April 2015 Group Meeting - Q & A Session with Diabetes Specialist Nurses

This month’s meeting was an opportunity to have a question and answer session with 2 members of MK Diabetes Care, a Diabetes Specialist Support Service commissioned to support Primary care through education, training and mentorship. The service aims to help improve clinical outcomes, reduce mortality & morbidity rates and improve quality of life for all adults with diabetes who are registered with a GP in Milton Keynes.


Lesley Scott, the Lead Diabetes Specialist Nurse and Amanda Kohli, Diabetes Specialist Nurse kindly donated their time to answers questions from group members. Structured diabetes education was a key topic and both DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) and DAFNE (Dose Adjustment for Normal Eating) were discussed. Currently in Milton Keynes DESMOND is only funded and offered to those people who are newly diagnosed with type 2 diabetes. However, people with existing type 2 are encouraged to use the resources that are available to them to aid their self-management, such as the companion guides that are available from their practice nurse or from Diabetes UK, dietician referrals and walking programmes.


DAFNE is a 5 day course that teaches people with type 1 diabetes how to match the carbohydrates they are eating with the correct dose of insulin, is currently not yet available in Milton Keynes. All people living with type 1 can choose to undertake the course and can currently be referred to a neighbouring diabetes service in Northampton. Plans to provide it in Milton Keynes are in development. A 3 hour carbohydrate awareness course is available through the dietetic department at MK hospital.

There are so many variables that can affect blood glucose levels for people with type 2 diabetes on insulin. People are advised to experiment with different foods and monitor glucose levels carefully to help detect patterns so insulin can be adjusted accordingly. Stress has a significant impact on glucose levels as it activates cortisol secretion. Cortisol, a steroid hormone, makes fat and muscle cells resistant to the action of insulin and enhances the production of glucose by the liver, so elevating glucose levels.

People with diabetes are advised that there are many different medication avenues possible and if their particular regime isn’t working to discuss the options available with their GP, practice nurse or request a referral to the Diabetes Specialist team at the Maple Unit.


The suggested prescribing of Statins for elevated cholesterol in people with diabetes was discussed. People are assessed for risk factors and if they meet the NICE guidelines for increased risk factors, ie, cholesterol level above 4 (5 for people without diabetes), then they are offered Statins. The use of Statins is a controversial topic and the question, ‘does the potential risk of side effects outweigh the potential risk of health complications?’ has to be asked.


The use of the Body Mass Index (BMI) as a measurement for obesity was discussed. BMI does not differentiate between muscle and fat and some people, generally with a lot of muscle, have a high BMI, but are not at risk for health problems, while some with a low BMI can be at risk. However, for the majority of people, the correlation holds.

Many over the counter remedies are not recommended for people with diabetes and this may be due to the sugar content or the added complication in people with reduced feeling due to peripheral neuropathy. It is advised to inform your GP of any non-prescribed medication or supplements you may be taking and to discuss any concerns or seek advice from your Pharmacist. The use of Metformin may lead to a vitamin B12 deficiency, causing a slow decline into anemia. This is not a routine test carried out at clinic.

This was a highly informative session and it was very beneficial to be able to discuss diabetes with professional but outside of a clinical setting.