Chronic Disease Management

Diabetes, Asthma, COPD, Heart Disease

Regular appointments are available at both Winscombe and Banwell Practices.

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Why have I been sent this information?

You are being sent this information because you recently had a blood test called HbA1c – this is a test of your average blood sugar from the previous 3 months. We use this to check for pre-diabetes and diabetes. 

Your result suggests you are within the pre-diabetes range. 

Your message should have included a letter which informs you of your latest result and its numerical value.  

What is pre-diabetes?

Prediabetes is a condition of higher than normal blood glucose, however it is not yet in the range for type 2 diabetes. Having pre-diabetes is a sign that your body is struggling to deal with the level of sugar in your blood. The good news is that with the right lifestyle approach it is usually possible to reverse it. However, if you do not use this opportunity to make some change there is also the risk that it could develop into Type 2 diabetes.

 You may be more susceptible to prediabetes if you have a family history of Type 2 diabetes.

It  can also be associated with being overweight and/or having too much fat in the liver or pancreas.

How can I lower my risk?

As having prediabetes or diabetes is essentially a sign that your body is unable to process sugar, the best way to improve things is to reduce the sugar you eat and/or drink. This can get your metabolism back on track to manage the sugar (or carbohydrate) you do eat.

These include:

  1. Obvious sugars – sugar sweetened drinks, sweets, chocolates, deserts, biscuits etc.
  2. Consider your intake of starchy carbohydrates as these turn into glucose (sugar) when you eat them.  These foods include: breakfast cereals (including porridge), bread, rice pasta, potatoes, crisps and any food containing flour such as crackers & wraps.
  3. Avoid ultra processed foods. These are products that have been made in a factory, they will be packaged with a long list of ingredients eg crisps, snack bars, ready meals, sauces, diet drinks.

What can I eat?

Real food: Meat/fish (or meat substitute if you are vegetarian), all vegetables (apart from potatoes or sweet potatoes –  above ground vegetables can be eaten without limit), eggs, nuts, all dairy, avocado, coconut, olive oil.

Fruit: Avoid or restrict tropical fruit such as mango, pineapple grapes and bananas. Avoid dried fruit and fruit juice. You can however eat berries/nectarines/apples/apricots/satsumas but in moderation. Fruit should be considered a treat rather than a healthy snack to be eaten freely.

Drink: Water, fizzy water, tea, coffee, fruit teas.

There are lots of resources and support for this approach: 

Managing PreDiabetes

Diabetes Metabolic Health


Once you have been diagnosed as having pre-diabetes, we will invite you once a year to have your HBa1c rechecked to check this is not moving towards a diabetes diagnosis (and show it reducing from the changes you make!). Your will normally be invited around your birthday month.

If you implement some of the changes on this page and want to see how you are doing, we would be happy to recheck your hba1c prior to the first annual check. This however should not be done too prematurely, as it can take up to 3 months for it to change once you have implemented the change. We would recommend doing this 3 months after you have made the changes to your diet to see its effect.

HbA1c below 42 mmol/L

You’re doing great and now outside of the prediabetes range – we will however continue to invite you once a year to monitor the situation.

HbA1c 42 - 47 mmol/L

You remain in the pre-diabetic range. Continue to work on the measures in this page to reduce your risk of future development and try to see if you can reduce your number over time.


HbA1c 48 or above

This means you have crossed over in to the diabetic range – we will normally ask you to repeat your blood test and then discuss the result with a clinician.

Alternatives to low carbohydrate approach

Although the lower carbohydrate lifestyle generally leads to a more rapid improvement in prediabetes not everyone chooses it or can manage it. There is also the option of the National Diabetes Prevention Programme (NDPP) details of this are attached to your intial text message / letter. 

Weight loss

Losing weight can help reverse prediabetes whichever approach you use.


Activity/exercise is a great adjunct to a healthy lifestyle and to be encouraged, but diet is the most important part. Many people find that once they start feeling better and losing weight, and normalizing their blood sugar, that they naturally become more active. Do anything you enjoy that includes movement, and it will help!

Stress/sleep Good quality sleep and stress management are also important, as both can affect your blood sugar levels, although these things are not always so easy to control as your food intake.

This information is designed to be the start of a conversation about your metabolic health. If you have more questions, or would like to discuss this further, please contact the practice to arrange a discussion with a member of the diabetic team.

Cardiovascular Risk Information

Why have I been sent this information?

You are receiving this information because you recently had a blood test to measure your cholesterol. As part of this process, we have then performed a risk assessment to help us gather information on your risk of developing cardiovascular disease – this includes things like heart attacks, strokes, and peripheral vascular disease (issues with the blood vessels).

However, cholesterol is only one part of this risk and we have used other factors to calculate this risk. Some of these are things we cannot change, and some things we can change!

  1. Age, gender, Ethnicity
  2. High blood pressure, cholesterol level, body mass index (Height and weight)
  3. Smoking, alcohol intake
  4. Medical conditions such as diabetes, rheumatoid arthritis, chronic kidney disease
  5. A strong family history of heart disease (in relatives under the age of 60)


Whenever we run this calculation, it will never be zero – and as we get older however hard we work on the other risk factors, the risk level will increase.  The number given will be a number out of 100 (this is the highest) and indicates what your risk of developing cardiovascular disease will be in the next 10 years. The number given to you will put you into one of the following categories.

Low risk - Less than 10%

This meams you have less than a one in 10 chance of developing cardiovascular disease in the next 10 years.

Moderate risk - 10 - 20%

This means out of 10 people with this risk, 1-2 of these people would develop cardiovascular disease.


High risk - More than 20%

This means out of 10 people with this risk, more than 2 of these people would develop cardiovascular disease.

How can I lower my risk?

Cholesterol is one part of lowering your risk. Alongside this, there are a number of lifestyle changes that you can do to reduce this risk. 

This includes:

  1. Stop Smoking – You can speak to one of our in practice stop smoking advisors or approach your local pharmacy.
  2. Eat a well balance diet – A low fat, high fiber diet including 5 portions of vegetables at day. 
  3. Reduce alcohol intake – aim for less than 14 units per week
  4. Keep a healthy weight – Aiming for a body mass index between 20 – 25
  5. Increase your activity level – small changes that become normal habits for you. 
  6. Control your blood pressure – alongside the things above, you may require medication for this. 

Almost everybody will benefit from these changes , even if your risk is low. One option would be to implement these lifestyle changes, and then recheck your cholesterol in 6 – 12 months at which point we can recalculate your risk. 

Medication to lower cholesterol

There are a number of medications that can help to lower your cholesterol. Overall, these are recommended if your risk is above 10%. 

Statins are one group of these medications and work by lowering your cholesterol and therefore lowering your risk of cardiovascular disease. They are taken once a day and on the whole have very few side-effects. 

You can use your QRISK number to see how much benefit you would get (and the risk of side-effects) from taking a statin by clicking here.

This information is designed to be the start of a conversation about your heart health. If you have more questions, or would like to discuss starting a statin please make a routine appointment with a clinician to do this. 

If you would rather watch and listen, or wouldlike  more detail – we would recommend you watch this video. 


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