of breath, swollen ankles, headaches, pain in legs,
problems with your feet, blurred vision, symptoms of hypoglycaemia or
hyperglycaemia?
Do you feel generally well?
Do you have any worries about your health that you wish to discuss with
your healthcare professional?
Are there any new developments in diabetes care that you need to know?
13 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
REGULAR CHECK-UPS - THIS IS NOT THE SAME AS YOUR ANNUAL
REVIEW
Routine check-ups should ideally take place every three to six months.
If you test your blood glucose or urine at home, take your record book with
you to the check-up. This is the ideal time to discuss any health worries that
you may have with your healthcare professional.
If you are worried about your health, contact your surgery.
It is essential in an emergency to get prompt medical advice.
CONTACT YOUR SURGERY IF
THE FOLLOWING APPLY

If you begin to feel thirsty or unwell

If you test your blood glucose levels at home and the readings are
CONSISTENTLY high. i.e.
before you eat over 10 mmols/l for a period of 6/7 days
or
if levels are over 15 mmols/l for 2 days

If you test your urine at home and it shows an increased frequency of
positive readings

If you have persistent nausea and vomiting and you are unable to keep
medication down

If you notice any problems with your feet that are causing you concern,
e.g. skin breakdown, swelling or change in colour
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Enfield/ECS – 2006 onwards
14
SOME OF THE MEDICATIONS USED IN THE TREATMENT OF DIABETES
It is now widely accepted that all people who have been
diagnosed as having Type 2 diabetes should be started on a
suitable healthy eating plan for a period of 3-4 months. If a
change in lifestyle is ineffective in bringing down blood
glucose levels, your healthcare professional will discuss
suitable medication for you to take.
Along with a suitable healthy eating diet you may be prescribed tablets or
insulin or both. Even when you start taking medication for your diabetes, you
will need to continue to follow suitable healthy eating recommendations. It is
important to note that diabetes is a progressive disease, which may require
increasing treatment regimens throughout your life span.
There are several types or groups of medication that work in different ways to
lower the blood glucose level. Your doctor will decide which type of tablet will
be best for you.
Most medicines have at least two names. One is the scientific (generic)
name, the other is the brand (proprietary) name that is given to the drug by
the company that manufactures it.
Your local pharmacist is an expert on drugs and can offer you additional
advice. Remember to read the information leaflet supplied with your
medication.
Brief descriptions are shown below:
SULPHONYLUREAS: Examples of tablets in this group are:
Generic name
Glibenclamide
Gliclazide
Glipizide
Brand name
Daonil
Diamicron
Minodiab/Glibinese
Sulphonylureas work by stimulating the pancreas to produce more insulin
and by improving the action of whatever insulin is being produced naturally.
They then lower the blood glucose by allowing glucose to enter the cells of
your body.
The side effects, which tend to be generally mild and infrequent, include
weight gain, gastro-intestinal complications such as nausea, vomiting,
diarrhoea and constipation. Risks can include hypoglycaemia, facial flushing
after drinking alcohol and disturbance of liver function i.e. jaundice.
15 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
BIGUANIDES: Examples of tablets in this group are:
Generic name
Metformin
Brand name
Glucophage
Glucophage SR
Biguanides work by increasing the amount of glucose taken in by the
muscles in the body and reduce the absorption of glucose by the intestines.
The side effects can include nausea and vomiting, occasional diarrhoea,
wind, abdominal pain, metallic taste in the mouth, itchiness and swelling of the
skin.
OTHER MEDICATIONS
Generic name
Acarbose
Brand name
Glucobay
This drug delays the rate at which you digest glucose. It slows down the rate
at which your blood glucose rises after you have eaten. The side effects can
include wind, a feeling of fullness and diarrhoea.
Generic name
Repaglinide
Nateglinide
Brand name
Prandin
Starlix
These drugs work in a similar way to a sulphonylurea. They are taken before
meals and increase the amount of insulin that is produced during a meal. The
side effects can include a risk of hypoglycaemia and sensitivity.
Generic name
Pioglitazone
Brand name
Actos
This drug helps the insulin that your body produces to work more effectively.
Side effects can include a risk of hypoglycaemia, stomach upset, swelling of
ankles (oedema) weight gain, anaemia, fatigue/tiredness. It may also increase
your risk of bone fractures. If you notice that your ankles become swollen or
you get breathless, contact your doctor immediately.
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Enfield/ECS – 2006 onwards
16
OTHER MEDICATIONS continued
Generic name
Exenatide
Exanatide (extended
release)
Liraglutide
Lixisenatide
Brand name
Byetta (twice daily injection)
Bydureon (weekly injection)
Victoza (once daily injection)
Lyxumia (once daily injection)
This medication increases the amount of insulin produced and stops the liver
producing a hormone called glucagon which releases glucose into the blood
stream. It also slows down the stomach emptying and also acts on the brain
to bring about a feeling of fullness. This commonly causes weight loss due to
a reduced appetite. It is given by injection. Side effects can include nausea,
vomiting, diarrhoea, decreased appetite, headache, dizziness.
Generic name
Sitagliptin
Vildagliptin
Saxagliptin
Brand name
Januvia
Galvus / Eucreas
Onglyza
This medication helps to reduce the blood glucose concentration by blocking
the breakdown of a chemical messenger that enhances insulin production. It
does not cause weight gain. Side effects can include nausea, vomiting, ankle
swelling.
Dapagliflozin
Forxiga
This medication works by blocking the reabsorption of glucose from the
kidney. As a result, glucose is flushed out of the body in the urine. Side
effects can include thrush (Candida), Urinary Tract Infection, nausea,
vomiting, diarrhoea and dehydration
Some people with diabetes may need a combination of different groups of
medication. Your diabetes healthcare professional will advise you on which
medications you require.
REMEMBER - when you do start taking medication for better control of your
diabetes you still need to continue with your suitable healthy eating plan as
well, so no cheating.
NEVER STOP TAKING YOUR MEDICATION EVEN IF YOU ARE FEELING
SICK.
CHECK WITH YOUR HEALTH CARE PROFESSIONAL IF YOU ARE
EXPERIENCING DIFFICULTIES IN SWALLOWING YOUR MEDICATION
OR YOU ARE VOMITING.
17 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
TAKING INSULIN
As part of your treatment plan your healthcare professional MAY suggest that
you need to commence insulin therapy.
Many people with diabetes are fearful of injecting themselves with insulin.
Discuss this with your healthcare professional who will give you the
information you need and put you at ease before you agree to start insulin. All
the possibilities will be discussed with you to enable you to make an informed
choice. You will be taught how to inject yourself with insulin and you will be
supported with an ongoing education plan while you get used to it.
Some of the main discussions which you will have before and once you have
started insulin therapy are:
 What type of insulin is going to fit in with my lifestyle?
 Which insulin pen is best for me to use?
 How do I use the insulin pen?
 How do I store my insulin?
 How do I dispose of the needles?
 Does anyone else need to know how to inject my insulin?
You will be given a demonstration on how and where to inject by a healthcare
professional. Insulin is always started with very small doses whilst you get
used to doing the injections. Insulin doses may be increased very gradually
depending on your blood glucose levels. This will be under close supervision
of your healthcare professional.
Your healthcare professional will also go into detail about the following:
 How to recognise and treat low blood glucose (hypoglycaemia)
 What to do if you become ill
 How often you should be reviewed at your diabetes clinic
 Travel, eating out, etc
For people with diabetes who have been taught to adjust their own doses of
insulin as a result of their tests, it is useful to test blood glucose levels prior to
or after meals, before and after exercise or as advised by your healthcare
professional.
Where to inject – Injections are given in fatty areas of the body, i.e. stomach,
thighs, buttocks or arms. People are no longer advised to self-administer
insulin into the arms as there is a risk of injecting into the muscle rather than
the fatty layer of the skin. It is good practice to rotate the injection sites as
continually using the same place may damage the tissue underneath.
Disposal of needles – Ask your healthcare professional about the safe
disposal of needles.
Remember – if you have any problems, contact your healthcare
professional.
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
18
YOUR DIET
KNOW YOUR OWN BODY - DIFFERENT FOODS CAN AFFECT PEOPLE
DIFFERENTLY
Following a suitable healthy eating plan is what we should all be eating.
Here are some healthier options for reducing sugar and fat in your diet.
To reduce your sugar intake it is
better to choose:
Artificial sweeteners, e.g. Canderel,
Hermesetas, Sweetex, Splenda
Reduced sugar jams and marmalades,
pure fruit spreads
Plain biscuits e.g. Rich Tea, Digestive,
Garibaldi, Ginger Nuts, Hobnobs,
scones, tea cakes, English muffins,
crumpets, fruit loaf, crackers or crisp
breads, sugar free sweets.
Take care or avoid these if you need to
lose weight
Sugar-free puddings, e.g. sugar-free
instant whip, jelly custard, low fat
natural or fruit yoghurts
Tinned fruit in natural/fruit juice stewed
fruit without sugar, fresh fruit
Maximum 3 portions of fruit per day
Low calorie, sugar free or no added
sugar squash or diet fizzy drinks, low
sugar hot chocolate drink, e.g. Options,
Highlights.
Pure or unsweetened fruit juice,
smoothies – maximum 1 small glass
(160mls) per day – taken with food.
19 Issue 4 – November 2013
To reduce your fat intake it is
better to choose
Grilled, poached, boiled, microwave
or oven baked foods. limit oil to 1
level tablespoon for a meal (enough
for 4 people)
Oils and margarines labelled ‘high in
monounsaturated or polyunsaturated
fat (use sparingly) e.g. olive,
vegetable, rapeseed, sunflower or oil
sprays.
Low fat mayonnaise and salad
cream, reduced fat salad dressings,
vinegar, lemon juice
Lean meat, chicken and turkey (no
skin), ham, gammon, low fat
sausages
Semi-skimmed or skimmed milk
Low fat natural or fruit yogurt (check
label), low fat Greek yogurt
Wholemeal crackers, plain rice
cakes, breadsticks, crispbreads,
plain popcorn, plain oatcakes
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Enfield/ECS – 2006 onwards
HEALTHY EATING PRINCIPLES
Eat regular meals based on starchy carbohydrates, which include wholegrain
varieties. Choose low fat reduced sugar high fibre breakfast cereals,
wholemeal bread, pitta bread, crackers and crispbread, pasta, potatoes,
Basmati rice, brown rice, chapattis, couscous, noodles, plantain, yam, sweet
potato.

Cut down on fats especially saturated (animal) fats and use monounsaturated and/or poly-unsaturated fats e.g. olive oil, vegetable oil, corn
oil or sunflower oil. Use semi-skimmed or skimmed milk, low fat reduced
sugar yoghurts and reduced fat cheeses. Grill, steam, microwave, stir fry
or oven-bake foods instead of frying them.

Eat foods that are high in fibre. For example beans, peas, lentils (pulses),
wholemeal and wholegrain products, vegetables, salad and fruit.

It is recommended by the Department of Health that you eat a
combination of at least five portions of fruit and vegetables a day. No
more than 3 fruit portions are recommended. A portion fits into the palm of
your hand. For example, a small banana, an apple, a slice of melon, 2
plums, a handful of grapes, a cereal bowl of salad or 3 heaped
tablespoons of vegetables.

Take care with fruit juice and only have one small glass a day of an
unsweetened version. Have fruit juice with meals only, never between
meals. Fruit juices are included as one of your fruit portions.

Choose sugar free food and drinks and use artificial sweeteners instead,
as this will reduce your intake of sugar.

Reduce your salt intake by reducing or leaving out salt in cooking, buy salt
reduced versions of processed and tinned foods and do not put the salt on
the table. Remember, cheese, stock cubes, packet soups, salty snacks,
‘smoked’ products and foods in brine are all high in salt. Flavour food with
herbs and spices.
Always check food labels because some low fat foods may be higher in
sugar and some low sugar foods may be higher in fat.
YOUR GUIDE TO READING FOOD LABELS
FOOD TYPE
Fat
Saturated fat
Sugars
Salt
Sodium
HIGH - per 100g
More than 20g
More than 5g
More than 15g
More than 1.5g
More than 0.6g
LOW - per 100g
Less than 3g
Less than 1.5g
Less than 5g
Less than 0.3g
Less than 0.1g
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
20
HEALTHY EATING PRINCIPLES

Keep within the recommended limits of alcohol intake, i.e. 2 units per day for a
woman and 3 units per day for a man. One unit is equal to a small glass of wine,
half pint of beer or lager or a pub measure of spirit. Never drink on an empty
stomach as alcohol can cause very low blood glucose levels. Have 2 or 3 alcohol
free days per week.

If you are overweight, losing weight helps control diabetes and also reduces the
risk of heart disease and high blood pressure. Aim to lose weight slowly, for
example a weight loss of 1-2 lbs (0.5-1.5 kg) per week. You may find it helpful to
use a smaller plate for your meals. You can also contact Diabetes UK who have
up to date information on portion sizes.

It is not necessary to buy food or drinks labelled as being ‘diabetic food’ as they
can be expensive and may have a laxative effect. These products have no
added benefit for people with diabetes.
TRAFFIC LIGHT LABELLING
Red means high
Amber means medium
Green means low
The food is high in fat or salt or sugar (or a
combination). Be careful how often you have these
It is alright to have some of the time but try to go
for green when you have a choice
a healthier choice
If the quantity is between the ‘high’ and ‘low’ figures, it is a medium
amount
REMEMBER – EATING FRESH IS BEST
IF YOU REDUCE YOUR WEIGHT BY JUST 10%






You will reduce the risk of heart attack, stroke and circulatory problems.
You will improve your mobility
You will reduce joint damage
You will feel less tired
You will feel less stressed
You will feel better about yourself
Enfield Diabetes Support Group can also give you additional support and
advice.
Ask your healthcare professional if you would like to see a dietitian for
either one to one dietary advice or group education or structured
education, for example, conversation maps.
For more information the Community Dietitians working in Primary Care
can be contacted on 020 8375 2973.
21 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
PHYSICAL ACTIVITY
Physical activity is good for you.

It can improve your circulation

It can help you to control your weight

It can make you feel good and give you a greater sense of well-being

Physical activity can help in controlling blood glucose levels
Physical activity improves your general health and helps your muscles to use
up glucose that has been stored in them. You do not need to join a gym to
increase the amount of physical activity that you do. If it has been a while
since you have undertaken any form of physical activity, it is recommended
that you check with your GP before starting any form of physical activity.
Housework or gardening can be included in the 30 minutes.
Here are some other tips on how to increase your physical activity levels:

Walking is an excellent way to start exercising, especially if you are older
or have other medical problems

Use stairs instead of lifts

When using buses or trains, get off one stop before the end of your
journey and walk the remaining distance

Park your car a little further away from work or the shops
It is important to test your blood glucose levels prior to exercise to
ensure that there is no risk of hypoglycaemia.
Once you are exercising regularly, you may decide to try other forms of
physical activity, for example swimming or cycling.
If you are not physically able to carry out these activities, ask your healthcare
professional about armchair physical activities which will help to build up your
strength.
If you have a heart problem or angina, contact Joan Firth for details of
the Heart Throbs physical activity classes on 01992 718155 or
www.heartthrobs.org.uk
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
22
SMOKING
Diabetes and smoking simply do not mix.
Diabetes increases the possibilities of suffering a heart
attack, stroke or peripheral vascular disease (reduced blood
supply to the legs and feet). When smoking is added to this,
you may double the risk of illness and shorten your life
expectancy.
Giving up smoking is not easy and you may not be able to give up at your first
attempt. It is important that you never stop trying to give up.
Smoking cessation groups are held at specialist smokers’ clinics - this is the
most effective way to stop.
Your local chemist may also be a specialist stop smoking adviser. They can
give you the necessary support on a one-to-one basis.
Either treatment option provides you with essential advice and support as well
as nicotine replacement therapy (patches, gum, etc) free of charge.
Phone freephone 0800 085 6258 or ask at your local chemist or visit
www.quitsmoking.uk.com
ENFIELD HEALTH TRAINERS
The Health Trainer Service in Enfield Primary Care Trust was launched in
August 2007. This service was a result of recommendations from a
Government ‘White Paper’ on health that identified that a new initiative was
needed to improve the inequalities within health in the United Kingdom.
There are 12 Health Trainers within Enfield PCT. They speak many
languages including Turkish, Urdu, Punjabi, Somali, Hindi, Gujarati and
English. The role of the Health Trainer is to give practical advice and support
to people who want to lead a healthier lifestyle. They provide this via one to
one sessions, allocating six sessions for each client. They can advise people
on weight loss, healthy eating, increasing physical activity levels and quitting
smoking.
There is a health trainer attached to the Diabetes Nursing team at Forest
Primary Care Centre Road who has been in post since January 2008.
For further information on this service please telephone 0208 370 8296.
23 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
FOOT CARE
Care of your feet is very important. In people with diabetes, the nerves to the
feet often become less sensitive (neuropathy) so you may not be aware of any
cut, burn, blister or infection.
GENERAL CARE
DO








Wash your feet every day with mild soap and warm water
Dry your feet gently and carefully especially between the
toes
Moisturise your feet and legs with a good quality
moisturiser but avoid putting any moisturisers between your toes
Check your feet daily especially between the toes. Use a mirror if needed
Cut toenails after a bath or shower as the nails are softer
Always keep your toenails trimmed
Always cut your toenails straight across
Make sure that the corners of the nails are gently rounded by using a file
DO NOT





Cut your toenails too short
Cut the sides of your nails
Attempt to cut your nails if you cannot see them clearly
Treat corns yourself or use corn plasters
Use creams or lotions between the toes
REMEMBER





Electric blankets and hot water bottles need to be used with caution
Never put your feet directly on to hot water bottles as this can cause
serious burns
See a podiatrist (chiropodist) if you have any problems. The podiatrist will
assess those people with diabetes who need podiatry care.
With the podiatrist’s (chiropodist) approval, you may use a pumice stone
gently
Many people will never see a podiatrist as not everyone needs to see one.
It is essential to make sure your feet are checked by your healthcare
team at least once a year.
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
24
WHAT TO LOOK FOR WHEN YOU CHECK YOUR FEET

Any change in the colour of your feet and toes. Certain
conditions may cause your feet to become red, purple, blue
or even black

A change in temperature, as hot feet may indicate infection
and cold feet could be a problem with your circulation

Unusual dampness in socks or tights could be due to a break in the skin,
blisters or infection

Any change of feeling in the feet, e.g. burning, pins and needles, sharp
pain, cramps or throbbing
FOOTWEAR
DO






Wear shoes/slippers at all times
Wear shoes with leather uppers
Make sure that your shoes fit you correctly, i.e. they do not rub
New shoes should be worn in gradually
Check the insides of your shoes for foreign objects or signs of wear before
putting them on
Wear loose top socks made from natural fibres, e.g. wool or cotton
DO NOT





Walk barefooted
Wear tight or worn shoes
Wear open toe sandals
Wear tight garters or suspenders
Wear slip-on type footwear
25 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
CONTROLLING YOUR BLOOD PRESSURE
Having your blood pressure checked is an important
part of your diabetes care. High blood pressure
(hypertension) is more common amongst people who
have diabetes. High blood pressure can increase the
risk of heart attacks and strokes and can worsen
retinopathy (eye disease) and nephropathy (kidney
disease). You need to make sure that when you attend for your annual
diabetes review, your blood pressure is taken as part of this check-up.
If you have been advised that your blood pressure is too high and you are
taking medication, you will need to have your blood pressure checked every
three to six months to ensure that it is stable.
Your blood pressure is usually recorded like this: 130
80
 The top number is the systolic pressure. This is the pressure that is
recorded when your heart contracts in order to pump blood round your
body

The bottom number is the diastolic pressure. This is pressure that is
recorded when your heart relaxes between beats
Your healthcare professional will endeavour to keep your blood pressure
below or equal to 130/80. If you have problems with your kidneys or your
eyes, your blood pressure needs to be lower. It is important to take your
blood pressure medication regularly, even if you feel well.
If you have been told that you need to lower your blood pressure, try the
following:

If overweight, aim to lose weight by reducing your calorie intake

Eat a healthy, balanced diet

Reduce your salt intake

If you smoke, STOP

Only drink alcohol in moderation. Be honest with yourself about the
amount of alcohol that you drink. Keep within the recommended
government guidelines ie 2 units per day for women; 3 units per day for
men

Take regular physical activity

Take prescribed medication
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
26
TAKING CARE OF YOUR HEART
Cardiovascular disease is the damage to the heart and blood vessels by a
build up of cholesterol (fatty deposits) on the linings of the blood vessels. This
can restrict the flow of blood around the body and can result in a heart attack,
stroke or problems with the circulation in the legs (Peripheral Vascular
Disease or PVD).
In the UK, cardiovascular disease is a major cause of ill health and early
death in the general population. However, those with diabetes are four times
more likely to develop the risk of coronary heart disease, strokes and
circulation problems.
You can help prevent cardiovascular disease by following the healthy living
advice in this booklet.
Cardiac Support Group
If you have a heart problem or angina, the Heart Throbs cardiac support group
hold monthly meetings which are friendly and informative with speakers
talking on a wide range of health related topics. People attending the group
can also discuss any worries they may have about their health or lifestyle with
others who have had similar experiences. These meetings are free but a
small charge is made for refreshments. Partners are also welcome.
The group also runs several afternoon and evening exercise sessions each
week with fitness trainers who are specialised in cardiac rehabilitation
exercises. A reasonable charge is made for these sessions.
27 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
BLOOD GLUCOSE MONITORING
If your healthcare professional feels that it is appropriate
for you to test your blood glucose levels using a blood
testing meter, either they or your local Pharmacist will
be able to advise you on the most suitable meter. You
will be advised about the amount of times that you need
to test by your healthcare professional.
According to the National Institute of Clinical Excellence 2008, you should aim
for a level of between 4 and 6.5 mmols/l before meals and up to 8.5 mmols/l
two hours after meals. If you find that your blood glucose levels are
persistently high (that is greater than 10 mmols/l) at different times of the
day, make an appointment to see your healthcare professional. Should the
results at any time start to fall outside an acceptable range on a regular basis,
then it is helpful to increase the frequency of the testing. Seek help and
advice from your healthcare professional taking the blood test results with
you.
Here are a few facts to bear in mind if you are testing your blood glucose
levels at home:

Do not get too concerned if you have a high reading every now and again

Do not become alarmed when your blood glucose levels rise after you eat
as this is entirely normal

Test on one day before eating and another day, test 2 hours after eating

Test before and after exercising

Don’t forget, any emotional stress can affect your blood glucose levels
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
28
Summary of the NHS Enfield advice for blood glucose monitoring for
those with Type 2 diabetes is given below.
Diabetes controlled by either diet and physical activity or tablets and
diet and physical activity:

People with well controlled diabetes may wish to test their blood glucose
levels. Discuss this with your healthcare professional.

If you wish to test your blood glucose levels then it is recommended to test
2-3 times a week at different times in the day.

If you find that your results start to fall outside of the acceptable range,
monitor and increase the frequency of testing. Speak to a member of your
healthcare professional taking your blood testing results with you.

If you experience hypoglycaemia symptoms whilst taking a sulphonylurea,
test your blood glucose levels and act accordingly. See page 32.
People with diabetes on conventional insulin therapy combined with
tablets. Maybe having fixed doses once or twice daily.

Blood glucose monitoring should be at least daily at differing times of the
day. If you find that your results start to fall outside of the acceptable
range, monitor and increase the frequency of testing. Speak to a member
of your healthcare professional taking your blood testing results with you.
People with diabetes on intensive insulin therapy. Having multiple daily
doses of insulin depending on the blood results:

Testing your blood glucose levels is essential.

You may wish to test your blood glucose levels 4-6 times a day to prevent
hypoglycaemia or hyperglycaemia.
It is important when using a blood glucose meter that it is working correctly
and uses up to date technology. NHS Enfield has organised for some
pharmacies to ensure that meters are working correctly, and if not will replace
free of charge. A list of these pharmacies can be found on page 30
29 Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
PHARMACIES THAT UNDERTAKE BLOOD GLUCOSE METER CHECKS
PHARMACIES INVOLVED IN EQA PROJECT FOR BLOOD GLUCOSE
METERS IN ENFIELD
Atkinson Chemist
20 The Grangeway N21 2HG
Atkinson Chemist
750 Green Lanes N21 3RE
Co-op Pharmacy
255-257 Hertford Road EN3 5JL
Co-op Pharmacy
247 High Rd EN3 4DR
Co-op Pharmacy
417 Hertford Rd EN3 5PT
Co-op Pharmacy
66 Silver St EN1 3EP
Forest Pharmacy
308a Hertford Road N9 7HD
Hayward Pharmacy
10 Queen Anne Place, EN1 2HB
Lloyds Pharmacy
261 Fore St N18 2TY
Lloyds Pharmacy
Florey Sq N21 1UJ
Lloyds Pharmacy
44 Cannon Hill N14 6LH
Lloyds Pharmacy
98A South St EN3 4QA
Lloyds Pharmacy
304 Baker St EN1 3LD
Sainsbury Pharmacy
681 Green Lanes N21 3RS
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
30
WHAT DOES MY HbA1c (Glycated Haemoglobin) MEAN?
In your blood there is something called a haemoglobin molecule which
contains iron and carries oxygen around the body delivering it to the cells.
The molecule lives for about three months and when it dies it is cleared from
the blood stream by your spleen.
During its life span, glucose molecules stick one by one to the haemoglobin
molecules. The more glucose that is in your bloodstream, the more glucose
becomes stuck to the haemoglobin from the blood.
When a blood sample is taken from you for your regular diabetes check-up, it
is measured to find out how much glucose is stuck to the haemoglobin
molecule. This gives an estimate of how much glucose has been in the
bloodstream for the past 3 months.
This test was reported in the past as a percentage reading. This has now
been changed to mmols/mol and you will receive your results from your
healthcare team in this way. The diagram below compares the two readings.
A simple guide is given below:
Between 48 - 59
mmols/mol
IDEAL CONTROL
Between 59 – 64
mmols/mol
REASONABLE
CONTROL
Above 64 mmols/mol
POOR CONTROL
Previously referred to as
Between 6.5% - 7.5%
31 Issue 4 – November 2013
Between 7.5% - 8%
8% or above
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Enfield/ECS – 2006 onwards
HYPOGLYCAEMIA - Causes, signs, symptoms and treatment
This is the medical term used for low blood glucose levels. It can also be
shortened to ‘Hypo’. The onset of these symptoms can be very rapid.
Hypoglycaemia occurs when the level of glucose in a person's blood falls too
low. The person often experiences 'warning signs' which occur as the body
tries to raise the blood glucose level. The ideal blood glucose level is
between 4.0 mmols/l and 6.5 mmols/l. Hypos occur when the blood glucose
level drops below 4.0 mmols/l.
Causes








If you take insulin or a sulphonyurea tablet, you may have taken too much
Lumpy injection sites (insulin absorption is affected). You may have
reduced the amount of carbohydrate in your diet
You may have delayed or omitted a meal
Increased stress levels
Increased your physical activity
Increased alcohol consumption
Hot weather can affect some people
Some drugs can cause hypoglycaemia
The following warning signs may vary from person to person.







Double vision/blurred vision
Drowsiness
Sweating
Hunger
Dizziness
Personality change/irritability
Lack of concentration







Fast pulse
Tingling of mouth and/or lips
Weakness in the legs
Feeling shaky
Going pale
Heart pounding
Confusion
Treatment for hypoglycaemia




Check blood glucose level if possible
Eat or drink something sweet, e.g. Lucozade 50–100mls or 3–6 glucose
tablets or 200mls orange juice or 1 tube of Glucogel (Hypostop)
Repeat if symptoms are not resolved after 5–10 minutes
When feeling slightly better eat your next meal or have a
snack like a sandwich or a banana
If hypos are occurring regularly, contact your doctor as your treatment may
need to be adjusted.
It is advisable to carry identification which includes medical information,
details of medication and the name and phone number of your GP. These are
available from your healthcare provider or Diabetes UK.
Issue 4 – November 2013
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Enfield/ECS – 2006 onwards
32
HYPERGLYCAEMIA - Causes, signs, symptoms and treatment
This is the medical term used for high blood glucose levels.
Hyperglycaemia occurs when the body is unable to use glucose effectively.
This leads to raised levels of glucose in the blood. When somebody has
diabetes, the glucose in their body is not turned into energy either because
there is not enough insulin or because the insulin that the body produces is
not being used properly. Hyperglycaemia occurs when the blood glucose is
greater than 10 mmols/litre before you eat. When you eat, the blood glucose
level rises as your body digests food.
Causes



You have stopped taking your medication or you are taking the wrong
dosage
You have reduced the amount of activity that you do
You have changed your diet
The signs and symptoms of hyperglycaemia








Thirst and dry mouth
Passing large amounts of urine especially at night
Tiredness
Blurred vision
Weight loss
Itching of genitals
Headaches
Short tempered
You may have experienced some of these prior to being diagnosed.
Treatment for hyperglycaemia




Ensure that you are taking the correct dosage of medication at the right
time
Take regular physical activity (do not exercise if your blood glucose
level is above 13mmols/l)
Avoid changes to your healthy eating plan and the timing of your meals
See your healthcare professional if symptoms persist
33 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
FEASTING AND FASTING
Feasting
Everybody over-indulges a little bit on special occasions
but when you have diabetes you will have to give more
consideration to the amount and type of food and drink
that you consume.
If you drink too much alcohol this can affect your blood glucose levels.
Remember that there is no harm in drinking in MODERATION.


Men should drink no more than 3 units a day
Women should drink no more than 2 units a day
1 unit of alcohol is half a pint of beer or lager or 1 small
glass of wine or 1 single measure of spirits
If you are having a celebration meal, try to fill your plate with more vegetables
or salad or choose healthy alternatives.
Remember to take care during religious festivals. This can be a very difficult
time for people with diabetes, especially if you are expected to attend lots of
functions or need to change your diet for a period of time.
Fasting
Many religions have periods of fasting. If you have diabetes and you are
considering fasting or taking part in a festival that will affect your diet or
medication or the times that you take them, you should see your healthcare
professional.
Do not stop taking or alter your medication without consulting your
healthcare professional.
Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
34
EATING WITH FRIENDS
Your friends may be concerned about what you can eat.
Explain your needs and ask what time you are going to
eat so that you can plan your meals throughout the day.
If you are going to eat later than your usual time, make
sure you have a snack at your regular eating time.
EATING OUT
It is a good idea to ring the restaurant to ascertain the menu.
Make sure you know how long you will have to wait for your
meal once you have ordered your food.
SOCIAL LIFE
Some aspects of your social life will change. You just need
to plan and make contingencies for emergencies. You will
need to be well organised and prepared. Whenever you go
out, as an added precaution in case you get delayed, always
carry one of the following: GlucoGel (HypoStop) which is
supplied by your GP or glucose tablets or biscuits.
Your friends and family should be aware of your diabetes and your needs.
Do not over indulge and remember, eat before you drink any alcohol.
You may wish to test your blood glucose levels before you go to bed
especially if you have been drinking alcohol. If your blood glucose result
is below 7mmols/l, you should eat a healthy snack before going to bed.
35 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
FEELING UNWELL
If you are feeling unwell, here are a few simple rules that you
should remember:

You should contact your healthcare professional if you are
sick and cannot eat. This is especially important if you are taking any
medication.

If you do not feel like eating solid food, try alternatives, for example milk,
soup, ice cream, fruit juice.

Test your blood glucose levels more frequently if you are ill as blood
glucose levels can be affected by illness.

If you have Type 1 diabetes, test your urine for ketones if your blood
glucose levels are greater than 14 mmols/l, or if advised to by your
healthcare professional.

Drink plenty of water or sugar free fluids. Aim to drink 5 to 7 pints (3-4
litres) in a day
CONSULT YOUR GP IF

You are vomiting for more than 2 meal times and are unable to take your
medication

You do not improve quickly

Your blood glucose levels remain high. i.e. before you eat over 10 mmols/l
over a period of 6/7 days or over 15 mmols/l for 2 days

Your blood glucose level is low. i.e. 4 mmols/l or under

You or your carers are worried
Remember - any emotional stress can affect your blood glucose levels.
Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
36
DRIVING AND DIABETES
Driving Licences
You must advise the DVLA that you have been
diagnosed as having Type 1 diabetes and you take
insulin. If you have Type 2 diabetes, you must inform
them if you begin to take insulin. This is your
responsibility and not the responsibility of your
healthcare professional.
This is a mandatory
requirement.
Contact the DVLA by telephone: 0870 240 0009 or www.dvla.gov.uk and
follow the links for ‘Health conditions that could affect your driving’.
Their address is: Drivers Medical Branch, DVLA, Swansea, SA99 1TU.
For people with Type 2 diabetes who are controlled by diet or diet and tablets,
there are no driving licence restrictions until you require insulin treatment.
You can retain your ‘until age 70’ privileges. When you approach 70 years of
age, licence renewal forms are sent automatically by DVLA to the address
shown on your driving licence prior to the expiry date. There is no fee for
renewal. When completing your form, you must sign the consent section for
your doctor to be consulted by the DVLA if required. The DVLA may request
that you have a medical check-up. Further information about the medical
rules for driving is given in the DVLA’s booklet INS57P.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/
193489/INF188_2.pdf
Different rules apply for people who need insulin to control
their diabetes. Diabetes UK can advise you on all aspects.
If you have to take insulin your driving licence will be
reviewed every 3 years.
Contact your healthcare
professional when renewing your licence.
If you take insulin, you must check your blood glucose level
prior to setting out on a journey and every two hours on a long journey. You
must carry appropriate treatment for hypoglycaemia with you. The DVLA may
ask to see evidence of blood glucose monitoring. Check the DVLA for more
information or Diabetes UK.
It is important to note that if you have been advised to contact DVLA and you
do not, your healthcare professional is legally bound to do so if they are
concerned about your fitness to drive.
It is essential to regularly check for up to date information.
Lorry
37 Issue 3 – June 2011
drivers
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Motor Insurance
You must advise your Insurance Company that you have
been diagnosed as having diabetes as failure to do so may
result in your insurance being invalid. It is not compulsory to
inform Insurers of any change in your medication but it would
be sensible to do so to reduce the risk of your policy being
voided if an accident occurred and the company was
unaware of your diagnosis. However, you must inform them if there has been
any alteration or restriction to your Driving Licence by the DVLA.
It is important to always carry some glucose tablets with you and to keep
some digestive biscuits and something to drink in your car just in case you
start to feel a hypo coming on.
If you have hypo symptoms when driving, the law requires that you

Stop the car in a safe position

Remove the keys from the ignition.

Get into the passenger seat if you are on your own

Eat or drink something containing sugar.

Do not commence driving for up to 45 minutes after the hypo
Refer to the hypoglycaemic advice on page 32.
You can be prosecuted if you are having a hypo and are behind the
wheel with the keys in the ignition. This is seen as being in charge of a
vehicle whilst under the influence of drugs. It might be best to move to
the passenger seat or get out of the car.
Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
38
TRAVEL
You can travel anywhere in the world that you wish as
there are no restrictions on your ability to travel. It is wise
to make some extra preparations before you start your
journey.

It is extremely important that you take out adequate travel insurance for
your trip

Check that ‘pre-existing conditions’ are not excluded from your cover
Diabetes UK will be able to give you advice and they also run a travel
insurance scheme for people with diabetes.
All vaccinations normally recommended are safe for people with diabetes.
Check with your healthcare professional to establish whether you require
immunisation prior to travelling. If you do, ensure that these are given in good
time as they may upset your diabetes control for a short time. Your blood
glucose levels may need to be checked more often for a few days after
immunisation. If, on advice from your healthcare professional you do have to
increase your medication, ensure that you reduce it again once your blood
glucose levels return to normal.
Medical attention is officially free in all EU countries providing you have
obtained the correct European health card before you go. This card proves
that you are eligible for free treatment and is available free of charge from
most Post Offices or your DSS office.
If travelling with a group, it would be sensible to inform your tour leader that
you have diabetes.
Diabetes UK has a useful booklet entitled ‘Travel and Diabetes - Managing
Away From Home’.
39 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
What to take with you when you travel

Identity card stating that you have diabetes with details
of your medication. (Identity cards are available from
the Enfield Diabetes Support Group or Diabetes UK)

Doctor’s letter explaining that you take insulin and need
to carry needles and blood testing equipment in your
hand luggage. Your doctor is perfectly within his rights to charge you for
the letter

Take a copy of your prescription list

All diabetes medication and blood testing equipment must be in your hand
luggage at all times. Remember, insulin and blood testing equipment acts
adversely to extreme temperatures

Twice as much medication as you think you may need

Your testing equipment. Advise the airline that you have this equipment
prior to travelling

A first aid kit. Include medication for travel sickness, diarrhoea, etc

Supply of food and drink in case of delays. Check airlines for up to date
information regarding taking liquids through customs.

Depending on your destination, you may need anti-malarial medication
and water purification tablets
If you are taken ill whilst on holiday, never stop taking your tablets or insulin
even if you are unable to eat and cannot take solid foods. You should seek
medical advice if sickness and/or diarrhoea persist. When you are travelling,
try to be flexible. Do not get too upset if your blood glucose control is not
perfect when travelling across time zones.
Diabetes UK has free destination leaflets for many countries throughout the
world giving useful information including useful phrases in the local language.
ENJOY YOUR HOLIDAY
Issue 3 – June 2011
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40
ENTITLEMENTS
Currently only those who take medication to control their diabetes, regardless
of their age, are entitled to free prescriptions. This also includes free blood
glucose testing strips and lancets. Ask your GP for an exemption form.
All people with diabetes, regardless of age, are entitled to an annual flu
vaccination free. It is strongly recommended that people with diabetes have
this vaccine. You are also entitled to a pneumococcal (pneumonia) vaccine
every ten years.
People with diabetes are entitled to a free annual eyesight check.
DENTAL CARE
Your dentist needs to know that you have diabetes before
treating you. You must also let your dentist know the
medication you are on.
As dental infections may affect your diabetes control, regular
check-ups are essential.
Currently there is no free dental treatment for people with
diabetes.
PERSONAL INSURANCE – this includes all health insurance and life
assurance.
It is important that you declare your diabetes when applying for any policy.
Any policy you hold at the time of diagnosis is unaffected but you should
advise the company.
If you have any renewal problems, contact Diabetes UK for advice.
41 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
EMPLOYMENT
Having diabetes does not mean that you will not be able
to find or keep a job. As some employers do not know
enough about diabetes, they may be reluctant to employ
someone with the condition.
It is essential to emphasise that having diabetes does not make any difference
in your capability to work. Ideally, you should have good diabetes control and
be able to adjust your medication around your working day if necessary.
Diabetes UK believes that everyone should be treated according to their own
merits and ability to do the job in question. If your diabetes is controlled by
diet alone or diet and tablets, it is possible to do most jobs providing you do
not have any complications connected with diabetes.
Since the extension to the Disability Discrimination Act in October 2004,
people with diabetes have greater employment protection than ever before.
There is a ban on some jobs for people who control their diabetes with insulin.
For example:












Armed Forces including RAF pilots
Merchant Navy
Prison Service
Airline Pilot, Cabin Crew (some airlines) and Air Traffic Control
Train driving
Driving large goods vehicles
Driving vehicles carrying the general public (buses)
Any job with the Post Office that involves driving
Working offshore e.g. on oil rigs, channel ferries or liners
Working at a coal face
Working at heights
Being a jockey
It might be difficult or impractical to plan your insulin injections to fit in with
your job, especially if you work shifts. This is much easier if you are on a
flexible injection regimen and perform regular blood tests. Your Diabetes
Team can help you to plan this. However, if you are already in a job when
your diabetes develops, in most instances it is possible to continue with that
employment.
Transport for London is now responsible for licensing of
Taxis and Private Hire vehicles. If you require information on
this issue contact them directly. Further details can be found
on the Transport for London website.
Phone number: 020 7286 1046.
Issue 3 – June 2011
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42
JOB APPLICATION
There may be a health question on the application form.
You should write that you have diabetes and add ‘well
controlled’ if appropriate. If you wish, you can state Type 1
or Type 2.
WHAT TO TELL AN EMPLOYER AND WORK COLLEAGUES
Let your colleagues know you have diabetes in a positive and simple way.
This will help them to understand your condition. Resentment about why you
are having snack breaks or going through a bout of being vague or even
argumentative will be prevented if your colleagues have the understanding
and knowledge they need about the effects of your diabetes.
You may find it useful to explain to your colleagues what treatment you need
in the case of a hypo. Find out your employer’s policy regarding First Aiders
administering treatment.
If your diabetes is diagnosed whilst you are in a particular job, inform your
Manager and Human Resources Department as you may have to have some
time off from work. Keep them up to date with your progress.
Studies have shown that people with diabetes do not take any more time off
work than anyone else. Do not use your diabetes as an excuse. It does not
make you more prone to sickness. As with all health appointments, organise
your diabetes appointments to fit in with your job.
If you have any concerns regarding your employment,
discuss these with your healthcare professional.
Contact Diabetes UK if you need further information or
advice.
43 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
!
COMPLICATIONS OF DIABETES
!
It is important that you know about some of the long-term effects of poorly
controlled diabetes in order to make informed and important decisions about
your own health care. There have been several long-term research studies
that have proved beyond doubt that good blood glucose control reduces the
risks of developing most of the diabetic complications.
Poor blood glucose control is likely to lead to any of the following
problems:
RETINOPATHY
You are entitled to a free eye examination if you have
diabetes and it is essential that you attend.
Retinopathy occurs when poorly controlled diabetes damages
the tiny blood vessels in the back of the retina (the seeing part
of the eye). These blood vessels can become abnormally
fragile and leak. These abnormalities may cause blurring and
occasionally loss of vision. Changes due to diabetes can usually be
prevented from affecting your eyesight if problems are detected early enough.
This may be before you notice any deterioration in your vision. It is essential
that you have your eyes checked every year for retinopathy as the back of the
eye is checked very thoroughly by dilating (widening) the pupils using eye
drops. This check is quite different from a sight test for glasses or glaucoma
check. You are advised not to drive for at least 2 hours following this test.
Plus, remember to take your sunglasses with you.
Presently, annual call/recall for diabetic retinopathy screening for patients
registered with an Enfield GP is provided by North Middlesex University
Hospital. Your GP, with your consent, will request that you are placed on the
retinal screening system. You will then be contacted by the hospital’s retinal
screening team to arrange for an appointment at one of the following sites:

The Diabetes Centre of your local hospital

One of the community diabetic retinopathy screening clinics eg Forest
Primary Care Centre
If this has not taken place, discuss this with your GP urgently.
Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
44
CATARACTS
Cataracts are degenerative changes in the lens of the eye. This causes the
lens to become cloudy which causes diminishing vision. A simple operation
where the faulty lens is replaced by an artificial lens is performed to treat
cataracts. If, during your routine eye screening, you are found to have any
sign of cataracts you may be referred to an ophthalmologist.
HARDENING/FURRING OF ARTERIES
(ATHEROSCLEROSIS/ARTERIOSCLEROSIS)
People with diabetes are at greater risk of developing arterial diseases such
as stroke, heart attack and poor circulation in the legs. Although hardening of
the arteries occurs to some extent in every person as they get older, evidence
suggests that it occurs earlier in people with diabetes. Maintaining a healthy
lifestyle will help you to minimise these risks.
Also at risk include people who:

Are overweight

Have a high fat intake

Smoke

Have high blood pressure

Have a family history of heart disease
If you are concerned about these issues, talk to your healthcare professional
or pharmacist who will be happy to give you guidance on how to reduce your
risks.
45 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
KIDNEY PROBLEMS - DIABETIC NEPHROPATHY
Your kidneys can be affected by diabetes in the following
ways.
In long-standing and poorly controlled diabetes, high blood
glucose and high blood pressure levels can affect the small blood vessels
that supply the kidneys. In the early stages this may not produce any
symptoms. It is important that at your annual check-up your healthcare
professional checks your urine for protein. This problem can be made worse
by poorly controlled blood pressure. If you are considered to have high blood
pressure, it is essential that you attend your surgery/clinic regularly for
review.
Infection - When the blood glucose levels are high you will have glucose in
your urine. This can make you more prone to developing infections of the
bladder (e.g. cystitis). These infections can then spread upwards towards the
kidneys.
NERVE DAMAGE - NEUROPATHY
Your body is full of tiny, fragile nerve endings that can be damaged by high
glucose levels in your blood stream. When this damage occurs it is known
medically as neuropathy. Neuropathy can be very common on diagnosis of
Type 2 diabetes. It can affect many parts of the body, for example:






Feet
Legs
Eyes
Hands
Bowel
Sexual organs
As neuropathy affects the feet and legs more often than any other parts of the
body, it is essential that you pay particular attention to the problems that may
develop in these areas.
Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
46
FOOT ULCERATION
Any or all of the following problems can combine and cause
foot ulceration.
People who have poorly controlled diabetes are particularly prone
to foot ulceration because:

They are more prone to infection

The nerves to your feet are not functioning as well as they should be and
as a result of this, the sensation to your feet may be altered. This reduces
any protection that normal sensation would give you

Hardening/furring of the arteries may reduce the amount of oxygen, blood
and nutrients that supply the tissues of your legs and feet
SEXUAL HEALTH FOR MEN
Erectile dysfunction or impotence
Erectile dysfunction means being unable to have or keep an
erection long enough to have sexual intercourse with your
partner. Approximately one in ten men over the age of forty will experience
erectile dysfunction whether they have diabetes or not. All men experience
failure to achieve an erection at some point in their lives and this problem may
increase with age. There is a wide range of treatments available and there
are many people that can advise you.
Erectile dysfunction may have physical or psychological causes, or a
combination of the two. Diabetes can cause damage to the blood supply to
the penis or to the nerves that control an erection. Other factors that can
cause this problem are:







Smoking
Drinking too much alcohol
Use of recreational/illegal drugs
Some medications used to treat high blood pressure and depression
Lack of the hormone testosterone can cause loss of interest in sex
Previous operations on your bowel, prostate or bladder
Damage to the spinal cord
47 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
The psychological causes of this problem may include:




Stress and anxiety
Depression
Marital/relationship problems
Guilt and fear of failure
You should discuss any problems that you have with your healthcare
professional. You may need to be referred by your GP to a specialist who
could be:


An urologist (a doctor who specialises in kidney, bladder, prostate and
genital problems)
A counsellor or psychologist
The treatments available include:





Counselling
Medication review including insulin
Drug therapy
Vacuum therapy
Self injection
The most appropriate form of treatment will be discussed fully with you.
Impotence is now well understood.
REMEMBER - HELP IS ALWAYS AVAILABLE
Issue 3 – June 2011
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48
SEXUAL HEALTH FOR WOMEN
Diabetes may not affect your ability to become pregnant,
provided that you have good control over your blood
glucose levels. All women need to look after themselves
prior to becoming pregnant. When you have diabetes, you
have to be extra careful with your health and well being prior to becoming
pregnant.
Speak to your healthcare professional as pregnancy can complicate diabetes.
Any woman with diabetes who wants to become pregnant must have prepregnancy counselling together with her partner. Your GP will give you the
go-ahead when it is considered that your diabetes control is good.

Excellent control of your blood glucose levels is essential before and
during pregnancy

Do not smoke

Take care with your food intake, the quality of your diet and your weight.
When you become pregnant, your blood glucose levels need to be tightly
controlled. If your diabetes is controlled by diet alone or diet and tablet,
prior to becoming pregnant you will need to commence insulin therapy

It is important to take folic acid tablets prior to becoming pregnant
CONTRACEPTION
The contraceptive pill does not suit all women and it may not be advised if
you:





Are older
Smoke
Are overweight
Have high blood pressure
Have heart or circulatory problems, or a family history of them
Most of the low dose contraceptive pills may be suitable for short-term use.
You will need to keep a check on your blood glucose and blood pressure
levels. Low dose progesterone only pills may be used.
The coil (IUD/Intra-uterine contraceptives) can be used providing that there is
no history of pelvic infections.
Barrier methods (caps/condoms) are safe to use but not as effective as other
methods.
49 Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
HRT – (Hormone Replacement Therapy)
Your healthcare professional will advise you if you wish to consider HRT.
THRUSH
Thrush (candida) is caused by a yeast infection that thrives in the presence of
a lot of glucose. If your diabetes is poorly controlled, you will be passing a lot
of excess glucose out of your body via your urine.
Creams, pessaries and tablets will help with your symptoms and many of
these are available from chemists. Ask your pharmacist for advice.
CYSTITIS
Cystitis is a lower urinary tract infection that causes the bladder to become
inflamed. Common symptoms include pain when passing urine, more
frequently passing urine, itchiness, pain in the lower abdomen and blood in
the urine. Cystitis is more common in women.
High blood glucose levels increase the risk of cystitis because glucose can
spill over into the urine creating a sweet environment in which bacteria can
grow and multiply. Improving diabetes control will reduce the likelihood of
cystitis developing. Your healthcare professional will be able to say whether
the increased need to pass urine is due to poorly controlled diabetes or is due
to cystitis.
Sometimes cystitis goes away by itself but other times a short course of
antibiotics is needed. It is especially important to see your GP if you are
pregnant or think you could be, as there is a small risk that cystitis can lead to
problems with the pregnancy.
Thrush, cystitis and urinary tract infections can be a side effect of
certain diabetes medication.
Issue 3 – June 2011
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Enfield/ECS – 2006 onwards
50
INDEX
Additional Information
Alcohol
Annual Review/Yearly Check-up
Anxieties
Blood Glucose Control
Blood Pressure
Blood Testing and Monitoring
Blood Vessel Damage
Blurred Vision
54
10, 14, 20, 26, 32, 34, 35, 47
12, 13
13, 18, 35, 38
7, 8, 9, 12, 13, 14, 17, 19, 20, 21, 28, 29,
31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 48
12, 20, 25, 26, 45, 46, 47, 49
17, 28, 29, 30, 31, 35, 36, 37
7
8, 13, 32, 33
Cardiac Support Group
Cardiovascular Disease
Cataracts
Check-ups
Cholesterol
Complications of Diabetes
Contact Numbers
Contraception
Coping with Diabetes
Cramps
Chiropodist see Podiatrist
Cystitis
27
27
45
12, 13, 22, 41
12, 27
44
5
12, 49
11
8, 25
Dental Care
Diabetes Support Group
Diabetes UK
41
1, 2, 5, 11, 54, 55
4, 5, 11, 20, 32, 35, 37, 40, 42, 43, 54,
55
20
7
11
9, 12, 14, 18, 19, 20, 26, 34, 35
37, 38
8, 33
37, 38
Diabetic Food
Diabetic Terms
Diagnosed (Initially)
Diet
Driving
Dry Mouth
DVLA
Eating Out
Eating with Friends
Emotional Stress
Employment
Entitlements
Exercise – see Physical Activity
Eyes/Eyesight
51 Issue 3 – June 2011
46, 50
35
35
28, 36
42, 43
41
12, 13, 26, 41, 44, 45, 46
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Enfield/ECS – 2006 onwards
Fasting
Feasting
Feeling Unwell
Feet
Flu Vaccine
Food Labels
Footwear
Foreword
Fruit and Fruit Juice
34
34
36
7, 12, 13, 22, 23, 24, 46, 47
41
19
24
2
18, 32, 36
Glucogel (Hypostop)
Glucose Tablets
Glucose Meter Check
Glycated Haemoglobin
32, 35
32, 35, 38
30
7, 31
HbA1c
Healthy Eating
Health Worries
Heart
Heart Throbs
High Blood Levels – see Hyperglycaemia
Holidays
Hormone Replacement Therapy (HRT)
Hyperglycaemia/Hyper
Hypertension
Hypoglycaemia/Hypo
Hypostop – see Glucogel
7, 12, 31
18, 19
22
20, 21, 23, 26, 27, 45, 49
21, 27
Illness
Immunisation
Impotence
Infection
Insulin, Injection and Sites
Insurance
Introduction
Itchiness
22, 36
39
47, 48
24, 25, 41, 46, 47, 49, 50
7, 8, 9, 12, 14, 15, 17, 29, 32, 37, 40, 49
38, 39, 41
6
8, 15, 33, 50
Job Application
42, 43
Kidney Problems
7, 26, 46
Life and Personal Insurance/Assurance
Low Blood Levels – see Hypoglycaemia
41
Mature Onset Diabetes
Medical Identification
Medication
8
32, 40
12, 13, 14, 15, 16, 22, 26, 32, 33, 34, 36,
38, 39, 40, 41, 42, 47, 48
9
38
‘Mild Diabetes’
Motor Insurance
39, 40
50
7, 13, 29, 33, 36, 46, 50
26
7, 13, 14, 15, 17, 21, 29, 32, 36, 38
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Enfield/ECS – 2006 onwards
52
Needle Disposal
Nephropathy
Nerve Damage/ Neuropathy
17
7, 26, 46
7, 24, 25, 46, 47
Optometrist/Opthalmologist
44
Pancreas
Pharmacist
Physical Activity (Exercise)
Pneumonia Vaccine
Podiatrist/Chiropodist
Pregnancy
7, 8, 14
11, 14, 30, 45, 50
9, 11, 12, 21, 26, 27, 32, 33
41
6, 24
9, 49, 50
Questions You Might Have
10
Regular Check-ups
Retinopathy
12, 22
7, 12, 13, 26, 44
Salt Reduction
Self Help
Self Monitoring
Sexual Health
Side Effects from Medication
Smoking
Social Life
19, 26
6, 11, 21
28, 29
47, 48, 49, 50
10, 13, 14, 15, 16
12, 23, 26, 47, 49
6, 35
Tablets
Thirst
Thrush
Tips
Tiredness
Travel
Treatment
Type 1 diabetes
Type 2 diabetes
9, 12, 14, 15, 16, 26, 29, 32, 37, 40, 42
8, 33
50
11, 21
8, 33
17, 39, 40,
10, 12, 17, 32, 33, 37, 43,
7, 8, 36, 43
7, 8, 9, 14, 29, 37, 43, 46
Unwell
Urine and Testing
Urologist
Useful Contact Numbers
22, 36,
8, 12, 13, 21, 22, 32, 35, 46
48
5
Vaccinations
Vegetables
39
19, 34
Weight (Reduction/Loss)
Who Is Most At Risk
Work Colleagues
8, 20, 33
9
43
Yearly Check-up
Your Responsibility
13
11, 37
53 Issue 3 – June 2011
© No part of this publication may be reproduced in any form without the permission of Enfield PCT/NHS
Enfield/ECS – 2006 onwards
Additional information sources
Diabetes UK – Produce a wide range of information on all aspects of diabetes.
Further information on diabetes can be obtained from local libraries and
bookshops. www.diabetes.org.uk
National Institute for Clinical Excellence (NICE) – www.nice.org.uk
This information has been jointly prepared by
Enfield Diabetic Patient Information Working Group including David Petts,
Ruth Waxman.
Enfield Diabetes Support Group
NHS Enfield Community Services Diabetes Nursing Team
Based on original documentation by Kit McAuley
All information correct at time of going to press.
This booklet is also available on – www.enfieldpct.nhs.uk
Issue 3 – June 2011
© No part of this publication may be reproduced in any form without the permission of Enfield PCT/NHS
Enfield/ECS – 2006 onwards
54
ENFIELD DIABETES SUPPORT GROUP
A LOCAL DIABETES SUPPORT GROUP IN THE AREA FOR
THOSE WITH DIABETES, THEIR FAMILY AND CARERS
WOULD YOU LIKE SUPPORT/COULD YOU GIVE SUPPORT?
MONTHLY MEETINGS ARE HELD ON A TUESDAY AT:
THE DIABETES CENTRE
CHASE FARM HOSPITAL
THE RIDGEWAY
ENFIELD EN2 8JL
FROM 7.30 pm TO 9.00 pm
GUEST SPEAKERS WILL TALK ON ALL ASPECTS OF
DIABETES CARE AND OTHER RELATED ISSUES
EVERYONE IS WELCOME
FOR MORE INFORMATION CALL:
RUTH – 020 8386 4416
DAVID – 020 8245 0948
edsg@blueyonder.co.uk
THIS GROUP IS RUN BY PEOPLE WITH DIABETES
FOR PEOPLE WITH DIABETES
55 Issue 3 – June 2011
© No part of this publication may be reproduced in any form without the permission of Enfield PCT/NHS
Enfield/ECS – 2006 onwards
Issue 3 – June 2011
© No part of this publication may be reproduced in any form without the permission of Enfield PCT/NHS
Enfield/ECS – 2006 onwards
56