Diabetes Service - Salford Royal, Salford Community

We would encourage patients who live in Salford and have diabetes to sign up to diabetes my way.

• The website Diabetes My Way https://diabetesmyway.nhs.uk/registration gives you access to your NHS clinic results and contains information and resources that help you understand more about diabetes and explains how to manage the condition more effectively.

Here is a video about the platform https://vimeo.com/443196236

People who use the service say that it improves their knowledge and helps them meet goals, it improves motivation and acts as a reminder for discussions with medical staff during appointments. The service is not a replacement for your normal care, but helps you get advice and monitor your results before, during and after contacts with your healthcare team.

Please sign up using NHS login;

• go to https://diabetesmyway.nhs.uk/registration and click the ‘Register’ button.

If you have any other questions, please email the Diabetes My Way team at manchester@mwdh.co.uk or visit their contact page for more details https://diabetesmyway.nhs.uk/contact-us/

Every year your G.P will invite you annually for all clinical screening including blood tests, urinary screening, observations such as blood pressure and weight, and foot checks. Eye screening is carried out at a different location due to the equipment required. This is to monitor your ongoing health and to help reduce your risk/prevent/slow down any long-term conditions.

A full list of the checks your G.P will be preforming and the reasons for them are below we strongly recommend all patients with diabetes attend their screening appointment. If you think its been more than a year since your last check please contact your G.P to arrange a diabetes review.

• Diabetes UK – Know your 15 Healthcare essentials https://www.diabetes.org.uk/Guide-to-diabetes/Managing-your-diabetes/15-healthcare-essentials/What-are-the-15-Healthcare-Essentials

Contents

Driving and diabetes

Travel and diabetes

Sex and diabetes

Pregnancy and diabetes  

Diabetes and Emotional wellbeing.

Exercise and diabetes

Exercise resources for Salford patients with type 1 diabetes

Driving and diabetes

If you take insulin to manage your diabetes its very important to be aware of the laws around safe driving and insulin further information can be found below

• DVLA  

https://www.gov.uk/driving-medical-conditions
Information about medical conditions, disabilities and driving

• Trend

https://trend-uk.org/wp-content/uploads/2018/03/A5_6pp_Driving_TREND_CONNECT.pdf
Safe driving and diabetes leaflet

Travel and diabetes

Below is advice for before going on a trip if you feel you need to speak with us please contact our team at least 2 weeks before you go away. Also check you have appropriate insurance.

Travel:

➢ https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/travel

Travel letters

For who use insulin to manage their diabetes we provide travel letters (free of charge) to support your journey through security and customs with any diabetes related equipment and medication you are carrying. We personalise the letter to you and your therapy and any technology you use.

Sex and diabetes

We would encourage all patients who are sexually active and not trying to get pregnant to use contraception. For patients with type one diabetes the contraception method you choose may affect your diabetes control for further information please review  the website below.

https://jdrf.org.uk/information-support/living-with-type-1-diabetes/health-and-wellness/contraception/

Having diabetes doesn’t mean you will have problems with sex, but we know that many patients with diabetes find sex a cause of worry or anxiety if this is the case for you there are things that can help.

You can find more information and support here Sex and diabetes | Diabetes UK | Sex, Relationships and Diabetes

Some complications of diabetes can lead to sexual dysfunction. If you believe this may be affecting you, we encourage you to speak to your G.P as they can review the concern and offer things to help.  

Pregnancy and diabetes  

Many patients with diabetes have a healthy pregnancy and give birth to a healthy baby. However, having diabetes means that you and your baby are more at risk of serious health complications during pregnancy and childbirth. The good news is that by planning and getting support from your diabetes team, you can really reduce the risks involved.

If you are thinking of having a baby, please contact us before you come off birth control so we can assist you to prepare. Once you inform us you are thinking of starting a family, we will make you an appointment in our pre-pregnancy clinic to discuss optimising your diabetes and general health. It important that your diabetes is well controlled before and during your pregnancy for both yours and your baby’s health.

You can find further information on what is required to prepare for your pregnancy as well  as well as testimony from women with diabetes at Pregnancy and diabetes | Diabetes UK

If you are pregnant, please contact our service or your G.P urgently we will refer you to the diabetes specialist midwifes to support you.

Diabetes and Emotional wellbeing

Diabetes doesn't just affect you physically, it can affect you emotionally too. Whether you've just been diagnosed or you've lived with diabetes for a long time, you may need support for all the emotions you're feeling.

Diabetes UK can offer support in many ways there is some further information and tips on managing diabetes and emotional wellbeing here.

Emotions and diabetes | How to cope | Diabetes UK

If you are feeling overwhelmed or down about your diabetes management, we would encourage you to talk about how you are feeling to your G.P or diabetes specialist. They can explore your feelings and if needed refer you for more specialist support such as a counselling service that specialises in patients living with a long-term health condition.

You can also call diabetes U.Ks helpline on 0345 123 2399 or email helpline@diabetes.org.uk to speak to a trained counsellor. They can give you information about your condition, take time to talk things through and explore how you’re feeling.

Exercise and diabetes

Being physically active is very good for diabetes. Whether you feel able to go for a run or a swim or can manage some arm stretches or on-the-spot walking while the kettle boils, it all makes a difference.

You can find further information here  Diabetes and exercise | Type 1 and type 2 | Diabetes UK

We have provided Links to programs and resources below to assist you in getting started. This list only includes services which you can self-refer to regardless of your diabetes type.

There are additional services in Salford that can help you be more active or lose weight. Please discuss with your G.P or your specialist team and they will make you a referral to the service best suited to achieve your goal.

• Health Improvement Service

Salford patients living with diabetes can access the Health Improvement Service. This service offers a wide range of physical activities – there is something for everybody. Such as chair-based exercise classes, group dance classes, walking and cycling groups, as well as a tennis session and beginners bowls.

You can find further information here Getting more active • Salford City Council

You can self-refer to this service by calling 0800 952 1000. or by accessing the following website   

 Refer yourself, a patient or client to the Health Improvement Service • Salford City Council

• JDRF Peak Empower you.

Empower You works with communities to support disabled people to lead active lifestyles. The programme offers 8 weeks of support to engage disabled people to be more active, making activities of interest accessible, to support long-term independent engagement and maintenance of activity.

You can find further information here Beyond Empower - helping places #DoItDifferently

You can self-refer or support someone to refer by accessing the following website  Referral – Beyond Empower Social Impact System

• Weigh Ahead

Weigh Ahead is a six-week weight management programme focusing on making healthy and sustainable dietary changes to help you reach or maintain a healthy weight. We run face to face groups across the city, or there is the option of an online group accessed via Microsoft Teams.

You can learn more and self-refer accessing the following website  Weight management • Salford City Council

Exercise resources for Salford patients with type 1 diabetes

We recognize that there are often additional challenges that come with exercising when you have type 1 diabetes. There are many excellent resources and support groups below to support you in exercising while managing your diabetes. You can also speak to your diabetes specialists for support, as we have plenty of knowledge and skills to support you in all aspects of physical activity and exercise

• My Lifestyle | My Type 1 Diabetes

A NHS website that includes  eLearning courses for adults with type 1 diabetes, to help increase understanding and confidence in self management.  

• Diathlete

https://diathlete.org/sport-and-type-1-diabetes/
A community of people striving for empowerment through education for people with Type 1 diabetes

• Diabetes Football www.thediabetesfootballcommunity.com and @TDFCdiabetes on twitter

The diabetes football community for anyone with type one diabetes  playing football

•  RunSweet  

http://www.runsweet.com/
Diabetes and sport, helping people with diabetes become winners.

• EXTOD

http://www.extod.org/patient-advice
Website aimed at providing advice and guidance to people with Type 1 diabetes on safely and confidently managing blood glucose levels before, during, and after exercise

• JDRF Peak

https://www.jdrf.org/t1d-resources/hcp/peak-program/
JDRF Exercise and Knowledge (PEAK) Program is a unique outreach initiative that gives clear guidance on how to safely pursue exercise. PEAK provides education on the environmental, dietary, and physiologic elements that affect physical activity in those with Type 1 diabetes.

We are happy for patients who are currently under our care to contact us for support with their diabetes management either by email or phone. However, we ask that you first review our FAQ as they may answer your question.

Please note if you are not under our care for your diabetes then please contact your G.P to discuss your diabetes management. They will be able to help you with your diabetes and can refer you to our service if they feel you require further specialist support.  

Content: Please click on the question to be taken to the answer

I have had bloods taken to review my diabetes such as Hba1c could you tell me the result?

I am not feeling very well, and I take insulin to manage my diabetes what do I do?

I have heard about an alternative way to test my blood glucose instead of pricking my finger can I get access to this?

I was given new diabetes medications or supplies (needles/ strips ect) in the diabetes clinic or at Salford royal hospital how do I get more?

I was taking a GLP-1 medication  (ie Dulaglutide (Trulicity®), Exenatide (Bydetta® or Bydureon®), Semaglutide (Ozempic® or Rybelsus®), Liraglutide (Victoza®), Lixisenatide (Lyxumia®) my pharmacist has said it has run out.

I am going to for a procedure and I have been told to stop eating and I want to know what to do about my diabetes medications? 

I would like to rearrange my appointment with your service how do I do that?

I am having a technical issue with my Libre sensors what do I do?  

I am having a technical issue with my Dexcom one sensors what do I do?

My blood glucose meter is no longer working what should I do?

Can I recycle my insulin pens and diabetes devices?

I was using the Accu-Chek Aviva Expert meter/ I have heard there are apps which help to calculate the amount of rapid acting insulin to give with food what do you recommend?

I would like to go on an insulin pump how would I go about this?

I am having technical issues with my insulin pump what do I do?

How to I order more supplies for my insulin Pump?

When I try to increase my diabetes treatment to improve my overall blood glucose, I experience Hypo symptoms although my blood glucose is higher than 4. Why is this happening and what should I do about it?

I have had bloods taken to review my diabetes such as Hba1c could you tell me the result?

In order to get your results please contact your G.P alternatively you please go to the Tab diabetes my way and sign up for this service. Diabetes my way allows you to review all your blood results in real time as well as additional useful information about your diabetes.

I am not feeling very well, and I take insulin to manage my diabetes what do I do?

When you are unwell it is normal for your blood glucose levels to rise as your body requires more insulin when we are poorly. If unwell we advise you continue taking you insulin (even if you are eating less than normal) and testing your blood glucose regularly you may need to adjust the dose depending on what is happening with your blood glucose levels.

Please read the advice below and if you need further assistance, please contact us for support. Please note we are not an emergency service so we may not get back to you the same day if you are extremely unwell and need an urgent review then please contact 111 or 999 for support .

For patients who take empagliflozin, dapagliflozin or canagliflozin to manage their diabetes please stop this tablet while you are feeling unwell and restart it once you are feeling better.

If you have type 2 diabetes please read the below advice

• Trend UK – Type 2 Diabetes Sick day rules

A5_T2Illness_TREND_FINAL.pdf (trenddiabetes.online)

If you have type 1  diabetes please read the below advice

• Trend UK – Type 1 Diabetes Sick day rules

https://trenddiabetes.online/wp-content/uploads/2020/03/A5_T1Illness_TREND_FINAL.pdf

I have heard about an alternative way to test my blood glucose instead of pricking my finger can I get access to this?

CGM/FGM sensors are only available on the NHS to people who meet the criteria set by NHS England.

If you have type one diabetes, please ask your GP to refer you to our service and we will book you an appointment to start you on it please note the sensors are in high demand so there is a wait list.

Most patient with T2DM don’t meet the criteria to go on the sensors via the NHS however your G.P will discuss with you if they feel you, are an exception.

All patients regardless of type of diabetes can also self-fund the sensors see below websites for more details.

Dexcom Continuous Glucose Monitoring | Dexcom

Home | FreeStyle Libre | Abbott

I was given new diabetes medications or supplies (needles/ strips ect) in the diabetes clinic or at Salford royal hospital how do I get more?

After we review you, your DSN or DSD will write a letter electronically instructing your G.P what supplies you need going forward. Then you will need to contact your G.P to ask them to prescribe further supplies which will then go to your pharmacy of choice for you to pick up.

I was taking a GLP-1 medication  (ie Dulaglutide (Trulicity®), Exenatide (Bydetta® or Bydureon®), Semaglutide (Ozempic® or Rybelsus®), Liraglutide (Victoza®), Lixisenatide (Lyxumia®) my pharmacist has said it has run out.

Unfortunately, there is a worldwide shortage, and we are unable to get a hold of these medications. For further information please go to leaflets and read GLP1 shortage  - Patient leaflet

If you are concerned about your diabetes since stopping this medication, please contact us with your blood glucose levels we can then assist you to adjust your medication if needed. If you are not currently under our care, you can self-refer for education on or you can contact your G.P for a diabetes review.

I am going for a Colonoscopy and I want to know what to do about my diabetes medications?  

If you are going for a Colonoscopy please review the Patient Information Leaflet for advice. If you have further  questions following this then please feel free to contact us.

I would like to rearrange my appointment with your service how do I do that?

If you can’t attend the appointment you were given please email diabetes.admin1@nca.nhs.uk they will offer you the next available appointment.

You can also call on 0161 206 8802

Please  kindly inform us that you cant attend as soon as you become aware so you appointment can be offered to other patients.

I am having a technical issue with my Libre sensors what do I do? 

If you are concerned the Libre may not be working, always use your finger-prick result to decide on any treatment

If you have any issues with the sensor falling off, giving lots of errors, or not giving accurate readings, please contact Abbott on 0800 170 1177 or via their online form on www.freestyle.abbott/uk-en/support/contact

We recommend you turn off automatic software updates on your phone until Libre notifies you they have updated the app to match the new software. We have provided information to answer the most common questions we get from patients below.

 Alarms

• General advice is to set the low alarm between 3.8 to 4.5
  • The low alarm will only sound once, and will not repeat if your level continues to drop
• The high alarm is optional, but if you want it on we recommend to set it above 17 initially so it doesn’t go off constantly
  • Once you are more used to the Libre and your normal patterns, you can lower the high target if you want to aim for tighter glucose control  

If you are unsure please contact the team to discuss the best targets for you

• Car or motorcycle drivers (Group 1) can use their Libre for the purposes of driving, and the level must be above 5.0mmol to safely drive

When you need to scan

• You can still scan to save a reading as often as you like, but as long as you are within 6 metres of your phone, the sensor will send it a new reading every 1 minute
• If you have been away from your phone and the app is showing ‘Signal Loss’, scan the sensor to connect it back up again
• If you are using the handset instead of the mobile app you will need to scan to get the glucose result

Try not to panic if you see the arrow going up or down; think if you’ve just had something to eat or given some insulin

Common Issues:

‘Scan again in 10 minutes’ this can happen as your blood glucose may be changing too rapidly, or you may be dehydrated

• • Make sure to allow over 10 minutes before rescanning or the timer will reset

Low alarms when asleep

• • You may get false low readings if you are lying on the arm your sensor is in
  • If your graph looks like a flat red line, this could be a false low
  • Always test your level with a finger-prick blood glucose test to double check if you need any hypo treatment as it may be a false reading.

Sensor level not matching how you feel

• There is a time-delay of at least 5 minutes between the sensor and your finger-prick
  • This could be longer if you have exercised, just eaten or given insulin
  • Always finger-prick if how you are feeling does not match the reading the Libre is giving you
  • Always use your finger-prick result to decide on any treatment

If you take Vitamin C supplements this can sometimes cause your level to read lower on the sensor than the finger-prick

If you take Aspirin this can sometimes cause your level to read higher on the sensor than the finger-prick

It is recommended you complete the libre academy training (https://progress.freestylediabetes.co.uk/) as soon as you are started on the Libre to allow you to get most out of your technology.

I am having a technical issue with my Dexcom one sensors what do I do?   

If you are concerned the Dexcom may not be working, always use your finger-prick result to decide on any treatment.

If you have any issues with your blood glucose levels or insulin doses, contact the Community Diabetes Team on 0161 206 8802 or salford.diabetescare@nca.nhs.uk

If you have any issues with the sensor falling off, giving lots of errors, or not giving accurate readings, please contact Dexcom  on 0800 031 57 63 or fill out their online support form on Product Support Request (custhelp.com)

You can also find a list of common errors and how to resolve them on their website at Dexcom ONE CGM System troubleshooting FAQs | Dexcom

We have provided information to answer the most common questions we get from patients below.  

We recommend you turn off automatic software updates on your phone until Dexcom notifies you they have updated the app to match the new software.

•             The app will not override your phone settings; so if your phone is on silent, the alarms will not sound

•             The transmitter is reusable for 3 months, you can check when it was activated under the Transmitter information

Alarms

General advice is to set the low alarm between 3.8 to 4.5

We recommend setting up the Snooze reminder for 20 minutes. This will then go off if your blood glucose level is still at or below your low glucose target after 20 minutes

The high alarm is optional, but if you want it on we recommend to set it above 17 initially so it doesn’t go off constantly

We recommend setting the Delay First Alert to 1 hour. This will mean the high alarm only goes off if you have been above your high glucose target for 1 hour

Once you are more used to the sensors and your normal patterns, you can lower the high target if you want to aim for tighter glucose control.  If you are unsure please contact your specialist clinician to discuss the best settings for you

Car or motorcycle drivers (Group 1) can use their Dexcom for the purposes of driving, and the level must be above 5.0mmol to safely drive

Try not to panic if you see the arrow going up or down; think if you’ve just had something to eat or given some insulin

Common errors:

Low alarms when asleep You may get false low readings if you are lying on the arm your sensor is in. If your graph looks like a flat red line, this could be a false low. Always test your level with a finger-prick blood glucose test to double check if you need any hypo treatment

Sensor level not matching how you feel. There is a time-delay of at least 2.5 minutes between the sensor and your finger-prick, This could be longer if you have exercised, just eaten or given insulin. Always finger-prick if how you are feeling does not match the reading the Dexcom is giving you. Always use your finger-prick result to decide on any treatment when unsure.

If you take Vitamin C supplements this can sometimes cause your level to read lower on the sensor than the finger-prick

If you take Aspirin this can sometimes cause your level to read higher on the sensor than the finger-prick

My blood glucose meter is no longer working what should I do?

You can order a new blood glucose meter from the company who make them, and they will send you a new one first class. The free phone number to order a new blood glucose meter can be found on the box and on your blood glucose meter itself.

Can I recycle my insulin pens and diabetes devices?

Unfortunately, much your medical equipment is not recyclable we are aware this is an important issue and we have been informed there are plans to change this in the future.

The good news is some insulin pens can now be recycled If you take Levemir, Tresiba, Novorapid, Fiasp, or  Novomix 30 you can use the Pen recycling scheme.

if you use any of these products you can order cardboard recycling boxes to be delivered from www.pen-cycle.co.uk.

Once you have filled the box you can post it off to be recycled at any royal mail postbox and at some participating pharmacies (ask your local pharmacy if they are part of the scheme)

You can also request from your diabetes specialist nurse to change your disposable insulin to a fixed pen which you then fill with insulin yourself to reduce plastic use.   

I was using the Accu-Chek Aviva Expert meter/ I have heard there are apps which help to calculate the amount of rapid acting insulin to give with food what do you recommend?

Unfortunately the Accu-Chek Aviva Expert meter has been discontinued and there are no other bolus calculator meters on the market. We are recommending patients who are used to having support calculating the amount of insulin with their carbs download a Bolus calculator app on their phone. We also recommend these apps for all type one patient who carb count their meals as many patients have found them useful.

A list of recommended apps is below we advise you try a few of them and pick the one right for you. If you would like support in setting up a bolus calculator, please contact us and we will arrange this. We can do this over the phone, via video consultation or in person.

• Carbohydrate Calculator chart - https://www.ndr-uk.org/uploads/pdf/2201468335335.pdf
• Bolus calculator chart - https://www.ndr-uk.org/uploads/pdf/2211461925720.pdf
• DiabetesM - https://www.diabetes-m.com/blog/press-releases/diabetesm-gets-an-ios-version-and-a-premium-subscription-service/
• Mylife Bolus calculator app - https://www.mylife-diabetescare.com/en-GB/products/therapy-management/mylife-digital.html
• MySugr app - https://www.mysugr.com/en/

I would like to go on an insulin pump how would I go about this?

Insulin pumps are an alternative way of managing diabetes for patients with type one diabetes. An insulin pump is a small electronic device that releases the regular insulin your body needs through the day and night. Insulin pumps do not currently take over the management of your diabetes for you, they still require very  close management and good carb counting skills. In order to go on an insulin pump patients must meet strict criteria set by NHS England. If you are eligible for an insulin pump your diabetes specialist will discuss the pros and cons of pump therapy with you. Following this discussion if you then wish to apply to go onto a pump an appointment will be made in the pump clinic with the diabetes consultant who will review your diabetes and decide if an insulin pump is the right therapy for you.

I am having technical issues with my insulin pump what do I do?

If your blood glucose is high and you are concerned your insulin Pump may not be working, Check Ketones and follow sick day rules leaflet as advised by your specialist pump team.

If you need advice on your diabetes management or you need support to change back to subcut injections contact the team at salford.diabetescare@nca.nhs.uk or 0161 2068802

If you have any issues with your pump such as: charging problems, connectivity issues, problems downloading data,  lost or damaged pumps or handsets, error messages and pump failure then please contact you pump company below as they can support you in fixing these issues.

• Medtronic pumps: https://www.medtronic-diabetes.com/en-gb/contact
• Omnipod pumps: https://www.omnipod.com/en-gb/contact-us
• Ypsomed pumps: https://www.mylife-diabetescare.com/en-GB/services/customer-care-helpline.html
• Tslim Pumps: https://uk.healthcare.airliquide.com/contact-us

How to I order more supplies for my insulin Pump?

If you are under the Salford diabetes team and need to order more pumps supplies, please email diabetes.orders@nca.nhs.uk

Please note we ask all patients to order new supplies at least 6 weeks before they have run out.

When I try to increase my diabetes treatment to improve my overall blood glucose, I experience Hypo symptoms although my blood glucose is higher than 4. Why is this happening and what should I do about it?

You are experiencing what we call a false Hypo which is completely normal if you are used to having high blood glucose levels. It’s important that you don’t allow these symptoms to put you off lowering your levels and improving your diabetes as they will go away with time. Please read our pseudohypogycemia leaflet for more information on how to manage false Hypos.