Diabetes Review

Please complete the ‘Long Term Conditions’ form before completing this form. Thank you.
Diabetes Review
Do you stick to a diabetic diet? More information on diabetes and diet is available at
Do you have any problems with skin care, circulation or sensation in your feet? More information on diabetes and footcare is available at www.patient.info/diabetes-foot-care. *
Have you been for diabetic retinopathy screening (eye photograph) in the last year? More information on diabetes and eyes is available at www.patient.info/diabetic-retinopathy. *

Please book an eye photograph by calling 01905 362780.

For men with diabetes: do you have any problems with weak erections during sex? *
Would you like to talk to a doctor about this?
For women between 15 and 50 with diabetes: diabetes and obesity cause a large increase in risks to mother and baby during pregnancy. The risk of miscarriage, still-birth, birth-defects and disability, difficult labour and other risks can be reduced by controlling diabetes before pregnancy. Would you like advice about planning a pregnancy? *
Do you drive? *
Please read the following information from the DVLA to make sure that you are driving legally and that your insurance is not invalidated: www.gov.uk/diabetes-driving.
There is a really good telephone-based diabetes education service in multiple languages. We highly recommend it. Please can we refer you to learn more about diabetes? *
Diabetes can be harder to control when you have another illness, like flu. Make sure you stay well hydrated. If you have a glucose meter please check your glucose more often. Continue eating as normally as possible. If you feel really unwell please don’t hesitate to contact us or 111. More information is available at www.patient.info/diabetes-and-illness. *