Updated: Jan 18
It's tempting to want your doctor to just fix your diabetes for you. But having the knowledge and confidence to be an expert in your own diabetes, so you can be a partner in your care, will really help both of you.
A diagnosis of Prediabetes or Type 2 Diabetes can be confusing and frustrating. You may not even be feeling unwell, and in fact you probably aren't. Your diagnosis doesn't mean that you have an illness, but simply that you are at increased risk of the long term complications of diabetes if care isn't taken to prevent them.
So it's understandable to just want you GP to tell you what to eat and what medications to take to fix your diabetes. But understanding your diabetes and the treatment options available, will make you a partner in your care and have real benefits for your long term health.
Why your Diabetes Review is not enough.
You are entitled to a regular diabetes review at your GP practice, and may be referred into a community or hospital diabetes team for additional support. At your review you will discuss your blood and other tests, and agree goals and treatments for your diabetes care.
But you only spend a few hours each year receiving support from your diabetes care team. The rest of the time you have to make your own decisions about your diet, lifestyle, medication and when to ask for support.
In the past people often had a family doctor who got to know them and their family by seeing them regularly through life. But this is becoming less common. The way GP practices are run is changing, using more salaried doctors rather than partners, and we are also more likely to move areas and GP practice these days.
You may now see a different doctor or nurse every time you have a review. These health professionals will be well trained and up to date with the latest medical treatment of diabetes, but will have little chance to learn about you and your life.
What information might be needed to make decisions about your diabetes care?
I have previously discussed this subject in relation to food in my blog 'Just tell me what I can and can't eat', but understanding more about your life is useful for decisions about all your diabetes care, and the only person who can be an expert on your life is you.
Things that might affect your food choices include who you live and eat with, particularly who does the cooking and shopping. Some changes might not fit in with other people in your household or you may not have control over what is bought and cooked. You will have your own likes and dislikes, and you may be a keen cook or not have the cooking skills or time to make complex recipes.
You job is also important. Do you work long hours or have work shifts might mean that your mealtimes change from week to week. Can you take food into work and keep it cool and do you have facilities to heat or cook food and somewhere clean to eat?
You might already have an active hobby or been keen to take one up, or you may have caring or work responsibilities which mean any changes have to be fitted in around this.
All these things not only affect what you choose to eat, but also affects choice of medication as some require regular meals, or others may give you more flexibility but need to be adjusted according to your food and exercise.
Understanding what works and how it works can help choose what's right for you.
An up to date understanding of the treatments available for diabetes can help you to work in partnership with your diabetes team to choose what will work for you and fit in with your lifestyle. It also helps to make the most of the limited time that your doctor or Diabetes Specialist Nurse has with you at your review.
It can sometimes be difficult to tell the difference between a new discovery about diet and diabetes and someone with a book to sell and excellent PR. Straightforward, practical advice on healthy eating and activity is rarely glamorous, and so often don't get the same coverage in the media. I talk more about this in my previous blog post 5 things dietitians wish the media wouldn't do.
So understanding which approaches have evidence that they work can be of great help. It's also important to understand about how much time and effort they require. Some might work really well, but need a lot of changes and just not be practical for you right now. Then it might be better to understand what small changes have the most benefits.
This also applies to diabetes medications. Rather than simply relying on the doctor to decide what you will take, understand how they work with your food and activity can help you understand what might work for you.
As mentioned above some medications need you to eat regularly. Others might give you more flexibility about what and when you eat, but might need to be adjusted according to your food and exercise. Some are very effective, but may increase your risk of gaining weight, so it is important to understand how to reduce the risk of this. Others might help you to lose weight, but only if you make the right changes.
Sometimes medications can be avoided all together with the right lifestyle choices. But only you can be the expert on whether you are willing to make the changes necessary, or whether medication may be a better option to reduce your long term risk.
Diabetes medications cost the NHS 10% of its budget. The complications that they prevent would cost very much more, but it is still important that new and expensive medications are only prescribed to those who would benefit from them the most. This means that there are strict criteria for who is prescribed them.
Having an understanding of how they work and being motivated to make the changes needed for them to be effectie
Having an understanding of how they work and the changes that you might need to make to your diet and lifestyle to make them most effective, can help you understand if you have the motivation to make these changes. This can also provide your GP or Diabetes Specialist Nurse with the evidence needed to prescribe them to you.
Knowing when to make changes and when to ask for help.
The aim of diabetes treatment is preventing its complications. If you understand the these and what the symptoms they might have, you can spot the any warning signs and make an appointment with your diabetes team to discuss them
How do I get this knowledge and confidence.
One of the best ways of becoming an expert in your own diabetes is to do a Structured Education Course. These are usually a couple of hours a week over 4-6 weeks where you learn more about your diabetes as a group. For Prediabetes there is the Diabetes Prevention Program, for Type 2 Diabetes X-PERT and DESMOND and for Type 1 Diabetes DAFNE and BERT1E, plus other courses developed and run locally.
Right at the moment these group courses aren't running due to COVID restrictions, but some departments are starting to run virtual sessions or they may be available online. Speak to your GP Surgery to find out what is available locally.
How an appointment with a Diabetes Specialist Dietitian will help.
Diabetes Specialist Dietitians are experts in diet and diabetes. They complete a four-year dietetics degree with clinical placements before starting work in the NHS, then usually work for a period as a general dietitian, seeing patients with a range of different medical conditions before specialising in diabetes. Upon graduating I worked in general diabetes and weight management for 2 years before working as a Diabetes Specialist Dietitian since 2009.
I am trained to look at all the scientific evidence on diet and lifestyle, and translate it into straightforward, practical advice that works. I am familiar with the different diet and lifestyle approaches for managing diabetes and how each interacts with medication prescribed for diabetes. This means that I can explain the benefits and drawbacks of each to help you make your own mind up about what changes you want to make to benefit your diabetes control and health.
When you book an hour-long appointment with me, you will have more time to have all your questions about diet answered. I will also ask you about all the things that might affect your food choices such as your medical history and medication, who you live and eat with, what your job and hobbies are and your likes and dislikes. This will help me to support you to decide which changes to make that will fit in with your life and work for you.
I am currently offering Video Consultations allowing you to talk to me at a place and time that suits you. Appointments can be booked online from my website by clicking the book now button below or click services for more information about what I offer.