Diabetes Care 4 U!

Welcome to Diabetes Care 4 U! Here you will find posters packed full of information and innovative ideas to ensure you have great Diabetes Care! Before you enter into the unique experience let us go over the problems of diabetes.
DIABETIC EYE DISEASE Most common cause of blindness in people of working age Stroke Eye Disease Heart Disease High Blood Pressure HEART and BLOOD VESSELS 2 to 4 fold increased risk of heart disease and stroke 75% have hypertension Kidney Disease

DIABETIC KIDNEY DISEASE 20% of all new patients needing renal dialysis therapy have diabetes

Remember with good care all complications can be reduced or even prevented!
Pain or loss of the lower legs due to impaired blood flow Peripheral Neuropathy (nerve disease)

FOOT PROBLEMS 15% of people with diabetes develop foot ulcer; 5-15% of these need amputation

If you think any area of your care needs to be addressed please make a note and discuss this with your Diabetes Care Team.

Enjoy the Posters!

Diet : Maintaining a healthy diet and

preventing or reducing overweight will help you control your diabetes

Advice
Exercise : Regular exercise will help to
maintain an optimum weight and will benefit all members of the family

Smoking : It is widely accepted that smoking

causes heart and lung disease. Most diabetic complications are worsened by smoking

Weight control : There is a greater risk of

Developing diabetes and heart disease with increasing waist circumference

Finnish Diabetes Study

This study was conducted to determine the effects of a programme of changes in lifestyle in patients with Pre diabetes

Lifestyle changes included Weight reduction greater than 5% (if needed) Fat intake less than 30% of calorie intake Saturated fat less than 10% of calorie intake Fibre intake greater than 15grams/ 1000 calories Exercise greater than 4 hours per week (brisk walking)

Carrying out this programme resulted in less diabetes by 58%

Are you eating healthy foods? How often do you exercise? Do you smoke? Do you know your target weight?

B lood P ressure
Target :

140 / 80

Very good control of blood pressure is required! Raised blood pressure can increase all complications of diabetes It is important that it is checked regularly Tablets maybe taken to control blood pressure You may need to change what you eat and exercise more
related death

60
Microvascular disease Retinopathy progression

Heart failure

any diabetes

Diabetes

stroke

Loss of 47%

UK Prospective Diabetes Study Blood Pressure Control Study

0%

related endpoints

vision

50 40 30

Aggressive blood pressure control reduces the risk of most complications in Diabetes

-10%
24%

-20% -30% -40% -50%

P=0.004

32% 37% 44% P=0.019 56% P=0.013 P=0.009 34% P=0.004

20
P=0.004

10 0

Its as simple as that!

-60%

P=0.004

Any diabetes -70% problem

Heart Failure

Stroke

Remember your target is 140/80 Have you hit the bulls-eye?

C holesterol
This is the amount of fat in blood Some blood fats are necessary to provide important energy sources Too much fat can cause you to be overweight, making it much more difficult to control your diabetes It can also cause heart problems
FAT
SERUM BLOOD
How much fat does your blood contain? The optimal target for blood cholesterol level is

LESS THAN 5

Proportion without major Heart problems (%)

SCANDINAVIAN SIMVASTATIN SURVIVAL STUDY

100 80 60 40 20
Simvastatin Placebo

This study showed that long-term simvastatin (cholesterol lowering drug) therapy reduces chances of dying and heart problems in patients with diabetes

55%
Risk reduction

0
0 1

Number of years on simvastatin

Do you know what your level is? Are you on target?

D iabetes C ontrol
Blood glucose needs to be kept within a controlled range

47
This can be helped by regular blood glucose monitoring at home and keeping an accurate written record. Bring it to clinic!

What is HbA1c%?
This value tells you the amount of glucose sticking to your blood over the last 60 days It reflects how well your diabetes has been controlled The aim is to have a value of less than

7.0%
Metformin, Gliclazide, Glimepiride, Pioglitazone , Rosiglitazone, Insulin and many other drugs

What drugs help to control diabetes?

UK Prospective Diabetes Glucose Control Study The UKPD study shows that good glucose control can decrease the risks of:

Risk of Diabetes Complications

10 9 8 7 6 5 4 3 2 1 0

Heart attack by 16% Cataract by 24% Kidney problems by 33%

- >160 <6 140 to 150 130-140 <130 6 to 7 >8 7 to 8

HbA1c%

Blood Pressure

Increasing

Are you in control of your diabetes? What is your HbA1c%?

Eyes
Is Diabetes slowly stealing your vision?
How your eyes work
Your eye has a lens and an opening at the front, which adjust to bring objects into focus on the retina at the back of the eye.

The retina is made up of delicate tissue that is sensitive to light rather like the film in a camera.
At the centre of the retina is the macula, which is a small area about the size of a pinhead. It is vital because it enables you to see fine detail.

A person with diabetes can have eye disease and not even know it until serious, irreversible vision loss has occurred The only way to diagnose early signs of diabetic eye disease is through a dilated eye exam at least once a year DIABETIC EYE DISEASE Diabetic Eye Disease(Diabetic retinopathy) is the commonest Normal retina Diabetic Retinopathy cause of blindness under the age of 65 in the Western World 37% of diabetes patients have retinopathy at diagnosis of diabetes 1500 new cases of blindness could be prevented by yearly screening in UK 20 years after diagnosis 95% with Type Macula Optic Disc Fatty Haemorrhage 1 diabetes have retinopathy Deposits 20 years after diagnosis 60% of patients with Type 2 diabetes have retinopathy Laser treatment can save eye sight getting worse in 90% of patients

When was the last time you had your eyes checked?

Feet
During a lifetime, your feet may walk the equivalent of four times around the world! To ensure that they continue their trip through life without complaint, it pays to look after your feet!
People suffering from diabetes can often experience loss of sensation in their feet. Even the smallest injury can lead to infection, which if not treated promptly, may lead to serious complications.

It is important that you examine your feet regularly. You should also feel inside all shoes for any seams or stitching which could rub the foot and lead to problems. It is important that you receive regular foot advice or treatment.

Foot Problems
15% of patients with diabetes will develop foot ulcers due to nerve damage and reduced blood flow Foot ulcers come before 85% of amputations in people with diabetes. Foot ulcers are the commonest cause of amputation in the UK

Liverpool Diabetes Clinic: Foot Protection Programme

When patients with diabetes and foot deformities attended regular clinics with a trained podiatrist and foot education, it was found that At 2 years ulceration was reduced to 2.4% compared with 3.5% Amputation was reduced by 3 times

When was the last time you had your feet checked?

Guardian Drugs
What are Guardian Drugs?
Guardian drugs are given to protect you from further diabetes complications

ASPIRIN
% Decrease in Events
Diabetes UK recommends taking aspirin to prevent against heart problems in all diabetes patients (greater than 30yrs) with any of the following: Heart attack, angina, high blood pressure, eye problems, blood vessel diseases and kidney problems Also if: Indo - Asian, overweight, high cholesterol, Heart Disease risk greater than 15%, family history, history of heart disease, smokers

30 25 20 15
- 14%

- 29%

10 5 0 Any cardiovascular problem Heart Attack

ACE INHIBITORS
ACE - inhibitors are drugs that have a special role in preventing diabetic complications. The HOPE study showed that one ace inhibitor, Ramipril reduced:

Heart Disease Stroke Kidney Eye disease

The names of these drugs end in PRIL

Do you know if you are taking any of the guardian drugs?

CHECKOUT

We hope you have enjoyed Diabetes Care 4 U! At your consultation your concerns will be discussed. Any factors that are relevant in your diabetes management will be highlighted. Once learnt never forgotten, so make sure you know your

ABC of Diabetes Care! Advice Blood Pressure Cholesterol Diabetes Control Eyes Feet Guardian Drugs
Thank you for participating in your Diabetes Care and Good Luck!

Diabetes Care 4 U! SCORE Card

SCORE
If Not smoking
ADVICE: Stop smoking, close attention to diet, weight reduction and exercise. Ensure diabetes education and regular follow-up with your diabetes care team. Comply with recommended treatment. Weight normal or if overweight and losing If you exercise for more than 4 hours per week BLOOD PRESSURE: Know your blood pressure. In most cases the ideal aim is less than 140/80. CHOLESTEROL: Aim total cholesterol levels less than 5.0 mmol/l or bad to good cholesterol ratio of less than 3. This is the LDL cholesterol divided by the HDL-cholesterol. DIABETES CONTROL: The usual aim is for a HbA1c% less than or equal to 7.0%. The HbA1c% is the amount of glucose that sticks to your blood over the last 2 months. EYE Examination: Make sure that your eyes are looked at carefully at least yearly after special eye drops have been put in. You should be referred to an Eye Specialist if needed.

1 POINT
1 POINT 1 POINT

If BP l40/80 or less

1 POINT

If level is below 5

1 POINT

If HbA1c% is equal to or less than 7.5%

1 POINT 1 POINT

If you have your eyes checked at least once a year

FEET Examination: You should check your own feet regularly and seek advice if needed. Make sure that your feet are looked at carefully at least yearly by a health care professional trained in diabetic feet examination. You should see a podiatrist if problems are identified. GUARDIAN DRUGS: Aspirin 75mg once daily: to protect against heart disease in all over the age of 30 years with any of the following: previous heart attack, angina, high blood pressure (once the pressure is less than 150/90), diabetic eye disease, blood vessel disease of the legs, early kidney disease, cholesterol problem, family history of heart disease, weight problem, Indo-Asian and smokers. Side effects should be discussed. ACE-inhibitors have a special role in preventing diabetic complications in most patients with diabetes. Please discuss this with your diabetes care team.

1 POINT
If you have your feet checked yearly

If taking aspirin

1 POINT

If taking an ACE-inhibitor

1 POINT

GOLD

SILVER

BRONZE

8-10

6-7

4-5

HOW DID YOU SCORE?