DIABETES CLINICS

My CP is starting a diabetes clinic in the local group practice and tells me that I no longer need to attend the hospital clinic. It’s much more convenient for me to go to see my CP but will this be all right?

You are fortunate that your general practitioner has a special interest in diabetes and has gone to the trouble of setting up a special clinic in the practice for this. Many GPs and practice nurses have had special training in diabetes and these general practice-based diabetes clinics are becoming more common.

They usually work well as long as you have uncomplicated diabetes and are well controlled, but you should be aware of the sort of care you can expect: Diabetes UK’s recommendations are given at the end of this section. We are sure that your hospital specialist will know about your CP’s new clinic and may even attend it from time to time. If you have any anxieties, why not discuss them with your doctor?

My CP is keen to test my urine every year to ‘look for evidence of kidney damage’. This sounds very frightening. Please explain.

The test goes by the name of microalbuminuria. For years nurses in diabetic clinics have asked for a urine sample which they test for protein. This is a crude test and is only positive when there is a lot of protein in the urine. The new test is very sensitive and detects minute traces of albumin (the body’s most common protein). Research has shown that protein detected in such small amounts is the first sign of kidney damage but at this early stage it can be reversed. This damage can be slowed by keeping the blood pressure below 135/75 and controlling the blood glucose – HbA1c 7% or less. The result of this test is often presented as a ratio of albumin (the protein) to creatinine, which corrects for the flow of urine at the time. The best result is to have a ratio of less than 0.5. The top limit of normal is usually quoted as 3.5 for women and 2.5 for men. If left untreated, the amount of protein in the urine will increase until it can be detected by conventional urine testing sticks. Over a period of years, this may progress to kidney failure and the possible need for dialysis or a kidney transplant. At the early stage of microalbuminuria, this process is reversible by control of blood pressure and glucose. There is good evidence that people with normal blood pressure and microalbuminuria can be protected by treatment with a tablet called an ACE inhibitor.