Diabetes and diabetes technology

Most diabetes care in the UK comes from GPs and NHS diabetes teams. A private consultation adds to that care, with time to look at one problem in detail: whether the diagnosis is the right type, why glucose levels have drifted despite your efforts, or how to get more from a sensor, pump or closed-loop system. Dr Spiliotis's research at Oxford was in type 1 diabetes and in the physiology of MODY, and these remain his main clinical interests.

Questions a consultation can help with

• Whether a diagnosis of type 1 or type 2 diabetes is correct, particularly with diagnosis under about 35, a parent with diabetes, your own insulin production still measurable years after a "type 1" diagnosis, or a slim adult who needed insulin soon after a "type 2" diagnosis
• Testing for MODY and LADA, and what a confirmed result means for treatment and for relatives
• Type 1 diabetes where glucose levels, hypos or weight are not where you want them
• Getting more from a continuous glucose monitor (CGM), insulin pump or hybrid closed-loop system you already use
• Diabetes after pancreatitis or pancreatic surgery, or brought on by steroid treatment
• Planning a pregnancy with diabetes (care during the pregnancy itself is best delivered by an NHS joint diabetes antenatal clinic)

When the type is not clear

Not all diabetes is type 1 or type 2, and the label given at diagnosis is sometimes wrong. MODY is inherited and often needs different treatment, sometimes none. LADA develops slowly in adult life and is often mistaken for type 2. Diabetes can also follow pancreatic disease or surgery, or be brought on by steroids. Getting the type right matters because it changes treatment.

Tests that may be arranged

• HbA1c and a review of glucose patterns from your meter, CGM or pump
• C-peptide, in blood or urine, which measures how much insulin your own pancreas still makes
• Islet autoantibodies (GAD, IA-2 and ZnT8), which point to autoimmune diabetes
• Genetic testing for monogenic diabetes through an accredited UK genomics laboratory, when the probability justifies it. If you meet the NHS criteria, your NHS team may be able to request it instead.

Sensors, pumps and closed-loop systems

If you use diabetes technology, the review starts from your downloaded data, so the discussion is about what is happening day to day rather than an average. Settings, meal insulin, exercise and alarms are the usual places to look.

Working alongside your NHS team

If you are under an NHS diabetes clinic you would normally stay under it, and sensors, pumps and supplies usually continue to come through the NHS. With your agreement, Dr Spiliotis writes up the opinion so that you, your GP and your NHS team have the reasoning and the recommendations in one place, and changes to insulin or devices are agreed with whoever manages them day to day.