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This page tells you more about Diabetes and local facilities for diabetic patients.

Diabetic clinics are held on Monday mornings in Llanharan and Thursday mornings at Pencoed.

Diabetes is a disease that leads to high blood glucose. Glucose is a sugar and we all need and use glucose in order to function properly. Our blood glucose levels have to be within the correct range, otherwise we start to feel ill. Diabetics get high blood sugars at levels of sugar intake that would not cause a problem for most people. Whenever we eat sugar, the levels in the blood start to go up as it is absorbed from the stomach. Our bodies then secrete a hormone called insulin from the pancreas. Insulin lowers the blood glucose so that it comes down to a normal level (between around 3 and 6 when tested in the lab). Diabetics may have a disorder of insulin production, or may develop resistance to the effects of insulin. As a result, their blood glucose levels remain high and may creep steadily upwards.
High blood glucose levels may lead to several problems. Glucose may seep into the sweat, skin, urine, body cavities etc. Bacteria and yeasts feed on glucose, so Diabetics may be prone to infections of all sorts: Skin infections and boils, "thrush" or candida, urine infections etc. Our bodies try to get rid of excess glucose by drawing it out in the urine. As a result, untreated Diabetics may pass lots of urine. Because they can lose a lot of fluid this way, they may be thirsty all the time. They may get up at night many times to pass urine. Children can wet the bed at a much older age. Tiredness and weight loss may be a feature. The problem for Doctors and patients alike is that these symptoms could apply to almost any disease and that the symptoms creep up slowly. They are, therefore, much less obvious because the symptoms can build up slowly over many months. High blood pressure is even more dangerous to diabetics than it is to everyone else. It seems that high blood glucose levels can accelerate the damage that can be done to the blood vessels due to high blood pressure and cholesterol. A large study called the UKPDS trial found that one of the most important things to be done in Diabetics is to tightly control the blood pressure. The ideal level is less than 140/80. Whenever you are seen in diabetic clinic, the Doctor will be checking to see that your blood pressure is mostly below this level. If it is not, you will be prescribed "antihypertensive" medication. To learn more about this treatment, please visit our section on high blood pressure.

Generally speaking, there are 2 main types of Diabetes:
Type 1 diabetes is the type of diabetes that affects younger people and children. These are the diabetics who invariably need insulin from the outset. These patients are usually managed at the hospital. Dr D J Beale, Dr D Jenkins and Dr J Williams are the specialists with an interest in Diabetes at the Princess of Wales Hospital, Bridgend.
Type 2 Diabetes (or "Maturity onset Diabetes") is the type of Diabetes that usually comes on in middle age. These are the Diabetics who come to our Diabetic clinic at the surgery. This type of Diabetes has a strong hereditary component and it is the type of diabetes that we will be concentrating on for the rest of this article.

Diagnosis of Diabetes
The threshold for diagnosing diabetes has changed recently. It is currently diagnosed by testing the blood sugar after fasting i.e. after not having had anything to eat since the day before. If the blood sugar is greater than a value of 7, then the patient has diabetes. The "grey area" is between 6 and 7. Some laboratories consider 6 to be the upper limit of normal. Sometimes, if it is unclear, we perform a test called the oral glucose tolerance test. This test is rarely done, but involves drinking a predetermined amount of glucose in a drink, then measuring the blood glucose response. A few days before each Diabetic Clinic appointment you will be given an appointment with the nurse to have a number of blood tests done to monitor the disease. The blood tests performed are HbA1c, Fasting glucose, Lipids & U&E. To see explanations of these tests, please see our section on blood tests.

Problems resulting from, or associated with, Diabetes
Many and varied, really.
Nerve damage can result in loss of sensation in feet. Any cuts or grazes may not be felt and the high levels of glucose can make infection more likely. Foot care is very important and Chiropodists have a very important part to play in the management of Diabetics.
Diabetes can lead to a deterioration in vision. High sugar levels can result in blurring of the vision and even damage to the retina (the back of the eyeball). In fact, it is sometimes possible to see clues that a person may be Diabetic by looking at the back of the eyeball. We sometimes see patients who have been sent to us by their Opticians because they suspect Diabetes. It is very important that Diabetics have regular (annual) eye checks. Many Opticians in Bridgend take part in a special Diabetic eye care programme.
Impotence can occur in men. Impotence means that they are unable to achieve or sustain erections. This can be due to nerve or blood vessel damage (or both). It is important to mention this problem to the Doctor. It is by no means unusual (you will not tell us anything that we haven't heard before!) and there are many new treatments available.
Blood vessel damage is one of the problems that can result in widespread damage. Strokes and heart attacks are more common. It is most important that we do all we can to reduce your risk factors long before you develop problems. Do not smoke. Take regular exercise and eat sensibly. As you probably know, our blood vessels "fur up" with deposits of fat in time. Diabetics are very susceptible to the effects of elevated Cholesterol and Triglycerides (these are both names of fats). We often prescribe tablets called "Statins" to reduce the levels of these fats. Before starting these tablets we like to do a blood test to check liver function. We aim to keep blood cholesterol levels below 5.0 and blood pressure below 140/80. Please see also our Cholesterol lowering diet.
Kidney damage can occur and this can lead to leakage of protein in the urine (see our section on urine testing)
Although this list of potential problems can sound disheartening, remember that there is much that can be done right now to prevent these problems from occurring. As ever, prevention is the key to success.
 

Treatment
Diet is the first line of treatment. For many, their blood sugars may be kept under control by reducing the amount of sugar in the diet. Remember that there are lots of hidden sugars in foodstuffs. Because this can be more difficult than it seems, we like to make an appointment for all our newly diagnosed Diabetics with the Dietician. Click on the picture to download our initial diet advice sheet.

If diet alone is insufficient to control Diabetes, then we move on to tablets.
Most of our type 2 Diabetics are controlled with tablets. Tablets may stimulate the pancreas to produce more insulin or even reduce the amount of sugar absorbed from the gut.
There are several categories of tablet:
Biguanides (e.g. Metformin). These tablets act all over the body to increase glucose uptake, thereby lowering blood glucose levels. They do not stimulate insulin release. Side effects include nausea, vomiting, diarrhoea and malaise.
Sulphonylureas (e.g. Glibenclamide, Glipizide). These tablets stimulate the release of insulin from the pancreas and may also act elsewhere in the body to enhance the effects of insulin. As insulin is released, the blood glucose levels fall.
Thiazolidenediones (e.g. Pioglitazone, Rosiglitazone). These tablets are some of the newest available and we only have a few patients taking these at present. They enhance the effects of insulin and reduce glucose production by the liver.
Alpha-glucosidase inhibitors (e.g. Glucobay). This medicine reduces glucose absorption from the intestine. If you absorb less, then the blood glucose levels are lower. Unfortunately, this can result in side effects such as increased gas produced in the bowel due to fermentation of unabsorbed sugar. The end result can be wind and flatulence!

Will I need to take insulin?
Most people with type 2 (maturity onset) diabetes do not need insulin. A small percentage of patients who fail to reach adequate control despite diet and tablets, may need to start taking insulin by injection.

Will I need any other treatment or equipment?
It is a good idea to carry a supply of dextrose (a sugar similar to glucose) tablets, just in case your blood sugars fall because of treatment. Blood sugar monitors (e.g. "Glucotrend") are extremely useful to patients and Doctors alike. There are a variety of different types. They are about the size of a cigarette box and can measure blood glucose from a drop of blood in seconds. You will need to buy one of these, because they are not available on prescription. The testing strips that are used by these machines can be obtained on prescription, however. Make sure that your testing strips are within their "sell by" date. In order to obtain a pin prick of blood, you will need a box of sterile "one-use" lancets (e.g. Softclix lancets). Again, these may be obtained on prescription. Each machine requires its own specific testing strips. When you ask for these items to be put onto your repeat prescription, we will need EXACT details of the machine, testing strips and lancets you require.
Urine testing strips are of little value and have been generally superseded by the newer blood testing machines. They can be misleading because even non-diabetics can secrete sugar in the urine if they eat enough.

The Diabetic Retinopathy Surveillance programme

When you make your appointment to see the Optometrist, please let them know that it is for a "Diabetic Screening Examination". This will help them to arrange your appointment time which will take a little longer than a normal eye examination.
During your Diabetic Screening Examination the Optometrist will need to put drops into your eyes to make your pupils larger. This allows the inside of your eyes to be viewed more easily. The drops take about 15 to 30 minutes to work and around 6 hours to wear off but sometimes the effect may linger on until the next day. The large pupils will make your eyes more sensitive to light, and distant and near objects may appear blurred, especially if it sunny. If you have a pair of sunglasses, it may be an idea to bring them along to the examination.
It is recommended that driving should be avoided for at least 6 hours after the drops have been put in.
After your eye examination, in the unlikely event that you experience any unusual symptoms, please contact your Optometrist or seek medical advice because you could be experiencing adverse reaction to the drops. Let them know that you have had drops put into your eyes.

Opticians taking part in the programme:

Cardiac Risk Assessment Clinic
Family History of heart disease? Diabetic? Worried about your heart? Aged over 40? There is a special clinic available to all at the Princess of Wales Hospital Bridgend.
Contact Delyth Townsend at the Coronary Heart Disease Risk Clinic at the Princess of Wales Hospital on 01656 752759 for an appointment. You do not need to see your GP to be referred to this clinic.

We will add to this page, depending on feedback from our patients. We regret that we cannot answer individual or personal questions online.

The information contained on this site is general information which is not in any way intended to replace the specific advice that patients may obtain from their own doctor about individual care.

©Pencoed Medical Centre 1998-2005