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Self referral form to join the Together Type 1 service. How to meet other young adults living with diabetes and join a buddying system

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Hello!

Welcome to Together Type 1. On this page, you can sign up to become part of this growing community for all children and young people (aged 11-25) who are living with type 1 diabetes.

Want to know more? Discover more about Together Type 1

Are you or the person you are signing up aged between 16 and 25?

YES, I'm aged 16-25

NO, I'm aged 11-16

NO, I'm not the right age for this programme

I want to be kept informed. Please use this
sign-up form

If you are under the age of 16 or are a parent/guardian nominating a young person under the age of 16 to join the programme, complete this
sign-up form

If you are signing up a young person under the age of 16 to join the programme but are not their parent/guardian, complete this
sign-up form

If you are over 16 and want to join the programme, complete this
sign-up form

If you are signing up a young person over the age of 16 to join the programme, complete this
sign-up form

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If you live in England, Wales, or Scotland, see the latest guidelines on whether you - or someone you're supporting- should be eligible for a flash glucose monitor (Freestyle Libre), continuous glucose monitor (CGM) or insulin pump to help manage diabetes.

If you live in Northern Ireland, you'll need to check the guidance with your healthcare team.

These are guidelines only, it's worth saying. Diabetes healthcare teams may have a local policy which they have to use in line with NICE guidelines as a minimum.
The information below includes guidelines for England and Wales that have come in from March 2022. Read our news story on these changes.
If you think you're eligible for tech for the first time, speak to your healthcare team when you're next due to see them. And ask what the guidelines mean for you. If you are using a flash glucose monitor and may now be eligible for a CGM, you may have to keep using the old one for a set time before being moved over.

Children under 18 with type 1 diabetes

CGM and flash glucose monitor (Freestyle Libre)

If your child is under 18 and you're in England or Wales, they should be offered a continuous glucose monitor (CGM) say NICE guidelines.

If your child is under 18 and you live in Scotland, national guidance says they should be offered a flash glucose monitor (Freestyle Libre). There is currently no guidance on CGMs. You'd need to check with your child's healthcare team if you think this is something that would benefit them.

If your child is under 18 and you're in Northern Ireland, you'll need to check the guidance with their healthcare team.

Insulin pump

If your child is under 12, and you live in England or Wales, a pump may be recommended if multiple daily insulin injections aren't practical or appropriate, say NICE guidelines.

If your child is over 12 and you're in England or Wales, they should be offered a pump if they meet one of the following, say NICE guidelines:

They can't get to their target HbA1c without severe hypos.

Their HbA1c remains high despite carefully trying to manage their diabetes.

For children in Scotland, national guidance says the same criteria for insulin pumps above should apply. Guidelines also say that people who require very small doses of insulin (often babies or very young children) should also be considered for insulin pump access.

For children in Northern Ireland, check the rules on insulin pumps for your child with your healthcare team

Adults with type 1 diabetes

CGM and flash glucose monitor (Freestyle Libre)

If you're 18 and over and live in England and Wales and have type 1 diabetes, you should be able to choose between a CGM or flash glucose monitor (Freestyle Libre) say NICE guidelines. You should be offered CGM if you are pregnant and have type 1 diabetes.

If you're in Scotland, national guidelines recommend that you should be offered a flash glucose monitor (Freestyle Libre) if you have type 1 diabetes. There are currently no national guidelines in Scotland for the use of CGM in the wider adult type 1 population, although it is recommended that CGM should be available to you if you are pregnant.

Insulin pump

If you're 18 or over and have type 1 diabetes and live in England or Wales, you should be offered an insulin pump if one of the following applies say NICE guidelines:

You can't get to your target HbA1c without severe hypos.

Your HbA1c remains high despite carefully trying to manage your diabetes.

If you live in Scotland and have type 1 diabetes, national guidelines recommend the criteria listed above should also be used to determine if you can access a pump.

If you live in Northern Ireland, check the guidance with your healthcare team.

Adult with type 2 diabetes

If you have type 2 diabetes and use insulin two or more times a day and live in England or Wales, you should be offered a Freestyle Libre to help you check your blood sugar levels if any of the below apply, say NICE guidelines.

you have recurrent or severe hypoglycaemia

you have impaired hypoglycaemia awareness

you can't monitor your own blood sugar levels but you could use a scanning device or someone else could scan for you

you should otherwise be advised to do a finger prick test at least 8 times a day.

Adults with type 2 diabetes in England or Wales who use insulin and would otherwise need help from a care worker or healthcare professional to monitor their blood sugar should be offered a CGM.

If you have a learning disability and use insulin, you should be offered a flash glucose monitor (Freestyle Libre) say NICE guidelines for England and Wales.

In Scotland, national guidelines recommend people with type 2 diabetes who use insulin intensively (four or more injections per day).

If your child has type 2 diabetes, there are no guidelines on technology access. But we believe many children living with type 2 diabetes could benefit from Flash or CGM use and we will be pushing the health system to make it available. If you think your child could benefit from Flash or CGM, speak to your healthcare professional about what options you have.

Pregnant with diabetes

If you're pregnant and have type 1 diabetes you should be offered a CGM. A CGM should be offered rather than a flash glucose monitor as evidence shows CGM can be particularly beneficial during pregnancy.

If you're pregnant and have type 2 diabetes or gestational diabetes you should be offered Flash or CGM if you have severe hypos regardless of your hypo awareness, or if you have unstable blood sugar, say NICE guidelines for England and Wales.

If you're in Scotland you should be offered CGM if you're pregnant and have type 1 diabetes. There are currently no national guidelines for CGM or Flash use in pregnancy when you have type 2 diabetes of gestational diabetes in Scotland.

If you're in Northern Ireland, check the guidelines with your healthcare team.

Adults with other types of diabetes

There is very limited NICE guidance on tech access for other types of diabetes such as LADA or those caused by another illness or rare genetic condition. But do check with your healthcare team. Depending on how you manage your diabetes you may or may not qualify. Your healthcare team are likely to apply the guidance for type 1 or type 2 diabetes based on the type of treatment you're receiving for your blood sugar levels.

We would suggest that if you manage your diabetes with two or more insulin injections, you should be given access to a flash glucose monitor (Freestyle Libre) or CGM.

If you don't qualify for tech

We know it can be frustrating if you don't meet the criteria set out by the NHS to access your tech. But there are steps you can take to try and change this.

Firstly, you can make your case to your healthcare professional, explaining how and why using a flash glucose monitor, CGM or insulin pump will help you to manage your condition.

Sometimes they can loan you a device for a short time to see how much difference it makes to your quality of life - or give some insights on what is affecting your blood sugars so you can make positive changes to help manage them.

Individual funding requests

Sometimes local policies mean you may not get access to the technology you need. You can ask your healthcare professional if they can help you submit a request for individual funding - an approach used to ask local decision-makers to fund technology outside of their normal policies. Your healthcare professional should know what the process is for your part of the UK and whether this is the right approach for you.

Write to your CCG or health trust or board

If you this doesn't help, you can also write to or email your CCG, Health Trust or Board and outline why you should be provided with the tech you want.

When making your case for any type of tech, include answers to the questions below if they're relevant, giving as much detail as possible.

If you've been self-funding your tech, what did you notice about your diabetes management before, during and after using the device?

What are the challenges you're currently facing with your diabetes management?

How do you think using the tech would help you with your blood sugar control?

Do you test as often as you have been advised or would like to? If not, why is that?

Do you experience regular hypos and what are the effects of this on your day-to-day life?

How does your lifestyle make it hard to monitor your diabetes without tech?

Do you struggle to perform finger prick tests regularly as part of your everyday routine?

Do you work in an environment where it is difficult to perform finger prick tests regularly? Can you explain why?

How would tech benefit you if you regularly play sport?

Get support from our helpline or online forum.

Please give our confidential  helpline  a call if you're looking for more information, advice or just someone to chat to. Whether you've got specific questions about the different types of tech available, or just want talk through your options with someone, our highly trained advisors are ready to help.

Or head over to our online forum to join hundreds of members talking about their experience with diabetes tech. You can ask questions, read conversations between existing members, or share your own knowledge and help others.

Find your CCG or health board

England

Enter your postcode into the Clinical Commissioning Group finder on the NHS England website. It will list your local services and their contact details.

Wales

There are 7 Local Health Boards across Wales. Find out which Board covers your region on the NHS Wales website, along with more information and contact details.

Scotland

There are 14 Health Boards covering all of Scotland. Find the full list and contact details on the NHS Scotland website.

In Northern Ireland, there is a Health and Social Care Board (HSC) and five Local Commissioning Groups (LCGs). Find your local group and their contact details.

What we're doing to help everyone get the tech they need

Everyone with diabetes should be able to get the tech they need to live well with diabetes and we won't rest until that happens. But nearly half of those who have tried to get diabetes tech have been refused it at some point.

We know that the emotional impact of not being able to access the tech you want and need can be really difficult. That's why we want you to know we're here for you.

Improving access to diabetes tech has the potential to impact many millions of people with diabetes. That's why our strategy over the next five years focuses on working towards a system where both existing diabetes tech, and the new innovations that become available, are accessible to all those who could benefit from their use.

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Getting a free CGM, flash glucose monitor (Freestyle Libre) or insulin pump on the NHS - who should qualify?

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If you live in England, Wales, or Scotland, see the latest guidelines on whether you - or someone you're supporting- should be eligible for a flash glucose monitor (Freestyle Libre), continuous glucose monitor (CGM) or insulin pump to help manage diabetes. If you live in Northern Ireland, you'll need to check the guidance with your healthcare team.

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Educational Resources for people living with diabetes | ABCD (Diabetes Care) Ltd

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Providing education to people with diabetes to help them make the best use of diabetes technology

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If you have type 1 diabetes, your blood sugar is too high because your body can't make a hormone called insulin.

Fewer than one in 10 people in the UK who have diabetes have type 1 diabetes. There is nothing you can do to prevent yourself or others developing type 1 diabetes. The exact causes are not known.

Although it's often diagnosed in childhood, people can develop type 1 diabetes at any age. You are at a slightly higher risk of type 1 diabetes if your mother, father, brother or sister has it.

Insulin is the main treatment for type 1 diabetes. You can't live without insulin injections or using an insulin pump. Checking and managing your blood sugar levels is important to help you reduce your risk of serious short or long-term health problems. These are called diabetes complications.

There is currently no cure for type 1 diabetes, but we're funding lots of research to help find new treatments and a cure.

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If you have type 1 diabetes, your blood sugar is too high because your body can't make a hormone called insulin. Fewer than one in 10 people in the UK who have diabetes have type 1 diabetes. There is nothing you can do to prevent yourself or others developing type 1 diabetes.

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Find out what you should think about before going to university.

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www.uhsussex.nhs.uk

01903 205111
01243 788122

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Sharing your libre data with Healthcare Professionals

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LibreView | Connect with Healthcare Professionals | Abbott

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With LibreView, all your FreeStyle Libre sensor glucose data can be stored in our secure, cloud-based management system and shared with Healthcare Teams.

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National helpline: 03302228181

Refuge: 0808 2000 247

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Signs, symptoms and useful videos

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Diabetic ketoacidosis, also known as DKA, is when there is severe lack of insulin in the body. This means the body can't use sugar for energy, and starts to use fat instead. When this happens, chemicals called ketones are released. If left unchecked, ketones can build up and make your blood become acidic - hence the name acidosis.

Diabetic Ketoacidosis (DKA) is a serious condition that affects people with type 1 diabetes, and occasionally those with type 2 diabetes (although they are more likely to be affected by Hyperosmolar Hyperglycaemic State (HHS)).

Some children and adults who don't realise they have type 1 diabetes don't get diagnosed until they are very unwell with DKA. It is important to be able to spot the signs and symptoms of DKA so that it can be treated quickly.

DKA is serious if it is not treated fast so these are some of the warning signs to look out for. Share this information with friends, relatives or anyone who looks after children, like teachers and childminders. This is so that they will be able to spot the symptoms of DKA, too.

Here Kate tells us about when her son Llewis became seriously ill with DKA and was diagnosed with type 1 diabetes soon after.

What are the signs and symptoms of DKA?

The signs of DKA include:

high blood sugar levels

being very thirsty

needing to pee more often

feeling tired and sleepy

confusion

blurred vision

stomach pain

feeling or being sick

sweet or fruity-smelling breath (like nail polish remover or pear drop sweets)

passing out.

Although most common in people with type 1 diabetes, people with type 2 diabetes can sometimes develop DKA. If you notice high blood sugar levels and spot any of the signs below it's very important to get urgent medical help.

In her video Kate mentions the 4Ts which are the four most common signs of type 1 diabetes. They are:

Toilet - Going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.

Thirsty - Being really thirsty and not being able to quench the thirst.

Tired - Feeling more tired than usual.

Thinner - Losing weight or looking thinner than usual.

The early signs of DKA can often be treated with extra insulin and fluids if it is picked up quickly. But if it isn't, DKA needs hospital treatment and can be life-threatening.

These symptoms are sometimes referred to as a 'diabetic attack', but this can also refer to other things, such as hypoglycaemia. You might notice these signs developing over 24 hours but they can come on faster, especially in children or if you use a pump. If you spot any of these symptoms it is a sign that you need to get some medical help quickly.

Checking ketones and blood sugar

Blood testing

Check your blood sugar straight away if you have any of the signs of DKA.

If your blood sugar is high, check for ketones. You can check your blood or your urine for ketones. A blood test will show your ketone levels in real time but a urine test will show what they were a few hours ago.

If you have type 1 diabetes you should get either a blood ketone monitor or urine testing strips for free from the NHS. If you have high ketone levels in your blood and suspect DKA, you should get medical help straight away.

When to get help with DKA

DKA is serious and must be treated in hospital quickly. Left untreated, it could lead to a life-threatening situation.

Treatment of DKA includes:

Being given insulin through a vein

Being given fluids through a vein to rehydrate your body

Being given nutrients through a vein to replace any you've lost

You'll also be closely monitored to make sure there are no serious problems with your brain, kidneys or lungs.

You'll be able to leave hospital when you're well enough to eat and drink and tests show a safe level of ketones in your body.

What can you do to avoid DKA?

You can help avoid DKA by monitoring your blood sugar levels regularly and altering your insulin dose in response to your blood sugar levels and what you eat.

Your blood sugar levels could be higher than normal when you are unwell. So, it's a good idea to work with your healthcare team to come up with some sick day rules for when you are ill. You may need to drink more fluids, take more insulin and check your blood sugars more than you would usually. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you (or your child).

It is still a good idea to contact your GP or diabetes team if:

You feel fine but are getting higher than usual readings for blood glucose and ketones.

You feel unwell but your blood glucose and ketones are only slightly higher than normal.

"The experience [of having DKA] has taught me that it's so important to listen to your body. No matter how many HCPs you visit, whether they're a GP or a diabetes specialist or a family friend who works in the field, you know your body and you know what feels right and what doesn't feel right. When it comes to diabetes, it's so important to trust your instincts."

Amber, 21, had DKA

What causes DKA?

For some people, becoming suddenly very ill with DKA can be what leads them to finding out they have type 1 diabetes in the first place.

If you have already been diagnosed with diabetes, the causes of DKA can include:

being ill with a chest infection, flu, Urinary Tract Infection (UTI) for example

high blood sugar levels caused by a growth spurt or puberty

not taking your insulin or missing doses

surgery or an injury

high blood sugar caused by having your period.

Sometimes, there isn't always an obvious trigger for DKA which can be worrying and confusing. But if you suspect you or your child has DKA it is important to get medical help straight away.

If you are concerned about any aspect of managing diabetes, you can always call our helpline for support on 0345 123 2399. Alternatively, you can head over to our forum where there are many people willing to offer support and share their experiences of diabetes.

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Diabetic ketoacidosis, also known as DKA, is when there is severe lack of insulin in the body. This means the body can't use sugar for energy, and starts to use fat instead.

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Our aim at ExCarbs is to help people with diabetes using insulin to feel comfortable with taking up exercise - our advice is not aimed at elite athletes but hopefully covers the basic rules for most people living with diabetes.

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Helping people with Type 1 Diabetes to be winners!

Why "Runsweet"? This came from advice from a person with type 1 diabetes who tried to "run sweet" to avoid hypos. We know we can do better!

Thank you all for the great feedback about the site. We now boast the widest sports content for people with diabetes on the web. we are now getting more than 30000 visits per month and are top in searches on Google. You continue to test the limits of what is possible, and have submitted great new content. Keep visiting. If you want to post any content, mail it to us. Our forum is also very popular. We now also have aFacebook page.

He has done it again! Rod Riddell's Marathon des Sables adventure with T1 DM
Major new focus on pump treatment and how to use your pump with exercise. New focus on guidelines for safe exercise.
Can you help with research? We are recruiting for a study ( ExTOD ) on the effect of structured education on Exercise and Diabetes. See Reseach page if you can help
You can download the Jephcott Medal Symposium lecture with Sir Steven Redgrave, on the topic: "Olympic Diabetes: What have we learned over the last decade?". Slides from his talk can be downloaded in PowerPoint and PDF formats. We also have some images of the award in our Gallery section.

Dr Gallen has also published a book aimed at medical professionals. More details can be found on our new Publications page.

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Helping people with Type 1 Diabetes to be winners! Why "Runsweet"? This came from advice from a person with type 1 diabetes who tried to "run sweet" to avoid hypos. We know we can do better! Thank you all for the great feedback about the site.

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DSN helpline Worthing : 01903 285044
DSN helpline (SRH): 01243 831577

Email: uhsussex.diabetesnurses@nhs.net

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Admin contact (Worthing):
uhsussex.diabetesadmin@nhs.net

Tel (01903 205111) ext 85889

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Diabetes shouldn't be a barrier to going on holiday. Planning ahead with things like what to pack, what food might be available and the weather can all help to avoid any problems while you're away.

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Video explaining hypoglycaemia

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Hypos are periods of low blood sugar. Although common for diabetics, a hypo can be unnerving.

With appropriate treatment the effects and length of hypos can be reduced.

Noticing you're having a hypo

Before you can treat the hypo, you need to notice that you are low on blood sugar.

The sooner you notice hypoglycemia, the less disruptive it's likely to be.

Typical signs of hypoglycemia include:

Feeling suddenly tired or weak

Having difficulty concentrating

Exaggerated mood changes

Feeling dizzy

Hypos can occur at any time, pay close attention to your blood sugar levels when exercising, playing sports or during physical activity.

Check it is a hypo by blood glucose testing

Where possible, test your blood sugar to ensure it is low blood sugar as some of the signs of low blood sugar may also represent higher blood sugar (such as tiredness or mood changes).

If you cannot test and are unsure if you have low or high blood glucose, it may be best to treat it as a hypo as hypoglycemia can quickly become dangerous if left untreated.

Act quickly

It is important that as soon as you notice or confirm you are hypo you treat the hypo immediately.

Immediate hypo treatment helps by:

How to treat your hypo

To treat the hypo, you need to take about 15 to 20 grams of quick acting carbohydrate

Take a quick acting source of sugar

Glucose tablets are ideal as they act very quickly and will take you out of the hypo quicker. They are also relatively easy to judge how much sugar you are taking.

Sugary drinks (Coke, Pepsi, etc)

Glucose tablets and glucose juice are ideal as they act very quickly and will take you out of the hypo as quickly as possible. They are also relatively easy to judge how much sugar you are taking.

You can also have five jelly baby sized sweets or four to five sugar lumps.

15-20g of sugar can be found in:

160ml (half a 330ml can) of sugary cola or lemonade

200ml (a small carton) of fruit juice

Sugary drinks can sometimes be a little more difficult to judge how much sugar you are taking but they're still a good source of sugar in an emergency.

You may also need slower acting carbs

If your next meal is not soon, you may also need to take 15-20g of slower acting carbohydrate to prevent a further dip in blood sugar.

15-20g of slower acting carbs can be found in:

Check blood glucose after 15-20 minutes

Check your blood glucose levels 15-20 minutes after treating the hypo. If your blood glucose levels are below 5 mmol/l (90 mg/dl), repeat the treatment.

Treating severe hypos: seizures

When a seizure is occurring, it will not be possible for a person to take sugar. It is also not advised to feed someone when they are having a seizure as this could lead to choking.

Where possible try to ensure the person having the seizure will not hit anything and cause themselves injury.

If they are on the floor, place something soft like a pillow or article of clothing to cushion their head.

Often a seizure will pass after a few minutes and this may allow the person having the seizure to take some sugar. If the seizure persists for more than 5 minutes, call for an ambulance.

Treating severe hypos: Unconsciousness or unable to take sugar

If unconsciousness occurs or the person is unable to take sugar, call for an ambulance

If you have a glucagon injection kit, check the glucagon is in date and administer a dose. If you have not given a glucagon dose before, read the instructions carefully before starting.

In some cases, unconsciousness may occur as a result of very high blood sugar levels. You can give the person a blood test to confirm, taking care to ensure their fingers are clean first.

If they have too high sugar levels, glucagon will not treat the problem but should not present a risk.

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Hypos are periods of low blood sugar. Although common for diabetics, a hypo can be unnerving. With appropriate treatment the effects and length of hypos can be reduced.

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Hypos are periods of low blood sugar. Although common for diabetics, a hypo can be unnerving. With appropriate treatment the effects and length of hypos can be reduced. Noticing you're having a hypo Before you can treat the hypo, you need to notice that you are low on blood sugar.

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For most people with diabetes, driving isn't a problem, and they can hold a driving licence and carry on driving. Here you'll find everything you need to know about diabetes and driving.

"As someone with diabetes, it's really important that I'm aware of the rules around driving in the UK" - Mim

How diabetes can affect driving

There are two main things about diabetes that can affect your ability to drive safely:

If how you treat your diabetes means you're at risk of having a hypo (where your blood sugar drops below 4mmol/l).

If you develop diabetes complications that make it harder for you to drive - like problems with your eyes (retinopathy) or nerve damage (neuropathy).

If these things affect you, you need to know what the rules are and what you need to tell your local driver and licensing authority.

The rules are different depending on what vehicle you want to drive. Here we'll talk mainly about what you need to know if you want to drive a car or motorbike (called a Group 1 licence).

To drive a lorry or larger vehicle, you'll need a Group 2 licence. There are different rules for this type of licence and they can be more complicated when you are driving with diabetes.

These rules come from the Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales, and the Driver and Vehicle Agency (DVA) in Northern Ireland. We use DVLA throughout this information, to make things simpler.

And remember, you need to know these rules if these things could affect you in the future if not now.

Driving and how you treat your diabetes

Can you still drive if you have diabetes? It depends if how you treat your diabetes means you're at risk of hypos, as this can affect your ability to drive safely.

So what makes you at risk of having hypos? Hypos can affect people who take certain medication to treat their diabetes, including insulin and medications like sulphonylureas. And some hypos can be really severe where you need help to treat them. Speak to your healthcare team if you're not sure whether you're at risk of having these and what you can do to prevent them. If you already know you're at risk of hypos, follow our checklist each and every time you drive.

However you treat your diabetes, use our table explaining the rules for your driving licence based on each type of treatment.

Driving and eye complications

Retinopathy is damage to the blood vessels supplying the eye's retina (the seeing part at the back of the eye) and it can cause sight loss. It's linked to high blood sugars and high blood pressure so it's more common in people with diabetes.

If you start having problems with your eyes, you need to let the DVLA know and you may need a special diabetes eye test for driving. It'll be done at an optician near you that's recommended by the DVLA and they'll pay for it.

Some eye problems can be treated successfully which means you can reapply for your licence. Ask your healthcare team if you're not sure.

Other diabetes complications that can affect driving

Neuropathy affects your nerves. Damage to your nerves can mean you lose feeling in your hands and feet, as well as causing problems in various other parts of your body. If it's severe then you should ask your healthcare team or the DVLA for more advice.

If neuropathy or an amputation mean you need an adapted vehicle, you'll have to apply for an adapted vehicle licence from the DVLA. Diabetes complications shouldn't have to stop you driving.

Heart complications can affect your ability to drive and being able to hold a licence. Your specialist heart team must advise you here.

Other conditions the DVLA need to know about include things that could cause loss of consciousness or concentration, like sleep apnoea. This can make it harder for you to concentrate in the day due to extreme sleepiness. Talk to your healthcare team or sleep clinic about this.

They also need to know about any problems you develop that make it difficult to negotiate traffic or act quickly. For example a stroke, which is a cardiovascular complication, is when blood can't get to the brain and it's starved of vital oxygen and nutrients. This can happen if your blood vessels are damaged or blocked and can make it harder for you to react quickly.

We have lots of information to help you understand the DVLA diabetes rule and when to talk to the DVLA about your driving licence - we've created tables about Group 1 and Group 2 licenses to help you find the information you need quickly and easily.

Your driving checklist if you're at risk of hypos

Follow this diabetes driving hypo checklist each and every time you drive. It's how you reduce your risk of a hypo at the wheel. And it's how you can carry on driving safely.

Know the symptoms of a hypo - if you've lost hypo awareness, you can't drive.

Keep spare test strips in the car and bring your meter with you.

Check your blood sugar levels before you set off and every two hours on long journeys.

Five to drive - your blood sugars have to be 5mmol/l or above before you drive. If they're between 4mmol/l and 5mmol/l, eat some carbs before heading out.

If they're under 4mmol/l - treat your hypo and check your levels again before driving.

Always keep hypo treatments where you can easily reach them in the car.

Take breaks on long journeys.

Don't delay meals or snacks.

Remember, the rules are more complicated around diabetes and truck driving or if you want to drive a large vehicle, with a Group 2 licence.

When to check blood sugar levels for driving

If you usually check your blood sugar levels, then you must follow the rules about when to check them. This means checking them within two hours of driving - however short the trip. On longer journeys, you must check them every two hours.

It's fine to use a flash glucose monitor or a continuous glucose monitor to check your sugar levels before you drive.

These rules are only about checking for low blood sugar levels - the DVLA don't have any specific limits on high blood sugar levels.

Speak to your healthcare team if you're not sure whether you should be checking your blood sugars - it depends what medication you're on.

If you start having a hypo while driving

It's the law that you must stop. And it's what you must do to avoid any risk of an accident. So find somewhere safe to pull in as soon as possible.

1. Pull over safely. If you feel like your blood sugar is low then make sure you pull over as soon as possible.

2. Switch off the engine. Take the keys out and move from the driver's seat - if you don't, the police can think you're still in charge of the car and you could be prosecuted.

3. Take fast-acting carbs, like glucose tablets or sweets, and some longer-acting carbohydrates too, like plain biscuits or crackers.

4. Don't drive until 45 minutes after your blood sugar level has gone back to 5mmol/l or above. This is the time it takes for your concentration to go back to normal.

If you're struggling with hypos, talk to your healthcare team about whether you should be driving.

You don't need to let the DVLA know that you've had a hypo - only if it's a severe hypo (where you need help to treat it). Severe hypos are a lot more serious so the rules are more detailed. We have more information about severe hypos if you don't know what they are.

Diabetes and car insurance

Most car insurance companies won't charge more if you have diabetes. You should complain if they do and if you're still not happy then try somewhere else.
You'll have to declare your diabetes as a material fact when applying for insurance. We've information about insurance and diabetes to help you.

Driving for work when you have diabetes

If you drive as your job or use a car to get to work, you're bound to worry about how changes to your driving licence could affect your job.

We have lots of advice and information on driving and work to help you understand what your rights are.

Can diabetes affect your driving license?

If you have your licence revoked then you can nearly always reapply for it after some time. It depends why you lost your licence. The most common reason is because of severe hypos, which is where you need help and can't treat it on your own.

You can apply for a new licence up to eight weeks before the date given on your refusal notice. What happens then will depend on why your licence was taken away. We have lots more information on what happens if you lose your licence.

More information and support on diabetes and driving

Our helpline has trained advisors who can help with specific problems or questions.

Our online forum is also a useful way to get tips and advice from others with diabetes.
Find out about all the DVLA rules about diabetes

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For most people with diabetes, driving isn't a problem, and they can hold a driving licence and carry on driving. Here you'll find everything you need to know about diabetes and driving.

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Reception tel: 01243 788122 ext 33740

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Diabetes mellitus: assessing fitness to drive

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✘- Must not drive ! - May continue to drive subject to medical advice and/or notifying DVLA ✓- May continue to drive and need not notify DVLA Information sent to drivers Insulin-treated drivers are sent a detailed letter from DVLA explaining the licensing requirements and driving responsibilities (see the INF294 leaflet in Appendix D).

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You can travel anywhere with diabetes. You just have to prepare to avoid any problems.

Before you travel

make sure your travel insurance covers health problems related to your diabetes

find out where you can get your insulin in the place you're visiting, and take a recent prescription with you

speak to your care team for advice about adjusting to different time zones

if you're flying, get a letter from your GP to say you have diabetes and need to take your treatment on to the plane

if you use a pump or a continuous glucose monitor (CGM), check with your airline before you travel about taking it on board - some airlines require paperwork for medical equipment

Packing for your trip

pack 3 times as much insulin, test strips, lancets, needles and glucose tablets as you'd expect to need

split your medicines, IDs and equipment into 2 different bags, just in case 1 gets lost

if you use a pump, pack insulin pens in case it stops working

put insulin in your hand luggage - the hold of the plane will be too cold and could damage the insulin

take a cool bag to stop your insulin getting too hot

take some form of diabetes ID, like a medical alert bracelet, to tell others that you have diabetes

take the contact details of your diabetic team, just in case you need their advice

take plenty of snacks in case there are any delays

do not put your pump through airport scanners or x-ray machines - let airport security know so they can check it another way

While you're away

be prepared to test more while you're away - hot and cold weather can affect your blood glucose levels and increase your risk of a hypoglycaemia (hypo) or hyperglycaemia

you may have to change your insulin dose depending on the temperature and different activities you're doing - speak to your diabetes team

take care if you're sunbathing, as this can affect your blood glucose levels

Diabetes UK has more information on what to do when you travel.

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Diabetes doesn't just affect you physically, it can affect you emotionally too.

Whether you've just been diagnosed or you've lived with diabetes for a long time, you may need support for all the emotions you're feeling. This could be stress, feeling low and depressed, or burnt out. The people around you can feel all of this too. Whatever you're feeling, you are not alone. Here's some information you might find helpful - you might like to share it with your family and friends too.

Coronavirus and your emotional health

We know that things feel a little scary and uncertain at the moment because of the coronavirus pandemic. Your experience of living with diabetes and the stresses it brings may make you more prepared to cope with this situation than most people. But we're here for you if you are struggling too.

"Focusing on things you can control could help people living with diabetes, or affected by diabetes, to manage any stress, anxiety or sleeplessness you may be experiencing during the coronavirus pandemic."

- Dr Rose Stewart, Principal Clinical Psychologist and one of our Clinical Champions

Focus on things you can control

If you're finding yourself worrying, it might help to try to focus on the things that you can control in your life. Here are some tips:

know your sick day rules

go to appointments if your healthcare team ask you to

check out your work policies around sickness and time off

keep important numbers handy

know the symptoms of coronavirus and what to do if you begin to feel ill

make sure you have supplies and repeat prescriptions up to date

look after your body - try to make healthy food choices, be active, get enough sleep and wash your hands more often

check out our recipe finder for new ideas

make sure to look after your mind if you're staying at home - keep in touch with friends and family if you can

say no to things if you need to, and ask for help if you feel you need it

get your news from reliable sources, but it's also okay to take a break from the news if it feels too much.

Things you can't control

Focusing your mind on things out of your control won't change things. This can lead to worry, so gently try to redirect your attention.

You might be feeling nervous, because your condition may make you more vulnerable to becoming unwell if you catch coronavirus. Or you might be worrying about who around you could catch the virus. But you don't have control over these things, so try to be supportive and understanding for the people who do get coronavirus. And remember that it is not your fault if you catch the virus too. Be kind and compassionate to yourself.

If you need to self-isolate, you may have to miss work, school or appointments. This is okay and the best thing to do to look after yourself and others.

You might also be worrying about some diabetes appointments being cancelled or finding it difficult to get hold of your healthcare team. There might be alternative options, like phone or video appointments, so look into these. Most appointments aren't urgent, but if your diabetes team really need to see you they will get in touch with an appointment. It's important that you try to go to these.

Not being able to get what you want from the shops can be stressful. You can't control the availability of supplies. Try to be patient and try not to panic buy. If you are having difficulty getting food supplies, we are doing our best to support you. Find out what we're doing.

It's not easy to stop feelings of anxiety and worry, and these are completely normal responses given the current circumstance. You can't control your feelings, but you can control what you do with them. Talking about how you're feeling might help. And the mental health charity Mind have put together some useful information about taking care of your mental health during this time too.

Talking about how you feel

Talking about diabetes and how it's making you feel isn't always easy. It can be hard to get started, or find someone you think you can open up to. Maybe you don't feel like you need to talk about anything or you don't want to burden anyone. But offloading some of what you're feeling has so many benefits, both for you and for those close to you.

Read our advice on talking about your diabetes. We've got tips to help you start those conversations with your family and friends, your boss at work, and really importantly your healthcare professional team.

Stress and diabetes

Everyone can feel stressed from time to time. But having diabetes to manage as well as everything else in life can feel very overwhelming. Stress can affect your blood sugar levels, so it's important you know how to recognise when you're stressed and how to deal with it. We can help you cope with stress when you have diabetes.

"I'm not superwoman and it's difficult to say that. Having been diabetic for more than half my life, I feel I'm not a role model for Oliver if I get stressed about it. But if I'm honest about the stress maybe that is helping him."

- Amy who has type 1 diabetes and her son Oliver who was diagnosed in 2019.

Coping with being diagnosed

Being diagnosed with diabetes can come as a shock. First reactions may be disbelief, feeling overwhelmed, even anger. Usually these feelings ease after a while and diabetes becomes part of life. But sometimes these feelings don't go away easily. If you feel this way, you're not alone.

There are lots of people out there to support you - your family, your friends, your healthcare professional team, and we're here for you too. We can help you get to grips with diabetes and help you find other people going through the same things as you. Take a look at our guide to being diagnosed to help you start adjusting to life with diabetes.

Depression and diabetes

Diabetes can be difficult to live with day to day and get you down, this is completely normal. But if these feelings won't go away, you might have depression. Having depression and diabetes is more common than you might think - people with diabetes are twice as likely to develop depression than people who don't have diabetes. We can help you know the signs of depression and how to manage it.

Diabetes distress

Diabetes can be really tough to live with. Sometimes people feel distressed, which can include feeling frustrated, guilty, sad or worried. It's understandable if you feel this way from time to time - you're not alone. There are lots of things you can do to help you cope with feeling diabetes distress.

Fear of hypos

Hypoglycaemia or a hypo is when your blood glucose level (blood sugar) goes too low. Not everyone with diabetes can get hypos, but some often worry or get anxious about having them. If these feelings don't go away or start to take over your daily life, then it's important you talk to someone about it. Find out how to work through your hypo anxiety.

Emotions and food

Diabetes can put more of a focus on food and diet. Having to pay close to attention to what you eat and learn new ways to cook can be stressful. Some people find they eat more when they're stressed or eat less because they're feeling low. Eating different foods can have an impact on your mood too - find out more about the link between your feelings and food.

Sometimes, it can mean more of a focus on weight and body image too. This can lead to an unhealthy relationship with food, something called
disordered eating, or possibly an eating disorder. Diabulimia is a serious eating disorder that people with Type 1 diabetes can develop. We've got more information on diabulimia and what can help if you're struggling with it.

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Diabetes doesn't just affect you physically, it can affect you emotionally too. Whether you've just been diagnosed or you've lived with diabetes for a long time, you may need support for all the emotions you're feeling. This could be stress, feeling low and depressed, or burnt out.

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Diabetes distress is what some people feel when they’re overwhelmed by the relentlessness of diabetes. This can lead to diabetes burnout. The way you react to things and the emotions you feel can vary for different people. You might feel frustrated, guilty, sad or worried. Sometimes you might feel a…

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Our services are available as usual during the Covid-19 pandemic. We are following Sussex Community NHS Foundation Trust guidelines and measures to ensure you are safe when receiving treatment. If you have any concerns about how Covid-19 may affect your treatment, get in touch.

Do you live with a long-term health condition? Time to Talk Health is a free talking therapies service that could help.
Time to Talk Health is not a crisis service and we are not able to provide crisis support. If you are in crisis and need urgent support please contact one of the following services:

Sussex Mental Healthline: 0800 0309 500 (24hrs)

The Samaritans: 116 123 (24hrs)

111 and ask for crisis support

Your local A&E department

Stay Alive App

Your GP and request an urgent appointment

We support adults in West Sussex to cope with one or more of the following diagnosed long-term health conditions:

A cardiac (heart) condition

Asthma

Chronic Obstructive Pulmonary (lung) Disease (COPD)

Diabetes - Type 1 Type 2 or gestational

Irritable Bowel Syndrome (IBS)

Long Covid - ongoing symptoms for 12+ weeks

Musculoskeletal (MSK) conditions

At Time to Talk Health, we know living with any of these conditions can be really difficult - you may become worried, anxious or low in mood, which can lead to even worsening health. Our friendly, qualified team of clinicians work with your physical health clinicians to help you if you're struggling to adjust to a new diagnosis or experience problems coping as your condition progresses.

How will it benefit me?

Our clinicians can support you to:

Help you understand the impact of low mood or worries on your health and vice versa

Overcome your fears, anxieties or low mood related to living with a long-term health condition

Reduce the impact of your long-term condition on your day-to-day life and relationships

Make and sustain healthier lifestyle changes, no matter how big or small

Reduce the impact of your condition on your work life, including support from our specialist Employment Advisor

What therapy is available?

After your assessment, we will recommend next steps for you, either from the range of treatments we offer or another service.

We offer:

An online self-help programme supported by one of our clinicians

Group sessions by video including:

One-to-one weekly sessions by telephone, video or in person, at venues across West Sussex.

Our partners

We partner withIESO, an online therapy provider. You may be referred toIESOafter your initial assessment with Time to Talk or Time to Talk Health. IESOworks via an easy to use platform which can be accessed using a computer, tablet orsmartphone. Find out more in the video below.
What our patients are saying
"Time to Talk Health and my allocated therapist was a life saver for me. My therapist was kind and supportive throughout. She helped me to recognise warning signs, not use avoidance and to work through my fear and panic." - Time to Talk Health patient

"My therapist was great, I could not have picked a better match for me. My therapist made me feel like me again and I have not felt like that for such a long time. I now have the skills to live a better life. Thank you so much". - Time to Talk Health patient

You can ask your healthcare nurse, doctor or GP to refer you, or you can self-refer to Time To Talk Health using the online referral.

You can also ring us on 01273 666480 Monday to Friday between 8am to 5pm. If you leave an answer phone message outside of these hours, we will respond to you the next working day.

You can also email us on: sc-tr.LTCreferrals@nhs.net

Once you've referred, we will arrange a time to complete a telephone assessment with you.

Assessments usually take place Monday to Friday between 8am-3pm. Please allow yourself an hour in a confidential space to talk through what your needs are. In some circumstances, we can offer face-to-face assessments. Please ask if you have particular requirements regarding your assessment.

We have appointments and courses from 8am to 6.45pm. Our office hours are Monday to Friday 8am to 5pm.

We deliver the Time to Talk Health service in venues across West Sussex. When you have your initial assessment, we will work with you to find the best location for you, or provide you with treatment you can access online or on the telephone.

Online mental health support

Living Well Programme is a free six-session self-management course developed for people living with any long-term health condition across West Sussex and is run by Sussex Community NHS Foundation Trust.

Time to Talk offers a range of talking therapy treatments for adults with common mental health problems like anxiety and/or depression not impacting on the long term conditions listed above.

The wellbeing hubs is a free, friendly and impartial service which comes from your local authority, the NHS and other partners, where you can find out more about local activities and support services.

Mind in Brighton and Hove is a mental health charity offering some services in West Sussex, including participation services, peer mentoring and mental health advocacy (IMHA, Community and Children/Young Persons).

Support for living with diabetes

Diabetes UK offers a range of online information, booklets to download, practical advice e.g. recipes, forums. There is a helpline staffed by trained counsellors, with knowledge of diabetes.
Support for living with a heart condition

British Heart Foundation offers a range of information and booklets about heart conditions and living with heart conditions. There is a helpline staffed by Cardiac Nurses and Information Support Officers. There are also details of support groups.
Support for living with COPD

British Lung Foundation offers information about lung conditions and living with lung conditions. There is a helpline available and details of local 'Breathe Easy' support groups.

COPDBreathe Easy support groups is run by members, encourages meeting others with COPD to share experiences and learn about living with the condition. There are groups throughout the UK.

Support for living with IBS

IBS Group is an online community support group specifically for sufferers of irritable bowel syndrome. Support to learn ways to cope with condition.
Support for living with Asthma

Asthma UK offers health advice and resources for those living with Asthma, including an Asthma Attack Risk Checker.
Support for living with MSK pain

Chartered Society of Physiotherapy lists MSK issues by body part which links to advice, guidance and exercises for pain. These MSK self-management resources are supported by NHS England and NHS Improvement.
Support for carers

Carers UK is a national charity for carers providing support and advice; has a helpline and online forum.

Carers Support West Sussex is a county-wide service offering practical advice, information and emotional support (including counselling, online and telephone support), support groups, social events and access to low cost activities. Details of specific support groups can be found via the website.

Quick links

Children's and Specialist Services

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Time to Talk Health - supporting people who live with a long-term health condition

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Our services are available as usual during the Covid-19 pandemic. We are following Sussex Community NHS Foundation Trust guidelines and measures to ensure you are safe when receiving treatment. If you have any concerns about how Covid-19 may affect your treatment, get in touch. Do you live with a long-term health condition?

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Tel: 01903 205111 ext 85543 or 86443

Email: uhsussex.wor.diabetesendocrine@nhs.net

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Get support for your wellbeing and mental health

Develop skills to build confidence, resilience and improve your general wellbeing

Try our wellbeing resources

Download or order copies of our resources that can support your mental health and that of others.

Guided learning: Wellbeing workshops

Sign up for a wellbeing workshop with one of educators to learn new skills to support you and others in everyday life.

Our range ofguided wellbeing workshops allow you to learn from us about ways to support your wellbeing and build resilience. Available for adults (ages 19+) and youth groups (ages 10 to 19), our flexible learning approach allows us to reach those in need in different ways.

Whether it's in a face-to-face or online session, we can help you and others build personal skills that can improve everyday life and help build stronger communities.

Why try a workshop?

Learn practical skills to support you and others in everyday life and improve your general wellbeing, including:

building confidence and self-esteem

coping with changes

managing challenges and overcoming adversity

approaching problems affecting you and your community

improving communication and empathy skills

Get in touch

We would love to hear your stories, especially if they inspire others. How do you build confidence and meaningful connections in your life? Have you overcome feelings of loneliness?

Please email us at yourstory@redcross.org.uk

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Wellbeing Support | Activities & ideas | British Red Cross

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Get support for your wellbeing and mental health Develop skills to build confidence, resilience and improve your general wellbeing Download or order copies of our resources that can support your mental health and that of others. Sign up for a wellbeing workshop with one of educators to learn new skills to support you and others in everyday life.

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Sex is important and part of some people's relationships. This isn't any different if you have diabetes.

Remember, having diabetes doesn't always mean you'll have problems with sex. And if you do, they might not last forever, there are things that can help. Sex and diabetes shouldn't be a cause of worry or anxiety for you.

We've got some pointers about the main things that people with diabetes worry about when it comes to sex. In this page we'll look at sex and diabetes in detail.

Blood sugar highs and lows

You might be wondering "What will happen to my blood sugars when I have sex?"

It's important to remember that sex is exercise, so it might make your sugars drop. If you've been drinking, depending on when and how much, you're more likely to have a hypo.

But not everyone with diabetes will have hypos. Make sure you check your blood sugars before you have sex. And it's worth having something sugary nearby just in case, so you can treat a hypo if you need to.

If you use an insulin pump, taking it out before sex might help you to avoid having a hypo. But this doesn't work for everyone.

Some people with diabetes get very nervous about having hypos. We call this hypo anxiety and if this is familiar to you, and it can affect how you feel about sex. If you've had hypos in the past then it's natural to worry about having them again. Talking to your partner about your fears around sex and diabetes might help. They could even help you plan and prepare in case of a hypo.

Sexual problems

Most people will have trouble with sex at some point in their lives, whether they have diabetes or not. Having diabetes doesn't mean you will have a problem.

Both men and women with diabetes are more likely to have sexual problems than people without diabetes.

What problems could diabetes cause to my sex life?

It is important to know that if you have high blood sugar levels for a long time then it can lead to serious complications. This can include sexual problems which we call sexual dysfunction.

High blood sugar levels can affect your nerves and blood vessels, which we call neuropathy. This means that they can also affect the ones that supply blood to your sexual organs. If this happens, it means that you'll have less blood flow into these areas. This can result in your losing some feeling to your genitals. Losing sensation can mean that becoming aroused physically and emotionally, can be harder. For men, it's called erectile dysfunction, or erectile problems.

Having diabetes can also mean you're more at risk of urinary tract infections (UTIs), thrush and vaginal dryness.

Sexual problems won't affect everyone with diabetes, but you should know how to reduce your risk of developing these kinds of problems and how to manage them.

Lower sex drive or libido

Lots of things can affect how interested you are in having sex. This is is called libido or sex drive and sometimes diabetes can lower your libido. But this isn't necessarily all down to your diabetes.

Being tired, depressed or and having low self-esteem can all affect how much you feel like having sex. As well as any medication you're taking, or any treatment you've had in the past.

The emotions you're feeling have a big impact too. If you're feeling embarrassed because of your pump or anxious about having a hypo, this can make you feel like you don't want to have sex.

It's not easy coping with all these feelings and emotions. But there's support out there and talking to someone about what's going on can be the first step. Know that you're not alone. Whether it's with a partner, friend, counsellor or your healthcare team, it's good to talk.

Sex and relationships

If you're in a relationship, diabetes can sometimes put a strain on it. From looking out for signs of a hypo to problems in sexual function, there's more to think about and plan for.

Communication is important in any relationship, and having diabetes doesn't change this. Talking over any issues and trying to resolve them together can help.

Remember that you're in it together. But if you're not sure where to begin, there are relationship counselors at Relate that can help you. Or give us a call because our helpline has people with counselling skills who are here to listen and help.

If you're single, you might not want to talk to your sexual partner about sex and diabetes at all. Sharing your feelings with a friend might be better. Do what's best for you and your diabetes.

Insulin pumps and sex

If you use an insulin pump, you might have all kinds of questions about how it might affect your sex life. You might be wondering what will happen when you have sex. You might worry that it will get in the way or one of you will pull it out by accident.

Or how do you explain what it is to a new partner? Take it off or leave it on? Put on a temporary basal, which reduces the amount of insulin that's delivered?

There's no right answer here, it's whatever works for you. Jen chats to us about her experiences of having sex with a pump, and what works for her.

Taking your pump off will mean it doesn't get in the way and you're less likely to have a hypo. But remember to put it back on again.

Leaving it on means your sugars aren't going to get too high, but on the other hand, they might drop too low.

We know diabetes can be a balancing act so try things out and see what works for you. If you're worried or need more advice, give us a call on our helpline or speak to your healthcare team.

Get more support with sex and diabetes

You're not alone. If you're worried or need advice or someone to listen, we're here to support you. You can call our helpline on 0345 123 2399 and talk to experts in diabetes.

Or join our online forum so you can chat to other people who might be having similar sexual problems as you.

Other organisations like Relate or the Sexual Advice Association specialise in sexual problems. Consider contacting them for support if you think it might help.

Remember, getting time and support with any sexual problems is one of your essential diabetes checks. This means you have a right to this kind of service as part of your diabetes care and it's free.

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Sex is important and part of some people's relationships. This isn't any different if you have diabetes. Remember, having diabetes doesn't always mean you'll have problems with sex. And if you do, they might not last forever, there are things that can help. Sex and diabetes shouldn't be a cause of worry or anxiety for you.

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Most women with diabetes have a healthy baby. But planning for pregnancy when you have diabetes is really important.

Having diabetes means that you and your baby are more at risk of serious health complications during pregnancy and childbirth. The good news is that by planning ahead and getting support from your GP and diabetes team, you can really reduce the risks involved. So you're more likely to enjoy a healthy pregnancy and give birth to a healthy baby.

Everyone's experience of pregnancy is different, and planning for it is important whether type of diabetes you have type 2, type 1, or another type of diabetes. See our tips below. We also have lots of information for you if you have gestational diabetes. And a page on type 1 diabetes and pregnancy, Here's Lucy talking about her experiences of pregnancy and type 1.

How to prepare for pregnancy when you have diabetes

Start taking the following steps to help you prepare for a healthy pregnancy:

You're not on your own, there's lots of support to help you. You'll get this from your healthcare team, but talk to your family and friends too.

We're here to help support you. We have lots of useful information to help you plan a healthy pregnancy, and if you still have more questions, give our helpline a call. Our helpline has highly trained advisors with counselling skills, and an extensive knowledge of diabetes to talk things through with you.

Our online support forum has a group specifically for questions and discussions about pregnancy. You don't need to log in to get involved and it can be a great way to get tips and advice from other people with diabetes going through similar experiences to you.

"I have type 2 diabetes and am on insulin. I'm 8 weeks pregnant and I'm struggling to know what to eat...anyone got any great ideas they can share?"

Online forum member

There are risks involved, but knowing what they are means you can take steps to reduce them. Let's talk about the risks:

You may have problems with your eyes and kidneys

It's more likely you'll have a larger baby - this can make the birth more painful and possible stress for the baby. So you may need a caesarian (C-section).

Your baby may be born with serious health problems, such as spina bifida. This is where the baby's spine doesn't develop properly

You could have a miscarriage.

Having diabetes can increase the possibility of problems in pregnancy, and this includes a miscarriage, which is the loss of a pregnancy during the first 23 weeks.

Planning for pregnancy is so important, and giving yourself enough time to prepare and look after yourself can help you on your way to having a healthy pregnancy and a healthy baby. If you have diabetes it's important to get support from your healthcare team, who can offer advice on managing your diabetes before and during your pregnancy to help reduce your risk of miscarriage.

You could also try this  Planning for Pregnancy tool  created by Tommy's - a charity dedicated to making pregnancy safer. It'll help you learn what you need to know.

Having a miscarriage for many women is an extremely upsetting experience and there are sources of support available. The charity Tommy's has useful information and support about miscarriages. You can speak to one of their midwives about your pregnancy, or if you need support and advice following the loss of a baby you can contact the team at  midwife@tommys.org. You can also call them for free on 0800 014 7800 (Monday to Friday, 9am to 5pm). The NHS has useful web pages too which offer advice and guidance.

After a miscarriage it is important to seek advice and support from your healthcare team about how to manage your diabetes well before getting pregnant again.

Living with diabetes also means there is an increased risk of stillbirth, or your baby dying at around the time of birth. Although this is rarer than miscarriage Tommy's has information to support you when dealing with baby loss.

But remember, you can greatly reduce these risks by planning ahead and getting support. Giving yourself enough time to prepare and look after yourself can help you on your way to having a healthy pregnancy and a healthy baby.

The first step in planning ahead is to make an appointment with your GP or Diabetes Specialist Nurse. You should do this before stopping any contraceptives.

If you think you might be pregnant already, contact your GP or diabetes team as soon as possible. They are there to help and will be able to give you advice and support. And don't forget, we have more information to help you during your pregnancy.

As soon as you start thinking about having a baby, it's very important to make an appointment with your GP or nurse. They can give you advice and will refer you to a pre-conception clinic.

The clinic is usually run by a diabetes midwife and a Diabetes Specialist Nurse. Here you'll get information about managing blood sugar levels, which medication you need to change or stop, taking folic acid, and how to plan for any problems that might happen.

Women with diabetes are 5x more likely to have a pre-term baby.

Knowing what to expect when you're pregnant, and after the birth will help you plan a healthy pregnancy. It's not just about understanding how diabetes affects pregnancy, but also how pregnancy affects diabetes.

You're more likely to have a healthy baby if you manage your blood sugar levels before you get pregnant, as well as during pregnancy.

Your HbA1c

You'll need to get your HbA1c checked before you stop using contraception. This is because a high HbA1c level can affect how a baby develops. This is really important in the first trimester (first 8 weeks of pregnancy), because the baby's organs are developing.

It's safest to keep your HbA1c level below 48mmol/mol.

If yours higher than 48mmol/mol, taking steps to safely bring it down will help reduce your risks. But if your HbA1c is over 86mmol/mol, it's not safe to get pregnant and you should talk to your healthcare team for advice.

Your blood sugar levels

You'll also need to check your blood sugar levels more regularly at home. This is so you can try to keep them in a safe range during the day.

If you have type 1 diabetes, you'll already have a blood sugar testing kit, but make sure it checks for ketones too.

If you have type 2 diabetes and don't have a blood sugar testing kit, ask your diabetes team for one.

Here's an example of some targets to aim for:

when you wake up and haven't eaten yet - 5 to 7mmol/l

before meals at other times of the day - 4 to 7mmol/l

90 minutes after meals - 5 to 9mmol/l.

Your diabetes team can help you set these targets - they may be different depending on your situation. They can also help you reach these targets, so you can reduce the risks for you and your baby.

Some diabetes medications aren't safe to take when you're planning a pregnancy. You'll need to get advice from your GP or nurse about which ones to stop. Metformin and insulin are safe to take.

If you're taking certain medications to treat other health conditions, you might need to stop these too. These include:

Tell your doctor if you take any of these. They will be able to give you advice about stopping or changing your medication.

After your baby is born, you can usually go back to the medication you were taking before. But if you're breastfeeding, stick to your doctor's advice and keep avoiding all the medication you stopped taking before you were pregnant. If you were taking glibenclamide, it's safe to start taking that again.

We have more information for you if you're breastfeeding.

Your doctor or nurse will prescribe you a high-dose folic acid (5mg) to take as soon as you decide you want to get pregnant. You should be taking folic acid 5mgs each day at least 12 weeks before you conceive as this also reduces the risks to your baby. You'll then need to keep taking this until you're 12 weeks pregnant.

This higher dose of folic acid is only available on prescription. You can't buy it over the counter.

Pregnancy can make some diabetes complications worse, such as eye and kidney problems. So it's really important to have eye screening and tests for your kidneys before you stop using contraception. Eye problems because of diabetes (diabetic retinopathy) can be treated if caught early, so screening is really important.

Your diabetes team can arrange this and they'll talk to you about the results. In some cases, you may be referred to a specialist team for extra support.

Get support

Deciding to try for a baby is just as exciting for you as it is for everyone else. And there's every reason to look forward to a successful pregnancy and a healthy baby.

But having diabetes means there are more risks involved. It's harder work as a result - with more checks, appointments and scans. And keeping very tight control of your blood sugar levels can be tiring and stressful at times.

If you have a partner, it's a good idea to explain all this so they can support you from the beginning. Or ask your friends or family to give you that extra support.

You're not alone in this and we're here to help too. You can call our helpline and talk to us about anything you're worried about or struggling with. Our trained advisors will be able to give you more information and support.

"Nothing prepared me for the anxiety I felt during pregnancy. Diabetes had always just affected me, but now everything I did or ate also affected my baby. However hard you work, perfectly in range blood sugars aren't always possible! And however much my consultants told me I was doing really well, I felt guilty if my blood sugars were higher than they should be.

During my second pregnancy, I was more prepared and mentioned my anxiety to my DSN, my midwife, my consultants, anyone who would listen! They did the best thing they could do - they didn't dismiss my concerns or just tell me I was doing fine, but listened, asked me to keep checking in with them and referred me to talking therapies and people who could help."

Maria, living with type 1 diabetes

Diabetes and fertility

Having diabetes shouldn't affect your fertility (your ability to get pregnant).

If you're finding it difficult to get pregnant, it's a good idea to talk to your GP. They will be able to give you more advice.

Finding out that you're pregnant

Finding out that you're pregnant is really exciting and while you're bound to have some worries, take time to enjoy this moment.

You'll still need to keep carefully managing your diabetes. We have lots of information to help you manage your diabetes when you're pregnant.

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Planning for a pregnancy when you have diabetes

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Most women with diabetes have a healthy baby. But planning for pregnancy when you have diabetes is really important. Having diabetes means that you and your baby are more at risk of serious health complications during pregnancy and childbirth.

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01243 788122 ext 32560

Email: uhsussex.srh.diabetesendo@nhs.net

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Tattoos have become widely popular, with a huge variety of art styles and body placements. When you have diabetes, the thought of getting a tattoo can raise several questions. Can you get a tattoo when you live with diabetes? Are there any special precautions you need to take?

Getting a tattoo with diabetes: it is possible and completely safe?

If you are living with diabetes, you might be wondering if tattooing is an option for you. The answer is yes. You can get a tattoo with diabetes. Whether you have type 1 or type 2 diabetes, there are a few things to consider before getting one.

You are seriously considering the idea of having a tattoo, but are worried about taking the plunge? Don't worry. It's normal to be anxious. There are lots of things to consider when getting one and you might have some questions, especially if you have diabetes. Will it be painful? How will I feel during and after getting it done? Where should I get the tattoo on my body?

A few precautions

Choice of the tattoo artist

Tattooing is perfectly safe as long as it is done in an approved establishment that respects the essential rules of hygiene. When choosing your tattoo artist, check that the tattoo parlour is clean and uses sterile equipment. Before making an appointment, you can also check the tattooist's credentials and read reviews by other clients.

Mention your diabetes to the tattoo artist

Consider talking to your healthcare professional about getting a tattoo if you have any concerns or questions. They will be able to check your haemoglobin level (HbA1c) and confirm that your blood glucose level is sufficiently stable [1,5] to ensure correct healing. Also, think about informing your tattooist about your diabetes so that they understand your needs and the possibility that you might need breaks, some snacks or treatment throughout the process. This will also help them to understand the best course of action if you require any medical assistance.

In recent years, a new type of tattoo has become popular: the "medical alert" tattoo. Specifically in the context of diabetes, it usually means getting "type 1 diabetes" or "type 2 diabetes" tattooed in order to inform medical staff of your medical profile in the event of an emergency.

The areas of skin to avoid

You might be wondering where to place the tattoo on your body and this is totally up to you. If you're living with diabetes, you may be advised to avoid tattooing certain areas of the skin for a couple of reasons. Some areas have less blood flow which can delay the healing process, such as shins, ankles and feet. Other areas may be affected by your diabetes or need to be used to administer treatment. These areas include the abdomen, thighs, buttocks or upper arms. You may be using these places for an infusion or injection site and it is preferable that they are free from tattoos.

Aftercare and healing

Once your tattoo is finished, the tattooist will advise you on how to take care of it, what to do and what not to do, and what products to use whilst you go through the healing process. General recommendations are as follows:

Gently wash it with lukewarm water or a neutral pH or antiseptic soap and carefully pat dry afterwards.

Apply a gentle moisturiser three or four times a day until it is completely healed.

Keep the tattoo clean and dry as best you can.

Try not to pick at any scabs that might form over your tattoo - this is your skin going through the natural healing process.

It can usually take around two to three weeks for a tattoo to heal but this completely depends on the size and placement of your tattoo. Your tattooist will be able to advise you on the expected length of time it will take.

By going to the tattoo artist when your blood glucose is stable, pre-preparing for your tattoo session, being mindful of locations on the body where you may have damaged skin or where you might administer treatment and carefully following aftercare recommendations, your tattoo journey is likely to be more comfortable for you.

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Tattooing and diabetes: can I get a tattoo?

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Tattoos have become widely popular, with a huge variety of art styles and body placements. When you have diabetes, the thought of getting a tattoo can raise several questions. Can you get a tattoo when you live with diabetes? Are there any special precautions you need to take?

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If you use insulin or medicine to manage your diabetes, you're entitled to free prescriptions, but if you're under 60 and living in England, you must have a medical exemption certificate before you can claim them. Free prescriptions mean you don't pay for any item you're prescribed, even if it's for something that's not related to your diabetes.
Prescriptions are free for everybody in Scotland, Wales and Northern Ireland.
If you do not use insulin or medicine to manage your diabetes in England, you may still be eligible for free NHS prescriptions if you meet certain criteria. You might meet these criteria if your circumstances have recently changed.

You can find out if you're entitled to free NHS prescriptions using their eligibility quick and easy online eligibility checker

What about dental treatment and other NHS costs?

Everyone with diabetes, regardless of how they manage their condition, may be entitled to free NHS dental treatment, and help with other NHS costs too ,if they meet certain criteria. You can use the online eligibility checker to see if you need to pay. If you're not entitled to free treatment, the checker will suggest other options for help with NHS health costs, such as the NHS Low Income Scheme or Prescription Prepayment Certificates.

By checking, you can help avoid the penalty charge notice and get the help you are entitled to.

Why you need a certificate to get free prescriptions

Legally people with diabetes need to have a certificate to claim free prescriptions. People with diabetes have always needed to have a medical exemption certificate to claim free prescriptions, but this is now being enforced through a central system the Government introduced in September 2014. If you claim a free prescription without a medical exemption certificate, you may be issued with a penalty charge notice and have to pay the cost of the prescription.

What to do if you've been issued with a penalty charge notice.

What to do if you haven't got a certificate

If you don't have a medical exemption certificate and you want to claim free prescriptions then you will need to get a form to apply for the certificate from your doctor's surgery.

The application form for the certificate is called FP92A. You will need to fill it in, then your doctor will sign it and send it off.

If you do not have a certificate, or your application for one has not yet been processed, then you will need to pay for your prescription. Make sure you ask your pharmacist for a FP57 receipt and refund claim form - you will be able to claim the money back once your certificate has been issued. This is because the medical exemption certificate is backdated one month from when it is issued.

Once issued, a certificate lasts for five years. Once you are registered for a certificate you should receive a reminder letter a month before it runs out.

More information about medical exemption certificates is on the NHS Business Services website.

What should I do if I have been issued a penalty charge notice by the NHS BSA?

The NHS Business Services Authority (NHS BSA) are responsible for checking that when people claim free prescriptions they are entitled to do so. If you do claim a free prescription and do not have a medical exemption certificate they may issue you with a letter, charging you for the prescription as well as a penalty charge.

Legally, if you claim for a free prescription and you do not have a medical exemption certificate then you have to pay the cost of the prescription. However, if you apply for a medical exemption certificate within 60 days of receiving the fine, then the penalty charge will be waived.

If you were issued with a penalty charge before 17 March 2015

The NHS BSA changed their system on 17 March 2015, to give people the chance to apply for a medical exemption certificate and have their penalty charge waived.

Before 17 March 2015 people were not automatically given the chance to contest their penalty charge. If you received a penalty charge before 17 March, the NHS BSA will write to you again and cancel your outstanding penalty charge, providing you already have a medical exemption certificate or apply for one within 60 days.

If you have already paid a penalty charge, it will be paid back to you providing you have a medical exemption certificate, or get one within 60 days of receiving the letter.

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If you use insulin or medicine to manage your diabetes, you're entitled to free prescriptions, but if you're under 60 and living in England, you must have a medical exemption certificate before you can claim them. Free prescriptions mean you don't pay for any item you're prescribed, even if it's for something that's not related to your diabetes.

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If you're a smoker and have been diagnosed with diabetes, giving up the habit is one of the most positive things you can do to both improve your health and reduce your risks of the long-term complications associated with the condition. Smoking is also associated with a higher risk of developing Type 2 diabetes.

Everyone risks damaging their health through smoking a cigarette, pipe or cigar, but for people with diabetes the risk may be even greater.

If you have diabetes, you already have an increased chance of developing cardiovascular disease, such as a heart attack, stroke or circulatory problems in the legs.

Combine this with smoking (which can also double your risk of complications) and you make the chances of developing these diseases even higher.

Giving up smoking

Giving up can be hard, but you don't have to carry the burden of quitting on your own. It has been shown that you are more likely to quit if you get the right support. Whichever method you choose, there are clear benefits from quitting and plenty of support to help you.

Stop smoking help

Call the NHS Smokefree Helpline on 0300 123 104

There are various treatments available to help you stop smoking, ranging from nicotine replacement therapies to prescription medication. For further information including 10 tips to help you give up, go to the NHS Choices website.

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If you're a smoker and have been diagnosed with diabetes, giving up the habit is one of the most positive things you can do to both improve your health and reduce your risks of the long-term complications associated with the condition. Smoking is also associated with a higher risk of developing Type 2 diabetes.

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Some people with diabetes can develop an unhealthy relationship or fixation on food. This can lead to something called disordered eating behaviour or possibly an eating disorder.

Diabetes and food are closely linked. Having diabetes can mean a bigger focus on diet, weight and body image, so it's not surprising that some people can start to feel negatively about food. Here we look at eating disorders and diabetes and explore what can be done to overcome this.

Disordered eating isn't the same as having a diagnosed eating disorder. But the signs and behaviours are similar, like skipping insulin for weight loss, or binge eating and making yourself sick. But one can lead to the other, so it's really important you get help before things get worse.

These eating problems are more common than you think - you're not alone in this. And they can happen to anyone, not just because you have diabetes. Here we'll help you recognise disordered eating behaviour, find out what can cause it and you'll read how some people have overcome this.

"I've realised I'm not the only one who's been through something like this. Peer support was invaluable to me."
- Lynsey, who had an eating disorder

How common are eating disorders?

It is estimated that up to 30% of people with type 1 diabetes have an eating disorder. Eating disorders are twice as common in people with type 1 diabetes than people without the condition.

It is estimated that 5 to 9% of people living with type 2 diabetes have binge eating disorder, although there needs to be more research in this area.

How to recognise an eating disorder with diabetes

If you're worried that you have an eating problem, it's important to know the warning signs so you can get the right support at the right time. This information is also for family members or friends who are worried someone they know with diabetes is developing an eating disorder.

Here are some of the signs of disordered eating:

increase in HbA1c or blood sugar levels that are going up and down a lot

going into diabetic ketoacidosis (DKA) or near DKA episodes

severely restricting what food you eat

binge eating (eating a lot of food very often and not feeling in control)

secrecy about diabetes management

trying to lose weight by making yourself sick or restricting insulin

fear of weight gain and concerns about body image

depression and anxiety

fear of hypos

diabetes distress

feelings of guilt, shame and judgement about eating habits, blood glucose levels and weight or body shape

denial of the seriousness of symptoms and conditions

exercising a lot without eating enough to balance it out.

Over time, disordered eating behaviours like this can lead to eating disorders, like anorexia, bulimia or binge eating disorder.

We've put together some questions to help you think about your relationship with eating. If you're answering yes to some of these, it's important that you talk to someone.

1. Do you make yourself sick because you feel uncomfortably full or do you feel guilty or ashamed about what you've eaten?

2. Do you worry you've lost control over how much you eat?

3. Have you lost quite a lot of weight in the last few months?

4. Do you think you're fat when others say you're too thin?

5. If you take insulin to treat your diabetes, do you ever take less insulin than you should?

Lots of people with diabetes have overcome these feelings and changed their eating behaviours. We've put together some next steps for you to think about, to get the support you need to overcome this.

Eating disorders and type 1 diabetes

Type 1 diabetes with disordered eating (T1DE), also known as diabulimia, is when you reduce or stop taking insulin to lose weight. This can happen alongside other behaviours such as restricting the food you're eating, over-exercising, binging, making yourself sick and using laxatives to try to control weight. Some people don't reduce or stop their insulin but instead control their weight and shape through food restriction or over-exercise, which indirectly limits the amount of insulin required. This is really dangerous, and can cause serious damage now and in the future too.

Lynsey had diabulimia and is now recovered. In her video she talks about how diabulimia affected her and how she overcame her eating disorder.

"I'm constantly still thinking about my weight but I don't miss my insulin any more. I consider myself recovered from diabulimia."
- Lynsey

Binge eating and diabetes

Binge eating is when you eat a lot of food in a short space of time. Some people make themselves sick afterwards, but not everyone. This is a serious eating problem and you need to be aware of the damage it can cause to your body.

This behaviour doesn't always develop into an eating disorder, but if it does it's a very serious mental health condition.

It's really important you talk to your healthcare team if you're binge eating. They can help you start to look at food differently and change how you feel about it.

"Really having to look at my relationship with food and break down where so much of the negativity around it all has come from, so I can start breaking the cycle. It's a frustratingly slow process as it's been decades in the making, but with my family's help, the psychologist I'm seeing, and studying 'intuitive eating', I can see that I'm making progress."

- Lucinda has been battling with binge eating disorder

What can cause eating problems when you have diabetes?

Anyone can develop eating problems. They don't just affect people with diabetes.

How they start is complicated and can vary for different people. Some people can feel depressed and binge eat for comfort, or some can get fixated with food because of certain pressures around them.

You might feel:

unhappy with your body

your life is out of control

diabetes is taking over too much of your life

depressed or anxious

pressured or controlled by others focusing on food

fixated on blood sugar levels being perfect.

"My family will say things like, 'You shouldn't eat that!'. They have no idea how hurtful that is to me. I know they're just trying to help, but I wish they wouldn't. It just makes me feel so inferior, so bad about myself."
- Julia, 45

These feelings and behaviours won't always develop into an eating disorder. So understanding what might be causing these negative emotions can be the first step in overcoming them. Take a look at our information on feelings and food when you have diabetes.

How eating disorders can affect your body

Eating problems can seriously damage your body. This can affect you right now and in the future too.

Short-term effects

Eating too much will make your blood sugar levels go too high. This is known as hyperglycaemia - hypers can make you feel really tired and cause headaches.

Restricting insulin will also make your blood sugar levels go too high. And this can quickly lead to a serious and life-threating complication called diabetic ketoacidosis, or DKA for short. You need emergency treatment for DKA.

Restricting insulin not only affects your blood sugars, it can also make you lose weight. But losing too much weight can make your bones and muscles weaker, which will affect how well you can get around.

If you're making yourself sick to try and avoid putting on weight, you're affecting your mouth health too. There's a lot of acid in vomit and this can damage your teeth and gums.

Long-term effects

If you have high blood sugar levels over a long period of time, it can seriously damage your blood vessels. Which can lead to complications in places like your feet, eyes and heart.

This might all sound scary or you might think these complications won't happen to you, but knowing what's at stake could help you prevent more problems.

"I'm just desperate that it doesn't happen to loads of other people. I've lost some of my eye sight, it's just not worth it."
- Lynsey

How can I overcome an eating problem?

This isn't going to be easy. Eating problems are serious and complicated. But reading this information and finding out more about eating problems is a good first step to overcoming them. We can help you take the next one.

You can find out about services available in your local area, using the HelpFinder on the Beat Eating Disorders (Beat) website.

If you are a young person between the ages of 16-25 with an eating disorder you can self-refer to FREED to get rapid access to specialist NHS treatment across England.

FREED is aimed at targeting young people who have been living with an eating disorder for fewer than three years. Early treatment has shown to achieve results and help stop problems escalating.

You can self-refer through the website and you will be contacted within 48 hours. Treatment can begin as soon as two weeks later.

You may also find helpful information on The T1DE Podcast.

Talk to other people with diabetes

You're not alone. You can chat anonymously on our online forum or go to a support group in person. Or follow us on social media to be part of our online communities and read what others are posting.

And if you're a friend or family member of someone with diabetes and worried they're developing an eating problem, show them this information and suggest they read our stories from Lynsey and Lucinda. It might help them realise they're not alone.

Talk to your diabetes healthcare team

Whether you've been diagnosed with an eating disorder or you think you might have one, you can get specialist help from a healthcare professional. This could be your GP, a dietitian or your diabetes specialist nurse.

Your diabetes team is there to help you with all aspects of your diabetes, including how you feel about it. Share your feelings with them. They won't judge you and together you can make a plan to manage your disordered eating.

They might refer you to a psychologist too. Who will give you really specialist advice and support, and talk you through different treatment options like talking therapies or medication.

Beat have information on how to talk to your GP about getting referred.

Write a food and feelings diary

Keeping a food and feelings diary can be helpful for understanding some of your eating patterns and emotions linked with food.

You can download My Food and Mood Diary (PDF, 36KB).

This is a great way to track what food you've eaten and the effect it could be having on your mood and your diabetes.

Think about bringing the diary to your next consultation (for instance, with a psychologist). They won't judge you for anything you write down and it will really help them understand how you're feeling. Try to be as honest as possible - the diary is there to help you.

Remember, whether you have diabetes or your family member or friend does, we're here for you. Call our helpline - our trained advisors are here to answer questions or just listen to anything you're ready to talk about.

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Some people with diabetes can develop an unhealthy relationship or fixation on food. This can lead to something called disordered eating behaviour or possibly an eating disorder. Diabetes and food are closely linked. Having diabetes can mean a bigger focus on diet, weight and body image, so it's not surprising that some people can start to feel negatively about food.

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Having diabetes means you’re at much greater risk of developing foot problems. But understanding how diabetes affects feet can help you avoid these complications. Raised blood glucose levels, also known as blood sugar, can damage the sensation in your feet. This can also affect your circulation, wh…

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Diabetic nephropathy is the name given to kidney damage caused by diabetes. It develops slowly, over many years, and is also referred to as kidney disease.

Almost one in five people with diabetes will need treatment for diabetic nephropathy. This may be a worrying statistic, but there's a lot you can do to reduce your risk of developing the complication. If spotted early enough, diabetic nephropathy can also be slowed down with treatment.

What causes kidney disease?

One of the main jobs of your kidneys is to filter your blood. They get rid of extra fluid and waste products from your body through your urine.

High blood glucose (sugar) levels can damage the small blood vessels and tiny filters in your kidneys. High blood pressure can also do this too. This can cause them to leak and not work as well. When this happens, abnormal amounts of protein from the blood can leave your body in your urine. This is often an early sign of kidney disease.

Symptoms of kidney disease

You may not have visible symptoms in the early stages of kidney disease. This is why it's so important to have the tests for kidney disease every year, as it can be spotted early and slowed down with treatment. If kidney disease progresses, you could notice symptoms like:

swollen ankles, feet and hands

blood in your pee (urine)

feeling really tired

being short of breath

feeling sick.

You may be feeling like this because your kidneys are struggling to clear extra fluid and waste from your body. But these symptoms can also be caused by other conditions, so it's important to talk to your doctor for more information and advice.

How can I reduce my risk of kidney disease?

There are lots of things you can do to reduce your risk of developing kidney disease:

Keep your blood sugar (glucose) levels within your target range

Keep your blood pressure down

Get support to stop smoking

Eat healthily and keep active

Go to all your medical appointments.

We have lots of information and support to help you - have you tried our Learning Zone? Thousands of people with diabetes are using it to help them manage their diabetes. You can also download a copy of our 'Diabetes and kidney disease' leaflet free of charge from our online shop.

Tests for kidney disease

The two tests for kidney disease are included in your annual review. You should normally have these tests every year but they might be happening differently at the moment because of the coronavirus pandemic. we've got more advice about what care you can expect during this time.

As part of your 15 Healthcare Essentials, you should have both of the tests for kidney disease every year.

Urine test (ACR)

A simple urine test called the albumin: creatinine ratio (ACR) looks for signs that protein is leaking into the urine. This is often an early sign of kidney disease.

Blood test (eGFR)

It tests for a waste product called creatinine. Your creatinine level and other information (such as age, sex and ethnicity) are used to estimate your glomerular filtration rate (eGFR). This is a measure of how well your kidneys are working.

It may take around a week to receive your test results. And you might need to have further tests. If you want more information whilst you wait, call our helpline and speak to one of our advisors for answers and support.

Some people are being sent, by their healthcare team, a home-based test that allows you to measure your albumin and creatinine concentrations in a sample of your urine, and your albumin-to-creatinine ratio (ACR). To do the test, you'll need the testing kit that's been designed to use with the app and need to pre-register using a unique link sent by your team.

The app guides you step-by-step through the testing process. You put a dipstick into your urine and take a photo of it using your smartphone. Computer vision algorithms are used to analyse the sample and give an accurate reading. After the analysis, the results are automatically sent to your patient electronic record so they can be reviewed by your doctor.

You can find out more on the NHS website.

Your GP may also give you an Information Prescription, developed by us, which can help you understand your test results and develop an action plan.

Treating kidney disease

The type of treatment you need will depend on the stage of kidney disease.

It's very important to keep your blood pressure under control to stop kidney disease from getting worse. You may be given tablets, such as ACE inhibitors or ARBs, to help with this.

Both ACE inhibitors and ARBs help to protect the kidneys from further damage, as well as lower blood pressure. That's why they are also made available to people without high blood pressure.

You may also get advice to avoid certain foods, but you'll need to get support from a registered dietitian to help you with the changes to your diet.

If you do develop late-stage kidney disease and your kidneys fail, your treatment options include dialysis or a kidney transplant. The good news is, as treatments and early diagnosis continues to improve, fewer people will go on to develop late-stage kidney disease.

More information and support about kidney disease

Talk with your diabetes team. They should be able to answer most of your questions. And we're here to provide support and information when you need it too.

If you have more questions, or just want someone to listen, give our helpline a call. You'll be able to talk things through with highly trained advisors who have counselling skills and an extensive knowledge of diabetes.

The National Kidney Federation have kidney disease leaflets and can put you in touch with a local group. Kidney Care UK also offers resources and support including a telephone counselling service that you may find useful.

Kidney Research UK are dedicated to research into kidney disease. We've been working together to identify the most important areas of future research, so that we can ultimately stop kidney disease in people with diabetes.

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Diabetic nephropathy is the name given to kidney damage caused by diabetes. It develops slowly, over many years, and is also referred to as kidney disease. Almost one in five people with diabetes will need treatment for diabetic nephropathy. This may be a worrying statistic, but there's a lot you can do to reduce your risk of developing the complication.

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Diabetic retinopathy - diabetes and eye problems

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Diabetic retinopathy Diabetes can affect your eyes in many ways. Some people go on to develop an eye complication called diabetic retinopathy. If you don't get this eye problem treated in time, it can lead to sight loss. This is a frightening fact. Losing your sight could affect your career, your family life and your independence.

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Keeping your mouth, teeth and gums healthy is an important part of managing your diabetes.

Living with diabetes doesn't mean you get free NHS dental treatment. You will still need to book regular check-ups with your dentist or find a dentist if you don't have one.

Another complication of diabetes is that you are more at risk of dental problems like gum disease, also called periodontal disease. We'll help you understand why you're at risk and how to keep your mouth healthy.

What's the link between diabetes and gum disease?

There is a link between diabetes and gum disease, each disease affecting the other, but we don't exactly know why.

Gum disease is a very common disease. But when you have diabetes, your risk is higher.

Gum disease is caused by one group of bacteria in plaque that makes toxins that inflame the gums, known as gingivitis. It can cause loss of bone around your teeth and gum recession over time. This can lead to tooth loss, known as periodontitis.

Gums that bleed when you brush your teeth are never normal and you should see a dentist. Untreated gum disease will always get worse. Please note: You cannot catch gum disease from someone else.

Gum disease can increase your blood sugar levels which can make other complications of diabetes, such as heart, blood vessels, eyes, kidney and nerve problems worse.

Controlling gum disease can help you control your blood sugar levels.

People with type 2 diabetes are around three times more likely to develop dental problems than people who don't have diabetes. People with type 1 diabetes are also more at risk.

Tooth decay

You are also at greater risk of developing another very common disease, tooth decay, also known as caries.

Too much sugar in your blood can lead to more sugar in your saliva, and that creates the perfect breeding ground for a second group of plaque bacteria. This bacteria produces acid which attacks your tooth enamel and dentine causing cavities. The longer sugar is present, the higher the risk of tooth decay.

Looking after your teeth and gums should be a basic part of how you manage your diabetes. You can prevent these potential complications by spotting them early and getting the right treatment from your dentist.

We've got information on how to keep your mouth healthy - a big part of this is about regularly checking your blood sugars and trying to keep to your target range and how well you control your plaque every day.

Types of common dental problems

Mouth problems linked to your diabetes can mean:

infection in the soft tissue and bone that support the teeth (periodontitis) and more gum recession

tooth decay

gum inflammation (gingivitis)

dry mouth (xerostomia) that increases your risk of tooth decay

fungal infections (oral thrush)

irritated and sore mouth, meaning you might have difficulty wearing dentures

tooth loss

abscesses

The early signs of mouth problems are things like bleeding gums, loosening teeth and bad breath. Your teeth may be more sensitive to hot or cold drinks or ache as cavities develop. If you notice these, don't ignore them and make an appointment with your dentist. Getting the right treatment early can prevent severe infections, tooth loss and other complications later.

How to keep your mouth healthy

Here's what you need to think about to protect your teeth and gums. It is what you do every day that counts.

Check your blood sugars - regularly check them and try to keep them in your target range.

Brush twice a day - If you have gum recession, use interspace brushes rather than floss to clean between your teeth.

See your dentist - having diabetes doesn't mean you get free dental treatment but you need to book regular check-ups. Ask for your Basic Peridontal Examination scores and what they mean to help you to monitor your own gum health.

Choose the right food and drink - follow a healthy, balanced diet which is low in sugar.

Don't smoke - smoking weakens your immune system, making it harder for you to fight a gum infection. And once you have gum disease, smoking makes it harder for your gums to heal. Get help with giving up smoking.

Keep your dentures clean. Do not wear them when you are asleep. Make sure you clean them regularly as a build-up of fungi can lead to a type of thrush in the soft tissues under your denture.

Remember to talk to your diabetes healthcare team for more advice if you need it. And give our helpline a call if you're worried about complications and need more support.

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Keeping your mouth, teeth and gums healthy is an important part of managing your diabetes. Living with diabetes doesn't mean you get free NHS dental treatment. You will still need to book regular check-ups with your dentist or find a dentist if you don't have one.

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This website is for people with type 1 diabetes living in England.

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There is a lot of useful information here to help you to understand and manage your diabetes in a way that suits you and your lifestyle.

Bertieonline is currently available in the English language for people who have access to a digital device connected to the internet.

Not registered yet? Register here:
create account

This site is provided by the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust as a service to people with diabetes.

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There is a lot of useful information here to help you to understand and manage your diabetes in a way that suits you and your lifestyle. Bertieonline is currently available in the English language for people who have access to a digital device connected to the internet. Not registered yet?

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Carbohydrate counting Reading labels (NDR)

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Carbohydrate counting weights and measures (NDR)

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Welcome to FreeStyle Progress. Log in or Register as a person with diabetes or a healthcare provider to start taking positive steps towards managing diabetes.

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Contact details - tech support & replacement sensors 

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Contact details - tech support & replacement sensors 

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Live Chat

For time-sensitive queries and help with simple things, live chat with us now
Click the 'Live Chat' icon in the header to chat now

Customer Careline

You can call us Monday to Friday between 8:00 AM and 8:00 PM, Saturday 9:00 AM to 5:00 PM (excluding Bank Holidays).

0800 170 1177

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Contact Us - Get In Touch | FreeStyle Libre 2

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For time-sensitive queries and help with simple things, live chat with us now Click the 'Live Chat' icon in the header to chat now You can call us Monday to Friday between 8:00 AM and 8:00 PM, Saturday 9:00 AM to 5:00 PM (excluding Bank Holidays).

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Online shop selling accessories, bags, blood testing equipment and all supplies necessary for people with diabetes. Major brands such as Myabetic, GlucoRX, Lift Glucojuice, ExpressionMed.

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Dexcom ONE+ Compatibility with Phones and Smartwatches | Dexcom

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View if your Dexcom ONE+ CGM app is compatible with your phone or smart watch, including iPhone, iPod touch, Samsung, Google, Motorola, and more.

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Getting started with Dexcom one+

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The Dexcom ONE+ is our newest Continuous Glucose Monitoring system that is smaller, faster and even easier to use.

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Follow these simple steps to discover what you need to know about setting up and using your Dexcom G6 real-time Continuous Glucose Monitoring (CGM) System.

Dexcom is here to support you on your journey with us, we'll show you how to get the best out of your Dexcom G6 and where to find additional help and guidance.

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Follow these simple steps to discover what you need to know about setting up and using your Dexcom G6 real-time Continuous Glucose Monitoring (CGM) System. Dexcom is here to support you on your journey with us, we'll show you how to get the best out of your Dexcom G6 and where to find additional help and guidance.

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Follow these simple steps to discover what you need to know about setting up and using your Dexcom G7 real-time Continuous Monitoring (CGM) system.

Dexcom is here to support you on your journey with us, we'll show you how to get the best out of your Dexcom G7 and where to find additional help and guidance.

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Follow these simple steps to discover what you need to know about setting up and using your Dexcom G7 real-time Continuous Monitoring (CGM) system. Dexcom is here to support you on your journey with us, we'll show you how to get the best out of your Dexcom G7 and where to find additional help and guidance.

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This app is for viewing glucose trends and reports.

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Extension: 84584 or 86858

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We spoke to young adults with type 1 diabetes to talk about sex, dating and relationships.

Sex, dating and relationships can be awkward for everyone, and worrying how type 1 diabetes might get in the way is normal. We talked to three different couples about those awkward moments when it feels like Type 1 diabetes just seems to get in the way.

Hypos in the heat of the moment. Insulin pump tangles. Plans screwed up to rush home to get insulin.

They also talked about how they deal with type 1 diabetes in their relationship day-to-day, and about what it means to have someone supporting you through the ups and downs of diabetes.

Having sex with an insulin pump

When Type 1 tries its hardest to ruin a good night, sometimes all you need is your testing kit, some perseverance and a supportive partner...

Dating with diabetes

When Ted found himself out for dinner with Storm, he had more than just first date nerves to think about...

Telling your partner

It's natural to worry about telling your new partner about your diabetes. It's difficult to open up to people sometimes but there isn't a right or wrong time to tell them about your diabetes.

Give them a small explanation of what diabetes is, about how you treat it and what things like hypos are. You don't have to go into loads of detail straight away, your diabetes is just another part of you that your partner will get to know about.

When Fawn and Chesney first started dating as teenagers, Fawn tried to hide her type 1 diabetes. It took an awkward car journey with her mum for Chesney to find out.

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We spoke to young adults with type 1 diabetes to talk about sex, dating and relationships. Sex, dating and relationships can be awkward for everyone, and worrying how type 1 diabetes might get in the way is normal. We talked to three different couples about those awkward moments when it feels like Type 1 diabetes just seems to get in the way.

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WRITTEN BY: BT1 Editorial Team

Type 1 diabetes affects more than just the physical. It's emotionally taxing and tests our constitutions daily. Whether you have type 1 or are a caregiver for someone who has it, you should know first that you are not alone.

If you have type 1 diabetes or are caring for someone who does, it is likely that you or your loved one will experience any of the following: stress, diabetes distress, burnout, diabulimia and/or depression. Sometimes talking to other people with diabetes who truly get it can make a big difference-connect with others at the Beyond Type 1 App.

For healthcare providers: Talking to Your Patients with Diabetes + The T1D Guide for Mental Healthcare Providers

Diabetes + Mental Health 101

Read more: Mental Health Risks Among LGBTQ Youth with Diabetes

Getting Therapy
Educational content related to mental health therapy is made possible with support from ​BetterHelp, an active partner of Beyond Type 1 at the time of publication. ​Editorial control rests solely on Beyond Type 1. Thank you to BetterHelp for offering everyone in our community two free weeks of professional online therapy. Learn more at BetterHelp.com/BeyondType1.

Boys' + Men's Mental Health
Educational content related to men's and boy's mental health is made possible with support from ​Lilly Diabetes. ​Editorial control rests solely on Beyond Type 1.
Diabetes + Anxiety

Read more: All About Low Blood Sugars

Diabetes Burnout + Diabetes Distress

Eating Disorders + Body Image

Read more: Eating Disorders & Body Image with Type 1 Diabetes

Parents + Partners: Your Mental Health Matters

Personal Stories: My Mental Health with T1D

Read More

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WRITTEN BY: BT1 Editorial Team Type 1 diabetes affects more than just the physical. It's emotionally taxing and tests our constitutions daily. Whether you have type 1 or are a caregiver for someone who has it, you should know first that you are not alone.

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YoungMinds | Mental Health Charity For Children And Young People

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YoungMinds are a mental health charity for children, young people and their parents, making sure all young people can get the mental health support they need.

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The campaign

There are more than 20 leg, foot or toe amputations each day due to diabetes. This is shocking, especially as four out of five of these amputations are preventable. This is where the Putting Feet First campaign comes in. We want to bring an end to the thousands of potentially preventable amputations affecting people with diabetes.

What needs to happen

We're campaigning across the UK to make sure:

People with diabetes know how to look after their feet and know what to expect from their health service

Local health services provide an integrated footcare pathway - the right treatment at the right time in the right place

Healthcare professsionals are more aware of the risk of diabetic foot disease and provide annual checks.

What you can do to Put Feet First

Do you want to get involved in our Putting Feet First campaign and help us raise awareness of diabetes-related amputations? Join our campaign.

Share your story

We want to hear your stories, whether you've been affected by foot problems or just want to tell us why you think the Putting Feet First campaign is so important. Share your story here.

Give some time

Whether you've got a few minutes to spare or an hour to give, there will be some way you can help. Go to our Diabetes Voices pages to find out more.

Look after your feet

Know how to look after your feet and know what care to expect from the health service.

Make footcare a part of your daily routine, just like managing your blood glucose and diet.

Order a copy of our Simple Steps to Healthy Feet leaflet (PDF, 43KB) to make sure you're taking good care of your feet day to day.

Attend your annual foot check. It's as important as your retinal screening appointment.

Make sure you order a copy of our leaflet What to expect at your annual foot check (PDF, 41KB) so that you know you are getting a thorough, quality check.

Know your risk of developing foot problems and make sure that you are referred if necessary.

Ask someone to assess the feeling in your toes by doing the Touch the Toes test.

Keep useful numbers handy, and know who to contact at the first sign of problems with your feet.

Janet's story

Janet was diagnosed with Type 1 diabetes when she was 12. Janet lost her leg when she was 40 and is campaigning so no one has to share her experience of an amputation. Since then she's met her MP, spoken to the media and helped our national 135 shoes campaign.

Alison's story

Alison was diagnosed with Type 1 diabetes at the age of 9. She developed foot problems after working at the Olympics in 2012. After having a toe amputated she started campaigning for better foot care. She's raised the issue with her local MP and spoken on TV about amputations.

Pat's story

Pat developed an ulcer which led to a serious infection and later a toe amputation. She feels that better care could have saved her toe. This is why she has campaigned with Diabetes UK for better local care, raising the issue with her local NHS bosses and persuading them to invest more in foot care.

Roy's story

Roy has had Type 1 diabetes for 51 years. He has had five toes amputated in total, the first in 2003. Roy's son was diagnosed with Type 1 in 2013 and this motivated him to campaign for better care. Since then he's spoke in Parliament, worked with his local MP and attended our campaign events.

Healthcare professionals

You can support the campaign by:

Understanding the risk of diabetic foot disease & talking to people about it to people with diabetes.

Order our leaflets Simple Steps to Healthy Feet and What to Expect at Your Annual Foot Check and hand out to patients with diabetes or display them in your surgery.

Providing quality foot checks, documenting the level of risk of developing foot ulcers, and telling people with diabetes what their risk is.

Quickly referring to specialists where necessary, and providing seamless transfer of care by following an integrated footcare pathway (PDF 435KB).

Participating in the National Diabetes Audit in England and Wales.

Participating in diabetes networks to influence the delivery of integrated care in your local area.

Commissioners and NHS healthcare planners

Local health services need to deliver the Integrated footcare pathway (PDF, 435KB) - that means providing the right treatment at the right time and in the right place for all people with diabetes:

Set up referral within 24 hours to a multidisciplinary specialist footcare team for those with ulcers.

Ensure appropriate referral to a foot protection team which has specialist expertise in assessment and management of disease of the foot.

Create local diabetes networks to join up and improve foot care for people with diabetes.

Campaign materials

All Putting Feet First materials are available via the online shop.

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Insulin Pumps in Hospital / Sick Day Rules / Pump Failures

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ABCD (Diabetes Care) is a company limited by shares in England and Wales under company number 7270377, whose registered address is 3rd Floor, 56 Wellington Street. Leeds, LS1 2EE Diabetes Care Trust (ABCD) is a registered charity number 1139057, a company limited by guarantee in England and Wales under company number 74248361,whose registered address is 3rd Floor, 56 Wellington Street.

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How to get started with glooko- patients (1)