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(Incorporating the Diabetes Research Foundation)

Diabetes Institute

The Diabetes Institute Of Ireland provides the most up to date care for people with Diabetes. Diabetes is a lifelong condition. However it need not prevent you doing anything you want to do.  You can still pursue almost any career, travel and take part in sports to a very high level, as has been shown by sportsmen such as Steve Redgrave, who won a gold medal in the Olympics for rowing, Tony Trabert, who won Wimbledon and many others, including Garry Mabet, who played soccer for Ireland.  Well controlled diabetes allows people to lead a normal life.The aim of the Diabetes Institute is to provide treatment to allow patients to live a normal and healthy life.         

What causes Diabetes?

Diabetes is caused by an absolute or relative lack of insulin, a hormone produced in the beta cells of the pancreas gland which converts food into energy or stores food as fat.  Blood sugar rises abnormally high if there is a deficiency of insulin.

One of the body’s most important processes is the conversion of food into heat and energy.  The food we eat consists of 3 main nutrients:

:Carbohydrate                        
:Fat                                            
:Protein      

Carbohydrates are especially important as a source of energy as they are rapidly converted to sugar/glucose (glucose is the simplest sugar – 2 glucose units make up 1 sucrose which is the sugar in the sugar bowl). 

Fat can also be used for energy but it only works properly if carbohydrate metabolism is satisfactory (ie. there is enough insulin) otherwise ketones are produced which make you ill.

Protein is used to build muscle and other organs and can also be used for energy under certain circumstances.

Glucose is very important because the body needs sugar at all times to keep the cells alive and to provide energy for the brain.

Glucose uptake

Before it can be used as energy glucose must enter cells such as the muscle and brain cells where it is needed for movement and mental activity,  the liver where it is stored as a quick source of energy and the fat cells where any excess food is converted to fat and goes into long-term storage. 

Glucose cannot just flow into these cells from the blood, it must move through channels on the cell surface. Insulin binding to the insulin receptor on the cell surface allows these channels to open and glucose can enter the cell.

Types of Diabetes

Type 1 Diabetes

Normally insulin is produced by the beta cells in the pancreas. In Type 1 diabetes the beta cells have been destroyed and therefore insulin is not produced.  Only 10% of the population with diabetes have Type 1 diabetes.  Although there is a genetic pre-disposition to Type 1 diabetes it is not usually inherited and there is a very low risk of diabetes for the child of a person with diabetes.   People with Type 1 diabetes are seldom overweight.  Antibodies to insulin-producing cells are found in newly diagnosed Type 1 diabetic patients and it is thought a viral infection suffered by a person with susceptible genes may be a trigger for diabetes.  However, this is only one theory and recent research suggests that there may be other factors involved in the development of Type 1 diabetes.

At first sufficient insulin is produced as the pancreas is deteriorating and blood glucose remains normal until almost all the beta cells have been destroyed.  A person who is developing Type 1 diabetes only becomes sick when almost all the beta cells have been destroyed and they have almost no insulin.  The beta cells do not usually recover once diabetes has developed although recent research has shown that it may be possible in the future to provide the conditions necessary for the beta cells to recover but this will be a long-term project. New research suggests that it may soon be possible at least to prevent complete destruction of the beta cells but treatment must be given at the early onset of the condition.

Type 1 diabetic patients must be treated with insulin and the aim of treatment is to keep their blood sugar as close to normal as possible.

Type 2 Diabetes

Type 2 diabetes affects 10% of the population over 50 and is increasing at an alarming rate. 90% of people with diabetes have Type 2 diabetes.  Factors which make people susceptible to Type 2 diabetes are:

• Being overweight
• Having a family history of diabetes
• Being over 40       
• Having had diabetes in pregnancy
• Having had a large baby
• Lack of exercise


The older people get the more likely they are to develop diabetes.  Type 2 diabetes comes on slowly and it is estimated that on average diabetes has been present for 7 years prior to diagnosis.  It is very important that diabetes is diagnosed so that it can be treated and the complications of diabetes can be avoided.  High blood sugars cause heart disease, kidney disease, damage to the back of the eye and foot ulcers.  However, well controlled diabetes is compatible with a long and healthy life.

People who have Type 2 diabetes have a defect in the beta cells of the pancreas causing them to produce insufficient insulin. These patients need pills to stimulate the beta cell to produce more insulin and if that does not work they need to be given insulin.  People who are overweight and develop Type 2 diabetes may also be insulin resistant. That means that the patient’s cells are producing plenty of insulin, maybe much more than normal, but the patient’s muscle, liver and fat cells are resistant to the action of  insulin and they need much more insulin to enable them to utilise glucose.  Insulin resistance is associated with being overweight, having a poor diet and taking little exercise. Treatment consists of a weight reducing diet and pills to make the cells more sensitive to the action of insulin. However they also have a defect in insulin production and may need to take insulin eventually.

Measuring Blood Sugar Levels

Blood sugar should be monitored regularly by both Type 1 diabetic patients and usually by Type 2 diabetic patients.  Patients on insulin are usually asked to measure their blood sugar four times a day so that adjustment of insulin can be made at regular intervals.  Type 2 diabetic patients usually measure their blood sugar only once or twice a day or less often if they are very stable.

Blood sugar is easily measured using a glucose meter.  These are very small, light weight and simple to use.  It only takes a very small drop of blood from a finger prick.  A spring-loaded pricking device which is almost painless, is used to take the blood which is applied to a strip in the glucose meter and the glucose reading appears in 5-10 seconds.

Fasting blood sugar should be between 4 and 6mmol/l

Continuous Glucose Monitoring

Continuous Glucose Monitoring System is a device which is implanted under the skin and takes a blood glucose measurement every 5 minutes throughout the day and night, for up to 3 days. It may either be used like a watch with a read-out and may be downloaded later to a computer. This way the patient and their physician can see exactly what is happening to the blood glucose levels round the clock. The sensor is inserted under the skin and is connected to a small pager-sized monitor. An electronic signal proportional to the blood glucose level is transmitted to the monitor.

“Hypo” or Low blood sugar

Hypoglycaemia ('hypo') occurs when blood sugar level falls below normal (4mmol/l).  The amount of insulin or tablets must balance the food intake and the amount of exercise. Hypo can result from taking more exercise than expected or too much insulin for the amount of food eaten.  It is important to reduce insulin/tablets if you are taking more exercise than usual and to increase if you are having a larger meal or less exercise than usual.


Signs of ‘Hypo’

It is important to learn to recognise the signs and symptoms of “hypo” as well as how to treat it.  The warning signs vary from person to person.

The typical signs are:
• sweating
• shaking       
• dizziness
• feeling cold
• irritable
• hungry
• tired and anxious. 

When hypoglycaemia occurs, it requires prompt treatment. The main objective is to raise the blood sugar level to normal. This can be achieved by taking sugar or a sugar containing drink such as Lucozade. This should then be followed by some form of carbohydrate food, such as sweet biscuits or bread and jam.
 
If the patient is unable to drink, due to an altered level of consciousness, then it is necessary to call an ambulance immediately and get the patient to hospital where they can be given sugar by intravenous drip.

Hyperglycaemia or High Blood Sugar

This is due to too little insulin/tablets for the amount of food that has been eaten. Exercise reduces the need for insulin so if you do not take your usual exercise you must increase the insulin/tablets unless you reduce your meal size.  Hyperglycaemia may also result from illness, infection and stress.  It is important to measure blood sugar frequently during illness. Even if you are not eating you may need more insulin/tablets.  If blood sugars remain high you should consult the Clinic urgently since high blood sugars slow down recovery.


Signs of Hyperglycaemia

• Tiredness
• Thirst
• Passing a lot of urine
• Genetal Itching
• Rash

Ketones  (Type 1 diabetes only)

If there are persistent high blood sugar levels over a period of time, then ketones may be found in the urine and blood. These occur as a result of the body breaking down fat as a source of energy. Ketones have the potential to be poisonous to the body. To test for the presence of ketones, simply dip a Ketostix into a urine sample and wait the prescribed time before comparing the colour change of the Ketostix to the guide provided. If ketones are present in the urine, and your blood sugars are high or if you have nausea or vomiting you should contact the Clinic urgently.

Injection Technique

Insulin is administered by a subcutaneous injection. The subcutaneous layer of tissue is located between the skin and the muscle layer, which lies below it.

Injecting insulin is a life long commitment. Therefore, injection sites are very important, so care must be taken when choosing these sites. It is not recommended to use the arms for insulin injections as there is usually only a thin layer of subcutaneous tissue in this area.

The insulin pen system has simplified insulin delivery.  Pens come in all sizes shapes and designs and many combinations of slow and fast acting insulin are available.  Pens may be disposable or may require cartridge refills similar to fountain pens.

A wide range of needle lengths are available designed to cater for a variety of needs.  The needles are now so thin and sharp that many people consider injections painless.

Giving an Injection

Remember to always change the injection site from one injection to the next.  Never give insulin repeatedly in the same site.  Always have a spare pen or pens available and spare refills if you are on a refill pen system.  Keep the spares in a fridge. 

Preferred areas for insulin injections:
The upper and lower abdomen, avoiding the umbilical region.
The upper outer part of the thigh.
The upper outer area of the buttocks.

The Insulin Pump

The insulin pump is another way to use insulin which some people find more convenient.  The insulin pump is not an artificial pancreas (because you still have to monitor your blood glucose level), but pumps can help some people achieve better control, and many people prefer this continuous system of insulin delivery to injections.
Insulin pumps are computerized devices, about the size of a mobile phone, that you can carry on your belt or in your pocket. They deliver a steady, measured dose of insulin (the "basal" dose) through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place. The needle is removed and only a soft catheter remains in place.
Insulin is delivered continuously over 24 hours. The patient may program different amounts of insulin at different times of the day and night or a bolus can be given manually ie. before during or after meals. Using a pump demands frequent blood sugar measurements since there is no reserve of insulin in the body such as is given by the long acting insulin given by injection.


Inhaled Insulin

An alternative to insulin injections has recently become available in the form of inhaled insulin.  Exubera, is a short-acting insulin delivered to the lung by means of an inhaler. It may offer adults with Type 1 or Type 2 diabetes an alternative to the insulin injections. The device is a lot larger than the insulin pen and is not approved for use by children younger than 18.  Exubera is not to be used by smokers or people who have quit smoking within the previous six months. It's also not recommended for people with asthma, bronchitis, or emphysema.
While Exubera appears efficacious, concerns have been raised about the safety of inhaled preparations and whether Exubera will
compromise lung capacity or damage lung tissue in long-term use.
 
Diabetes Diet

A normal healthy diet is advised for people with diabetes. A healthy diabetes diet is one that contains a high percentage of vegetables and fruit, a moderate amount of protein (meat, fish, eggs, cottage cheese), a low amount of fat (cheese, meat, sauces) and in particular a low animal fat diet.

People who are overweight need to reduce the calorie content of their diet by eating less food and drinking less!

Loosing weight is difficult.  Many people are surprised by the number of calories contained in fruit and vegetables.

Refined sugar is absorbed very quickly and is best avoided except at the end of the meal when absorption will be delayed because of the other food in the stomach.  Remember refined sugar is high in calories and low in appetite suppression! Cakes and sweets will increase blood sugar rapidly.

General Cooking Tips

• Do not fry. Instead grill, bake, poach, steam, microwave or boil foods.
• Use low fat dairy products, such as skimmed or semi-skimmed milk.
• Use fats or oils which are high in mono-unsaturates (olive oil).
• Try to use brown rice or pasta in place of white rice as it contains more fibre. If you choose a lower fibre variety of rice or pasta, serve it with higher fibre foods like extra vegetables.
• Choose high fibre rather than low fibre carbohydrate foods (e.g. wholemeal bread). Use low fat cheddars or cottage cheese.
• Rich sauces such as thick gravies, mayonnaise and salad cream should be avoided. If you need to lose weight or your cholesterol is high use light mayonnaises or low calorie salad creams instead. Consider using natural or diet yogurt instead of cream or light cream.
• A high salt diet may increase blood pressure.  Avoid processed meats and foods. Sausages, hamburgers, meat pies, crisps, chips and oven chips have a high fat content and a lot of salt (People with high blood pressure should especially reduce their salt intake). 
• A moderate amount of protein (e.g. meat, poultry, fish, cheese) is recommended.

Carbohydrate advice for people with Diabetes

There are three types of carbohydrates, each of which have different effects on blood glucose levels. Refined sugars (sucrose, glucose or fructose) increase blood glucose levels very rapidly and should be used urgently to correct 'hypo' attacks.
Starchy foods with a high fibre content rather than low fibre starches are recommended. This delays absorption and improves control of diabetes.
Low fibre starches are white bread, rice, potatoes, pastas and breakfast cereals such as cornflakes.  High fibre starches are wholemeal bread, brown rice, brown pasta, wholegrain cereals such as bran cereals and porridge.

Diabetic Products

Foods labelled 'suitable' for people with diabetes are usually not suitable due to their high fat content.
Non-calorie sweeteners may be used freely. Products sweetened with artificial sweeteners can be taken freely.
Remember, if you are overweight and have been advised to lose weight you must reduce your food.

Alcohol 

Alcohol may be included as part of a healthy diet, but remember alcohol stimulates insulin secretion in people who still have some beta cells and may cause hypoglycaemia in Type 2 patients.
Never drink on an empty stomach and do not substitute alcohol for food. It may be necessary to eat with or shortly after alcoholic drinks. Test your blood sugar after alcohol ingestion to ensure maintenance of good control.  Avoid sweet wines, cider and liqueurs. If you dilute spirits use soda water and sugar free mixers. If you are overweight, keep your alcohol intake low since alcohol is high in calories.
Remember to inform your friends/colleagues that you have diabetes and take insulin.  They should be instructed in the symptoms of hypos and if they see you behaving in a strange manner they must insist that you either do your blood sugar to make sure it is normal or else insist that you take sugar.  You may not recognise the symptoms of hypo when you have taken alcohol and your friends may just think you are drunk. That may be a very dangerous mistake to make.

Pregnancy and Contraception

All usual methods of contraception are suitable for people with diabetes
                                                                                     

Pregnancy

Diabetes is compatible with normal healthy pregnancy and healthy infant.  Unfortunately, poorly controlled diabetes is associated with an increased risk of abortion, still birth and foetal abnormalities.  It is for this reason that it is of the utmost importance that pregnancies are planned and that excellent control of diabetes is present at conception and maintained throughout pregnancy.  It is recommended that at least 2 near normal HbA1 levels be obtained prior to conception. Thus it is extremely important that you discuss matters concerning pregnancy with the consultant and that you schedule frequent visits to the clinic prior to pregnancy and in the early stages of pregnancy, before you start attending the maternity hospital.  It is from the adherence to these guidlines that the results of pregnancy have improved dramatically and the outcome of pregnancy is now little different from that of women that do not have diabetes.  Pre-pregnancy and pregnancy are a time when the person with diabetes and the Clinic must work together in an intensive way whether it is through visits to the clinic or through frequent telephone contact.  If you are not attending for pre-pregnancy advice, do contact the Clinic as soon as you know you are pregnant.

Living and Lifestyle


Exercise and Sport

Regular exercise keeps you fit, controls your weight, allows insulin to work better and reduces the risk of heart attack and stroke. Regular exercise is important for a long and healthy life. Virtually all sports are open to people with diabetes and indeed many world class athletes have diabetes.

Depending on the type of exercise, you may need to lower your insulin dose and increase your food to avoid low blood sugar levels (hypos). Vigorous and prolonged daytime exercise may cause hypoglycaemia during the night, and extra carbohydrate may be necessary at bedtime.


Holidays and Travel

Diabetes does not prevent you from experiencing new places or cultures. For example a team sponsored by the Diabetes Federation of Ireland successfully climbed Kilimanjaro, the highest mountain in Africa.

Before travelling it is advisable to:
• Contact your family doctor or clinic to get the necessary vaccinations. Bring a letter from the Clinic to explain that you need to carry syringes/needles etc in the cabin.

• Arrange adequate medical insurance (The diabetes Federation of Ireland has special offers)

• Carry a diabetes identity card or engraved discs/bracelets wherever you are going.

• Discuss managing sickness and diarrhoea with the Clinic beforehand. As a precaution, drink only bottled water, avoid salads in hot and underdeveloped countries and consider hygiene levels in restaurants.

• Keep insulin cool (e.g. in a thermos flask) and wrap the pens, cartridges, vials etc in cotton wool, tissue or paper to prevent breakages.

• Carry insulin, pens, syringes and other equipment in hand luggage.  When travelling by air, insulin should not be stored in the main baggage area as it may freeze, making it less effective.

• To maintain good control of your diabetes, be extra vigilant with blood-glucose testing to monitor the changes of routine and food. Always carry glucose sweets or a fast acting carbohydrate.

• Find out what types of insulin are available abroad in case of emergencies. If you are taken ill on holiday, never stop your insulin even if you cannot take food or drink. Usually illness requires increased doses of insulin.

• Test blood sugar every hour and take quick-acting insulin to keep blood sugar levels normal. Make sure you know what to do if you're suffering from an acute illness.

Employment

Diabetes may be misunderstood and feared by some employers. If you are the right person for the job, it is important that you can show that diabetes will not affect your work. Always tell your colleagues you have Type 1 diabetes and explain that it will have no impact on your performance when well controlled. Explain hypoglycaemia and what needs to be done in an emergency.

Diabetes is not a disability. If you think you have been discriminated against, consult the Diabetes Federation of Ireland and your solicitor. At present, treatment with insulin precludes entry into the following:  The Gardaí, Fire and Ambulance services, the Armed Forces, train driving, airline pilots, air traffic control and bus drivers.

Medical Entitlements

The long term illness booklet given to all diabetic patients on diagnosis is not means tested and entitles the patient to free prescription drugs and medicines such as insulin, diabetic tablets and tablets for high cholesterol and blood pressure.  Syringes, pens, test strips and monitors and both urine and blood-glucose monitoring are also free.  All medication and drugs relating to diabetes, including drugs for blood pressure and for lowering cholesterol, can then be obtained at any pharmacist on production of the booklet, free of charge.

Driving

When applying for a driving licence an eye test must be taken. Answer 'YES' to Question 13 on the Application Form for a provisional or full driving licence which lists diabetes among a series of other 'disabilities'. Otherwise the licence will be invalid. A special form (Reg. D501) should be filled in by the Clinic to inform the licensing authority that your diabetes is controlled and will not impair your safety as a driver. You must sign the form in the doctor's presence.

Before driving always do a fingerprick blood sugar if you use insulin

When driving carry glucose tablets in the car if you're on insulin or tablets that cause low blood sugar.   It is not wise to drive for more than two hours without a snack or blood sugar check if you are on insulin. Stop at the slightest sign of a 'hypo'.


Motor Insurance

The Diabetes Federation if Ireland has negotiated special motor insurance packages for members above the age of 30 years with no loading because of diabetes.  Younger drivers may also be offered terms without loading for diabetes.

Avoiding the Complications of Diabetes

The Pathway to Continuing Good Health

Poor control of diabetes can be a major cause of heart disease, stroke, blindness, kidney damage and foot ulceration.  As well as looking after blood glucose and making sure HbA1 (long-term glucose control) is below 6.5%, it is important to have the eyes examined regularly for damage and to have blood pressure, cholesterol, liver function and kidney function tested.

The Heart

People with diabetes are more susceptible to heart disease, not only because of high blood sugar but also because cholesterol and blood pressure are so often raised.  High cholesterol and high blood pressure can damage the heart.  It is important to have cholesterol and lipids checked regularly. 
Cholesterol for a people with diabetes should be below 4.5mmol/l and LDL cholesterol, the bad cholesterol, should be below 2.0mmol/l.  Triglycerides should be below 1.8mmol/l

Blood pressure

High blood pressure damages the arteries but is easy to treat.  High blood pressure (hypertension) is a BP consistently higher than 135/80. For people with diabetes, it is healthier to have a BP below 140/80. Hypertension is a common condition, and if it is controlled it reduces the risk of a stroke, heart attack and damage to other blood vessels, just as in people without diabetes. Hypertension can be successfully treated and it must be monitored regularly. Resting blood pressure should usually be lower than 135/80. Blood pressure is the pressure in your arteries, and is recorded as follows:

135 (higher number is recorded when your heart pumps)
80   (lower number is recorded when your heart relaxes)

Erectile Dysfunction

Erectile dysfunction is common in middle aged men and may be due to the normal aging process, psychological problems including anxiety and depression or physical disorders.  Diabetes per se is never a cause of erectile dysfunction unless damage has been caused to the nerves or arteries due to poor control of diabetes over many years.  Sometablets to control high blood pressure may cause erectile dysfunction.  It is important to discuss erectile dysfunction with the consultant since good treatment is often available.

The Kidney

Poor control of blood sugar and blood pressure can damage the kidneys. Early detection of kidney damage is very important as progression can be prevented and reversed. Early damage is diagnosed by testing the urine for very small amounts of protein (microprotein). This test should usually be carried out once a year.


Eye Care

Damage to the back of the eye (retinopathy) is a very serious complication and can lead to blindness. It is preventable over the years by good control of blood sugar, blood pressure and high cholesterol. The eye should be examined at least once every 2 years, since early detection of retinopathy and appropriate treatment prevents blindness.

Foot Care

Diabetes, if it has been present for many years and poorly controlled, can sometimes cause damage to the nerve endings (neuropathy) resulting in numbness, tingling or pain in the toes and feet. If you have neuropathy, you may not always be able to feel discomfort or pain and ulcers may develop.
Narrowing or hardening of the arteries can also occur and can reduce the blood supply to the feet, causing poor circulation with cold feet and cramp in the calf muscles.
Feet should be examined during your annual check-up. The doctor and podiatrist will test for neuropathy by using a tuning fork, reflex hammer and pricking the feet with a pin, and will also look for signs of circulatory problems.
Contact the Clinic urgently if you find any sores, redness, swelling, skin damage or athlete's foot. If you find any corns or calluses, arrange to see the Clinic podiatrist. Never use razor blades to pare the corns and never use corn plasters if the feet have been damaged by diabetes.
 
Diabetes, if well controlled, is compatible with a long and healthy life. Complications are preventable and will not occur if diabetes is well controlled throughout your life.

Diabetes Clinic

The Professionals involved in Diabetes Care and their Role

The Diabetes Consultant
The Consultant will be looking after your diabetes.  He will advise you when to see the ophthalmologist, nurse specialist, podiatrist and if necessary the cardiologist or any of the other specialists involved in the care of diabetic patients.

The General Practitioner
He will probably have made the diagnosis of diabetes and the Consultant will work closely with him/her deciding on how to treat your diabetes.


The Diabetic Nurse Specialist
The Nurse specialising in diabetes is attached to the Clinic and she will advise you in all aspects of diabetes. She will instruct on measuring blood sugar and how to give insulin injections.

The Educationalist
The Educationalist will explain what happens to the body when someone develops diabetes.  Knowledge of nutrition will play a major part in your understanding of diabetes and its management. The Educationalist will instruct you on the role of blood sugar measurements in adjustment of treatment to keep the diabetes under good control and explain factors which influence blood sugar control such as weight, exercise and illness.

The educationalist will also teach blood sugar measurement and how to give insulin injections and many other practical aspects of diabetes. She will be available for phone calls and will help to advise you on adjustments of insulin and tablets.  Group educational sessions will be held at regular intervals since group discussions and support often lead to a better understanding of the condition and a feeling of security about your diabetes.  Group sessions can be fun and can be very re-assuring particularly to patients recently diagnosed with diabetes.

Dietician
The dietician will assess eating patterns and will advise on the changes necessary to comply with a healthy diet.  The dietician will advise on the calorie content of foods and the glycaemic index and thus help with understanding how various foods influence weight and blood sugar.

The Podiatrist
The Podiatrist will advise you about foot care. This is particularly important in older people and those who have damage to arteries or nerves.  The clinic will advise you on the necessity of review by the podiatrist but you may elect to see the podiatrist at any time.  Remember poor shoe selection is a major cause of food damage.  The shoe should fit the foot, the foot should not be made to fit the shoe!
 
Psychiatrist and Psychologist
The diagnosis of diabetes is very often traumatic not only to the patient but also to the family and some patients have difficulty in coming to terms with it.  It is very important to be able to speak about your fears and tensions that arise within the family.  The Psychologist and Psychiatrist are available to speak with you and the consultant will refer you if you so wish.

Ophthalmologist
Most patients will be referred to the eye specialist for a routine examination soon after diagnosis and once a year after that.  Retinopathy (the damage to the back of the eye) can be successfully controlled but of course it is much better to avoid damage to the eye with good control of diabetes.

For more information on The Diabetes Insitiute or to book a consultation call us now:

The Diabetes Institute of Ireland,
Suite 29 - 32, Beacon Consultants Clinic,
Sandyford, Dublin 18
Phone 01-2390658 Fax: 01 - 294 5466
E-mail:
info@diabetesinstitute.ie

 

The Well

Professional Fees

• Initial Consultant with Consultant 250 Euro
Diabetologist
• Follow up Consultant visit 180 Euro
• Dietician Consultation 80 Euro
• Podiatrist Consultation 80 Euro
• Eye Examination 80 Euro
(including retinal photography)
• Opthalmologist 250 Euro
(and other specialist appointments)
• Nurse Specialist 50 Euro
• Bloods 50 - 120 Euro
• Cardiac Assessment 250 Euro
• Education Program 120 Euro
(4 sessions)
• Managed Care Programmes Individually priced
(Annual)

Where the patient has private health insurance, it will
be possible to claim a portion of the costs back from
their insurance company. The amount that can be
reclaimed is dependant upon the individual insurance
company and policy. Please ask the Institute’s staff for
additional information.
All professional fees are tax deductible and the Diabetes
Institute Of Ireland can provide a Med 1 form to facilitate this.

The Diabetes Institute of Ireland,
Suite 29 - 32, Beacon Consultants Clinic,
Sandyford, Dublin 18
Phone 01-2390658 Fax: 01 - 294 5466
E-mail:
info@diabetesinstitute.ie