If these are well controlled the risks of death and complications of diabetes is reduced.

These will be central to the annual review

What is it? 

• A measure of the force your heart uses to pump blood around your body, which is usually presented as two numbers i.e. 120/80.
• The 1st number is the systolic pressure (the maximum force your heart uses)
• The 2nd number is the diastolic (the minimum force your heart uses)

Targets

• Type 2 diabetes: Below 140/80
• Type 1 diabetes (or Type 2 diabetes with complications of diabetes): Below 130/80

Why do we monitor this?

• High BP combined with Diabetes is associated with increased risk of Cardiovascular disease (e.g. Heart attacks and Strokes)

How to improve Blood Pressure

• Low Salt Diet
• Losing Weight
• Stop Smoking
• Exercise
• Blood pressure tablets may be recommended

What is it?

• A type of fat found in the blood
• Two types of molecules carry cholesterol throughout the body:
• LDL Cholesterol (low-density lipoprotein), or “Bad” Cholesterol, makes up most of your body’s cholesterol. High levels raise your risk for heart disease and stroke 
• HDL Cholesterol (high-density lipoprotein), or “Good” Cholesterol, absorbs cholesterol & carries it to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease & stroke.

Targets

• Total Cholesterol: under 4.0 mmol/l
• LDL levels: below 2.0 mmol/l
• HDL levels: at least 1.0 mmol/l (men) or 1.2 mmol/l (women)
• Total cholesterol / HDL ratio: less than 5

Why do we monitor this?

• High levels of total or LDL Cholesterol associated with increased risk of Heart Attacks and Strokes, particularly in Diabetics.

Improve cholesterol levels

• Diet Modification
• Tablets (Statins)

What is it?

• A measurement how much Haemoglobin (the oxygen carrying protein in red blood cells) is saturated with Glucose (glycated).
• This can be obtained from a blood sample and is the best measurement of long-term glucose level as red blood cells live in the body for 8-12 weeks.

Targets

• This may be an individualised target and will be discussed and set at the annual review with the diabetes team.
• In general, 48mmol/mol or under
• 53mmol/mol if on medications with hypo risk
• Up to 69mmol/mol if severe frailty or dementia

Why do we monitor this?

• As our best measurment of glucose control this can help guide our team and you to best achieve your targets and reduce you disease progression.

How to improve cholesterol levels

• Diet Modification
• Optimal Tablet and/or Injectable therapy

What is it? 

• A measure that uses your height and weight to work out if your weight is healthy.
• BMI is calculated by dividing your weight in kilograms by your height in metres squared.

Target

• A BMI of 18.5 to 24.9 is considered ideal for most adults.
• A BMI of 25 to 29.9  is considered overweight.
• A BMI of 30 or more is considered Obese.

Why?

• Being overweight or obese is a risk factor for developing Type 2 diabetes and many other poor health outcomes which it why we monitor your weight.

• How to improve BMI
  
  • Increase exercise/activity or changing diet to lose weight 

This depends on your gender and ethnicity.

For a healthy measurement you need to aim to be less than:

• 80cm (31.5in) for all women
• 94cm (37in) for most men
• 90cm (35in) for South Asian men.

This is because you have a higher risk of Type 2 diabetes if you are of Black or South Asian background

What is it? 

• A term to describe the glucose concentration in your blood (e.g. 5 mmol/l)
• 'BM' is another term you may hear used- it doesn't stand for anything other than the name of the company that first made glucose monitors in this country, and the shorthand 'BM' stuck.

Target

• Before meals (pre-prandial) : 4 to 7 mmol/l for people with type 1 or type 2 diabetes
• After meals (post-prandial) : under 9 mmol/l for people with type 1 diabetes and under 8.5mmol/L for people with type 2 diabetes

• "4 is the floor" -  A glucose of 4mmol/l or below is called Hypoglycaemia or a ‘Hypo’. It is a medical emergency. 

• "5 to drive" - Those on treatments that can cause a Hypo must ensure that their blood glucose is 5 mmol/l or above (taken within two hours of setting off) for any journey longer than two hours. 

Why?

• High sugar levels are the definition of Diabetes and are associated with progressive multi-organ damage if left unmanaged
• Low sugar level (Hypoglycaemia or Hypos) can be associated with light headedness, fainting and seizures 

How to improve Blood Glucose 

• Alter Lifestyle / Medication therapy / Insulin

What is it?

• A computer program used for predicing outcomes in cardiovascular disease using risk factors and data points (age, height, weight, blood pressure, smoking status, cholesterol levels...etc)
• The risk is given as a percentage (%) chance of having a cardiovascular event (such as heart attack or stroke)

Targets

• Changes with age, but for non-elderly patients a QRISK of 10% indicates therapy with cholesterol lowering medication may be indicated.

Why?

• Increasing QRISK suggests an increased risk of cardiovascular event

How to improve Q RISK

• Diet Modification
• Increase Exercise/Activity
• Stop Smoking
• Cholesterol lowering (Statin) therapy

What is it?

• Adults should get some sort of activity per day

Target

• In general this is 150 mins moderate intensity activity per week/2 activities per week that improve strength / balance / flexibility ( 30 mins per day - does not have to be 30 mins in one go - can be split 20/10 or 15/15 etc)

Why?

• This will improve overall health, mental well-being, insulin sensitivity, weight loss

How to improve activity

•  Find something you like to do and mix things up - its also good to  involve others