The importance of 15 Healthcare Essentials

November marks diabetes awareness month and to raise awareness local charity Diabetes Gibraltar has written articles highlighting the symptoms, treatment and stories of those living with diabetes. The articles will run weekly on Fridays throughout the month of November.

If diabetes goes untreated or unchecked the high blood sugars can affect various cells and organs in the body. Complications include kidney damage, often leading to dialysis, eye damage, which could result in blindness, or an increased risk for heart disease or stroke.

One of the more debilitating and mutilating conditions associated with uncontrolled diabetes is damage to the small blood vessels which supply the extremities such as the feet. This poor circulation will result in an insufficient blood supply to the nerves, leading to peripheral neuropathy, loss of sensation in the feet which if damaged or injured can result in severe wounds which do not heal, culminating in lower limb amputation.

Your Annual Diabetes Review should cover many of your 15 Healthcare Essentials, assess your control over your sugars and allow early detection of diabetes related complications followed by early intervention, giving you the best possible chance of improvement. It is also an opportunity to regularly review and assess your individual treatment plan and enable support if you should need it. The information gained from your diabetes follow-up provides up to date data for our local GHA diabetes registers, which in turn drives improvements in the delivery of diabetes services.

Everyone living with diabetes should undergo a Diabetes Care Review at least once a year with the GHA Diabetes Team at the PCC. However, some people, such as those newly diagnosed, children, or those already suffering complications will have reviews more often than annually.

At your annual diabetes care review your diabetes team should:

1. Take your height and weight (to check if you are under or overweight), check your BMI and compare this with your previous records. If necessary, an action plan will be discussed with you. Obesity and raised waist circumference increase insulin resistance and therefore deteriorates the blood sugar control.
2. Take your blood pressure. This will be recorded so that the GP’s have access to your record. If there is an abnormality the team will advise you to seek an appointment with a GP. An acceptable blood pressure would be less than 140/80mmHg. And less than 130/80mmHg if there is evidence of renal impairment.
3. Review your blood glucose control, if you are checking your sugars with a glucose meter or sensor glucose monitoring it is a good idea to bring along a week’s record of your values to discuss this at the appointment.
4. Review your HbA1c, the 3-month blood glucose check, which gives an average value of how the sugars have been over the past 3 months. Good control will be estimated at a value between 48 and 58 mmol.
5. Review your cholesterol levels. There is a value of total cholesterol, which can then be divided into HDL cholesterol which is the good cholesterol which comes from unsaturated fats (good fats) and LDL cholesterol which comes from saturated fats (bad fats)
6. Discuss any issues you have with your diabetes or health in general. Do you have questions about your medication? Are you suffering any side effects? Would you like to discuss how to avoid hypos or ask why your blood sugars are high at a particular time of day. If you are Type 1 you have the chance to discuss going onto a different regimen, such as pump therapy.
7. Advise any change in regimen, lifestyle, or medication – including any side effects.
8. Check your injection or infusion sites if you are on insulin.
9. You can also talk about depression, emotional distress, or sexual dysfunction, as these tend to be more common in people with diabetes.
10. Check that you are getting your annual eye check by the Ophthalmology Department at St. Bernard’s hospital.
11. Check your feet for infection, injury, nerve damage and poor circulation as these are the most common causes of diabetic foot problems
12. Discuss the possibility of taking an educational course such as group education for Type 2 diabetes self-management and patient empowerment, or carbohydrate counting and dose adjustment for Type 1s.

Covid-19, lockdown and restrictions has created a pressure on medical resources for the diabetes community. If you have diabetes and have not received your 15 Healthcare Essentials in 2020 and 2021 it is your right to demand your basic care entitlement and to continue to receive it every 12 months. Call 56001534 and ask for an appointment.

Act now. Keep tabs on your care. Make sure you are receiving the 15 health care essentials live longer.