Diabetes
There are about 2.35 million diabetics in the UK. The missing million .... One million people in the UK have diabetes but are unaware of it.
Diabetes, a chronic condition, the direct result of which is a high blood glucose level, this can lead to damage to the small blood vessels (microvascular) of organs like the eyes, kidneys and nerves; or larger blood vessels (macrovascular) of the heart or peripheral vascular system, as the human body was designed for blood glucose of about 5 mmol optimum most of the time.
Normally when we eat sugars or carbohydrates, blood glucose may rise to 8 mmol but usually not higher, then insulin is released from the pancreas, insulin then either stores the glucose in the liver or enables it to be used for energy. Conversely glucagon is released when blood glucose levels fall too low (below 4 mmol) to release glucose from storage in the liver so organs have the energy to keep working. The interplay between insulin and glucagon regulates blood glucose levels to a narrow range (4 to 8 mmol).
It is the high blood glucose levels that happen immediately after a meal that can cause the most damage.
In diabetes either the insulin is not produced and released at all, or not enough is released, or if it is released it doesn't work anymore (insulin resistance), so that the glucose stays at high levels in the blood.
Symptoms of (untreated) Diabetes
- Frequent urination
- Excessive thirst
- Thrush infections in woman, or itchy skin around the genitals
- Unusual weight loss
- Tiredness or fatigue
- Infections
- Blurry vision
Who is at risk?
- Those with a family history amongst close relatives.
- Those who are overweight - especially central obesity.
- Those with Heart disease, Hypertension or Cerebral Vascular Disease.
- Over 40 years of age.
- Asian or African Caribbean descent.
- Cardiovascular history eg raised blood pressure
- Those taking certain drugs like: Beta-Blockers, glucocorticoids (some steroids), some diuretics (thiazides) etc.
- You had gestational diabetes or the baby weighed more than 9lbs at birth
On average a person has had (type 2) diabetes for about 10 years upon actual diagnosis of diabetes by the doctor, by which time microvascular complications may have started to occur in 50% of patients.
All Green Light Branches can test your blood glucose level.
Types of Diabetes:
Type 1 - Insulin is not produced and released at all, due to a genetic, auto-immune or viral cause, it usually starts at an early age (diagnosis peaks around 10-14 years of age). It develops quickly over days or weeks and may present as drowsiness, confusion, nausea and vomiting, breath that smells of acetone and dehydration. Type 1 diabetics must inject insulin 2 to 4 times a day. It is more common with people of African or Asian decent;
Type 2 - some insulin is released, but not enough, or doesn't work due to resistance. In resistance more insulin is released in compensation due to the insulin not working properly, gradually the insulin producing cells become defective as they overwork and reduce in number and diabetes develops. It usually occurs later in life progressing slowly (although in developed countries the age of onset is reducing dramatically - so that teenagers are developing type 2 diabetes), usually in overweight persons, smokers or those who have a genetic link. Also people of African-Caribbean and South Asian descent are more prone at a younger age. Either lifestyle (losing weight, exercising more), tablets and/or insulin are used to treat it.
Both types lead to high blood glucose and hence organ damage. Neither can be cured. 90% of diabetics are type 2.
Diabetes may develop during pregnancy - gestational diabetes - but usually goes once the baby is born.
Medication
Type 1 diabetics require Insulin to be injected several times a day, along with other medications.
Type 2 diabetics take a combination of different drugs every day, unfortunately about a third of diabetics don't take their medications correctly so risk the long-term complications.
Testing for diabetes
Many people are walking around today, unaware they are (type 2) diabetic, they may have some of the symptoms above but haven't been to a doctor for a check-up. Unfortunately all the while damage is being done to organs. This is why it is important to check for diabetes, especially if you are suffering any of the symptoms, or there is a family history, or you are overweight, or in certain ethnic groups.
Consequences of long term uncontrolled diabetes.
- Eyesight - diabetes is the leading cause of blindness in the UK
- Kidneys - about 1000 people per year go onto dialysis because of the complications of uncontrolled diabetes
- Amputation - Diabetics are 15 times more likely to need an amputation
- Cardiovascular - Diabetes can lead to angina, heart attacks and strokes
If you are Diabetic then knowing what your blood glucose levels are, enables you to tailor your drug treatment or lifestyle to keep blood glucose in the optimum range. If the blood glucose levels are high consistently then your treatment is not working, and you risk suffering the long term damage to organs. Conversely having a very low blood glucose (a "hypo") can lead to coma or death. Symptoms of a "hypo" include: sweating, feeling hungry or faint, anxious/irritable/aggressive/confused/irrational/can't concentrate, trembling, palpitations (racing heart), blurred or double vision, and tingling lips.
Normally blood glucose levels are tested by drawing a small sample of blood and placing it on a test strip inserted into a blood glucose monitor. This gives you your blood glucose level at that precise moment.
In diabetics blood glucoses levels seem to have more peaks and troughs - dropping with exercise, rising after a meal, especially rising to higher levels after sugary or carbohydrate type foods, meaning blood glucose levels do not always give a direct correlation with the diabetic's control and disease prognosis, so many diabetics take readings at different times of the day to build up a picture of blood sugar levels over the day.
Health
Dental
Always inform your Dentist that you are a diabetic.
Diabetics are more troubled by dental plaque, which is a major cause of gum inflammation. The gums also take longer to recover from damage in diabetics.
Visit your dentist regularly, brush and floss regularly, and use an anti-plaque mouthwash.
Illness
Blood glucose levels behave unpredictably during illness leading to "hypos" or Hyper-glycaemia.
If you are ill, you may want to test your blood glucose levels more frequently, and adjust your insulin or food intake accordingly.
Diet
The diet for people with diabetes is not a special diet. It is the normal healthy diet recommended for everyone - low in fat, sugar and salt, with plenty of fruit, vegetables and starchy (eg bread, pasta, potatoes, rice and cereals especially wholegrain) foods. Eat less fats especially saturated (animal) fat, choose diet, low sugar or sugar-free drinks but you don't need a completely sugar free diet. You do not have to prepare special meals separate from other family members, or buy in special foods like "diabetic" foods as they are unnecessary and give no extra benefit. Eat regular meals and control alcohol intake.
Foot Care
Diabetics should have their feet checked by a Chiropodist annually, if you neglect your feet you may end up with serious problems in later life, due to nerve damage (neuropathy).
Avoid extremes of hot (don't put feet on hot water bottles, check bath temperature) and cold. Don't use corn products or cut your own corns. Do dry our feet well, especially between toes and moisturise if skin is dry and rough (not between toes), make sure shoes fit well.
Eye Care
Eye problems like retinopathy (small blood vessels in eye are blocked or start to leak or bleed) are reduced through good blood glucose control, have a free annual check of your eyes to detect any problems at an early stage so they can be treated to prevent long term damage.
Lifestyle
Exercise
Physical activity helps to:
- regulate blood glucose levels
- Make insulin work more effectively
- reduce weight
- improve blood cholesterol and blood pressure
- help to prevent coronary heart disease
It doesn't matter what physical activity you do eg cycling, walking, swimming, tennis as long as you enjoy it, and so you keep it up. Also incorporate it into your everyday events eg walking to the shops, using the stairs not the lift, cycling to work, getting off the bus one stop earlier etc.. Try and aim for 30 to 40 minutes, 3 to 4 times a week depending on age, ability, time limitations. Any activity that makes you warm and breathe a bit faster will help, and it can be split up amongst the day - 5 minutes here, 5 minutes there all count.
Before taking up exercise for the first time discuss with the doctor or nurse, so they can discuss blood glucose levels with you and what to do in the event of a "hypo" etc, diet before exercise etc.
Driving
It is required by law to inform the DVLA if you have diabetes that requires you to take tablets or inject insulin, you will still get a license but it may need to be renewed more often.
Holidays
Make sure you have enough (or more) medication (including test strips and meter) for the duration of your holiday, plus a note from your doctor (preferably in the language of your destination) about your condition and what medications you are taking. While on holiday try and adhere to your normal routine as regards meals, exercise, sleeping and medication. Also check your travel insurance covers diabetes.
Related Conditions
Many Diabetics also have "diabetic dyslipidaemia" which is basically low levels of HDL-Cholesterol (the "good" cholesterol) and high levels of triglycerides and lipids in the blood after meals, this can lead to atherosclerosis or furring of the blood vessels. Therefore cholesterol and triglyceride tests are important in diabetics. Ideally levels should be below 1.7mmol/l for triglycerides, and 4mmol/l for cholesterol.
Hypertension also determines the degree of vascular damage to both the small (kidneys, eyes and liver) and large blood vessels mentioned in the first paragraph at the top of the page, so blood pressure control is important in diabetics. Ideally blood pressure should be below 130/80mmHg.
Smoking cessation is very important in diabetics as smoking also causes vascular damage to the small blood vessels, and along with diabetes increases your risk of heart disease.
Related external Links
The information given here is of a general nature, for particular information talk to your pharmacist or doctor, especially if you have any other diseases, are taking other medicines, suffer other conditions or pregnant etc.
