Looking for something?

Find it in our extensive resource library!

Smart Filters

  • Reset
  • Services

  • Who it's for

  • What it’s about

  • Format

View: 893

Download: 1

Diabetes annual review

All people living with Diabetes (Type 1 and Type 2) are offered appointments every 3 months, and more often than this if they need extra support. They also are offered regular support in between appointments by their Diabetes Educator.

Routine clinic appointment health checks

HbA1c from a finger-prick drop of blood

HbA1c is an important blood test that gives a good indication of how well your diabetes has been controlled over the previous 2 to 3 months. The target we aim for is less than 48mmol/mol, as this minimises the risk of diabetes complications developing. If your blood sugar levels have been in the target range of 4-7mmol/l most of the time, we would expect your HbA1c to be less than 48mmol/mol.

Height and weight

Height and weight are checked as a part of each appointment and are plotted on Centile and BMI charts. These show us what your height and weight are like compared to other people your age, whether your weight is proportional to your height, and if you are growing in height and weight at the right rate. If your growth is not as expected, it can indicate other problems, and may be discussed in your clinic appointment.

Blood pressure

Blood pressure is checked to make sure it is not too high. It is unusual to see high blood pressure in children and young people, but if your blood pressure is too high, it could indicate that your kidneys are not working as well as they should be. However, if coming to clinic makes you worried, this can also make your blood pressure higher than usual! We may lend you a blood pressure cuff to check your blood pressure at home when you are relaxed. In older people, high blood pressure can also be a risk factor for heart disease and strokes, so it is important to pick up any changes early on.

Diabetes annual review

You should have a number of additional health checks once a year. This is your diabetes annual review and is an opportunity to check for any early signs of other health concerns which may be related to diabetes.

Diabetes can cause damage to the blood vessels in the body. These include the tiny vessels supplying the eyes, nerves and kidneys and also to the larger blood vessels in the legs and heart.

Keeping your blood sugar within the target range of 4-7mmol/l for as much of the time as possible, will reduce your chances of developing complications in the future. If blood sugars stay high over long periods of time, there is a greater the risk of developing diabetes related complications. You can reduce your chances of problems by trying to keep your time in target range to over 70 percent, and your HbA1c result below 48mmol/mol.

Even if your HbA1c is less than 48mmol/mol, an annual review is important, as it is a time to remind you of other precautions you should take to keep yourself as healthy as possible.

Tests done at your annual review are outlined below. There is also information and advice about keeping as healthy and safe as possible when you have diabetes. Please ask if you have any questions or would like to discuss anything.

Eyesight checks

Eye tests with an optician are recommended at least every 2 years for all ages.

Additional to routine eye tests, from 12 years onwards you should have a diabetes retinal screening appointment. To register for this eye screening you need to sign a form, either in clinic or at your GP. You will be sent a list of registered Opticians who have special retinal cameras to take photos of the back of your eye after your pupils have been dilated by eye drops.

This is to help recognize the early signs of diabetic retinopathy so you can have treatment to protect from damage to your vision, or even reverse eye changes if they are found early.

Retinopathy is rare in young people under 12 years of age, and tends to be related to consistently high blood sugar levels over a long period of time.

Foot care with diabetes

High blood glucose levels over very long periods of time can affect the feeling and reduce the blood supply to your feet, which can mean that sores or blisters don’t heal as well as they should.

During the annual review appointment your feet will be examined by either the doctor or nurse. This is to check that the feet are healthy, that the toenails or verrucae are not causing any problems, and to discuss good foot care. The sensation in your feet will also be checked, as high blood glucose levels over many years can damage the nerves (neuropathy).

To help keep feet healthy and protected from any damage:

  • keep shoes well fitted, make sure they do not rub or pinch
  • keep toe nails trimmed, cut straight across the nail, not round at an angle
  • wear socks with shoes
  • do not go barefoot, instead wear slippers or sliders
  • moisturise dry areas

Wee test

You will be given a small pot and asked to provide a wee sample. This is sent to the laboratory where they will test for traces of a protein called Albumin. You may hear it called urinary microalbuminuria screen. If there is protein present, it could indicate that the kidneys are not working as well as they should, but the test can be falsely positive if it is not from the first wee you do in the morning. You may be contacted to repeat it just to be sure.

The kidneys have a few important functions. One is to filter and clean the blood to get rid of any waste by making urine. They also regulate the amount of fluid and various salts in the body, which also helps to control blood pressure, and they release several hormones.

Nephropathy is the name for kidney disease associated with diabetes.

Vaccination against seasonal flu

It is important to protect your general health when you have diabetes.

Flu is a viral infection which is easily caught through coughing and sneezing. It is recommended that you have a vaccination to protect you against flu once every year. Catching flu can affect your blood glucose levels, and being unwell can increase your risk of developing high blood glucose levels and ketones.

Talk to you GP or practice nurse about booking your vaccination. They are generally available from October to January.

It is also recommended that you are also immunised against Pneumococcal infections. If you were born after 2006 and are fully immunised, you should already be protected through the childhood vaccination programme, but it is worth checking with your GP.

Injections and cannula sites

Some people notice lumps that can form under the skin if you inject in the same place too often, or insert your pump cannula or pod in the same place every time it is changed. This is called lipohypertrophy (also known as lipos).

These lumps can stop the insulin from being absorbed and working properly, so make sure you rotate where you inject and choose a different spot each time. Your sites will be checked at annual review, but if you notice any lumps, especially if they are not going away, speak to your diabetes doctor or nurse to check them at any time.

Wellbeing questionnaire

You will be given a well-being questionnaire to fill in before you go in to see the consultant.

This helps us to understand if you are finding any aspects of life with diabetes particularly difficult, such as fear of hypoglycaemia, managing your diabetes at school, or just feeling really fed-up with it all, and to find the most appropriate ways to help support you.

It may be helpful for you to talk to one of our psychologists. You can ask for this at any time and if a psychologist is not available in clinic, we can arrange a separate appointment.

Blood tests

Depending on your age and the type of diabetes you have, blood tests should be taken every year to screen for the following:

Coeliac disease

Coeliac disease is an auto-immune condition sometimes associated with diabetes, where the body is unable to process gluten which is found in wheat products. You many hear this referred to as Tissue Transglutaminase (TTG test).

Thyroid disease

Thyroid disease is where the thyroid gland produces a hormone which regulates the body’s metabolism. People with diabetes may have a slightly increased risk of having an underactive thyroid. An underactive thyroid is treated by taking thyroxine tablets. This is also an auto-immune condition. We test for Thyroid Stimulating Hormone (TSH) and the thyroid hormone T4.

Kidney function

Kidney function is measured by a test called Urea and Electrolytes (U&Es).

Cholesterol

Cholesterol is a fatty substance known as a lipid and is needed for the body to function normally. It is mainly made by the liver, but can also be found in some foods. Having a high level of lipids in the blood (hyperlipidaemia) can have an effect on health.

Liver function

Liver function tests tell us if there is any suspicion of liver disease, most commonly fatty liver disease which is associated with insulin resistance.

Liver function tests or cholesterol may not always be taken in children under the age of 12 years.

Numbing cream or spray can be used if you would like.

Support

You are entitled to apply for financial support 3 months after a diagnosis of diabetes, either Disability Living Allowance (DLA) if you are under 16years, or Personal Independence Payment (PIP) if over 16.

This is a benefit for people with a long term health condition or disability. A child or young person with diabetes often needs extra parental supervision and you may be awarded an allowance until your child becomes fully independent. There are different levels of financial support and not everyone will meet the threshold for additional financial help. Application forms are available online.

Disability living allowance (DLA) for children

Personal independence payment (PIP)

Oral health

We recommend regular dental check-ups as young people living with diabetes have a higher risk of tooth decay and inflammation of the gums. This is due to bacteria thriving in high levels of glucose in the saliva, so it is really important to develop a good oral hygiene routine. This can happen if blood glucose levels are higher than the target range, or because of hypo treatment.

If you treat a hypo overnight remember to brush your teeth afterwards.

Brush twice a day with toothpaste containing fluoride and spit it out, do not rinse it off. You can also use a fluoride mouthwash if you are over 7 years of age.

If you are not registered with a dentist, you can find one here.

Identification

We recommend that you carry some form of identification stating that you have diabetes and use insulin. This means that people can easily recognise your condition in an emergency, for example, if you should have a severe episode of hypoglycaemia. This is increasingly important as you gain independence and may be going to concerts and festivals or staying away from home. Here are 2 links for available bracelets, bands and chains:

Medicalert and SOS Talisman retailer.

Smoking

Smoking is one of the main causes of preventable illness and early death. We may ask about smoking, or vaping, and will offer to refer to the smoking cessation service if this is something that applies to you.

Useful websites and apps

Digibete

DigiBete is a website video platform and app, and is a one-stop-shop for young people’s T1 diabetes management.

The app is free of charge and you can watch videos about food, exercise and tips on managing symptoms. You can individualise your app and record your ratios, doses, clinic appointments, and also find out who your healthcare team members are. Ask the team for a clinic code to give you access.

There will be a T2 version coming out in 2023.

Social media groups

One of our families set up a Facebook Group for peer support and friendship. It is called Sheffield parents of children with diabetes.

There is also a Diabetes UK Sheffield group.

Instagram: Sheffielddiabetesuk

Email: sheffielddiabetesgroup@gmail.com

Charitable Organisations

Diabetes UK

Juvenile Diabetes Research Foundation (JDRF)

Is something missing from this resource that you think should be included? Please let us know

Contact us

Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

How useful did you find this resource?*

NHS

Western Bank
Sheffield
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

Interesting Facts


We’ve got a special MRI scanner just for teddies so children can see what it’s like before they have a scan.

Help to transform our extraordinary hospital into something even better.

@

By continuing to use the site, you agree to the use of cookies. more information

The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.

Close