GROUP MEETINGS 2007

JUNE GROUP MEETING

The theme of our June meeting was decision making. The evening was led by Prof. Nigel Mathers, a practising Sheffield G.P. and Dr. Chierk-Jung Ng who is over from Malaysia to work on a PhD involving research into patient decision aids. We heard from the doctors and held discussions about our own experiences.
Being diagnosed with diabetes immediately brings the need to make decisions about lifestyle, medication etc. and at different stages we need to make different decisions, some of which are easy and some difficult. To make a decision (such as whether to go on to insulin after being treated by oral medication), you need to gather all the information, assess the risks (such as side effects) and benefits and consider your own values and priorities in life. Hopefully you can then discuss all these with your doctor (or other Health Service practitioner) and come to a decision together. You need to be clear about the decision you are making and to know all possible options. If you feel you need support or that you haven't enough information, find out what help is available e.g. from Diabetes UK, from the NHS website. If you feel pressurised by others try to focus on what matters most to you. Make a list of all your questions and talk to people who have undergone similar experiences.
What came out of the evening was that when making choices about diabetes or other conditions, there is often no right or wrong decision. A good decision should be an informed one, one which is consistent with your own values, one which you are likely to act on and one you are happy with. A good decision should be a shared one between yourself and your health care practitioner (G.P., Diabetes Nurse, hospital doctor etc).
The NHS have a range of decision aids, but they are not always known about by patients or offered by doctors. If you would like to know more, or to help in research into the use of decision aids, please get in touch (see Contacts on back page), and we will pass your details onto Prof. Mathers and Dr. Ng.

UPDATE: Since the meeting we have learned that Dr. CJ Ng and Prof. Mathers have secured funding for their research into decision aids and a full project entitled PANDA (People and patients decision aid) is to commence. The Steering Group, which includes several of our members, will start to meet in September and we will get a report in the autumn of 2008.
 

MAY GROUP MEETING: UNDERSTANDING FOOD LABELS

At our May meeting we had an interesting talk by Carla Gianfrancesco. a Specialist Diabetes Dietitian at the Northern General Hospital. She said that by reading food labels we can learn more about food and nutrition, make healthier choices and compare different products. The information on the labels helps us to see beyond any health claims and gives us more confidence in making choices as well as enabling us to get more variety into our diets.
The nutrition panel always gives the totals per 100 gm.
PROTEIN is needed to carry out repairs to the body, but most people easily get enough.
All CARBOHYDRATES (sugary and starchy foods and drinks) increase blood glucose levels, and some people find it useful to count how many grams they consume. The labels also give information on the amount of SUGARS, which includes both natural and added sugars. Natural sugars are fructose which is found in fruit and lactose from milk. The figures alone don't say which sugars are which and sometimes you need to look at the list of ingredients as well to work out this information e.g. yoghurt can appear to be very high in sugar but this is from the lactose as well as from any fruit. If fruit is high on the list of ingredients, then most of the sugar will be from this source.
The amount of FAT in food is important for people with diabetes. There are 2 types - saturated and unsaturated. The total fat in the diet should be reduced, but particularly the level of saturated. Monosaturates are the best choice. Even a small change in fat levels can help keep weight down.
FIBRE includes soluble fibre, found in pulses, oats, fruit and vegetables and insoluble found in wholemeal bread etc.
SODIUM, contained in salt, needs to be kept to a low level. To covert sodium to salt, multiply by 2.5.
Manufacturers can make any health claims as there are no laws relating to what terms such as "light" actually mean. You need to read the label to get the real information.
There have recently been changes to FRONT OF PACK LABELLING. The Food Standards Agency recommends the traffic light system, which is supported by Diabetes UK, and is being used by Waitrose, Sainsburys, the Co-op and Marks and Spencer. The Food and Drink Federation has developed its own system, which gives the percentage of GDA but does not use colour coding, and this is used by Tesco, Kelloggs, Nestle and Coca Cola.

See the table below for how to work out amounts contained in foods.

There is lots of information on the Sheffield Community Dietitians Website.
Visit  www.sheffield.nhs.uk/dietitians/index.php

To print off resources, click on 'community nutrition pack' on the left hand side, where there is free information for patients and health care providers.

For further information and advice about food visit the Food Standard Agency's websites:
www.eatwell.gov.uk

www.food.gov.uk

www.salt.gov.uk
 

At our April 2007 meeting Prof. Simon Heller spoke about:

HYPOGLYCAEMIA

A hypo occurs when the level of glucose in the blood falls too low. The condition is common partly because of ineffective ways of delivering insulin into the bloodstream. Under normal circumstances the body's insulin level rises quickly on eating a meal and then falls immediately afterwards, whereas giving an insulin injection leads to a higher level in between meals. The brain needs a continuous supply of glucose, which is as important as oxygen. If levels become too low the brain does not function properly leading to problems such as slow reaction times, and in order to protect against this there is a detection system in the brain which sets up a response to try to limit the fall in blood glucose. This includes the release of hormones including adrenaline. Symptoms include sweating, tremors and palpitations and lead to loss of concentration, drowsiness, anger / sadness and confusion. Severe cases can result in seizure or coma. People can learn to recognise their own symptoms and take in carbohydrates to compensate. There can be a vicious circle of hypoglycaemia, especially if an individual's glycaemic control is fairly tight, and the body's defences can be damaged by the frequency and duration of hypos. In Type 2, the longer you have had diabetes the more risk there is of severe hypos.
At the request of the DVLA, Prof. Heller conducted some research to assess the risks caused by hypos in people with Type 2 diabetes who had been put onto insulin. At the moment these people are restricted over driving licenses such as taxi and HGV licenses. Different groups of people were monitored, using continuos glucose monitoring, and all hypos over a period of 9 - 12 months were recorded. It was shown that in the early stages the risk of hypos for those Type 2's on insulin was only the same as for those treated with tablets.   

At our February 2007 meeting we had a presentation on

DIABETIC FOOT PROBLEMS - Prevention and management

 by Peak Mann Mah, Specialist Registrar in Diabetes and Endocrinology at the Royal Hallamshire Hospital.

She told us that diabetic neuropathy is the leading cause of non traumatic lower extremity amputation and that 15% of people with diabetes get foot ulceration and so it is very important to look after the feet. More education is needed in this area. The risk of foot ulceration increases with age and is more common in males and in people with limited joint mobility. Symptoms of neuropathy include numbness, pins and needles or pain. Wearing inappropriate footwear can cause damage to the feet. You should check your feet regularly and look out for any abnormalities such as swelling, colour change, discharges or ulcers. Any such changes should be reported immediately to your doctor. Using cream helps to prevent dryness and it is important to ensure that shoes are not too tight or too loose. Everyone with diabetes should have an annual foot screening and patients should be educated in foot care.

The information presented on this site is for general use only and is not intended to provide personal medical advice or substitute for the advice of your physician. If you have questions or concerns about individual health matters or the management of your diabetes, please consult your diabetes care team.