Our team consists of two doctors (Dr. Deconinck and Dr. Nollet), diabetes educators, a psychologist and a referral midwife.
| Diabetes educators (nurses): | |
| Ms D. Alleman | Ms A. Barbez |
| Ms S. Baes | Ms M. De Graeve |
| Ms L. Feryn | Ms M. Ghekiere |
| Ms J. Sucaet | Ms J. Debruyne |
| Ms K. Vancayzeele |
| Diabetes educators (dieticians): | |
| Ms A. Lamérand | Ms J. Vanderfaeillie |
| Ms E. Mollen | Ms Anne-Sophie Jongbloet |
| Diabetes educators (podiatrist): | Ms A. Six |
| Psychologist: | Ms S. Vuchelen |
| Referral midwife Diabetes mellitus: | Ms C. Pauwelyn |
All consultations take place by appointment through the Endocrinology - Diabetology secretariat.
Diabetes mellitus consultations for first-time visitors take place on Mondays (morning and afternoon), Wednesday mornings and Friday mornings in Ypres.
Women with gestational diabetes coming for their first consultation can be seen on Monday afternoons, Thursday afternoons and Friday afternoons in Ypres. The group sessions are held on Thursday afternoons.
Control consultations for diabetes mellitus take place in Ypres on a daily basis.
Control consultations for diabetes mellitus take place in Poperinge on Wednesday and Friday mornings.
Diabetes mellitus is a chronic condition where the blood sugar level is too high.
There are different forms of diabetes mellitus. The most common forms are type 1 diabetes mellitus and type 2 diabetes mellitus.
Type 1 diabetes mellitus
In type 1 diabetes mellitus, there is destruction of (part of) the insulin-producing cells of the pancreas (pancreas: an organ located behind the stomach, at the top of the abdomen), as a result of which the body does not produce enough or any insulin.
It is therefore necessary to start insulin treatment from the time of diagnosis, for life.
Type 2 diabetes mellitus
In type 2 diabetes mellitus, there is a two-fold problem: insufficient insulin is produced; in addition, the body no longer responds properly to the insulin present.
Overweight, sedentary lifestyle and older age increase the risk of developing type 2 diabetes mellitus. In recent years, however, with the increase in obesity, we often see type 2 diabetes mellitus developing in adolescents.
For patients with type 2 diabetes mellitus, we can now delay insulin therapy longer, thanks to new medication. Ultimately, a large number of people still have to start taking insulin, but that is easier than in the past.
Treatments
Both Dr Nollet and Dr Deconinck treat all forms of diabetes mellitus, but Dr Deconinck focuses more on the treatment of adult patients with early onset diabetes mellitus (both type 1 and type 2 diabetes mellitus). Dr Deconinck published, in particular, an international article about patients who developed type 2 diabetes mellitus before the age of 45.
Symptoms such as fatigue, thirst, frequent urination, blurred vision or weight loss are frequent. However, it often happens that you experience only little discomfort and that an increased sugar level is accidentally detected by a blood sample at the GP. We suggest that you have your sugar level checked annually by your GP from the age of 40-45 years.
If you are overweight, have had gestational diabetes or have a family history, you fall into a risk group for developing diabetes mellitus.
In case of type 2 diabetes mellitus, your GP/diabetologist will start prescribing a diabetes diet, preferably explained by a dietician.
The emphasis is on ‘a healthy diet' (actually good for all of us!) by, among other things, avoiding highly soluble sugars (such as granulated sugar, lemonade, confectionery, jam, etc.) and limiting fat intake (mainly limiting saturated fats). Many ‘diet products for diabetes patients' are too fatty and we advise against them.
In addition to following a diet, your GP will often decide to start medication (pills, an incretin or insulin).
In the case of type 1 diabetes mellitus, insulin therapy will need to be commenced immediately. This is now easier than it used to be. The insulin needles are very fine and the insulin pens are easy to use. The diabetes nurse teaches the pricking and most patients get the hang of it quickly.
In addition, patients with Type 1 diabetes mellitus can opt for treatment with an insulin pump. Recently, the hospital also started offering the innovative Hybrid Closed Loop system. Here, the glycaemia values of a glucose sensor are transmitted to the insulin pump. The pump automatically calculates the amount of insulin to be administered.
We recommend purchasing a glucometer (obtainable from your health insurance fund, pharmacy, via the primary diabetes educator or via the JYZ Diabetology Department (if included in the Diabetes Convention)). With this meter you can check your blood sugar level yourself by a finger prick.
The aim (for most) should be to obtain fasting sugar levels lower than 100 mg/dL and pre-meal sugar levels lower than 140 mg/dL.
Hemoglobin A1c can be determined by means of a blood sample (to be requested by your GP). This blood test indicates your average sugar control over the past three months. This value should be less than 7% (for most people). This way, you have the least chance of developing diabetes complications.
Furthermore, you should strive for perfect blood pressure (for most, lower than 130/80 mmHg), a low blood fat content and to quit smoking.
If the blood sugar level continues to rise, a life-threatening situation can arise: the diabetic coma!
Years of insufficient sugar control leads to:
However, it does not have to lead to such complications: the better the treatment, the lower the chance of developing these complications!
Patients with type 1 diabetes mellitus cannot be helped with pills. Also in patients with type 2 diabetes mellitus, the pills can lose their effect and sugar levels will rise as a result. Treatment with incretins or insulin is often the only solution. As these are proteins that are destroyed in the stomach, they should be administered via subcutaneous injections.
Many patients with highly elevated sugar levels are afraid of having to self-administer insulin. However, this has become much easier in recent years. With the help of a pen and fine needles, it can barely be felt.
You can be taught this by a diabetes nurse (both in primary and secondary care). Most patients quickly master this and feel much better immediately!
People who inject at least three times a day (with insulin and/or incretin) can receive free nutritional advice and free material for intensive glycaemic control via de ‘Diabetes Convention'. An appointment must be made for this at the Endocrinology secretariat (+32(0)57 35 72 70).
If you only take pills, but will soon need to add treatment with incretin, one or two injections of insulin, you are eligible to start a ‘Type 2 Diabetes Mellitus Care Pathway'. In certain circumstances, you are entitled to a free glucometer and glucose test strips within this care pathway. You can learn more about this from your doctor.
Optimal management of your blood sugar, blood fats and blood pressure leads to a better quality of life: you feel more active and healthier! Moreover, you have less chance of developing vision loss, kidney problems, foot wounds and cardiovascular disease.
We are happy to assist you with this.
We would also like to refer you to the website of the Diabetes League, an independent Flemish association of and for people who are faced with diabetes mellitus.
To enable optimal treatment for patients with diabetes, the diabetes convention and the care pathway for type 2 diabetes mellitus were established.
The Diabetes Convention is a kind of contract between the patient, the treating doctor, the hospital and the health insurance company (RIZIV) through which a person with diabetes receives certain benefits.
For example, these patients receive material for intensive glycaemic control and support in the Jan Yperman Hospital. The condition is (usually) that the patient needs at least three daily injections (with insulin and/or incretin).
In 2012 the Jan Yperman Hospital obtained the RIZIV/INAMI recognition for the use of insulin pump therapy in patients with type 1 diabetes mellitus. Since 2016, it has been possible to measure glycaemic levels using the flash sensor method or by means of continuous glucose monitoring.
Criteria
To be eligible for developing a Diabetes Convention, the hospital must meet certain quality criteria. We therefore ask our patients to comply with certain agreements when signing this contract:
To be able to detect or further follow up on diabetes complications you should visit your GP annually and have a urinalysis (to detect or monitor protein loss) performed. We also ask you to have your cholesterol and other fats checked annually. In addition, reference will be made to the need to pursue a healthy lifestyle: a healthy diet, sufficient physical exercise and to quit smoking.
Emphasis is also placed on the importance of proper foot care. If you are unable to do this properly, you can contact a podiatrist. In case of foot wounds or painful feet, please contact your GP immediately. He/she will then decide whether a referral to the Multidisciplinary Diabetic Foot Clinic is necessary.
We will then provide you with the necessary test material for the intensive glycaemic control. Clear limits have been set for the amount of material that will be covered by your health insurance company. If you want more material, you will have to pay for this yourself. You can choose to measure your sugar level using strips and a finger prick, through a flash sensor method or by means of continuous glucose monitoring. The latter two technologies are only free of charge for patients with type 1 diabetes mellitus or with absent pancreatic function. For other patients, these methods cost at least €75 per month.
Administration
There are also some administrative requirements when signing this contract. To be eligible or to remain eligible, you must have a Global Medical File (GMF) from your GP. Permission to join this convention is given by the medical officer of your health insurance fund and is valid for a period of 1 year. This approval must therefore be renewed annually. You will be notified in writing by us two months in advance. Please make a Diabetology appointment in good time by telephoning +32(0)57 35 72 70. We therefore ask that you visit your doctor so that he/she can perform the requested blood and urine tests in advance and provide them to us.
Entry to the Diabetes Convention by name and the material assigned to a specific patient can therefore only be used by this patient.
We ask you to inform us immediately if you have changed your health insurance fund or if you are staying abroad for more than three months.
The ‘Type 2 Diabetes Mellitus Care Pathway' is a contract between the patient, GP and the treating endocrinologist, which gives the patient certain benefits. The GP is the coordinating doctor and is assisted by the endocrinologist.
One of the conditions for being able to conclude a care pathway is that the patient will soon have to start, or has already started, treatment with an incretin, one or two injections of insulin. The patient should also have at least two contacts a year with his GP and visit the endocrinologist at least once a year. In addition, the patient must observe a healthy lifestyle, follow the advice correctly and have a number of examinations performed.
After this care pathway has been signed by all parties and approved by the health insurance fund, the patient is entitled to a free glucometer and glucose test strips in certain circumstances, as well as diabetes education. The co-payment for consultations with the GP and the specialist is no longer applicable. There is also the option of receiving financial compensation in the form of reimbursement for a dietician and/or podiatrist.
More information about the Type 2 Diabetes Mellitus Care Pathway can be found on the website http://www.zorgtraject.be/.
Over the past 10 years, the treatment options for type 2 diabetes have expanded to such an extent that the care provider has a large choice between different classes of medication.
Because the international recommendations, drawn up by the international associations EASD and ADA, do not take into account the reimbursement criteria in Belgium, the UZ Leuven endocrinology department developed the "T2D Helper", an app that looks at both the individual patient and the reimbursement criteria in Belgium.
Prof. Dr. Ann Mertens: "The app is much more focused on the individual patient thanks to a smart filter function that takes into account factors such as renal function limitations and problems patients may experience such as an increased risk of hypoglycaemia and weight gain."
The app came about thanks to intensive cooperation between the UZleuven endocrinology department and the IT department. Doctors and healthcare professionals can download the app for free in the App Store for the iOS version and via the Google Play Store for the Android version.
T2D Helper is available for Android and iOS.
