Extensive Set of Slides for Self and Patient Education based on the Alphabet Strategy for Diabetes Care

1. Living with Diabetes
Module 1
Initial diagnosis and gaining control
Type 2 diabetes

2. Living with Diabetes
• Programme objectives- Module 1
– To understand the 2 main types and causes of diabetes
– To explore the range of feelings upon diagnosis
– How to gain control of your diabetes including
• Lifestyle changes
• Regular blood/urine testing

3. Living with Diabetes
• Diabetes is becoming increasingly common.
– Some statistics
• Over 4 million people with Diabetes in the UK
• ¾ million unaware of their condition
• By 2025 predicted to grow to 5 million
• 8% of the population will be affected
SO YOU ARE NOT ALONE!

4. Living with Diabetes
• What is Diabetes?
– Condition in which the amount of glucose in the blood is too high
and the body can’t use it properly
– Glucose comes from starchy foods
like bread, rice or potatoes and is also
stored in the liver
– A hormone called Insulin normally
controls levels of glucose in the blood.
– If you have diabetes the glucose in the
blood is not taken into the cells and used
as energy

5. Living with Diabetes
• Types of Diabetes
– There are 2 main types
• Type 1 the body is unable to make any insulin and usually appears
before the age of 40
• Type 2 develops when the body can still make
some insulin but not enough or the insulin
made does not work properly. This usually
appears after the age of 40. In African - Caribbean
and South Asian communities it can occur as early
as 25 years of age

6. Living with Diabetes
• What causes Diabetes?
– Nobody is sure but Type 2 often runs in families
– People are at risk of diabetes if they
• Are overweight
• Have a poor diet
• Do not exercise regularly

7. Living with Diabetes
• Recognising the symptoms
– Some common warning signs
• Increased thirst
• Passing water frequently especially at night
• Weight loss
• Tiredness
• Genital itching/thrush
• Slow healing of wounds
• Blurred vision

8. Living with Diabetes
• Upon diagnosis
– Being diagnosed comes as a shock
– People react differently but all struggle to make sense of their
diagnosis
HOW DID YOU FEEL WHEN YOU WERE DIAGNOSED?
THIS BEHAVIOUR IS NORMAL
Your concerns will fade as you understand more and become
confident in your ability to cope.

9. Living with Diabetes
• Lifestyle changes
– Only you can manage your condition. To do so
effectively some lifestyle changes will be necessary
– You will need a plan!
– Your health care professional
will help but you need to set your
own targets
– Involve your family as they need
to know how to help and will keep you motivated

10. Living with Diabetes
• Your Care Plan
– Establish where you are and what changes you will
need to make with your Healthcare professional
– Key elements of your plan will include;
• Weight
• Diet
• Physical activity
• Smoking and drinking habits

11. Living with Diabetes
Smoking
– Stopping smoking is the single most positive thing you can do.
WHY?
– Having diabetes means you run a higher risk of damaged blood
vessels, this can lead to heart attacks and problems of blood
circulation especially to your legs and feet. Combine the effects
of smoking which clogs up the arteries and quitting makes
sense.
Ask your healthcare team for help

12. Living with Diabetes
• Alcohol consumption
– You don’t have to give up drinking just because you
have diabetes but drink sensibly.
– Follow the recommended daily intakes
• 1-2 units for women
• 2-3 units for men
– Remember alcohol is a source of
additional calories as well

13. Living with Diabetes
• Diet
– People always ask; what can I eat?
• The answer is a balanced diet which is;
– Low in fat
– Low in sugar and salt
– High in fibre
– Has plenty of fruit and vegetables
• Your healthcare professional will refer you to a registered
dietician to refine your diet to suit your personal needs
www.nottinghamdiabetes.nhs.uk

14. Living with Diabetes
• Physical activity
– Research shows you can benefit enormously from
increasing your level of activity
• Moderate activity for half an hour every day is
recommended BUT DON’T GO MAD!
Build up the levels gradually You must
enjoy your activity for it to be sustained.
Walking, gardening, swimming, dancing,
cycling are all good ways of increasing
your activity levels

15. Living with Diabetes
• Testing for good control
– Monitoring your blood or urine for glucose is central to
keeping your diabetes under control
• You also need to understand how exercise, diet and
medication can affect your control
GOOD CONTROL MEANS KEEPING YOUR BLOOD
GLUCOSE LEVELS BETWEEN 4-6MMOL/L

16. Living with diabetes
• Blood testing
– Results are more accurate than the urine test as real
time results are gained
– Ensure that you read instructions
carefully and record your results.
This will allow you to learn how
different levels of exercise or diet
can affect your control and support your care plan
Your healthcare professional will show you how to test
and record your results and dispose of any sharps.

17. Living with Diabetes
• Summary
– At the end of this module you will be able to:
• understand the main types and causes of diabetes
• describe the symptoms of diabetes
• recognise some of the varied emotions
people experience upon diagnosis
• state the importance of your care plan
and changes in lifestyle to maintain
good control
• describe the importance of testing and recording your results

18. Living with Diabetes
Module 2
Care and Support

19. Living with Diabetes
• Programme objectives - Module 2
– At the end of the Module you will be able to:
• Describe the standards of care a person
with diabetes should receive from the NHS
• Understand the different treatments
available and how they change over time
• Recognise the symptoms and treatment
of hypoglycaemia
• Explain the importance of keeping people informed and when to
notify the authorities of your condition

20. Living with Diabetes
• The healthcare team
– People with Diabetes have a huge team to
support them including
• Your GP
• Practice nurse
• Diabetes specialist nurse
• Dietician
• Podiatrist (for foot problems)
• Eye specialist
• Diabetologist (consultant) www.foothealthcare.com
www.tednelson.net
www.pro.corbis.com

21. Living with Diabetes
• Standards of Care
– There are recommended standards of care
which you are entitled to at various times as
follows:
• Initial diagnosis
• When you start using insulin
• When your condition has stabilised
• Annually
Are you aware of your entitlement?

22. Living with Diabetes
• Standards of Care - At initial diagnosis
– Full medical examination
– Agree named contact to support you at your surgery
– Talk from healthcare professional on
– diabetes and services available
– Talk from dietician
– Information on diabetes and driving,
job, insurance
– Agreement of your own “Care Plan”
– Opportunity to participate in structured education
– Support should you need it to cope with your diagnosis
www.pro.corbis.com

23. Living with Diabetes
• Standards of Care – Starting on insulin
– Instruction on how to inject, look after your insulin,
pens and dispose of sharps (needles)
– Possible side effects of using insulin
– How to test your blood for glucose
and understand the results
– Discuss “hypos” and what action to take
– Be given supplies of medication and
equipment and how the equipment works
www.bddiabetes.com
www.dudley.nhs.uk

24. Living with Diabetes
• Standards of Care – Once under control
– Have access at regular intervals (4-6mths) to support
– Contact details for specialist advice
– More education sessions as and when required
– Review tests with your GP at least annually

25. Living with Diabetes
• Standards of Care – At least annually
– Weight checked
– Urine tested for traces of protein
– Blood test for kidney function, cholesterol
and other blood fats
– HbA1c test for long term control
– Discuss home test results and incidence of Hypos
– Check blood pressure
– Check vision and back of eyes are photographed (retinal
screening)
– Legs and feet for circulation and feeling
– Injection sites examined if on insulin
– Discuss your Care Plan, progress towards your targets

26. Living with Diabetes
• Treatment – Type 2
– Most people start on tablets, diet and
exercise to control their condition
– 20% manage on diet and exercise only
– 25% need insulin
Diabetes is a long term condition and
your medication will change over time.

27. Living with Diabetes
• Sick day Rules – Key points
– Don’t stop taking your medicine
– Drink plenty of unsweetened fluids
– If you can’t take solid food,
drink sugary drinks or sweets
– Test your blood glucose regularly
– Test for Ketones if you have the kit
– If blood glucose levels are over 15 mmol/l or urine tests are
positive you may need to increase your dose. Ask your GP
– Rest!!
– Contact the GP if you can’t keep anything down, blood glucose
levels are continuously high or are unsure what to do

28. Living with Diabetes
• Dealing with “hypos”
– Hypos are caused by there being insufficient
glucose in the blood due to;
• A missed meal
• Too much exercise
• Injecting too much insulin
• A lack of carbohydrates in the food www.hypoglycaemic.com

29. Living with Diabetes
• Symptoms of a “hypo”
– Common signs include;
• Shaking
• Feeling faint or wobbly
• Sweating
• Tingling lips
• Hunger
• Anxiety or feeling irritable
• Fast pulse or palpitations
• Blurred vision
Get to know your signs and symptoms

30. Living with Diabetes
• “Hypos” Actions to take
– Take fast acting carbohydrates: eg jelly beans,
glucose tablets, sweets or a sweet drink
– Followed by a sandwich, bowl of cereal
or the next meal
– When driving always have fast acting carbohydrates on board just
in case of emergencies

31. Living with Diabetes
• Keeping people informed
– Inform your employer/ work mates
– Inform DVLA normally it will not prevent you from driving. If you are on
insulin they will reduce your license to 1-3 years
– Inform your insurance company. It’s best if in doubt to tell so you know
you are covered by the policy
– Inform other healthcare professional/health/ sports club
– Use a medi tag or carry other form of
identification concerning your condition
in case of emergencies
– You can get free prescriptions provided
you are not treated by diet alone

32. Living with Diabetes
• Further Training
– There are a number of recognised education
programmes including:
• DESMOND
• X-PERT
• Experts Patients Programme
• DAFNE (for Type1 patients)
Ask your GP for more information

33. Living with Diabetes
• Summary
– At the end of this module you will be able to:
• List the various healthcare professionals
supporting your “Care Plan”
• Describe the standards of care you can
expect to support your condition
• Understand your treatment and how to
recognise, treat and avoid “hypos”
• Understand who and why you need to
keep people informed about your condition
• Talk to your GP about education choices

34. Living with Diabetes
Module 3
Diet and Exercise

35. Living with Diabetes
• Programme objectives
– At the end of the module you will be able to;
• Describe a healthy diet which meets your needs
• Describe the benefits of increased physical activity
• State the importance of checking your feet regularly
• State the importance of retinal screening and how good
control can benefit your eyes
www.cornwall.nhs.uk

36. Living with Diabetes
• What can I eat?
– A healthy balanced diet
– 80% of people when diagnosed with
diabetes are overweight so often it’s
important to loose weight as well
– Follow the advice of your dietician
and healthcare team and you will
not only loose weight but feel
much better as well

37. Living with Diabetes
• 10 steps to Healthy Eating
– Eat 3 meals a day spread over the whole day
– Eat meals based on starchy foods e.g. bread, rice, choose foods
with a low glycaemic index
– Cut down on the fat you eat especially saturated animal fats
– Eat more fruit and vegetables 5 a day
– Include more beans and lentils in your diet
– Aim to eat 2 portions of fish a week
– Reduce sugar and sugary foods
– Use less salt 6 grams or less per day
– Drink alcohol in moderation only 2 -3 units per day
– Avoid diabetic foods/ drinks

38. Living with Diabetes
• Healthy Eating
– The Eatwell plate, Use it to get the balance of food
right.
www.nottinghamdiabetes.nhs.uk

39. Living with Diabetes
• Food labelling
– Use food labels to help your “healthy eating”
• Remember to consider portion size as well
as the nutritional values, guideline daily
amounts can help in this respect
• Traffic light system
– You can see at a glance if the food has high
medium or low amounts of fat, sugar and salt
– RED = High in fat, sugar or salt we are trying
to cut down on
– AMBER= Neither high or low
– GREEN = Low in fat, sugar or salt therefore a
healthy choice
Most foods are a mixture of red, amber and green so
go for more greens and ambers for the healthy choice
www.bhf.org.uk

40. Living with Diabetes
• Physical Activity
– Increasing activity has a positive effect on your weight, blood
glucose and blood pressure levels. It also reduces the risk of
heart disease
– Discuss the right type of exercise for you with
your GP and choose something you enjoy
otherwise it won’t last.
– Half an hour activity each day is the current
recommendation
– If you are on insulin or some tablets you may
become more susceptible to hypos as exercise
lowers your blood glucose levels. Carry some
fast acting carbohydrates in case of emergencies

41. Living with Diabetes
• Caring for your Eyes and feet
– High blood glucose levels cause damage to your
blood vessels and nerves over time
– Your eyes and feet are particularly susceptible and
can lead to blindness and amputation of limbs if not
carefully monitored

42. Living with Diabetes
• Looking after your Eyes
– To avoid complications you should
• Maintain good blood glucose and blood pressure levels. This will
reduce your chances of developing retinopathy by 76% (damage
to the back of the eyes)
• Always attend your annual eye screening
clinic as early identification of retinopathy
can prevent blindness
• Have your eyes tested regularly by your
optician

43. Living with Diabetes
• Looking after your feet
– Your feet may not be receiving a good blood supply
due to damaged blood vessels. This may lead to loss
of feeling in your feet (Neuropathy)
– To avoid complications you should
• Check your feet daily
• Treat minor injuries seriously to avoid
more serious damage occurring
• Have your feet checked at least annually
by your GP or podiatrist more often if required
• Always wear appropriate and comfortable footwear
• Don’t walk bare foot

44. Living with Diabetes
• Summary
– At the end of this module you will be able to:
• Describe 10 steps to eating a healthy diet
• Use food labelling as a guide to eating a balanced diet
• Describe the benefits of increased physical activity and the
risks involved
• Understand the importance of retinal screening and good
control to avoid complications
• Understand the importance of caring for your feet and regular
inspection to avoid complications

45. Living with Diabetes
Module 4
A strategy for Life

46. Living with Diabetes
• Programme Objectives
– At the end of the Module you will be able to:
• Describe the alphabet strategy
• Name some of the more common
complications caused by diabetes
• Understand the importance of good
control and its impact on your health
• Make changes to your lifestyle and create a Care Plan suited
to your needs based on the Alphabet strategy

47. Living with Diabetes
• The Alphabet Strategy
– The alphabet strategy is based on understanding the causes and
complications which arise if your diabetes is not controlled
properly
– Based on 7 key areas of care
• Advice
• Blood pressure
• Cholesterol
• Diabetes control
• Eyes
• Feet
• Guardian drugs

48. Living with Diabetes
• Common complications
– The Alphabet strategy is designed to reduce
complications such as:
• Retinopathy (causes blindness)
• Heart attacks and strokes
• Nephropathy (Kidney damage)
• Foot and leg problems (amputations)
• Erectile dysfunction (in men)
• Peripheral neuropathy (loss of feeling in toes etc)

49. Living with Diabetes
• Alphabet Strategy-7 key areas for your Care Plan;
ADVICE
• Diet - a healthy balanced diet
• Exercise – 30 minutes every day on average
• Smoking – most complications are worsened by smoking
• Weight control – increased risk of diabetes and heart disease
with increasing waistline
• Alcohol – daily intake, max 14 units per week, alcohol free days
• Driving – Always keep glucose in the car in case of a hypo
• Hypos - When blood glucose levels are below 4 mmol/l
• Blood glucose levels – Generally 4 to 7 before meals and on
waking,
• HbA1c: Usual HbA1c target below 58 mmol/mol (7.5%)

50. Living with Diabetes
• Alphabet Strategy-7 key areas for your Care Plan:
BLOOD PRESSURE
– Your target should be 140/85
– High blood pressure increases the risk of
complications
– Check regularly and increase activity levels
– Review your diet and change if required
– Better control = heart attacks down by 21%
Strokes reduced by 44%
Death related to diabetes reduced by 32%

51. Living with Diabetes
• Alphabet Strategy-7 key areas for your Care Plan:
CHOLESTEROL
– Some blood fats are necessary to provide energy
– Too much fat in the blood causes weight problems
– It can block vessels over time and cause
heart attacks and strokes
– 2 types of Cholesterol HDL = good cholesterol
LDL = bad cholesterol. Targets LDL =2
HDL =1 for men 1.2 for women
– To control cholesterol- maintain low fat diet, exercise and loose weight if
required. Take statins daily under GP instructions
– This will lower the risk heart disease and strokes
www.abc.net.au

52. Living with Diabetes
• Alphabet Strategy- 7 key areas for your Care Plan:
DIABETES CONTROL
– Regular testing at home is essential aim for 4-6 mmol/l before meals
– HbA1c% test This value tells you the amount of glucose sticking to your
blood over the last 60-90 days and tells how well your diabetes is
controlled.
– Your HbA1c target is less than 58mmol/mol (7.5%)
– 100mmol/mol reduction in your HbA1c reduces complications as
follows;
• Poor circulation to legs reduced by 43%
• Eye and kidney disease reduced by 37%
• Heart failure reduced by 16%
• Heart attacks reduced by 14%
• Stroke reduced by 12%
So it’s worth knowing your HbA1c%!!

53. Living with Diabetes
• Alphabet Strategy- 7 key areas for your Care Plan:
EYES
– Diabetic Retinopathy most common cause of blindness
– 37% of Type 2 patients had some retinopathy at diagnosis
– 1500 new cases of blindness could be
prevented by annual eye screening
– 60% of diabetes patients have
retinopathy 20 years after diagnosis
– Laser treatment can save vision in
90% of cases
– Serious damage can occur to your eyes without you being aware
– Retinal screening is the only way to diagnose the eye disease
early DON’T MISS YOUR RETINAL
SCREENING IT’S IMPORTANT

54. Living with Diabetes
• Alphabet Strategy- 7 key areas for your Care Plan:
FEET
– People often loose feeling in their feet
– Even the smallest injury can lead to serious complications if not treated
promptly
– Get your feet checked annually by a
podiatrist or your GP
– People with diabetes are 15 times more
likely to have lower limb amputation
– 15% of ulcers will result in amputation
– Remember always wear comfortable fitting shoes
CHECK YOUR FEET EVERY DAY

55. Living with Diabetes
• Alphabet Strategy- 7key areas for your Care Plan:
GUARDIAN DRUGS
– Guardian drugs help minimise your risk of complications
– Your GP will advise
– Aspirin for those who have had stroke or heart attack (and some other
people) to reduce heart attacks/strokes
– ACE inhibitors or ARBS have a special role in preventing
complications and research has shown they reduce the incidence of
heart disease, strokes, kidney problems and eye disease.
– Statins are used to reduce cholesterol levels in the
blood to 4mmol/l or below. Treatment can reduce
the incidence of cardiovascular disease by 33%.
– Pregnant women should never be given statins
or ACE inhibitors or ARBs and some other drugs

56. Living with Diabetes
• Summary
– At the end of this module you will be able to
• Describe the alphabet strategy
• Name some of the more common complications caused by
diabetes
• Understand the importance of good
control and its impact on your health
• Make changes to your lifestyle and
create a Care Plan suited to your
needs based on the Alphabet strategy

57. Living with Diabetes
• Alphabet Strategy
– Advice
– Blood pressure
– Cholesterol
– Diabetes control
– Eyes
– Feet
– Guardian Drugs
It’s your strategy for life

58. Our patients need to be liberated from diabetes and its complications to reach their
highest state of mental, physical and spiritual development…..this can encourage
philanthropy and help society at large. VP
Alphabet Strategy In Gujarati