Case Study: George Mellows (Part 4) – A visit to the Diabetes Educator

February 18, 2015 by Imagine_David 3 Comments

George Mellows is aged 55. He lives with his wife and his two teenage children, aged 15 and 19.

George works Monday to Friday 8.30 am until 4.30 pm . He works at a desk in a sedentary role, getting minimal activity in his working day. George has not played any sport for some time, but he does enjoy playing lawn bowls.

*** Previous Posts: Part 1 here ; Part 2 here ; Part 3 here ***

George has now had diabetes 3 months. He has had a consultation with his dietitian and found some healthy choices to make that not only fit with his diabetes self care plan but also things he enjoys!

This past 2 weeks George has been measuring his blood glucose level with a view of discussing the results with the diabetes educator. George feels confident that he can identify the causes of hyperglycaemia

On diagnosis, George’s doctor commenced George on Metformin 500mg in the evening with dinner. This has not changed.

The table below is his most recent blood glucose levels. George has highlighted the blood glucose levels that are over his target in red.

The Visit

“Self-management means having a daily management plan, setting goals, solving problems and taking responsibility. But it certainly does not mean you are on your own. Mutual trust and respect between yourself and your doctor and other members of the health care team, as well as regular communication with them, are vital to effective self-management.

Previously, traditional care was based on doctors and health professionals being seen as the experts responsible for the diagnosis and management of care. It was accepted that people’s lives should be fitted around their diabetes with goals set by the health professionals.

But this approach is not effective. Diabetes requires daily management. Doctors are not available every day, leaving responsibility for day-to-day care on the patient and the family.

In addition, good results are difficult to achieve if the person involved is not an active participant or does not understand the reasons behind management decisions.

Patient Empowerment takes a new approach. It moves the focus from the doctor to the patient. It involves fitting diabetes into your lifestyle with you making the choices and taking charge of your management and the consequences.” Diabetes Australia

Tools

On arrival in the consultation room George was asked by the receptionist to complete:

* The Diabetes Distress Scale (download here DDS and HERE )

* The Diabetes Knowledge Questionnaire (download here DIABETES KNOWLEDGE QUESTIONNAIRE (old rtf format) )

George felt a little uncomfortable initially using these ‘tools‘ to complete these ‘tests’. However, the diabetes educator saw George acting a little uncomfortable in the waiting room and explained that the purpose of these tools would be to individualise the visit based on the knowledge and needs of George.

George felt more comfortable with this explanation, and managed to complete both before the visit started in person. *He also felt that it might have been good to complete these at home before the visit.*

"Enjoying a good quality of life is my goal" George — **“Enjoying a good quality of life is my goal” George**

“How did you feel about completing those tools George?” the diabetes educator asked as they sat down to start the session.

” At first it was a little like being in school; but when you saw I was puzzled about them, and explained how we could use them in this session, I felt like I was going to be listened to, not just spoken at and told what I should and shouldn’t do” replied George.

The diabetes educator then used these with George to open and lead the session. George was also a little surprised at this, expecting the diabetes educator to be focussed on his blood glucose levels.

The diabetes educator started with the knowledge questionnaire, only asking George about the question he had gotten incorrect. By the end of the first 20minutes George was feeling that he was learning new things despite al of the reading and research he had been doing on the internet.

George hadn’t even considered the importance of foot-care, despite being aware that diabetes can effect the nerves and the blood supply to parts of the body.

Diabetes Distress

Diabetes may lead to specific problems and increased stress, which we often call “diabetes distress”.

Daily life and general stress levels can affect your diabetes control. How well your diabetes is going can in turn affect your general stress levels – so it is a bit of a chicken and egg. It is very important to get the general stress in your life under control, as this will assist with your diabetes management. Likewise, feeling settled with your diabetes management will decrease your overall stress.

If you are struggling with stress at work, or in your personal life, it can be harder to manage diabetes and it suffers. We all experience stress and life would be boring without some stress! People say they would rather not have stress in their lives, but in fact we need a balance between just enough stress and not too much, to keep us alive and active. Not all stress is bad believe it or not.

Some of the things that can lead to diabetes distress are:

Worry about food changes
Management of blood glucose levels
Weight management
Going onto insulin/medication
Hypos (low BGL)
Depression & mood swings – have been shown to be higher in people with diabetes
Relationship & sexual problems
Work stress, discrimination in relation to your diabetes
Disclosure – wondering if you should tell people about your diabetes
Lack of understanding or support from family/friends
Guilt, fear, worry, panic & anxiety about diabetes and your future
Risk of Complications
Feeling alone and isolated
Seeing or hearing about all the things that can go wrong
Feeling out of control
Other mental health problems such as an eating disorder
Feeling overwhelmed and exhausted
Lack of information

Blood Glucose Levels

Towards the end of the session the diabetes educator and George decided to take a careful look at the blood glucose levels that George had been measuring.

The diabetes educator asked “George, why do you test your blood glucose level?”

George was a little taken aback by this question. He thought that everybody just had to, that it was a part of having diabetes.

After a moment he said: ” To determine if my diabetes self care plan is working well, or if there needs to be some changes to my meal planning, or my exercise, or to my diabetes medication.”

George identified clearly the things that would impact on his blood glucose level, and also identified that weekdays at lunchtimes when he didn’t move very much was a problem for him.

Future Planning

The plan at the end of the session was to make an appointment with an exercise physiologist and a podiatrist, and then return to the diabetes educator in 6 months (unless he felt the need to return sooner).

George also had a plan to talk with his manager to have 60 minutes for lunch and go for a 20 minute walk each working day after he had eaten. This meant that he would have to work back an extra 30 minutes. But he also felt it was well worth it if it meant having a better quality of life, and potentially a longer working life (by minimising the risks to his health caused by high blood glucose levels).

George felt that he had achieved quite a lot in his first few months of living with diabetes, but was also aware that this was only the beginning of a lifelong journey.

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#shortcuts or the #longwayround? Which is best? Making decisions & weighing up #choices

May 17, 2014 by helwild 2 Comments

Yesterday I had an appointment at the Dentist. Groan. Yes, it was just a checkup & clean, but I did end up with a new filling as well. My dental appointment had been delayed by about 6 weeks, due to a month long virus that had also resulted in the cancelling of appointments with my optometrist, chiropractor, my flu shot, my mammogram, and my podiatrist. I’m still catching up! So it’s been a bit of a marathon of the rounds of all my health checks, most of which are diabetes related. But all (most) is well, my HbA1c results are good, as was my random bgl fasting test & my urine tests for kidney health, my feet are doing well, my eyes are unchanged. My blood pressure was up on the day I finally got my flu shot, maybe I’ll have to change medication for that. Sigh. My chiropractor has previously worked miracles on my back, shoulders, hips and is now focussed on my knees. I know I need his help to keep mobile for the sake of my diabetes management as well as heart, lungs etc. My dentist is also important in terms of my oral health, as being able to eat & enjoy the fibrous & ‘healthy’ foods also helps my diabetes management.

Largely because I have diabetes, this is a never ending journey of health checks. I feel fortunate to live in Australia with its great universal healthcare system and affordable health insurance, compared to some countries. I do feel sometimes as though I’ve been going ‘the long way round’ to arrive back where I was before all these checkups. It all seems so hard to fit in, & I’m not always motivated nor sure that my results will be positive. I know I’m lucky: some people are following up these same health care checks and getting not so good news. Sometimes it’s tempting to delay or postpone or ignore the need for getting tests done. It all gets so complicated, fitting appointments into our regular life. It’s tempting to take the ‘short cut’ & ignore it all, relying on the bgl meter & how we ‘feel’. Sometimes we’re scared of getting ‘bad news’. But at the same time we know that by getting the tests it means that we can get proper advice, and at least know the best path to take to improve or maintain our health.

So in the afternoon, feeling fine after my filling, I decided to take some exercise. Normally that’s a walk in my suburban neighbourhood, which does have some pleasant options & is something I can do easily, as everywhere I go is relatively flat. I can also do some local shopping, with all staple needs & some luxury items being walkable, even the post office & my pharmacy are walkable. Some days I will do several short walks. Yesterday was another glorious warm day in Adelaide, & I decided to pop up to the local Conservation Park, at Morialta.

I parked my car under some tall gum trees, & hopped out. Usually I walk on the flat, a slow steady imperceptible incline takes me on a delightful walk, crossing the creek several times, then to the waterfall at the end. Usually I see lots of birds, butterflies, and koalas.

Most of the time I am out of mobile phone range, because of the walls of the Gorge, which is quite nice. My husband often tags along, but he climbs, heading for the Tops & walking a circular route around the ridges, crossing over the waterfall at the top, and meeting me back at the car. Yesterday he was feeling a little unwell, so I was alone.

As I hopped out of the car, ready to walk down to the creek trail, I glanced over my shoulder. I saw the beginning of the track my husband usually takes. I used to walk that track with him, but now I am too slow to keep up. I thought, ‘Oh, I might just walk partway up Hogan’s Track today’. So I started. The track is wide, & has been improved since I last walked it, but it’s still a physically demanding trail. The slope is quite steep in parts, and the sunny afternoon made me hot very quickly. I was intending to go partway, then head back for my usual flat walk. Somehow I just kept finding the motivation to keep going, with frequent stops, until I found myself at the top of the ridge. Here there are several options. I could head straight back down the broad track I had just come up. I could go to one of two lookouts. I could head up higher, to the next ridge, which provides good views of the city. I looked at the sky, and at the time on my mobile phone. I had about 30-45 minutes until the sun set. I knew I did not want to be heading down in the dark. So I took an option which was not the shortest, but which was manageable in the conditions and in the time frame. I headed along another ridge for Hogan’s Lookout, and a mad scramble down a ‘shortcut’, which would shave off about 300 metres of climbing, but I knew would be a more challenging descent. As I took the path leading to the lookout, I heard a soft grunt & a rustle. I felt a little surge of fear, you never know what creature might be about, and I’d seen no humans on my ascent. I looked off the narrow path, and there was a large echidna! Poor thing was clearly more afraid than I, and was trying to bury herself, face first, all fluffed up with her spines. I took a photo, spoke to her quietly, & headed on to the Lookout.

As I neared the Lookout, I could see there was a great view, and the sun was starting to head to the horizon.

Another decision: which way down? I could retrace the Lookout trail, & head back down the wide track I’d come up. Or I could take the scramble trail, much steeper & narrower: shorter by about 300 meters, but would probably take longer, as I would need to be more cautious. I found the start of the trail, not easy, as it is infrequently travelled and the start is steep and somewhat overgrown. I could see the track of a bicycle, muddy wheeltracks. I thought, if someone has recently gone down on a bicycle, I should be able to make it on foot. So over the edge I plunged.

I was rewarded with great views, birds, butterflies, & an ankle & knee threatening descent. The sun was going down, & the level of difficulty was every bit as challenging as I’d thought it would be. There were so many traverses of this steep descent that I lost count. The rains had gouged out little gullies in the centre of the narrow track, which of course was littered with stones & rocks. Most of the way I had fantastic views, into the Gorge & over the plains, with the low sun casting long shadows, with Adelaide spread out before me. There were feral olive trees scattered amongst the eucalypts, & animal droppings indicating wallabies or kangaroos. I started to worry about how long it was taking, but then I recognised that I was almost on the final traverse, & popped around a corner to glimpse my own car, parked below me amongst trees.

By this time I was covered in a fine film of sweat. My knees were somewhat tender, but they always are, even if all I do is sit. I’m pretty sure that the exercise endorphins & the mindfulness practice were kicking in, because what I felt was elation. I’d challenged myself, both physically & mentally. I’d made good decisions. I’d achieved something that I’d though was no longer possible for me to do. I reached the last little slippery slope, popped back down onto the road, crossed over & followed the creek back to the car. As the sun set, I drove slowly home, feeling quietly happy, and very blessed. I had done something that I thought might be too hard, but by thinking & strategising I’d achieved it.

Helen Wilde

Helen is a Senior Counsellor with Diabetes Counselling Online. She has been the parent of someone with Type 1 diabetes since 1979, and has lived with type 2 diabetes herself since 2001.

Diabetes can't stop me! — Diabetes can’t stop me!

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Diabetes Type 2: A Self Care Plan

April 6, 2014 by Imagine_David Leave a Comment

Diabetes is primarily managed by you – the person living with diabetes every moment of every day.

Source: The DAWNTM needs model 2011. DAWN Study 2001; DAWN Youth Study 2008; DAWN2 Dialogue Events 2011. — Source: The DAWN needs model 2011. DAWN Study 2001; DAWN Youth Study 2008; DAWN2 Dialogue Events 2011.

By making smart choices most of the time, you will be successful in reducing the physical burden of diabetes.

Working with a team of appropriate health care professionals, you can also reduce the emotional burden of living with diabetes.

This guide is aimed at helping you put together a plan that works for you, as well as ensuring that all of the aspects of self-care are covered.

There are many things that you can do to keep your diabetes care on track.

Many people when first diagnosed with diabetes don’t now where to start.

Well meaning friends or family, health professionals (who may not be experts in diabetes self management planning) often give information that is not fact, but amog the many myths of diabetes self-management.

The media – who like to sensationalise ‘news’ – is often incorrect in what they publish, not current best practice.

Diabetes is not about ‘sugar’, but about your body not making enough insulin to process carbohydrate foods, your body’s main source of fuel.

So initially most people have a big focus on food. They think that they need to cut out sugar, not eat this eat that…….

The complete diabetes self care plan is much more than the healthy meal plan.

Here are some suggestions to help you identify what you can do to reduce the risks of developing health problems from a diabetes self care plan that is incomplete.

Key Treatment Areas

To simplify the basic treatment options (for all of us, not just people with diabetes) think: ‘support, diet, exercise, medication, measurement’.

Support

The DAWN2 (Diabetes Attitudes, Wishes And Needs) research suggests that:

“The DAWN2 study highlights, especially from the perspective of people living with diabetes, that good diabetes care requires care management support” Ingrid Wallaing

and

“Better (health) outcomes and better quality of life are linked to receiving psychological support from others” Ingrid Wallaing

Whether that support comes from your friends or family, or your health care team, managing diabetes alone can increase the risk of anxiety and depression. Here at Diabetes Counselling Online we can offer some support in the short to medium term. However it is in your best interest to put together a team of appropriate health care professionals – ideally those who specialise in the revision of diabetes self management education and support – in your local area.

“The practical tasks of diabetes sit on the background of the emotions, thoughts, feelings, worries and anxieties you may have about diabetes and about the rest of your life.” Diabetes Counselling Online website

Healthy Meal Plan

No doubt you have met the ‘Diabetes Police’ – those well meaning friends, family, work colleagues who want to tell you what you can and can’t eat.

No doubt you have heard from the media what diet is in fashion today.

But, have you developed a good working relationship with the ‘food specialist’ – your dietitian?

Healthy eating, no different to the other members of your family

The Role of Your Dietitian

Dietitians are highly educated (university qualifications) professionals. They provide guidance to people living with diabetes (and other medical conditions) on all nutrition-related matters. In diabetes self-management design their role is to empower people to understand more about how diet and lifestyle affect their bodies and glucose control.

Ideally their goal is to empower the individual to design their own meal plans based on sound knowledge. In some circumstances, they will produce meal plans to individual requirements e.g for the elderly, for people who want to be ‘told’ what to do, etc.

The long term goal of a dietitian is to have their clients (patients) make sustainable changes that will improve their wellness and quality of life.

Your Role

“Limit intake of foods containing saturated fat, added salt, added sugars and alcohol”
Find how you can best access a dietitian.
Make a food diary for 4-5 days before you visit – this is a list of everything you eat and drink, how much, what time etc. Every detail can help your first meting with the dietitian be a success
Write down your questions about food as they come to mind. It may be helpful to keep a notebook and write the questions in here. Take your questions about food to the dietitian.

Exercise

Exercise is often misinterpreted.

Simply move more, for at least 15 minutes 3 times per day, and you will start to get some health benefits.

There is no need t join a gym, or t pay money for a personal trainer. In fact many a time I have heard from my clients the program a personal trainer has given them – it is dangerous. Being pushed too hard too fast.

The Role of the Exercise Physiologist

The Medicare system recognises the importance of exercise in the role of diabetes self-management so much that they subsidise an Exercise Physiologist for you to connect with.

“Exercise physiology is the study of the acute responses and chronic adaptations to a wide range of physical exercise conditions. In addition, many exercise physiologists study the effect of exercise on pathology, and the mechanisms by which exercise can reduce or reverse disease progression. …..”

We know that exercise can help your insulin work better for up to 12- 24 hours post-exercise.

Exercise is a particularly potent tool for glucose control, cholesterol, blood pressure and weight management.

A daily dose of exercise combined with a health meal plan may lead to weight loss and may delay the need for medication.

Your Role

Find how you can best access the exercise physiologist, or at least a physiotherapist to guide you in an exercise program that you can do with safety, confidence, and achieve health benefits.
Consider activities that you do every day, as well as activities that you enjoy and may not have done for a long time. E.g. cycling, bushwalking.
Make a list of questions for the exercise physiologist and take these to your appointment/s.
Caution: Talk with your exercise physiologist and other members of your health care team about exercising when your BGL is over 15mmols – it may be best not to exercise in this situation.
Start to move more, simple slow steps towards your goal.

Medication

People with type 2 diabetes will need some medication. Maybe not immediately, but at some point the body will need some help. Type 2 diabetes is progressive. Over time the pancreas will make less insulin.

As we discover more and more about the body and its different chemical actions, we may find a medication that will stop this decline. At that point we will still be talking medication.

So, who is the expert at prescribing diabetes medication? Most of the time it will be your GP, sometimes an endocrinologist – particularly if you have been diagnosed with diabetes whilst in a hospital.

The Role of the Doctor

With so many diabetes medications available today one of the judgments your doctor needs to make is which one is best for you. This decision will take into account:

Your overall health
Your kidney and liver functions
Your weight
Your ability to remember to take your medication
What is available to you on a public prescription
Are you willing to pay for a private prescription? (the financial cost to you)
The combination of medications you are already taking

Your Role

Ask your doctor
- What your options are
- When will diabetes medication be required
- What you can do to keep your doses of diabetes medications to a minimum
- Talk to your pharmacist
  - About the medications you are prescribed. Be clear about how and when to take them.
  - About a Webster pack or a pill box.

Measuring

Type 2 diabetes can be present with no symptoms. Your advantage is having been diagnosed: you now have a chance to put into place a self management plan that can reduce your health risks into the future

Your Doctors Role

Amongst many other things, your GP is there to measure and prescribe.

The RCAGP’s has a checklist of tests that can be carried out to ensure your health is managed with a preventative paradigm. Ask Your Doctor

Your Role

By visiting your doctor at least every 3 months you can keep a check on things like blood pressure and cholesterol: things that can be high enough to cause a problem without you feeling any symptoms.

Diabetes is primarily self-managed with the help of your health care team.

Checklist

Use the simple checklist below to assess where you are in terms of your diabetes management and understanding. If you answer no to any of the questions, you may like to talk to the most appropriate member of your health care team: your GP, diabetes educator, dietitian, counsellor or podiatrist.

How healthy are your basics?
Healthy Meals: I have consulted a dietitan in the past year, and I follow this plan most days of every week.		YES	NO
Exercise: I have consulted an exercise physiologist in the past year, and I follow this plan most days of every week.		YES	NO
I understand and take my Medications as prescribed?		YES	NO
Alcohol: I drink no more than 2 standard drinks a day		YES	NO
I am a Non Smoker		YES	NO
Are you confident that you can:
Make a healthy meal plan to manage your diabetes and general health?		YES	NO
Implement a safe and effective exercise program?
Understand how your medications work?		YES	NO
Interpret and act appropriately on your blood glucose results?		YES	NO
Interpret and act appropriately on your blood pressure and cholesterol results?
Put your hypo plan into action when needed?		YES	NO
Implement a safe and effective foot care plan?		YES	NO
Implement a safe and effective sick day plan?		YES	NO
Understand driving and insurance requirements?		YES	NO
Talk with comfort to your health care team about any concerns?		YES	NO

Are your immunisations up to date?
Immunisations up to date		YES	NO

Are you on target?
HbA1c	YES	NO
Blood Pressure	YES	NO
Cholesterol	YES	NO
Are your reviews on schedule?
Eyes (1-2 yearly)	YES	NO
Kidney (yearly)	YES	NO
Feet (yearly)	YES	NO
Teeth (6 monthly)	YES	NO

With your knowledge of diabetes, what else can you think of that is, or could be, a part of your diabetes self care plan?

Who might you ask to support you in achieving your health goals, or designing your health care plan with you?

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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Diabetes Holiday

January 28, 2014 by Imagine_David Leave a Comment

Inspired by a post online: “Having a don’t wanna be diabetic night. So tough sometimes”

I thought I would explore with you if this is something many people do.

So what could this ‘holiday‘ involve? What might this ‘holiday‘ from diabetes look like?

Putting away your blood glucose monitor for a day, a week?

Do you need to measure your BGL every waking moment? Usually, not. Many discussions have been held all over the world about how much to check your BGL. There is no globally correct answer to this question – except to check frequently enough to ensure your self-care plan is working, and to keep yourself safe in times of illness or changed routine. It needs to be a personally chosen thing, what works for you.

Eating Whatever You Like?

Do you do this? Eat the things you like, in an amount that meets your healthy eating plan? If you still think that as a person with diabetes there is a list of ‘banned substances’ – things you are ‘not allowed to eat’ then maybe it is time to consult with a dietitian. Times have changed for the better!

Not Exercising?

Most people don’t exercise every day. And most people when on ‘holidays’ tend to exercise more: walking around a new city exploring; swimming in the pool of the cruise ship; shopping!

Not Taking Your Medication

Sadly, this one you can’t get away from if you have type 1 diabetes. If you have type 2 diabetes, it may be possible to miss a few doses of medication, but would you want to?

Stress

So, here’s where the hard part comes: stress. Living with diabetes every day is stressful. It is hard work. It is relentless. Taking a holiday from this stress lies within your emotional strengths. If you haven’t used the skills and knowledge of our counseling team here at DCO to assist you to achieve that ‘holiday’ from your diabetes, then maybe its time. Time to learn some stress management strategies to be able to leave your diabetes stress at home and take that break. By factoring a ‘holiday’ into your diabetes self-care plan you may just be able to relieve some of that stress.

Support from Others

A large part of self managing diabetes is sharing the load, sharing the knowledge. Having a moan, or sharing a positive experience, so that others may learn from you.

Some of the replies to the original post above included:

“I agree…I’ve had plenty of those days..”

“I feel like that to. It’s such a struggle”

“Had it for about 2-years, then my doctor kicked my a** and smartened me up. Gets depressing every now and then but seeing low numbers first thing in the morning actually makes me want to try harder.”

“I know how frustrating it can be. I struggle to keep my BS down because of being diabetic & I have tumors causing cortisol problems which makes BS stay high”

“It’s hard.. My friend with type 2 just got dx with cancer and I am starting to volunteer with our local Christian program that helps the homeless and less fortunate get back on their feet. It will keep me busy and take my mind off of things and when I see them hungry and cold it brings reality back into check. Our disease sucks.. And I have a lot more health stuff going on, but this group has been invaluable to me! The roll call helps me see where I’m at and reading responses and having people reach out is so wonderful. I’m newly dx but I feel blessed there are other people that walk in the same shoes who are happy to connect with you. Medicine and technology has come a long way.. My Great Grandpa died from t2 complications but that was forever ago when they didn’t have as much info. I see more advancements in the future and we WILL kick diabetes ass! I have bad days too.. But we’re all here for ya. We’ll get each other through this hang in there”

Your Thoughts?

Do you take time out from your diabetes now and then? How do you do it safely? Please share

Regards,

David Mapletoft

Diabetes Educator @ Diabetes Counselling Online

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FACES of DCO Diabetes Week Blogs: Mikki’s story

July 14, 2013 by Helen-Edwards 2 Comments

My name is Mikki, I am 48 years old and live in Ayr, Nth Qld.

I was diagnosed with Type II Diabetes about 4 years ago and have struggled with this the whole time. I also have Bipolar Disorder and suffer Anxiety attacks regularly.

I have 2 wonderful children, a daughter, 21 who has given me 2 beautiful grandsons, and my son is 24. They are my life and what keeps me going in life.

Recently I have developed the onset of Heart disease and also struggle with high cholesterol. I take a multitude of tablets morning and night and now a long acting Insulin shot at night.

The hardest thing for me is facing the fact that I can’t have the foods I love to eat anymore. It is a struggle as I have a sweet tooth and no self control. I am obese and have a back injury making it hard to exercise. Some days are so dark I just want to curl up in bed and forget about life.

I spend my days at my laptop doing surveys or playing on Facebook and also reading stories on the Diabetes Counselling Website. I also like to research new recipes to incorporate into my diet.

Being in a rural town, I am isolated from Specialists like Dieticians and Diabetes Educators, Podiatrists etc. I see them every 6 weeks or so depending on the need. It’s not their fault as they have a wide area to cover.

Stumbling onto Diabetes Counselling is great as I can write to them late at night when I can’t sleep. I am grateful to them for the support I need and will continue to use them again.

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