Navigating Diabetes Through the Seasons

Good morning, Dr. Fernandes. Thank you so much for your time to answer a few questions for our Hammersmith and Fulham community on healthshed.com. Please can you introduce yourself? My name is Paula Fernandes and I am a GP in Hammersmith. I work at the Hammersmith surgery and I have a special interest in diabetes. Thank you very much. So just thinking about the winter months, what effects of winter do you commonly see in patients with diabetes? Are there any concerns that you proactively address? So patients do tend to feel less inclined to go out and to exercise, and particularly because it's cold. also because they're having to wear a lot of clothes. So whereas patients in the warmer months more likely to do these activities because it's easier, in the winter people tend to stay indoors more. That really is one of the things that we try and encourage people to maintain is continuing with activity and exercise. Thank you. And do your patients typically need extra support in the winter months with their diabetes? Yes, in particular with their diet. For one thing, in the summer months, there are far more fruit and vegetables available in the shops and everywhere. Whereas in the winter months, They tend to veer more towards carbohydrates and sugary food and comfort food. People are more inclined to want to eat cooked food. So it's then a question of trying to support them with going for the healthier options and keeping carbohydrates down. They also need encouragement to maintain a good fluid intake, because obviously, you know, drinking cold drinks is not so appealing when it's cold weather. So it's helping them to find drinks that they do enjoy. And what resources do you offer to help them with these challenges with diet? We have support groups. We also have our regular sessions with our patients where they come to see the nurses. We have check-ups that we encourage them to come to where we continue to discuss healthy living and lifestyle. And what advice do you regularly give to patients struggling with diabetes control during the winter months? Right, so here I feel that we need to be much more supportive rather than punitive. We tend to be very critical and we tend to tell patients what they are not doing well when they come to their regular checks and come to see the GP. And during the winter, well in fact all through the year, but particularly during the winter, I feel that we need to be much more supportive of little lapses and encouraging people not to be despondent about having lapses but to accept them and to know that they can just start again. We also try and encourage patients to communicate with each other and because they are indoors much more to use resources such as the online resources to refer back to the structured education resources that hopefully they've attended. We have the No Diabetes website that we have encouraged our patients to register with and there is a wealth of resource on that website too. Thank you very much. And then thinking about the spring, the spring months, a spring often inspires fresh goals. What changes do your patients with diabetes tend to focus on? Any goals that they share with you regularly? Yes, people are feeling much more inspired. The sun is shining, hopefully, they're more likely to be meeting up with friends and family and people are much more likely to be wanting to make changes. We try at this time of year to once again set educational meetings up so that we can do some regular checks to see where patients have, what changes that they could make. So we do some blood tests, we arrange for them to come in and see the nurses, and based on their blood tests and so on, we discuss making medication changes, which hopefully won't mean too many medication changes, or reducing their medication because they may be exercising more, they may be going for more walks outdoors, there are more daylight hours, so it's much, much better for them to be going out into the parks and generally moving more. Thank you. And what would you say to our members who have diabetes, who are part of the health shared community, in terms of trying to motivate them to take on new health goals in the spring? Well, we start very much with setting smart goals. So little steps, making things measurable, not going, you know, patients sometimes say, oh, I'm going to lose a great deal of weight, but trying to get them to set a target for weight loss if that's what they want to do, but working in partnership with patients to set up goals for them, improving their diet, improving their activity, and focusing much more on the four pillars of health and not just on medication. So looking much more at nutrition, relaxation and sleep, as well as movement and activity. Thank you, and of the eight health behaviours and 12 characteristics, Is there one that your patients with diabetes seem to connect with most? Well, it's difficult to say, because we try and encourage them to connect with all eight. I suppose stress management is something that is often regarded as being quite challenging and engaging with healthcare, because sometimes the patients feel they haven't reached their targets. They can feel that they've failed. So it's supporting them not to feel that they've failed, but to see it as being a starting point for making change. And also, I must say, getting adequate sleep is very important because we all know that inadequate or poor quality sleep definitely causes worsening of all the diabetes parameters. And how do you see health-shared communities contributing to diabetes support in the spring months? Very much giving people the ability to share information, to support each other. We know that from all the programmes that have been run previously, educational programmes and and so on, that everybody takes on the information to some extent or another, but once they've stopped attending these groups, they forget or they lose the incentive and the motivation. So continuing to be able to share and encourage each other is where we've seen the biggest changes made. And being able to expand this would be hugely useful. And how can we encourage patients to engage on these communities on healthshare.com? I suppose it's just really making it much more available having much more information as to how they can join these supporting groups using the digital platform would be very useful but not all our patients have the same digital awareness, or in fact, the same access to digital abilities. So we need to think about how we can enable those patients and try and, you know, improve health equality in that way. Thank you. And now moving on to the summer months, although sometimes it doesn't feel like summer. What particular challenges does this time of the year, the summer months, bring for managing diabetes? Well patients are now thinking about travelling abroad, they are also much more relaxed generally, hopefully, so there could be slipping in their healthy eating. The other thing is that when patients go abroad they sometimes go to countries where the diet changes can affect their diabetes. So some countries they eat far more carbohydrates or far more sugary food and everyone on holiday may feel they can relax their alcohol consumption which you you know, they normally keep a tight rein on. And it's being able to actually say to patients that these could be challenges ahead of them, and just helping them to be aware of how they can either have restraint or have healthier options, or if they are going to relax their own restrictions, restrictions then when they come back to being able to once again restart with their healthy goals. And you previously referred to sleep earlier. With the summer months we have the longer days and the shorter nights. Have you seen or can you advise on any effective coping strategies for improving sleep, especially the summer? Well we do encourage again patients to look at their bedrooms to try and minimise light in the bedrooms, so trying to have dark window blinds and curtains, trying to turn off the blue lights of mobile phones and computers and so on in the bedroom and trying to get to bed at the same time, if that's possible, as they do the rest of the year, or at least trying to get the same number of hours of sleep that they normally do. Because we know that there is an importance in having good sleep. And furthermore, what changes in food and activity levels do your patients find challenging with their diabetes? I know you were mentioning earlier travel abroad being an issue as well, including also alcohol intake. Can you expand on that a bit more? I think that everything is so much more available in the summer, outdoors and everywhere. We often see ice cream, for example, and you know when you're feeling harsh and you're walking around with your friends and family, it's very tempting to have these sort of things. And one doesn't want to take away the pleasures and joys of eating this sort of food, but I think making, helping people to be aware of how the various tempting types of food and drink affect their blood sugars is most useful and can be quite challenging. But patients tend to want to engage with that and being self-aware and being knowledgeable. So we do help them when they come to their regular checkups with maintaining the healthy lifestyle as much as they possibly can and encouraging them to maintain movement and exercise. They're much more likely at this time of year to be happy to exercise outdoors, for example, rather than having to be in the gym, which is excellent. Thank you. And are there any other health behaviours or amongst the 12 characteristics that you would like to comment on in relation to summer? I think that the health characteristics, the main ones for people to actually feel that they are responsible for their own health and that it is not always the healthcare professionals telling them what to do, that we can help to inform them or to direct them on where to find information and support, but enabling them to tell us, to communicate with us, how they want us to support them and how they want to manage their diabetes, which is, after a lifetime condition. So we very much want to be working together and having, you know, for them to have the confidence to know that we are here to support them rather than to tell them what to do. Thank you. And lastly, moving on to the autumn questions. So do the autumn months bring any specific challenges for patients with diabetes and how would you advise they manage these? So I think in the autumn people are really getting ready for the winter, the summer holidays are over, some people feel a bit of a dip in their mood, The days are getting shorter, it's getting colder, and it's another time for encouraging people to be optimistic and helping them to once again look at different ways in which they can exercise different resources or using the same resources that they have done through rest of the year for support and information, but encouraging them, reminding them that, you know, this is just another time of year. And again, people are also looking forward to Christmas, which we know brings its own stresses and strains, as well as, you know, the joy of the festivities and celebrations and the diet that they're worried they're going to be needing to control. So allowing people to not be so rigid with goal setting at this time of year. And are there any things that you do differently to support patients with diabetes during the autumn months and going into winter? I think it's very much responding to patients' needs. On the whole, the challenges are very much the same as in the rest of the year. In the autumn, I think it's much more when we get to the depths of the winter that it's more difficult. And do your patients make any particular preparations going into the winter months to protect their health? Can you name any examples you may have seen? The whole point about making sure they have adequate medication, have prepared themselves in terms of warmth is very important, that they are maintaining communication with the friends and family that they have or other members of the community, directing patients to community resources like there are park runs, there are park walks, there are walking groups and joining these groups. There are also groups that support each other getting together and talking both online and face-to-face. They support each other with talking, with activities such as dancing, preparing food for each other, and I think we need more of this. It's been very, very helpful for people who have found these groups and how to look for them. And in your view, how could a health-shared community platform better support poor diabetes during the autumn and winter months? Oh I think being able to share resources or having a means of patients being able to look at look at the resource that a platform like this could offer to see for themselves where the resources are is you know where these groups are or how they can find for for example, gyms that are perhaps subsidised because a lot of people in the autumn and winter unable to exercise outdoors also find it quite expensive to go to gyms or find swimming pools that they can afford. And I think that a platform like healthshared.com could very much help with that. Thank you. Lastly, do you have any words of encouragement or a message of motivation for patients with diabetes going through the autumn and winter months? You know, I've often heard patients say that being given the diagnosis of diabetes was the turning point in their lives and in a way it gave them the push they needed to change their lifestyle and live a healthy life. And I often talk to patients about the fact that although we keep saying that diabetes is a lifetime condition, a long-term condition, many, many, many people can take their condition into remission. They can give up on medication, they can continue to maintain a healthy lifestyle, and their families often gain from their own changes in diet and lifestyle. Thank you very much.