Septembers Minutes

Septembers Minutes

My apologies for the lateness of these minutes.

Sian Ward DSN from Tredegar Ward (Temporary home from Richmond House). Sian very kindly came along with a power-point presentation, which she has given me permission to send with these minutes.

I contacted Sian following our August meeting where we discussed the results of our blood tests and what they meant at our annual review.

Sian explained that she is one of the team of Diabetes Specialist Nurses who will visit you if you are in hospital to make sure you are getting the correct care whilst in hospital, they also hold clinics at the Tredegar Ward at St Woolos.

Our annual review is the time we get to have our bloods checked and our HbA1c measured. But this is not the only thing checked with our bloods.

Our annual review is a series of tests, a chance to talk to our healthcare professionals and meet the people who will help and support us with our diabetes control, it’s also an opportunity to pre-empt potential problems and learn about new innovations in care.

It’s an individualised plan of care of monitoring and controlling your diabetes. If you can’t make your annual review appointment, please, please make an alternative appointment to make sure you are having your bloods checked.

This is the time to formulate a care plan and hopefully by the end of these minutes we can work towards a plan of questions to ask that is relevant for everyone. It’s a time to set personal goals and find out how its managed.

So, an HbA1c of under 48 is that of a non-diabetic person. And it’s a goal to aim for. Over an 8-12-week period our red blood cells are completely replaced by our amazing bodies so over a 12-week period is a fair average of what your blood glucose levels are. This is the stage where your levels determine how to treat your diabetes, Type 1 diabetes will always require insulin as their pancreas does not produce its own insulin. Type 2 diabetes will be assessed on an individual basis, for example, can your blood glucose levels be controlled with diet and exercise, is there anything that could cause your levels to be raised e.g. If you are unwell as this can push your levels up. Or do you and your doctor have to talk about medication.

At this state your cholesterol will also be checked, this is the amount of fats (Lipids) are circulating in our blood, if it’s too high a statin would normally be prescribed. This is important as high fat levels (HDL cholesterol) are the “bergs” that float around with our blood causing furring up of blood vessels which in turn can lead to circulatory problems and complications with blood supply to areas like our feet.

Your blood pressure is also taken during your annual review, high blood pressure is a risk factor for heart attacks and strokes, high blood pressure itself is a risk factor with your diabetes, if it’s too high it will be checked a few times to make sure it’s nothing untoward or if you need to be prescribed medication to help control it.

You will also be asked to provide a urine sample, this checks for protein in your urine and also, ketones which are extremely important in Type 1 Diabetes. Your kidneys are your filter system for your blood and any increase in levels or function of your kidneys could be a sign of uncontrolled diabetes and leading to kidney failure. So, what is checked for your kidney function? Well, they filter creatine from our blood, in a test called the ACR which if shows a rise in creatine could be a sign of kidney damage and should be no higher than 130. Another test on the kidneys is the EGFR – which measures the filtration rate of your kidneys, the normal value of kidney filtration is 90 or above. If it’s any lower than this is shows that your kidney filters are not working at 100%

You will have your foot screening done at your review where you must take off your shoes and socks, you will have sensation tests and circulation tests performed on your feet, your nails will be checked and overall condition of your feet, if there are any problems you will be referred to the Podiatry services for further treatment.

You will be initially referred for your eye screening at your first diagnosis appointment and then you will be called back every year where your eyes will be checked for any background retinopathy.

Your BMI will also be calculated at your review, unfortunately the BMI does not distinguish between fat and muscle so even the burliest fittest rugby players will have a very high BMI and the values of the BMI were determined in the 1950’s of which a lot has changed so it’s okay as a guide, and basically identifies if you are carrying too much fat around your organs.

Your annual review is your chance to talk to your healthcare professionals, they may suggest things like giving up smoking, losing weight, structured education courses such as DAFNE or X-pert. And an opportunity for you to ask questions such as, what are my creatine levels, is my kidney filtration above 90.

This is also your opportunity to ask about emotional and psychological support is available.

A very informative presentation by Sian who also answered questions from the group.

Hope this covers everything we talked about.

This month we have Public Health Wales coming along to talk about health screening, I look forward to seeing you there.