Complication Check

Eyes

• Any eye problems

Refer to Diabetes-Accredited

Optometrist promptly

Kidneys

Legs, Feet & Toes

(See appendix for how to check)

> Dipstick protein ABSENT but raised microalbumin/creatinine ratio on 3 occasions

• Creatinine normal range

■ Proteinuria

■ Creatinine above normal range

Same Day Referral

• Blue/White Foot (ischaemia)

• Skin crack/blister

• Acute swelling

• Referral Required

■Absent pulses but normal colour

■ Neuropathy

• Altered shape

■ Chronic swelling

Lisinopril 2.5 mg od adjust dose until BP <125/75

Refer to Diabetologist

Refer to Diabeticare Foot Service (Out of Hours contact on-call Medical Reg)

Heart

Acute Chest pain/tightness

A&E

Chronic Chest pain/tightness

Refer to

Cardiologist

Infection

If severe/ no response to treatment in 2 days

Diabeticare/ A&E

Diabetes in Hillingdon Referral letter

Date of appointment Date of referral

To: Diabeticare From:

The Hillingdon Hospital Uxbridge

Middlesex UB8 3NN

Name Address

Telephone (day) Occupation

Date of birth NHS number Hospital number

(night)

Mobile

Date of diagnosis of diabetes

Family history

yes / no

Symptoms thirst/polyuria/weight loss

Other

Complications

Coronary dis. Periph. vase. dis.

Stroke/TIA

Hypertension

Retinopathy Cataract

Neuropathy

Nephropathy

Skin problem/ulcer Foot problem

Infection

Ketoacidosis Hypo

Other medical history

Other medical history

Smoker yes/no Alcohol

Weight Height

Diagnostic glucose Fasting Choi. Trig. FT4

Na K U Creatinine units/week BP

Random/2hr TSH Hb

Driver? yes / no Urine dip

HbAlc

WBC Pits

Bilirubin

ALT AlkPhos Albumin

Treatment

Signed

Allergies

Diabetes in Hillingdon Your name

Consensus Care Date

Questions for people with diabetes

Please fill in this form before you see your doctor or nurse. It is to help check how you and your diabetes are getting on.

Changes? New surname / address / phone number? Please note It here:

Have you been to hospital in the past year?

(as an in-patient or out-patient) With what?

How is your blood glucose? Don't forget to bring your record

Have you had low sugar reactions (hypoglycaemic episode)?

Did you know It was happening? Did you need help?

Have you had any of the following:

Problems with your vision

Yes / no

Soreness of vagina / penis

Yes/no

Chest pain or discomfort

Yes / no

Breath lessness

Yes/no

Problems with your feet

Yes / no

Foot rubs / blisters / cracks

Yes/no

Change in foot / toe colour

Yes / no

Foot pain

Yes/no

Tingling in hands or feet

Yes / no

Numbness in hands or feet

Yes/no

Thirst

Yes / no

Passing urine more often

Yes / no

Have you any questions you want to ask?

Have you any questions you want to ask?

SCREENING FOR THE AT RISK DIABETIC FOOT IN GENERAL PRACTICE

Guide to the use of Monofilaments for sensory testing on the foot

1 Use the 10g monofilament to test sensation.

2 The sites to be tested are indicated on the foot diagram below.

3 Apply the filament perpendicular to the skin's surface (see Diagram A).

4 The approach, skin contact and departure of the monofilament should be approximately 1.5 seconds duration.

5 Apply sufficient force to allow the filament to bend (see Diagram B).

6 Do not allow the filament to slide across the skin or make repetitive contact at the test site.

7 Randomise the order and timing of successive tests (to reduce potential for patient guessing).

8 Ask the patient to respond 'yes' when the filament is felt.

9 Do not apply to an ulcer site, callous, scar or necrotic tissue.

SCREENING SITES DIAGRAM A

Consider the patient's feet to be 'at risk' if the patient cannot feel the 10gm monofilament at any of the sites marked.

Diabeticare Hillingdon Hospital

DIAGRAM B

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