From diabetes.org.uk
Diabetes can cause other health problems that can become serious if not picked up and monitored or treated in the early stages. So regular diabetes health checks – sometimes called your yearly or annual review – are part of your routine NHS treatment.
As part of your annual review, these are the health checks you should be offered:
A blood test where enough blood is taken to be sent to the lab to check your:
- HbA1c your average blood sugar levels for the past three months
- Cholesterol levels how much fat is in your blood
- Kidney function how well your kidneys are working.
You should be asked to provide a urine sample that is sent to the lab to check:
At the appointment you should also have:
- A foot check which may be done safely once every two years if your last check showed no problems
- Your weight and height measured to work out your Body Mass Index (BMI)
- Your blood pressure measured.
Your healthcare team will also ask if you smoke, so you can be offered help to stop.
It may not be at your annual review appointment, and is likely to be done by a different team, but you should also be invited to:
- A diabetic eye check this is not the same as a sight test at the optician. Photos are taken of your eyes to see how diabetes is affecting them, as it can damage the blood vessels and cause an eye problem called diabetic retinopathy.
If your last diabetic eye check was clear, it may be safely offered once every two years rather than once a year.
If you’ve been finding it hard to manage your blood sugar levels, be kind to yourself. Rather than being tempted to skip your health checks, see appointments as an opportunity to be as honest as you can with your healthcare team – and ask for help.
Early treatment can help prevent or lower your risk of serious health problems from high blood sugar levels. These include sight loss, toe or leg amputations, kidney disease, heart attack and stroke.
So it's important to get all of your health checks. See below the most common diabetes heath checks people miss out on - and tips to make sure you get them.
Diabetes health checks people are more likely to miss out on
People are less likely to have their urine check for kidney disease, eye check and foot check than the other diabetes health checks.
It can be difficult to access your annual review or diabetes health checks appointments – but as routine NHS care, it’s something that GPs and hospital teams should have set aside time for. So don’t feel guilty about chasing up appointments. They are there to help you and your team monitor how diabetes is affecting other parts of your body and help keep you healthy.
There are also other reasons why people may not get these health checks. Find out some of these reasons and see our tips to help you get these checks:
Providing a urine sample to check for kidney disease
Lots of people miss out on this check because providing a sample of your wee isn’t always easy.
You might be sent a bottle to wee into at home, or have to provide a sample on the day of the appointment. Some people find this stressful but also a bit messy. Equally, carrying around a urine sample all day if you’re going to work isn’t practical.
Tips to make providing a urine sample easier
Ask the healthcare professional doing the check for flexibility. If you need something bigger to wee into or if you’d rather take the bottle home, do ask.
You should also make sure the lid is on safely and could try wrapping tissue around the sample bottle or putting it into sealed bag if you are worried about it spilling.
Sally, who has type 2 diabetes: "I don't want to carry the urine sample around in my bag at work all day, so I do it at the surgery. I've started using the toilet they have upstairs so I don’t have to walk through the waiting room with it."
Getting a diabetic eye check
Lots of people miss out on this check because the diabetic eye check appointment is usually done at different clinic and not at your GP surgery or hospital.
So, you may feel uncomfortable seeing someone new, or having to travel to a place you don’t know. Some people may also worry about the results of the eye check more than other tests.
You also won’t be able to drive after your appointment as you’re often given eye drops to help make the photo of your eyes clearer, which can make them blurry for a while afterwards.
But it is important to get this check to see if diabetes is affecting your eyes so you can get treatment to delay or prevent it affecting your sight.
Tips for making sure you get a diabetic eye check
Remember that this isn’t a sight test, so you won’t have the expense of buying new glasses, if this is worrying you.
It’s important to think about how to get to and from your appointment especially as you won’t be able to drive afterwards. If the appointment is hard to get to by public transport, check with the eye check provider or GP if there are other clinics that may be easier to get to even if they're further away.
And if you’re unsure about the check itself or going to a new place, ask a neighbour, friend or relative to go with you.
If you aren’t getting diabetic eye check appointments, you should contact your GP or hospital team. They can refer you to your nearest eye check service. If you are housebound, you should ask them how you can access these appointments in a way that’s accessible to you.
"Having my eyes checked prevented me losing my sight as problems with a build-up of fluid around my retina and issues with my blood vessels were caught early. I was able to get treatment before any lasting damage.
James Baillie, who has type 1 diabetes
Getting a foot check
Sometimes there may not be enough time at your annual review appointment for a foot check to be done. And sometimes you may worry about your feet not being as clean or smelling as you’d like.
Tips for making sure your feet are checked
If there isn’t time for a foot check, do insist on a follow-up appointment. It isn’t enough for you to have checked them yourself.
If you’re worried about someone touching your feet remember the person checking your feet is a trained professional and has seen it all and they will not mind.
When you attend appointments, it can speed things up if you wear something that’s quick and easy to take off and put back on. So, for example wear socks instead of tights and shoes that are easy to remove.
“The GP asks if I’ve noticed any changes in my feet, if I say no, they don’t check them. So unlike the blood test results, I don’t feel confident that there aren’t any problems. I feel too embarrassed to ask if they can do a foot check,” John, who has type 2 diabetes.
Other possible reasons people may not get their diabetes health checks
Having to repeat the checks
Sometimes it can be frustrating if you are asked to have the same checks at a hospital diabetes service and at your GPs.
To stop this happening, if your check-ups are done by your hospital team, you’ll need to ask your hospital team to send the information to your GP. And ask your GP to add any test results from the hospital to your records.
Fear of being judged
If you don’t get on with your healthcare professional – or feel they judge you, then it can be difficult to attend your appointments. Ask if it is possible to see a different healthcare professional for your diabetes health checks. If that’s not possible, but your relationship with the person doing the checks is preventing you from going, then think about whether you want to change your GP or diabetes team.
Worry about starting medication
The thought of having to start medication for diabetes can be worrying for some people, especially if they have read about the side effects. But there are now several different types of medications for type 2 diabetes so if you are having side effects or don't like how the medication is making you feel, you should talk to your diabetes team about what medications may be best for you.
Prioritising other things above your health
It can be hard to make time for your health checks, especially if you are not sure why they are important. Busy lives can mean you prioritise work, family or other life pressures. But we know that diabetes related health problems can come on quicker in younger people so it’s important to take time out to make sure your health is being looked after.
What other diabetes care should I be getting?
If you have diabetes, there is other NHS care available if you need or want it. There are also certain checks and appointments that you should have when you're first diagnosed - see below.
We've also got lots of information about the NHS care to expect when you have gestational diabetes.
NHS care to expect when you’re first diagnosed
Everyone living with diabetes should have certain checks and appointments when they’re first diagnosed with diabetes, to make sure you understand your condition and can live well with diabetes. If you didn’t have any of these when you were first diagnosed, speak to your healthcare team.
Everyone living with type 1 or type 2 diabetes should have:
A full assessment of your medical history, and anything going on in your personal life that might affect your diabetes.
A referral to a diabetes group education programme that works for you and your cultural background, or the same type of education in a one-to-one appointment if you prefer. This should be within a year of diagnosis if you live with type 1 diabetes.
Information about the medical exemption form for free prescriptions if you live in England. You don’t need this in Northern Ireland, Scotland, and Wales as prescriptions are free for everyone.
Within six months of being diagnosed with type 1 diabetes, you should have:
An individual diabetes management plan, discussed and agreed on with your healthcare team, that works for you and your cultural background, including your personal targets, contact details for your diabetes team and follow-up plans.
Detailed information on how to live well with type 1 diabetes including giving your insulin, counting carbohydrates, managing hypos, managing when you’re ill, physical activity, and DVLA requirements for driving.
A review with a dietitian.
Your antibodies measured to confirm your diagnosis if it’s not clear what type of diabetes you have.
When you’re diagnosed with type 2 diabetes, you should have:
If it’s right for you, a discussion about weight management or weight loss and type 2 diabetes remission, which is when your average blood sugar levels are no longer in the range for diabetes and you don’t need medication.
A review of your emotional wellbeing and mental health needs.
A review of your medication.
A summary of your agreed diabetes management plan and when it should be reviewed again.
NHS care to expect if you need it
There are some diabetes checks and appointments that you should have access to but not everyone will need. Speak to your healthcare team if you think you need any of this help but aren’t getting it.
Everyone with diabetes should have access to:
An HbA1c check every three to six months if you’re struggling to meet your targets.
The chance to meet and get support from other people living with diabetes.
Good quality care with access to diabetes specialists if you’re in hospital, including access to mental health support if needed.
Pre-pregnancy review if you’re planning to have a baby, and advice from specialists at least 12 weeks before stopping contraception.
Regular reviews at least every two weeks by the diabetes team during pregnancy.
Support with sexual health concerns.
A review of your emotional health and wellbeing needs.
A review and update of your management plan.
Appointments in a way that you prefer, whether that’s by phone or face to face, or reviewing your blood sugar levels with your healthcare team online, for example.
Specialists who can help you manage any diabetes complications.
Everyone living with type 1 diabetes should have access to:
A review of the diabetes knowledge you already have and would like to have,
Advice about your diet from a dietitian.
A thyroid function blood test.
A chat about diabetes technology offered locally that could help you. This includes continuous or flash glucose monitoring, which everyone should have access to if they would like it, or an insulin pump if you are not meeting your targets.
Support from specialists who can help you manage your medication and blood sugars around physical activity.
Everyone living with type 2 diabetes should have access to:
Support to lose weight if you want or need to.
Advice on physical activity.
Technology to monitor your blood sugar levels, like a continuous glucose monitor, depending on certain criteria.
You will also have access to other NHS care that is still important for your diabetes management, like flu and Covid-19 vaccines, screening services for other conditions, help to give up smoking, weight management support, and dental care
Some areas offer other opportunities to improve your general health and diabetes wellbeing, like weight management, organised physical activity and active community groups. Ask your healthcare team what other support is available to you.
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