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Leaflet: My personal diabetes care plan

Diabetes Services

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Last updated: July 2020
Next review: July 2022
URN: 0062

Page 1: About you


NHS number:

Practice nurse or other diabetes team contact:

Next review date Tests required before review

Page 2: Medication

Please record your medication here and keep your record up to date, or staple a copy of your current prescription list here. If you are on insulin remember to keep your insulin passport with you.

Reminder: Please bring this care plan to all appointments and write your results on page 3. Compare your results with the charts on pages 10 and 11. Before your review, check page 5 and consider what you would like to discuss. After your review, think about what changes you want to make, pages 6-7.

Page 3: Results

Please tick all that apply:

Date Leaflet given Date Leaflet given Date Leaflet given
High Risk
Moderate Risk
Low Risk
Skin condition
Dry? Corns?
Hard skin?
Change in foot
sensation or
loss of feeling?
Foot pulses

Pulses: As a general rule if the pulses in your feet are felt, then the circulation to your feet is okay.

Skin condition: Dry skin is not as healthy or strong as supple skin and tends not to withstand rubbing, knocks and bumps feet receive.

Change in shape: Feet that have an unusual shape tend to be at increased risk of problems developing from shoes or other toes rubbing
and causing sores.

Sensation: Diabetes can affect how well the nerves in your feet work. If they are not working properly, this can cause strange feelings in your
feet or no feeling at all. If you have little or no feeling in your feet, you may not be aware when they are being damaged, e.g. blisters forming,
or being rubbed.

Page 4: Foot risk status

Please record your results to monitor your progress.

Test Date & result Date & result Date & result Date & result Date & result Date & result
Blood pressure
Body mass index (BMI)
Waist measurement
Diabetic retinopathy
screening (annual)

What do the results mean? See pages 10 and 11.

Page 5: Your questions

To get the most out of your healthcare appointments think and plan what you’d like to discuss. Here are some topics to help you:

  • Food choices
  • Test results
  • Low mood, stress or worry
  • Activity
  • Medication
  • Eye screening
  • Smoking
  • Sex life

What would you like to talk about at your review and include in your personal action plan?

  • My weight
  • Managing/coping with diabetes
  • Long term problems
  • Pregnancy

Pages 6-7: My personal plan

My personal plan is a way to think about changes you want to make in your life. We know if we write these targets down, we are more likely to move forward long-term.

The things I am worried about are:

Choose one or two changes you would like to focus on:

Write down what you are going to do about these. It might help to take small steps at first
and give yourself a time limit. Think about any barriers that may get in your way and how you
plan to overcome them.
Date and
time limit



Pages 8-9: Lifestyle and test result traffic lights

Understanding lifestyle choices and test results can help with managing diabetes.

Results and choices which give the best long term outcomes are coloured green. Amber or red can help to suggest areas for change to
reduce your long-term risks.

Physical activity

Number of 30 minute sessions per week:

7+ 6 5 4 3 2 1 0

Regular physical activity is extremely important for good blood glucose control and weight management. It also helps protect against heart disease.

Physical activity includes all forms of exercise, e.g. walking, swimming, cycling, gardening, housework, taking the steps when you can.

Ask your GP or practice nurse about exercise in your area, or call the Sport and Active Lifestyles team for more information: 01275 882730


Do you smoke?

No Yes

Smoking is a major cause of heart disease and stroke. If you currently smoke, ask your GP or practice nurse for help to stop smoking.

Food intake

A balanced diet is key to keeping healthy when you have diabetes. Do you:

Eat regular meals across the day? Yes No
Choose wholegrain breads and cereals? Yes No
Use low fat cooking methods? Yes No
Cut down on sugary foods and drinks? Yes No
Add salt to cooking or at the table? Yes No
Eat at least five portions of fruit and veg a day? 5-8 4 3 2 1 0

A portion of fruit and vegetables is about the amount you would fit in the palm of your hand. For example: one large fruit (apple, banana, pear, orange); two small fruits (plums, apricots);  handful of berries or grapes; 2-3 tablespoons of cooked, raw, frozen or tinned vegetables or beans; or a small bowl of mixed salad.


Units of alcohol/week:

Men and women 0-7 7-14 14-21 21-28 28-33 35+

The Department of Health recommends that you should not regularly drink more than 14 units per week. It is best to spread this evenly over
three days or more. One unit is equal to: ½ pint beer, lager or cider; 100ml glass of wine; one pub measure of spirits.

Pages 10-11: What do the results mean?

Your personal range will be discussed with you by your clinician. The ranges may vary in those who are elderly or if you have other health

Body mass index and waist circumference

Body mass index (BMI) is a measure of body fatness. High BMI and waist circumference can contribute to heart disease, high blood pressure and stroke. It can also worsen diabetes control.

Body mass index* 22 23 24 25 26 27 28 29 30+

Waist circumference**

Male <94cms/37ins 94-102cms/37-40ins >102cms/40ins
Female <80cms/31.5ins 80-88cms/31.5-34.5ins >88cms/34.5ins

* For South Asian people a BMI of 23.1 or more is considered high risk. Waist circumference is a measure of the central body fat or central obesity.

** For South Asian people a WC>90cm (35”) is high risk for men and a WC>80cm (31.5”) is high risk for women.

Blood pressure (BP)

Systolic 125 130 135 140 145 150 155 160 165+
Diastolic 65 70 75 80 85 90 95 100 110+

Blood pressure tells you how hard your heart has to work to move blood around the body. Having high blood pressure can increase your
risk of heart disease, stroke and kidney disease. The top number is the highest pressure when your heart beats and pushes the blood around
your body. The bottom number is the lowest pressure when your heart relaxes between beats.

Blood fats

Total cholesterol 2 3 4 5 6 7 8 9 10 11+
LDL cholesterol 1 2 3 4 5 6+
HDL cholesterol 0.5 1.0 1.5 2.0 2.5+
Triglycerides 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0+

Total cholesterol measures all the cholesterol in your blood, too much can increase your risk of heart disease and stroke.

Low density cholesterol (LDL) increases your risk of cholesterol build-up in your arteries (‘bad’ cholesterol).

High density cholesterol (HDL) helps protect against heart disease (‘good’ cholesterol).

Triglycerides are a measure of the fat circulating in your blood.

Non HDL cholesterol  is your total cholesterol minus your HDL cholesterol (‘good’ cholesterol) and is the sum of all the ‘bad’ cholesterols added together (including LDL cholesterol).

Blood glucose

A fasting or a random blood glucose indicates your glucose level at the time of test.

5.5 6.0 6.5 7.0 7.5 8.0 8.5 9

The target ranges are: before meal 4-7 mmol, two hours after meal up to 8.5mmol/L (or up to 9 mmol/L for insulin users) but your target may be different depending on your age and other health problems.

HbA1c mmol/mol – HbA1c gives an indication of your average blood glucose levels over the previous 2-3 months.

48 53 59 64 70 75 81 86

Page 12: Useful information

Diabetes education

Education courses across North Somerset
01275 885166

Diabetic Retinopathy (Eye) Screening
0117 405 5000

Foot Care (NHS Podiatry)
01275 885070

01934 647031

Diabetes UK
Essential diabetes information from the UK’s leading diabetes organisation
Telephone: 0345 1232399

Groups for support and education events:

Portishead Diabetes Support Group
Diabetes Practice Nurse: 01275 841630

Weston Diabetes Support Group
Ann Barrett: 01934 822679

Avon and Somerset Peer Advisors, Weston General Hospital
Telephone: 07586 320855

Go4Life North Somerset
Health walks, yoga and cycling

Planning pregnancy

Books and app for diabetes and weight loss

Food smart app, eat well and move more advice