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Diabetes Type 2

Care and treatment for type 2 diabetes

Diabetes care in the NHS is provided mainly by GPs. If there are any problems, you may be referred to a hospital-based diabetes care team. Most of the people we talked to were treated by the GP and/or specialist nurse, but others who had been treated in hospital as emergencies, or who had developed complications with diabetes were receiving specialist care in hospital. Those with other illnesses as well as diabetes used a combination of hospital and GP care. 

 

Shahnaz goes to hospital for regular checkups (video in Urdu).

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Age at interview: 54
Sex: Female
Age at diagnosis: 31
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And so, do you go to a special clinic or' who are your doctors?

Yes, there is a diabetic clinic here, you know the hospital. In the hospital there is a separate department for diabetes doctors and approximately every eight months you get an appointment where they take the whole, the urine sample, blood sample and check so that'Then after that they check your whole condition, they look at your symptoms, to see if they haven't got worse, they check your feet to see if there are any wounds, so in this way, they do the whole check up properly.

So how do you find it all this treatment and having to meet doctors?

It's okay. As long as God is keeping me alive I'll have to do it, won't I? I have to be cautious, and meeting doctors is also necessary, and I never miss an appointment.

Talking about your diabetes treatment and treatment management, have you ever had any complaint or any problems or felt troubled?

No, so far by God's blessing I haven't had anything like that. Everything is okay, all the doctors are also very good here, they care very much. And they also tell me 'This is what you should do, this is what you should use.' So there isn't anything like that.

 

Nasir goes to the hospital once a year and only goes to the GP if he has any problems with his...

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Age at interview: 38
Sex: Male
Age at diagnosis: 28
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Generally I'm not bad but sometimes, you know, like I say you can have your wee moments where you lose it for maybe a month or so or six weeks, and then you have to sort of drag yourself back on track. So the GPs etcetera here in [city], they've been quite good. I find that the clinic I go to, the diabetic clinic, it's at a hospital in [city] called the [hospital name], I only see them once, just once a year now. So they leave it to you to monitor it, and obviously if you've got problems go to your GP. 

And in some ways I think, leaving it to yourself can be a bit more riskier because you know that, I know that my appointment's in October, then I know, two months before if I'm good, when they take my tests it'll come out okay, and although that's wrong it's just psychological you can fall into the trap where you know, that okay I've got an appointment in October right from about the end of July, August I will be good and it'll all come out okay and the doctor won't say, you know, “You've been this, that and the next thing.” 

And how often do you see your doctor?

For diabetes? The GP? I actually don't see the GP about the diabetes now at all. Only if something was going wrong would I make an appointment and go and see them, but I generally find that the medication I'm on is, tends to be working and I think I know, you know, whether I've been good or bad. And from that and then from the blood test you know how it's going to impact you, and you've got your annual or bi-annual visit to the clinic really is enough.

Okay where they check you out?

Yeah they do the, you know, the A to Z of all the tests so, I think, I think with the GP it's only if something was going wrong that, you know, and felt maybe the medication wasn't working or you were being good as it were, and your sugar levels were still high, then obviously I'd make an appointment and go and see my doctor but, apart from that I probably wouldn't really.

 

Brian has colitis and attends diabetes clinics at the hospital and the GP and says that the...

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Age at interview: 69
Sex: Male
Age at diagnosis: 62
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The hospital do an annual check. And apparently it's always near your birthday; I hadn't realised that till recently. And the GP, the practice nurse sees me twice a year, every six months. She just basically asks me how things are going. Sticks a stick in my urine sample. Doesn't have the sort of machine they have in the outpatients at the hospital. Because they have a wonderful little machine. They just put the stick in and it disappears and comes back and a whole screed of information appears on it - really impresses me, that, because I'm a man of the technological age. But the GP is basically just a dipstick they check for keytones and sugar. And they say automatically, you know, 'Well, you do know your sugar's high?' 'Yes.' Or, 'Your keytones aren't too bad.' And then they send blood samples off to the hospital.

In [city], the GP I don't see until I want to. There's no regular contact. The practice nurse, diabetic nurse sees me twice a year. The consultant sees me irregularly, but he's available if the nurse needs him. If the practice nurse is worried at all she can get me an extra appointment. I tend to go every three months to see the consultant. He has a good link with the surgery. Because within, I was going to say hours, but within a couple of days of him having me in to see him, he then has a report to my GP. And, especially if there's been any change in the medication, by the time I get round to contacting the surgery, they know that the medication has been changed and will provide it for me. So in [city], I mean I can't speak for other towns, but in [city] the service is extremely good.

So is it that when you have your, when you have a, a question about diabetes or, or a problem with your diabetes, you go to the diabetes consultant? And if you have, you, you know, get in touch with the diabetes consultant?

Yes. I mean if it, if it blew up suddenly, I would possibly try to see my GP. And then he would possibly, you know, he, as I said earlier, not all GPs are fully conversant with every illness, they can't be, and as I say my GP isn't particularly conversant with diabetes. So he would either go along and see his colleague, who may be more conversant, or immediately get a link with the hospital and get an emergency appointment to see the consultant.

And it does work. I mean it's only happened once. But it, within sort of three or four days there was a phone call saying, 'Will you come along and see the consultant.' But usually the quarterly visits to see the consultant are such that he's got all the blood tests in front of him and all your, all his statistics, and a quick scan of his television screen and he can advise you how things are going.

 

Adrian explains that he sees his GP for diabetes care and a private consultant for lymphangiectasia.

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Age at interview: 53
Sex: Male
Age at diagnosis: 48
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No, no actually, it's a private consultant who I see probably now while everything's going smoothly it can come down to an annual checkup. I did see him quite regularly last year when there were various sort of complications and issues that took several months to bottom out.

To deal with?

That turned out to be the lymphangiectasia. Which was difficult to diagnose I gather, it's uncommon and that is what had resulted in the fluid accumulations, oh and, a chest infection, TB actually, a sort of TB, and that was by reason of the reduced antibodies. So I am in addition to the diabetes drugs I am actually currently on a course of antibiotics, well specific antibiotics for that infection, which is a two year course.

So I mean how often would you see your, physician - a consultant is it?

Well I think he is a physician actually, and I mean I haven't seen him actually for several months, simply because I've been seeing so many others. But I probably, I probably will make an appointment to go and see him again soon because of a general update.

And for the annual… I mean do you get annual checks as well for I mean do have a retina scan and…?

Oh yes, yes I do actually. Yeah, and that I do in my GP's surgery.

So how does that work? You see, you don't see the GP normally?

No. But they know that I have type 2 diabetes, and I get my drugs and prescriptions through them, and they simply put me on a list for a retina scan, scanning once a year, and I dutifully go and do it.

So who prescribes the drugs?

That, my physician then reports to my GP and suggests that he issues the prescriptions he recommends, and that happens.

Everyone with diabetes should have an annual check-up with the GP and specialist nurse at the GP practice. Each person will have a range of tests to check long-term blood glucose levels (the HbA1c test), blood pressure, kidney function and cholesterol. Patients also have their weight checked and BMI (Body Mass Index) calculated and recorded. The nurse or a podiatrist carries out an annual check of the feet and tests for loss of feeling in the feet and legs, to pick up early signs of nerve damage (neuropathy). Dietary advice is provided by nurses or by referral to a specialist dietician. It is important for all people with diabetes to have an annual eye check and this is normally done by a recall system for retinal photography carried out by designated opticians/optometrists.

The Department of Health has set out national standards for NHS organisations and professionals for diabetes care and prevention. The Diabetes National Service Framework was developed by diabetes clinical experts and patients with diabetes. Good diabetes care includes:
  • Awareness of the risk factors for type 2 diabetes.
  • Advice and support to help people at risk of type 2 diabetes reduce that risk.
  • Access to information and appropriate support for people with type 1 and type 2 diabetes, including access to a structured education programme, such as DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed or X-PERT Health).
  • An agreed care plan, helping all people with diabetes to manage their care and lead a healthy lifestyle, including a named contact for their care.
  • Information, care and support to enable all people with diabetes to optimise control of their blood glucose, maintain an acceptable blood pressure and minimise other risk factors for developing complications.
  • Access to services to identify and treat possible complications, such as screening for diabetic retinopathy and specialised foot care.
  • Effective care for all people with diabetes admitted to hospital, for whatever reason. (From NHS choices 2014.)
 

Stuart goes to the GP for routine checkups and also sees a chiropodist and dietician.

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Age at interview: 60
Sex: Male
Age at diagnosis: 55
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At the six-monthly check I go and see the, the practice nurse, who has an interest in diabetes. And she takes the blood, she takes the measurements, and the weight and the height, and various other bits and pieces of test and asks the questions. And then at the twelve-monthly check, which is in my case towards the end of the year, we do the same thing. And once the results come back I then have to go and see the doctor, who interprets the results, if you like, and, and will then make a decision whether some other course of treatment ought to take place or whether we're quite happy to go along for the next twelve months.

And in the interim, if it's felt necessary, we'd go, I'd go and see the chiropodist. The dietician I've seen once. But, you know, she was saying that, you know, because of what, the way we eat, then she couldn't really improve a lot on, on that. So I don't see her very often. And we have an annual eye test, eye check, just to make sure everything's behaving as it should do at the back of the eyes.

So I think, I think I'm fairly well looked after. I mean my particular GPs' surgery, I can get an appointment the same day, and I could wander up and sit down and wait and see a doctor. So there isn't a problem accessing either the doctors or the nurses up there. So I do know that if I had any concerns or wanted to know something, then quite easily I could get that information. And if I wanted something of a more general nature, then I could perhaps have a look on the Internet and see whether I could find anything out. But there, there hasn't been an occasion to do that as yet.

Many people talked about going to their local 'diabetes clinic' at the GP's surgery whenever they had any problems. Diabetes clinics, usually run by a specialist nurse, provided people with advice about medication, diet and weight control and also monitored when people needed their medication changed. Some people had been invited to diabetes workshops when first diagnosed.

 

Raj who also has a blood disorder (polycythemia) sees his GP every 3 months and finds it reassuring.

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Age at interview: 42
Sex: Male
Age at diagnosis: 41
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And how often do you see your GP now?

Well, mostly I, now I go to, every three months. If I need to go before or if I think I don't feel that well or there is something, I need to change any medicines, I can go any time. That's not a problem. They say to me like, 'Just give us a phone call and you'll be straight in, you know. That's not a problem at all, you know.' And they are always there to help me out. Nurses, doctor, they've been fantastic. I couldn't complain about them, you know. The way they done the things, they've done all, the thorough tests and everything. It's not only the diabetes, related, other things as well. They check everything to make sure everything else is okay.

What do you mean?

It's all the other tests, you know, related with the diabetes, like my kidneys, you know. They check, you know, my blood is flowing into the, my veins properly, that sort of thing. You know, like they check my feet, that sort of things, and make sure all my nerves and everything is fine, you know, and that sort of things, you know. They're always there, and the things like they always either phone me or just send me the letter, 'Right. You need to come over here to get it checked and everything, to make sure your health is okay.' So they're always supportive in that way.

 

Tina has regular contact with her diabetic nurse at the GP surgery and goes to the diabetic...

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Age at interview: 45
Sex: Female
Age at diagnosis: 33
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I see the GP I see, well I see my diabetic nurse at my GPs. I also still go to the [local] hospital which is diabetic the [name] diabetic centre there - I still go there but they only see me about once six months. So for more regular contact I would see my diabetic nurse at the doctors.

And what kind of things are they looking for when you go to the regular clinic? What happens to you do you get weighed, measured, blood tests. Can you just talk me through?

Yeah. Yeah. So, you get weighed. You get, they do blood tests sometimes - not all of the time - but most of the time they do a blood test. Most of the time you have to do a fasting blood test before you go to the clinic, about a week before you go to the clinic normally, you do a fasting blood test.

They just generally talk to you about how you've been managing. You know, how your sugar levels, you can keep a record of your sugar levels. I don't actually keep a record on in a book because of my eyesight, but I can, I can keep a record on my sugar monitoring, you know, finger thing, you know, that I prick my finger with to get the blood, you know, it keeps a record on the actual machine. Sorry, I don't know what it's called [laughs].

So yeah I keep a record on that and they just generally talk to me about how I've been coping with various situations. I mean eating out that sort of thing you know.

 

Rita goes to see the diabetes nurse every month for a checkup.

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Age at interview: 74
Sex: Female
Age at diagnosis: 68
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So how often do you see a nurse or a doctor?

Once a month you have to go, and you've got to do your things, you know. I've got all that there. And they're just keeping you in check. And then every I think it's three months or four months they check up on your pills etc, you know. Because you have to take pills that suit your diabetes. It's like cough mixture. You can't buy a cough mixture unless you h-, ask the pharmacist. Because they tend not to give you cough mixture now, the doctors.

But is there a diabetic nurse? And without naming any names, are there diabetic nurses?

They don't come visit, no.

But over there in the surgery?

There, oh, yes, they've got a proper diabetic clinic on that side, and the surgery is this side. Yes, there's two sisters there and there's a little nurse who does your blood and weighs you. And there's two sisters and there's another two nurses in there I think. Yes, there are. You know, they take your blood, take your blood, and then they stick needles in your feet, [laugh] feet, you know, your pressure, is it? is all right.

Yes.

Yes. Oh, yes, I suppose, yes.

So how often does that happen?

I don't go very often. Maybe my fault, because I don't feel that ill with it.

But do you have to go every, on a regular basis?

You have to have, your tablets have to be checked up, and to see if you're taking the right tablets etc. And you get all this thing done to you. But other than that I don't go.

But that's, how often is that? Is it three months or six months?

I think, it's about eight weeks I think. I can't remember now. About eight weeks I think. Yes, about that. But they always say, 'If you feel, if you feel ill or anything like that, just ring the doctor and the doctor will make an appointment either with the doctor or with the nurse.' But I, if, if I'm a bit worried over anything, which isn't very often, I will phone the nurse, I'll phone the clinic, not the surgery. Although it's all in the same grounds. I will do that.

Some of those working full-time said that diabetes clinics were always held on weekday mornings or afternoons and so were inconvenient. They wanted the chance to see their own GP at evening or Saturday clinics. Others who worked full-time said they preferred getting care from hospital clinics.

 

Wasim thinks it would be difficult to get the support he needs from his GP and prefers being...

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Age at interview: 29
Sex: Male
Age at diagnosis: 28
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Now, I know more about it - still probably don't know doesn't as much as probably could do - but it's been a constant learning curve because there's always' I mean in the whole process of me coming from hospital to home, there's been bits missed out that I've had to pick up on. You know, there's the support while you're at hospital, fantastic, look after you, brilliant. The transitional phases... They're the bits where it gets a bit messy, you know, it's where one's passing the beacon to the other but the other one is not really ready for it or they're not fully aware of the situation. 

Do you mean by that when you left hospital, it was a question of getting your notes to your GP?

I think that was faxed over. But I think the phrase that came to mind for me was that they were 'winging it'. They were basically going on the fly, they were basically, you know, looking at it as it came and, you know. To be fair ever since I've left the hospital, I've only ever seen my GP at my surgery once. See, he only does two sessions a week, in the afternoons or mornings and, and, you know, it's hard when you've got work commitments to try and take the time off. I mean my work's been really supportive they've, whenever there's been an annual check up thing, or the need, you know, then they'll give me time off to do it. So they're really supportive. 

But obviously in terms of the surgery everything I've really had information wise, I've had fantastic support from the diabetes specialist nurse at the hospital, you know, at the clinic, they're the ones that have been the most helpful, if ever I've had any queries they've got like an answering machine service, they get back to you. 

But you say you're not really getting on going regular check ups at the GPs?

Oh no.

Why is that?

I think from what I read, and what I understand of the whole system, you can choose where you want to have your treatment for, and even though. I don't know whether or not this is something that's... and based on what I've read and what I perceive about everything at the moment, the doctor's purely registered us so they get some sort of funding because I'm a diabetic patient under their care. Yet I'm not seen by them, I'm seen by the hospital. The only other things that I've really had are the you know the retinopathy scan when they check whether or not you're getting the glaucoma. I had one of those letters from the NHS Trust, went to one of these walk-in centres where they have a mobile unit, but everything else has been through the hospital.

 

Pamela works full-time in London and would like to be able to see her GP on a Saturday morning.

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Age at interview: 54
Sex: Female
Age at diagnosis: 50
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But looking back at your experience of type 2 diabetes so far, is there anything that you feel like you could have done with more support on?

I would have liked to have had evening access to the GP, that would have been... or Saturday morning, that would have made my life much, much better. I had access to dietitians. I'm not, I'm not sure that anything else would have really helped. It was about me not wanting to be helped I think. But just from a physical point of view, certainly having' I mean you can't even pick up a prescription at my GP on a Saturday morning, you know. I've now got them arranged that they will take them to [supermarket]. They go to [supermarket] and I collect them there. Because [supermarket] pharmacy stays open till 9 or 10 o'clock at night. Which is really useful, you know, when you work. So I think that, you know, just that would have made a difference. It would have meant that I wasn't so worried about the effect on my working life. I think that would have, would have eased that pressure, yes.

When people had used the internet to search for information about diabetes (see Looking for Information and Support) or when there had been a story about diabetes in the media, some people wanted better access to their GP for reassurance. Several wondered why GPs couldn't respond to queries with simple emails or text messages and help put their fears to rest. 

Several people for whom English was a second or third language, said they valued being able to see a GP with an expertise in diabetes who could talk to them in their own language. 
 

Last reviewed March 2016.
Last updated March 2016.
 

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