University College Hospital. Diabetes annual review

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1 University College Hospital Diabetes annual review Children and Young People s Diabetes Service You can protect your future health It s not only good blood glucose levels that protect you from complications of diabetes. Good blood pressure and normal cholesterol levels also keep you healthy. All children (over the age of 5 years) and young people with diabetes must have an Annual Review to assess your overall health. This leaflet describes what things we look for and why. HbA1c and Glucose levels We use HbA1c as a measure to tell us about your glucose levels over the last 3 months. High HbA1c levels indicate that your blood glucose levels have been high. Research has shown that having high glucose levels over a long period of time make it more likely for the body to develop complications of diabetes. Target HbA1c: Research tells us that young people with diabetes should aim for a HbA1c of 47 mmol/mol (6.5%).

2 Cholesterol is a type of fat that our bodies need to work properly We all have cholesterol in our blood. There are two kinds of cholesterol. Bad cholesterol is dangerous for the body. Doctors call this LDL cholesterol. It gets stuck in the walls of the blood vessels which are the pipes carrying blood around the body. LDL can block the blood vessels as seen in the picture. This is called atherosclerosis. If a pipe blocks then blood cannot get through and it can cause a heart attack or a stroke. Target LDL: Less than 3.5 Good cholesterol helps protect you. Doctors call this HDL cholesterol. Good cholesterol stops blood vessels from blocking. Some people say it acts like a cleaner to keep the pipes clear. Target HDL: More than 1.2 Good blood pressure helps protect your body. Blood pressure measurements are made up of two numbers. The top one is the pressure when your heart is squeezing the blood; the bottom is the pressure when your heart is relaxed. Doctors call the top number systolic and the bottom number diastolic. Your immune system may attack other body parts Your immune system fights infection when it enters the body. Sometimes this goes wrong and the immune system can attack healthy parts of your body. This is called an autoimmune condition. Type 1 diabetes is an auto-immune condition. Your immune system may attack other parts of your body, especially the thyroid gland and gut. Both of these are treatable and we check for them each year in your annual review blood test. Thyroid gland controls energy, weight and more. The thyroid gland is at the bottom of your neck. It makes thyroxine which is a chemical that helps your body to work properly. Too much or too little thyroxine can affect your weight, body temperature, mood, energy levels and can even cause constipation. Around 1 out of every 50 children and young people with diabetes don t make enough thyroid hormone. This can be treated with a small tablet each day. 2

3 Coeliac disease means that your body can t digest gluten. People may not know they have coeliac disease which is why we do a blood test each year. It can cause diarrhoea, constipation or pains. Coeliac disease can be treated by removing gluten from the food that you eat. Around 1 out of every 100 children and young people with diabetes, also have coeliac disease. Treating damage to the body to keep you healthy High blood glucose levels, high blood pressure and high cholesterol can all harm the eyes, kidneys and nerves. We can treat early damage to help stop further harm. Kidneys work to keep the blood clean. Early damage to the kidneys can cause too much protein to leak into your urine. A urine sample can tell us if your kidneys are working well. High blood glucose levels and high blood pressure may damage the back of your eyes called the retina. Early damage can only be found by having a retinopathy/diabetes eye test. It is important to find early damage so that we can help protect the eyes from problems such as blindness. How to do your annual diabetes review We will organise for you to have your annual review. However, if you think you should have had this done and we have not discussed it, please ask us at your next diabetes clinic visit. Blood test You will need to have a blood test. Routinely you can eat beforehand, however if your family have a history of heart disease, or you have previously had raised cholesterol, you will need to be starved for this test. Ideally this can be done before breakfast. It is ok to drink water but nothing else, unless you have a hypo which should be treated as usual and the test postponed. The blood test can be done by the nurses in children and young people s outpatients or by the phlebotomy staff based on the 1 st floor podium in the main UCLH building. For younger children, you may want to organise to have one of the play specialists to come with them and help distract them whilst they are having this done. Urine test The urine is tested for protein and albumin/creatinine ratio (ACR). These help us measure your kidney function. Initially, this can be done by a random urine test (collecting a small amount of urine in a small pot). Sometimes the results of this show we have to do a more in depth test, and we will ask for a 12 hour urine test. Please collect all the urine that you pee over 12 hours in the large bottle. Start in the evening and make sure that you collect everything overnight and the first one when you wake up in the morning. 3

4 Eye Test This screening if offered to all people with diabetes over 12 years old and needs to be done every year. You will be referred to the screening programme by your GP and this is done locally. Talk your GP if you are over 12 and have not been offered this. The eye test is called retinal screening, where a specialist will take photos of the back of your eyes. They will put some drops in your eyes to make it easier for them to see the back of your eyes. This will affect your vision for a number of hours later so it is important for someone to accompany you. My annual review results Protecting my health in the future HbA1c less than Diabetes control 6.5% or 47 mmol/mmol Systolic less than: Blood pressure Diastolic less than: Good cholesterol (HDL) More than 1.2 Bad cholesterol (LDL) Less than 3.5 Checking for auto-immune conditions Thyroid gland Coeliac disease No thyroid antibodies No coeliac antibodies 4

5 Checking for damage caused by diabetes Kidneys Less than 2.5 Eyes No damage Feet No damage Gums Normal Contact Details Office Hours (Mon-Fri 9am to 12pm): (Children s Diabetes Nurses) Emergency mobile (Mon-Fri 8am 6pm): Out of Hours: and page Paediatric On-call Registrar uclh.cdlime@nhs.net or uclh.cdorange@nhs.net Further information and fact sheets can be found on our Children and Young People s Diabetes web page at If you need a large print, audio or translated copy of this document, please contact us on We will try our best to meet your needs. First published: 19/07/2013 Date last reviewed: 01/08/2018 Date next review due: 01/08/2020 Leaflet code: UCLH/SH/PAED/CYPDS/REVIEW/2 University College London Hospitals NHS Foundation Trust 5