Diabetes

COVID-19 service update: 

We are accepting all appropriate referrals into the service and they are being assessed on a priority basis. Some consultations will remain remotely delivered, however where it is deemed clinically appropriate support will be offered face to face in a clinic venue or with you at home.

The structured education programme is now being delivered to groups virtually, however it is also offered on a 1:1 basis if deemed clinically appropriate. Some face to face sessions are also offered at key venues around the city. 

You may find the following website pages useful:

• Attending your Appointment at Home
• Attending your Appointment in a Clinic
• Attending your Virtual Appointments

We are a short term specialist service for patients who are currently taking the maximum dose of oral medication (maximum oral triple therapy) to control their Type 2 diabetes. Usually this is patients with a HBA1C (the blood marker used for diabetes) of over 75 who require specialist intervention from diabetes specialist nurses, dietitians and GPs with a specialist interest in diabetes. 

Who's it for?

Our service is only for people who have Type 2 diabetes.

Referrals

Refarrals can be made by:

• GPs or hospitals
• Patients themselves 
• Allied Health Professionals  

The LEEDS Programme

The LEEDS Programme is an education programme for people newly diagnosed with type 2 diabetes. The course covers information about Type 2 diabetes and how a carefully controlled diet, exercise and lifestyle changes can help to prevent longer term complications. 

The structured education programme is now being delivered to groups virtually, however it is also offered on a 1:1 basis if deemed clinically appropriate.

Find out more about the LEEDS programme 

Service Information

• QEating Well and Diabetes

  The Eatwell Guide

  The Eatwell Guide can help you get a balance of healthier foods. It can be used by people with health conditions. In the past diet advice has been different e.g. for diabetes, kidney conditions, arthritis, mental health and mood.

  Advice given by a specialist may be different to the Eat Well Guide. In these cases, people should follow their specialist’s advice.

  To eat a healthy balanced diet, eat a variety of different foods from each section of the Eat Well Plate and, in the right portions. 

  

  Potatoes, bread, rice, pasta and other starchy carbohydrates

  Starchy foods are an important part of each meal. Try to have 5-6 portions per day if you are female, 6-8 per day if you are male. Try to choose the wholegrain types as these will help you feel fuller for longer. These foods contain B vitamins which help release energy from the food we eat and help the body to work properly.

  Controlling your intake of carbohydrates can help to reduce your blood glucose levels and help to keep them steady. To achieve this, eat similar portions of carbohydrates from meal to meal.

  Example:

  Breakfast: wholegrain cereal (2 portions)

  Lunch: jacket potato (2 portions)

  Evening meal: cooked rice 4-5 tablespoons (2 portions)

  Starchy Carbohydrate	Measure	Portion
  Corn Flakes	4-5 Tablespoons	2
  Bran Flakes	4-5 Tablespoons	2
  Chapati	Small	1
  Chapati	Large	2
  Pitta Bread	1/2	1
  Wheat Biscuits	2 Biscuits	2
  Porridge	4-5 Tablespoons	2
  Chips	4-5 Chips	1
  Chips	8-10 Chips	2
  Potatoes	Egg Size	2
  Jacket Potato	Fist size	2
  Bread	Medium slice	1
  Bread Roll	One	1
  Cooked Rice	4-5 Tablespoons	2
  Crisp Breads	Two pieces	1
  Cream Crackers	Three	1
  Cooked Pasta	4-5 Tablespoons	2
  Cooked Spaghetti	4-5 Tablespoons	2

   

  Fruits and Vegatables 

  1 portion of fruit or vegetable is approximately one handful.

  Try to have at least 5 different types per day. During weight loss ensure you have the correct portion size of fruit and spread them out during the day. These foods are full of essential vitamins and minerals which help protect us from life threatening diseases such as heart disease, diabetes, cancer, kidney disease, liver disease. Fruit and vegetables can be tinned (ideally in natural juice rather than syrup), frozen or fresh.

  Example:

  Breakfast: chopped banana on cereal

  Lunch: mixed salad in or with a sandwich

  Evening meal: 2-3 different types of vegetables

  Snacks: Mid-morning (1 portion of fruit)

  Mid-afternoon (1 portion of fruit)

  Fruit and Vegetable	Measure	Portion
  Carrots	½ Plate	1
  Mixed Salad	½ Plate	1
  Fresh Orange	150 ml	1
  Satsuma	2 small	1
  Orange	Handful	1
  Peas	½ plate	1
  Ochre	½ plate	1
  Banana	Small	1
  Plum	2	1
  Apple	Handful	1
  Mini Sweetcorn	½ plate	1
  Broccoli	½ plate	1
  Cherries	Handful	1
  Raisins	½ Handful	1
  Grapes	Handful	1
  Cauliflower	½ plate	1
  Sprouts	½ plate	1
  Apricots	2	1
  Dried apricots	3	1
  Strawberries	Handful	1

  Dairy and alternatives

  Dairy foods are a good source of calcium, which help keep our bones strong. Try to include 2-3 portions per day. Try to choose low fat and low sugar types. Example: 3-4 cups of tea or coffee with skimmed or semi skimmed milk (1 portion)

  Dairy and Alternatives	Measure	Portion
  Milk	½ Pint	1
  Soya Milk	150ml	1
  Cheese Slice	One slice	1
  Grated Cheese	20g	1
  Cottage Cheese	Small Pot	1
  Low Fat Soft Cheese	One triangle	1
  Yoghurt	Small Pot	1
  Yoghurt Drink	Small Pot	1

  Oils and spreads

  Some fats are essential as part of a healthy balanced diet as they provide us with energy and some important vitamins (vitamin A and D). However, eating too much fat can be unhealthy. Saturated fats (less healthy) e.g. butter and lard are solid at room temperature and are associated with increased risk of heart disease. Unsaturated fats are liquid at room temperature and considered to be healthier fats.

  Choosing mono-unsaturated spreads and oils e.g. olive and rapeseed oil helps to lower the ‘bad’ cholesterol and increase the ‘good’ cholesterol. There are also poly-unsaturated fats e.g. sunflower, soy and sesame oils.

  It’s important to remember that all fats are high in energy (kcals) and portion sizes should be small.

  Aim for 2-3 portions per day.

  Example:

  1 tsp oil per person when cooking (1 portion)

  1 tsp unsaturated spread per person on bread (1 portion)

  Oils and Spreads	Measure	Portion
  Low Fat Spread	1 teaspoon/ 5g	1
  Mono or poly-unsaturated oil e.g. sunflower, soy, sesame	1 teaspoon/ 5g	1

  Beans, pulses, fish, eggs, meat and other proteins

  Protein rich foods contain essential vitamins and minerals, these foods help our body to repair itself and provide us with a strong immune system. Too many of these foods are unnecessary and may lead to weight gain if eaten in excess, therefore only 2-3 portions per day is required.

  Example:

  Lunch: sliced meat or tuna or beans (1 portion)

  Beans, Pulses fish, eggs, meat and other proteins	Measure	Portion
  Eggs	2	1
  Bacon	2 small rashers	1
  Sausages	2 thin	1
  Sardines	Tin	1
  Fish fingers	2	1
  Pork/ Lamb Chop	2-3oz/ 50-70g/ x1 palm of hand	1
  Chicken	2-3oz/ 50-70g/ x1 palm of hand	1
  Steak	2-3oz/ 50-70g/ x1 palm of hand	1
  Meatballs	2-3oz/ 50-70g/ x1 palm of hand	1
  White Fish	2-3oz/ 50-70g/ x1 palm of hand	1
  Salmon steak	2-3oz/ 50-70g/ x1 palm of hand	1
  Green Lentils	X1 palm of hand	1
  Red Lentils	X1 palm of hand	1
  Kidney Beans	X1 palm of hand	1
  Cannelli beans	X1 palm of hand	1
  Butter beans	X1 palm of hand	1
  Chickpeas	X1 palm of hand	1
  Baked Beans	X1 palm of hand	1
  Soya Mince	2-3oz/ 50-70g/ x1 palm of hand	1

  Eat less often and in small amounts

  This section now sits outside the main 'plate' section of the Eatwell guide. These foods are higher in fat and sugar and provide little nutritional value to our diet. We can still enjoy them as part of a balanced diet but it is recommended that we eat small portions of these and reduce how often they are consumed.

  Example:

  1 small packet of crisps (1 portion)

  1 biscuit (1 portion)

  Beans, Pulses fish, eggs, meat and other proteins	Measure	Portion
  Sugar	1 teaspoon/ 5g	1
  Tomato Sauce/ Salad Cream	1 teaspoon/ 5g	1
  Peanuts	½ handful	1
  Scone	1/2	1
  Plain digestive	1	1
  Orange sponge biscuit	2-3oz/ 50-70g/ x1 palm of hand	1
  Fun Size chocolate bar	Fun size / 1	1
  Biscuit bar	one	1
  Crisps	25-30g bag	1

  Drinks

  Water, lower fat milk, sugar-free drinks including tea and coffee all count.

  Aim to drink 6-8 glasses per day.

  Note: Limit fruit juice and / or smoothies to a total of 150ml a day.

  Alcohol

  The maximum recommended number of units for men and women is currently 14 units a week – ideally not all in one go and at least 2 alcohol free days. A UK unit is 10ml of pure alcohol.

  Adding 2-4 units per day to your usual diet can lead to an increase in weight of around 4lbs in four weeks.

  Alcohol	Measure	Unit	Calories
  Lager/ bitter	Pint, 3.5%	2.8	182
  Light Spirit	25ml, 37.5%	1	120
  Dark Spirits	25ml, 40%	1	55
  Red Wine	125 ml, 12%	1.5	93
  White Wine	175ml, 12%	2.1	130
  White Wine	Bottle	9	556
  Alcopop	Small bottle, 5%	1.4	200
  Cream Liqueur	45ml	1	199

   

  For more information and support:

  NHS Eatwell Guide.

  One You Leeds (Eat Better, Cook Well)

  Forward Leeds

  If a person is worried about the amount of alcohol they drink and would like to seek professional help, contact Forward Leeds on:

  • 0113 887 2477
  • info@forwardleeds.co.uk

  Type 2 Diabetes - A guide to snacking

  Your body produces and uses insulin to help use certain foods (nutrients) in the diet called carbohydrates to provide energy. When you have diabetes the insulin your body produces is either not enough or is not working as efficiently as it should be. This is causing your blood glucose levels to rise above the normal range.

  Controlling your intake of carbohydrates can help to reduce your blood glucose levels and help to keep them steady. To achieve this you could have similar portions of carbohydrates from meal to meal. One area you may want to focus on is reducing your snacks to less than 15g of carbohydrate.

  You should aim to include no more than one snack between each meal. Including more than this may increase your calorie intake excessively and lead to weight gain.

  Carbohydrates

  Carbohydrates all break down into glucose and will affect our blood glucose levels. Foods containing carbohydrates are:

  • Starchy Foods (Potatoes, Granary Bread, Takeaway food, Pasta, Rice)
  • Milk and Yoghurt
  • Fruit
  • Food with added sugars (Cereal, Cereal Bar, Chocolate, Cakes, Biscuits)

  How many carbohydrates should I be eating?

  • Starchy carbohydrates are your body’s main source of energy so we recommend you include a source of these with every meal.
  • Having regular carbohydrates can help to reduce your risk of hypoglycaemia (blood glucose levels below 4mmol/l).
  • Ideally you should be aiming for meals to contain a similar amount of carbohydrate day to day as this will help to keep your blood glucose levels steady.
  • Initially you could aim for meals to provide between
    30-50g per meal and your snacks to provide less than 15g.
  • Your dietitian may recommend a more specific amount if you are trying to achieve a particular goal.

  What carbohydrate free snacks could I include?

  • Nuts (plain or roasted) - one small handful.
  • Cheese (a matchbox sized portion of hard cheese).
  • Lettuce wraps - you could try filling these with meat fish or salad and a small amount of low calorie or vinaigrette dressing.
  • Eggs - 2 eggs a day is a reasonable portion.
  • Avocado - you could try stuffing these in a similar way to the lettuce wraps or turning them into guacamole. 1/2 an avocado is one portion.
  • Vegetable sticks with 2-3 tablespoons of hummus / guacamole / salsa.
  • Edamame beans with a light coating of your choice of spice / herbs.
  • Any plain meat or fish for example chicken breast, ham, prawns, tinned tuna.
  • Olives or gherkins.
  • Omelette (made with very little milk). You could add any vegetables / meat to this.

  Tip - Any of these snacks can be mixed together to make up 15g of carbohydrate. But remember that including too many snacks may lead to weight gain if your calorie intake is increased too high. Speak with your dietitian if you are unsure of how many snacks you could include for your needs.

  Sweet Food (Containing 15g or less carbohydrate)

  Type of food	Amount of carbohydrates (grams)
  1 x bourbon, chocolate digestive, custard cream, ginger biscuit, oreo	8-9
  3 x party rings, malted milk, nice, rich tea	15
  1 x plain digestive	10
  1 x mini muffin	14
  1 x medium handful of any fresh fruit	15
  20g popcorn (2 x handfuls) - sweet or salted	13
  1 tablespoon peanut butter	4
  Small yoghurt 100kcals or less	15 or less
  74g of blueberries or strawberries (one medium handful) + 4 tablespoons crème fraiche	11
  2 x rings of tinned pineapple (juice drained)	8
  Light hot chocolate made with water	5
  Small ice lolly (80ml)	15

• QPhysical Activity and Diabetes

  Being physically active is good for diabetes.  It’s important to remember that being active is even more beneficial if you’re also making healthier food choices, not smoking and getting enough sleep.

  There are many benefits of being active when you have type 1, type 2 or other types of diabetes. Moving more can:

  • Help the body use insulin better by increasing insulin sensitivity
  • Help you look after your blood pressure, because high blood pressure means you’re more at risk of diabetes complications
  • Help to improve cholesterol (blood fats) to help protect against problems like heart disease
  • Help you lose weight if you need to, and keep the weight off after you’ve lost it
  • Give you energy and help you sleep
  • Help your joints and flexibility
  • Help your mind as well as your body
  • Help people with type 2 diabetes improve their HbA1c.
  • In some cases, this can help people with the condition go into diabetes remission.

  Making the choices right for you

  In general, it’s best to try and do a mixture of different types of activity. This is because different types of activity have different benefits, and use different parts of your body. 

  If you have diabetes complications or other health conditions that affect how much activity you can do, it can be difficult to know what exercises to try.

  If you’re feeling worried, talk to your GP or healthcare team first. They will be able to give you advice on how you can adjust things to suit you.

  Keeping active at home

  If you're spending time at home, there are lots of ways to get active and keep moving that much more. How about doing:

  • On-the-spot walking during TV ad breaks
  • Stretches for your arms and legs whilst sat in a chair
  • Hoovering your home or washing your car
  • Using cans of food as weights

  Keeping active on the move

  It’s surprising how a slight change of routine can increase your physical activity levels and help you feel better when you’re living with diabetes. This could include:

  • Getting off the bus one stop earlier, or parking further away from your destination
  • Taking the stairs instead of the lift or escalator
  • Using your food shopping as weights
  • Walking
  • Cycling

  For more information and support:

  • Diabetes UK - Exercise
  • We are undefeatable
  • We are undefeatable - Leeds
  • Active Leeds
  • One You Leeds (Move more, Be smoke free, eat better, cook well)
• QHypoglycaemia

  Hypoglycaemia (very low blood sugar)

  In Leeds, we want people with diabetes and the people around them to be aware of hypoglycaemia so they know how to recognise it and how to manage it.

  Glucose is a sugar carried in the bloodstream that your body uses for energy. If you have diabetes and take certain treatment, your blood glucose levels can sometimes become too low. This is called hypoglycaemia (or a “hypo”) and occurs when your blood glucose level drops below 4 mmol/L.

  Do test your blood glucose levels if you feel that you are having a having a hypo.

  What are the symptoms?

  Early signs and symptoms of a hypo include:

  • Tingling of the lips
  • Hunger
  • Palpitations
  • Trembling and shaking
  • Becoming pale
  • Sweating heavily
  • Feeling anxious

  Symptoms may vary from person to person, but you will feel “different” very quickly.

  If you miss these early signs, the symptoms may get worse and include:

  • Slurring your words.
  • Behaving oddly
  • Being unusually aggressive or tearful.
  • Having difficulty in concentrating.

  If you do not treat your hypo at this stage, you may become unconscious.

   

  Who gets a hypo?

  • If you are injecting insulin or taking diabetes tablets that make your body produce more insulin, then you may be at risk of hypos.
  • If you are not sure how your diabetes tablets work, discuss this with your local pharmacist.

  What causes a hypo?

  A number of situations can cause a hypo:

  • Drinking too much alcohol or drinking alcohol without food
  • Too much insulin or too many diabetes tablets.
  • Delayed or missed meals
  • Eating less starchy foods than usual
  • Unplanned or strenuous activity
  • Incorrect insulin injection technique

  Sometimes there is no obvious cause, but treatment should always be carried out immediately, as advised.

  How to treat a hypo:

  If you recognise that you are having a hypo, you should treat it immediately with something that will raise your blood glucose quickly. Suitable quick-acting glucose treatments to provide 15g to 20g carbohydrate are:

  • 200ml (a small carton) of smooth orange juice (
  • 60 ml glucojuice
  • 5 glucotabs
  • 6 dextrose tablets
  • 4 standard jelly babies

  If you do not feel better after 10 to 15 minutes (or your blood glucose level is still less than 4 mmol/L) repeat ONE of these treatments.

  When you start to feel better, and if you are not due to eat a meal, eat some starchy food, like 2 plain biscuits or a small banana.

  If you are not able to treat your hypo yourself, but you are still conscious and able to swallow, someone can give you glucose gel if you have this available. 

  How to avoid hypos

  • Eat three regular meals a day and include a small portion of starchy carbohydrate at each meal, such as bread, rice or potatoes.
  • You may need to eat more carbohydrate before and after physical activity.
  • Keep to sensible alcohol limits and do not drink on an empty stomach.
  • Take your medication at the recommended dose and times.
  • If you are testing your blood glucose levels, and notice your readings are regularly dropping, discuss this with your diabetes team as you may need a change in medication or your insulin regimen adjusted.
  • Always carry glucose with you to treat hypos quickly.

  If you become unconscious, you will need immediate emergency treatment. Someone should dial 999 for an ambulance. You should be put on your side with your head tilted back. Glucose treatments should NOT be put in your mouth.

  Driving and hypos:

  • Keep glucose treatments in the car within easy reach at all times.
  • Check your blood glucose before driving and every 2 hours if it is a long journey.
  • Your blood glucose level should be more than 5 mmol/L to drive.

  If you have a hypo while driving, stop the car as soon as possible. Remove the keys to demonstrate you are not in charge of the car, and move into the passenger seat if safe to do so. Treat the hypo as advised.

  You should not drive for at least 45 minutes after recovery because your response rates will be slower.

  The DVLA has guidance in place for reporting episodes of hypoglycaemia. It is important you notify them in line with this guidance. The latest Medical Standards of Fitness to Drive can be found on the DVLA website.

  • Diabetes - Assessing fitness to drive
  • Hypoglycaemia and driving
  • Driving assessment 

  Remember:

  • Having a hypo means that your blood glucose level is too low.
  • Act IMMEDIATELY by eating or drinking something that will raise your blood glucose quickly.
  • Never ignore the warning signs.
  • Make sure other people know what to do when you are having a hypo.
  • Always carry glucose and diabetes identification.

  Consequences of frequent hypos:

  • You may not recognise future hypos.
  • Fear and anxiety of getting further hypos.
  • Effects on employment and driving.

  If you are concerned about anything within this section, please discuss this with your healthcare professional.

  Useful resources

  • TREND-UK
  • Diabetes UK, 0345 123 2399
  • Driver and Vehicle Licensing Agency - Diabetes

  Disclaimer: These links will take you to an external website for which Leeds Community Healthcare does not review or control the content.

• QTop 10 Blood Glucose Tips

  Getting accurate and useful home blood glucose measurements

  1. Make sure that you understand the relevance of blood glucose testing and why you have been asked to test your blood glucose.

  2. Ensure your testing strips are in date and stored in the original container or packaging, as recommended by the manufacturer. Once you have opened the packaging, the strips will have a limited shelf life. Please ensure you check the manufacturers guidance.

  3. To keep the test strips in good condition, replace the lid on the test strip container if applicable as soon as you have removed the strip.

  4. Always wash and dry your hands thoroughly before testing. Do not use wet wipes or alcohol swabs as these could affect the blood glucose result.

  5. Make sure that you use an appropriate finger pricking device and a new lancet for each test. Some finger prickers offer adjustable penetration depth which can help reduce unnecessary discomfort.

  6. When testing:

  • Make sure that your hands are warm as this will help the blood flow and make testing less painful. Holding your hand towards the ground can also help blood flow
  • Use a different finger and a different area each time to minimise pain and help skin healing
  • Prick to the side of the finger tip to get the blood sample as this tends to be less painful than the fingertip
  • Gently squeeze the finger to get enough blood for the test and ask for help from your health care professional if you struggle to get enough blood

  7. Do not leave the meter or strips in extremely hot or cold environments as this may cause an inaccurate reading.

  8. Always re-test if the blood glucose result does not match your symptoms

  9. It is important that you test your blood glucose at variable times to understand how your current diabetes treatment is working and to enable safe treatment adjustment. You will have been advised to test your blood glucose either daily, twice daily, 2-3 times daily, 4 times daily.

  Please record your measurements in your blood glucose monitoring diary and bring your results and meter to all your appointments. Most meters offer computer software that can help you record and analyse your results.

  10. Remember to dispose of sharps safely in a suitable sharps container.

  Remember -  Always read the instructions provided with your meter, keep your user guide for future reference and complete and send the warranty card provided. A helpline is also provided by the meter manufacturer for any other meter-related queries. Ask your diabetes health care professional for advice if you are having any difficulties testing your blood glucose levels.

• QTop 10 Insulin Tips

  Getting the most from your insulin treatment 

  
  1. When you collect your insulin check the insulin name is correct and it is within the expiry date.

  2. To keep your insulin in good condition:

  • Store your spare insulin supplies in the fridge, near the front or in the salad compartment, to avoid freezing.
  • The insulin you are currently using can be left out of the fridge at room temperature for up to a month. Avoid leaving in extremes of heat or cold, for example on a window sill, near a radiator or in a cold car.

  3. Remember to use a new needle for each injection. Remove the needle from the pen when you have completed your injection and discard in a suitable sharps disposal container.
  4. Remember to wash your hands and make sure your injection site is clean.
  5. Remember to:

  • Perform a safety check (air shot) before every injection to ensure that the needle and pen are working correctly.
  • Dial up your dose accurately.
  • Inject your insulin into the subcutaneous fat layer using the injection sites recommended by your diabetes health care professional.  Avoid any sore, swollen or lumpy areas.
  • Insert the needle at an angle of 90 degrees trying to avoid indenting the skin. Your healthcare professional will advise you whether you need to lift your skin prior to your injection.
  • Press the injection button until the dial returns to ‘0’.
  • Count to 10 before removing the needle from your skin.

  6. Some types of insulin need to be mixed before use. Check your insulin guidance, but if in doubt mix. To mix, roll your pen between your hands 10 times and invert 10 times. Do not shake.
  7. It is important to time your insulin correctly to ensure that the medication works well for you. Some types of insulin need to be taken with food, some at the same time each day. The type of insulin you use will depend on your individual requirements.
  8. Do not inject through clothing to make sure the insulin is injected correctly and to minimise infection risk.
  9. Remember to move your injections around the different injection areas to help keep your injection sites healthy and to allow your insulin to absorb correctly.
  10. If you experience any problems with giving your insulin seek help from your diabetes health care professional.

  For more information visit:

  Diabetes - Better Care Insulin

   

• QType 1 - what to do when you are ill

  Everyone has days when they are not well. If you have diabetes, being unwell can affect your glucose (sugar) control so it is important that you know how to manage this.

  How does illness affect your glucose (sugar) levels?

  When you are ill, especially if you have an infection and high temperature, your body is less responsive to the insulin you inject. Insulin is a hormone which controls your glucose level. Being unwell therefore usually makes your glucose levels rise, even if you are eating less than usual.

  You can also produce ketones when you are unwell. These are produced when the body is unable to use glucose for energy.

  What might you experience?

  • High blood glucose levels
  • Ketones in the blood higher than 3.0 mmol/L
  • Thirst
  • Stomach pain
  • Drowsiness
  • Passing more urine than usual
  • Others may notice your breath smells of acetone or pear-drops
  • Feeling and/or being sick
  • Fast and deep breathing
  • Sweet or metallic taste in the mouth

  It is possible to manage your diabetes effectively during illness, keep your glucose levels in or near to target, and prevent the development of ketones by following this advice.

  Looking after yourself

  • Rest: avoid strenuous exercise
  • Prevent dehydration by drinking plenty of sugar-free fluids. Sip gently throughout the day (at least 2 ½ to 3 ½ litres or 4 to 6 pints in 24 hours)
  • Treat symptoms such as a high temperature or a cough with basic over-the-counter medicines such as painkillers and cough syrups. These do not have to be sugar-free varieties as they contain very little glucose and are taken in small quantities. Ask your pharmacist for advice.
  • Contact your GP if you think you have an infection as you may need antibiotics
  • Monitor your glucose levels by your usual method e.g. capillary glucose or continual interstitial glucose monitoring while you feel unwell. Test your blood/urine for ketones

  What do ketone levels mean?

  • Less than 0.6 mmol/L is normal
  • 6 to 1.5 mmol/L means you may be at risk of developing diabetic ketoacidosis (DKA) so test again after 2 hours
  • 6 to 2.9 mmol/L means you are at risk of diabetic ketoacidosis. and should contact your diabetes team or GP as soon as possible
  • 3 mmol/L or higher means you have a very high risk of diabetic ketoacidosis and should get emergency help as soon as possible

  If you are only able to do a urine ketone test, a result of 2+ means you may be at risk of developing diabetic ketoacidosis.

  You may need to adjust your insulin dose while you are ill, especially if your glucose level is high and you develop ketones.

  Seek urgent medical help if your readings remain higher than usual, or you feel very unwell and you

  Managing your insulin dose when your blood ketones are less than 1.5mmol/l

  If your glucose more than 11 mmol/L and/or you feel unwell, either with no ketones or blood ketones less than 1.5 mmol/L (negative or trace of urine ketones), then you need to:

  • Sip sugar-free fluids, at least 100 ml/hr.
  • Eat as normal if possible. You need food containing carbohydrate (carbs), insulin and fluids to avoid dehydration and prevent diabetic ketoacidosis
  • Test glucose and blood ketones every 4 to 6 hours including during the night
  • Aim to take your usual insulin dose. However, if your glucose is above 11 mmol/L, take additional insulin as below

  Glucose	Insulin dose
  11 – 17 mmol/L	Add 2 extra units to each dose
  17 – 22 mmol/L	Add 4 extra units to each dose
  More than 22 mmol/L	Add 6 extra units to each dose
  Call your GP or nurse if your glucose remains higher than normal

   

  If you start vomiting, are unable to keep fluids down, or are unable to control your glucose or ketone levels, you must seek urgent medical advice. DON’T STOP TAKING YOUR INSULIN EVEN IF YOU ARE UNABLE TO EAT.

  Managing your insulin dose when your blood ketones are 1.5 mmol/l or higher

  When your glucose more than 11 mmol/L and/or you feel unwell, either with blood ketones 1.5 mmol/L or higher (+ or more of urine ketones), then you need to:

  • Sip sugar-free fluids, at least 100 ml/hr.
  • Eat as normal if possible. You need food containing carbohydrate (carbs), insulin and fluids to avoid dehydration and prevent diabetic ketoacidosis

  If your blood ketone metre is reading between 1.5 to 1.3mmol/l (+ to++ urine ketones), give an additional 10% of your total daily insulin dose as rapid acting or mixed insulin every 2 hours.

  Give an additional 10% of your total daily dose as rapid-acting or mixed insulin every 2 hours	Total insulin dose
  1 unit	Up to 14 units
  2 units	15 to 24 units
  3 units	25 to 34 units
  4 units	35 to 44 units
  5 units	45 to 54 units
  If you take more than 54 units of it you are unsure how to alter your dose, contact your specialist team or GP.

  If your blood ketone metre is reading more than 3mmol/L (+++ to+++ urine ketones), give an additional 20% of your total daily insulin dose as rapid-acting or mixed insulin every 2 hours.

  Give an additional 10% of your total daily dose as rapid-acting or mixed insulin every 2 hours	Total insulin dose
  2 unit	2 units
  4 units	4 units
  6 units	6 units
  8 units	8 units
  10 units	10 units
  If you take more than 54 units of it you are unsure how to alter your dose, contact your specialist team or GP.

  What do I do next?

  • Test your glucose and blood ketones every 2 hours including during the night.
  • If your glucose is more that 11 mmol/L and ketones are present, then repeat the process outlined in this section.
  • If your glucose is less than 11mmol/L adjust your insulin does back to normal. (This will happen as your illness resolves).

  If you start vomiting, are unable to keep fluids down, or are unable to control your glucose or ketone levels, you must seek urgent medical advice. DON’T STOP TAKING YOUR INSULIN EVEN IF YOU ARE UNABLE TO EAT

  Your body uses a lot of energy when you are unwell, even if you are resting. Try to eat as normal but if you cannot manage your usual meals, replace these with light and easily digested foods such as soups and milky puddings. See the table below for a list of alternative food options. Each portion is equal to approximately 10 gram carbohydrate (e.g. an eggsize potato, a small slice of bread or a tablespoon of cooked rice or pasta):What can you eat and drink?

  • Fruit juice 100 ml
  • Milk 200 ml
  • Plain vanilla ice-cream 1 large scoop
  • Tomato soup 200 gram (half a large tin)
  • Low fat yoghurt 150 gram (1 small pot)
  • 2 Rich tea or malted milk biscuits

  When to seek help

  Get to hospital urgently if any of these apply to you:

  • If you are pregnant and have ketones
  • If you vomit for the duration of 2 meals (i.e. 4 hours) and are unable to keep fluids down
  • If you have persistent ketones despite increasing your insulin
  • If you become drowsy and/or breathless
  • If you have acute abdominal pain
  • If your condition worsens despite following the advice given in this leaflet

  If you need to go to hospital, remember to take a list of all your medications and insulin safety card with you.

  Even if you are not eating, never stop your insulin

  Being Prepared

  • Make sure you always have plenty of insulin and glucose and ketone monitoring equipment available
  • Make sure your ketone strips are still in date if you have not used them for a while
  • Keep a few simple medicines such as painkillers and cough syrup in a safe place in the house
  • Discuss how to manage your diabetes when you are unwell with your doctor or nurse so you know what to do if you become ill and know when to seek help
• QType 2 - what to do when you are ill

  Type 2 diabetes what to do when you are ill

  Everyone has days when they are not well. If you have diabetes, being unwell can affect your blood glucose control so it is important that you know how to manage this. This section will give you essential information on:

  • How illness affects your blood glucose levels
  • Looking after yourself
  • What to eat and drink
  • Managing your medication
  • When to seek help

  How does illness affect your blood glucose?

  When you are ill, especially if you have an infection and high temperature, your body is less responsive to the insulin you produce naturally or may be injecting. Insulin is a hormone which controls your blood glucose. Being unwell therefore usually makes your blood glucose levels rise, even if you are eating less than usual.

  Symptoms of high glucose may include:

  • Thirsty
  • Passing more urine than normal
  • Tiredness

  Looking after yourself

  • Rest: avoid strenuous exercise
  • Prevent dehydration by drinking plenty of sugar-free fluids. Sip gently throughout the day (at least 2 ½ to 3 ½ litres or 4 to 6 pints in 24 hours)
  • Treat symptoms such as a high temperature or a cough with basic over-the-counter medicines such as painkillers and cough syrups. These do not have to be sugar-free varieties as they contain very little glucose and are taken in small quantities. Ask your pharmacist for advice.
  • Contact your GP if you think you have an infection as you may need antibiotics.
  • If you can monitor your blood glucose, check at least 4 times daily while you are unwell
  • You may need to adjust your diabetes medication while you are ill
  • Seek medical help if your readings remain higher than usual, you feel very unwell and you are not sure what to do

  What can you eat and drink?

  Your body uses a lot of energy when you are unwell, even if you are resting. Try to eat as normal but if you cannot manage your usual meals, replace these with light and easily digested foods such as soups and milky puddings. See the list below for a list of alternative food options. Each portion is equal to approximately 10 gram carbohydrate (e.g. an egg-size potato, a small slice of bread or a tablespoon of cooked rice or pasta):

  • Fruit juice 100 ml
  • Milk 200 ml
  • Plain vanilla ice-cream 1 large scoop
  • Tomato soup 200 gram (half a large tin)
  • Low fat yoghurt 150 gram (1 small pot)
  • 2 Rich tea or malted milk biscuits

  Managing your diabetes medication

  If you take diabetes tablets or a non-insulin injection and feel unwell:

  Continue to take your tablets even if you are not eating. However:

  • If you are taking metformin or an SGLT2 inhibitor and you are vomiting or have diarrhoea, you should stop this medication immediately as you may be at risk of dehydration. You will need a check for ketones if you take an SGLT2 inhibitor
  • If you take a tablet which helps your body to produce more insulin, such as gliclazide, you may need to increase the dose or even need insulin injections for a short time while you are ill. You will need meal replacements if you are unable to eat normally
  • Contact your GP if you feel like your symptoms are prolonged or getting worse
  • If you are injecting a non-insulin glucose-lowering medication and develop acute abdominal pain, nausea and vomiting, stop the injections immediately and seek urgent medical attention

  If you take insulin:

  • Monitor and record your blood glucose levels at least four times a day (at mealtimes even if you are not eating your usual meals, and at bedtime)
  • If your blood glucose readings are higher than usual, you may need to increase your insulin dose. Contact your GP or diabetes nurse if you are not sure how to do this.

  If your blood glucose levels are lower than usual (because you are eating less than usual) you may need to reduce your insulin or any tablet you are taking which helps your body produce more insulin.

  Managing your insulin doses during illness

  If your blood glucose is persistently greater than 11 mmol/L, you will need to increase your insulin dose

  Blood glucose level	Additional insulin
  11.1 to 17 mmol/L	Add 2 extra units to each dose
  17.1 to 22 mmol/L	Add 4 extra units to each dose
  Over 22 mmol/L	Add 6 extra units to each dose

  If you are taking more than 50 units in total daily, you should double the adjustments. All adjustments are incremental and should be reduced gradually as the illness subsides. Contact your doctor, practice nurse or diabetes specialist nurse for advice if you feel unsure about adjusting your insulin doses.

  If your blood glucose levels are dropping down to 4 mmol/L or less, reduce your insulin dose by 10% (i.e. if your dose is usually 20 units, reduce by 2 units, if it is usually 40 units, reduce by 4 units). Make sure you have suitable “hypo” treatments available such as dextrose tablets, glucojuice or jelly babies

  When to seek help

  Call your GP or diabetes specialist nurse for immediate help:

  • If you are pregnant
  • If you have persistent vomiting and are unable to keep fluids down
  • If you become drowsy and breathless
  • If you have acute abdominal pain
  • If your condition worsens despite following the advice given in this leaflet

  If you need to go to hospital, remember to take a list of all your medications and insulin safety card (if injecting insulin) with you.

  Being prepared

  • Make sure you always have plenty of tablets/insulin and monitoring equipment especially in winter-time, when people around you are unwell or you are travelling and may become ill.
  • Keep a few simple medicines such as painkillers and cough syrup in a safe place in the house.
  • Discuss how to manage your diabetes when you are unwell with your practice nurse or doctor so you know what to do if you become ill and when to seek help.
• QFlash Glucose Monitoring

  Flash Glucose Monitoring

  A monitor called 'flash' can help people to check their sugar levels. The brand is called FreeStyle Libre®. It is the only one available. Unlike traditional finger-prick devices (that measure glucose levels in the blood), FreeStyle Libre® measures the glucose in your interstitial fluid. This is via a sensor the size of a two-pound coin, applied to the upper arm. It can provide a near-continuous record of your glucose levels, which is produced by scanning the sensor with a reader device.

  Some people can be considered for flash monitors on the NHS. The criteria are listed in the West Yorkshire and Harrogate Commissioning Policy.  If you do not meet the criteria, you will not be considered for FreeStyle Libre®, but the healthcare teams will of course continue to support you in all aspects of your diabetes care.

  For more information visit:

  • Flash Glucose Monitoring System - Freestyle Libre
  • Managing your diabetes - Flash Glucose Monitoring Diabetes UK

  The specialist diabetes team can consider this technology for the following groups only:

  • People with Type 1 diabetes who: are testing capillary blood glucose more than 8 times daily, are pregnant (12 months inclusive of post-delivery period), cannot monitor their own blood glucose due to disability, have occupational or psychological circumstances which would merit a Libre device and where the decision for Libre was made by a specialist MDT, have repeated severe hypoglycaemia.
  • People with diabetes and on haemodialysis and on insulin treatment who are testing capillary blood glucose more than 8 times daily
  • People with diabetes associated with cystic fibrosis and on insulin treatment
  • People with Type 1 diabetes or insulin treated Type 2 diabetes who are living with a learning disability and recorded on their GP Learning Disability register.

  There is a choice of blood glucose monitors on the market. There is only one flash glucose monitor manufactured at the moment. This is called FreeStyle Libre®. People who are not eligible for funding on the NHS can trial and purchase this device privately here.

• QDiabetes Support in Leeds

  Diabetes Courses and Support in Leeds

  Know Your Risk

  Diabetes is preventable. If you would like to check your risk of diabetes (or someone you know would), for more information and support, please visit the Diabetes Risk Score website.

  Leeds Diabetes UK Support Group

  Diabetes UK Support Group (Facebook)

  Diabetes UK chat: Your Friends in the North.

  Diabetes UK Helpline

  Get specialist information and advice on all aspects of living with diabetes. Call us for answers, support or just to talk to someone who knows about diabetes.

  Call: 0345 123 2399*, Monday to Friday, 9am to 6pm

  Email: helpline@diabetes.org.uk

  *Calls to 0345 numbers cost no more than calls to geographic (01 and 02) numbers and must be included in inclusive minutes on mobile phones and discount schemes. Calls from landlines are typically charged between 2p and 10p per minute while calls from mobiles typically cost between 10p and 40p per minute. Calls from landlines and mobiles to 0345 numbers are included in free call packages. Calls may be recorded for quality and training purposes.

  LEEDS Programme

  If you have type 2 diabetes, the LEEDS Programme will improve your knowledge about your condition and help to give you the skills and motivation to take control and self-manage it. 

  LCH LEEDS Programme (leedscommunityhealthcare.nhs.uk)

  Psychological Wellbeing and Diabetes Course

  Leeds Community Healthcare NHS Trust - Psychological Wellbeing & Diabetes

  Learning Disability

  If you or someone you care for has a learning disability, find out more on at the Learning Disability Service webpage

  Self-Management Support

• QBritish Sign Language (BSL)

  British Sign Language Resources

  Healthier Living with Diabetes

  Topic	Who provides the information?	Access the information here
  Healthier You	NHS	British Sign Language sessions | Healthier You - NHS Diabetes Prevention Programme (stopdiabetes.co.uk)
  Eatwell guide	NHS Inform Scotland	Eatwell Guide (BSL) | Translations (nhsinform.scot)
  Eating healthily when you have diabetes	Bristol Community Health	Healthy eating when you have diabetes - BSL and subtitled version - YouTube
  Activity guidelines	NHS Inform Scotland	Keeping active guidelines (BSL) | Translations (nhsinform.scot)
  Keeping Fit	UK Deaf Sport	Sport and Wellbeing Weekend Final by UK Deaf Sport, including Jamie Fuller - YouTube
  Obesity and BMI	SignHealth	SignHealth Obesity - YouTube

  Living with Diabetes

  Topic	Who provides the information?	Access the information here
  Diabetes symptoms	SignHealth	SignHealth Symptoms of Diabetes - YouTube
  Symptoms and causes	NHS Inform Scotland	Diabetes - British Sign Language (BSL) | Translations (nhsinform.scot)
  What is diabetes?	NHS Inform Scotland	Diabetes - British Sign Language (BSL) | Translations (nhsinform.scot)
  Type 1 and 2 diabetes	British Deaf Association	Type 1 and Type 2 Diabetes - British Deaf Association (bda.org.uk)
  Diabetes and the body	Diabetes UK	Animation about diabetes and the body with subtitles and British Sign Language - YouTube
  Understanding diabetes	Diabetes UK	Understanding diabetes - with subtitle and British Sign Language - YouTube
  Diabetes risk factors	British Heart Foundation	British Heart Foundation - Diabetes, Heart Healthy Series [British Sign Language] - YouTube
  High Cholesterol	British Heart Foundation	British Heart Foundation - High Cholesterol, Heart Healthy Series [British Sign Language] - YouTube
  Hypos and hypers	SignHealth	SignHealth Hypos&Hypers - YouTube
  What is a stroke	SignHealth	What is a stroke? - SignHealth
  Type 1 diabetes (self management)	Digibete	Essentials - BSL - DigiBete
  Diabetic emergency	British Red Cross	Everyday First Aid: Diabetic emergency [BSL version] - YouTube
  Diabetic eye screening	NHS Inform Scotland	This is a Scottish video: Your guide to diabetic eye screening (BSL) - YouTube For local information on appointments visit: Diabetic Eye Screening | Mid Yorks

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