Key Facts on Diabetes

Type 1 Diabetes accounts for between 5 and 15% of all diabetics. It develops if the body is unable to produce any insulin and although it usually appears before the age of 30, it is sometimes referred to as juvenile diabetes, because it is often diagnosed in childhood. You can’t prevent Type 1 Diabetes because it is an Auto Immune Response where the body has destroyed the insulin producing cells in the pancreas.

The main symptoms of Type 1 Diabetes are (you may not have all these symptoms):

• Blurred vision
• Thirst
• Tiredness
• Weight loss
• Frequent visits to the toilet (going for a wee) especially at night
• Slow healing
• Thrush or frequent genital itching

All of which generally happen relatively quickly, usually in the first few weeks of becoming diabetic and can be reversed once treatment starts.

Those with Type 1 Diabetes must receive insulin by regular injection or pump and effective management is important to prevent some of the more serious side effects of diabetes which include:

• Heart disease
• Blindness
• Stroke
• Nerve damage
• Kidney failure

Healthy diet and regular exercise are also essential in staving off the long-term damage diabetes can do to your body.

85% of all those with Diabetes are generally Type 2. It largely effects the over 40’s in the White population and the over 25’s in the Black and South Asian populations.

The 2 main reasons for having Type 2 are that either the pancreas is not producing enough insulin or the insulin is not doing its job properly. This can be because of people being overweight; the cells become furred up and the insulin is unable to transfer the glucose to the body cells. The body cells need glucose and so therefore the blood sugar levels rise and consequently the insulin levels also rise in a continuing spiral, until the pancreas eventually wears out.

In contrast to Type 1, with Type 2 the symptoms are very slow and people can have diabetes for 10 years without realising. The symptoms are the same:

• Increased thirst
• Blurred vision
• Tiredness
• Weight loss
• Frequent visits to the toilet (going for a wee)
• Slow healing
• Thrush or frequent genital itching

Weight loss and exercise can help but most people will need some form of medication to treat it. Medication will usually come in tablet form however in severe cases insulin may be needed, this does not mean you now have type 1 diabetes.

During pregnancy hormones block the usual action of insulin. This helps to make sure your growing baby gets enough glucose. Your body needs to produce more insulin to cope with these changes. Gestational diabetes (diabetes in pregnancy) develops when your body can’t meet the extra insulin demands of the pregnancy.

Gestational diabetes is relatively common, about 5% of expectant mothers will have the condition. It usually begins in the second half of pregnancy, and goes away after the baby is born. If gestational diabetes doesn’t go away after the baby is born, it’s possible that you already had diabetes and that it was picked up during your pregnancy. Recent research has indicated that woman who have had gestational diabetes are likely to develop types 2 diabetes later in life. Make sure you are tested for type 2 diabetes at your postnatal check ups.

Many woman will not have any symptoms but common ones are:

• Increased thirst
• Frequent visits to the toilet (going for a wee)
• Tiredness

These symptoms are however also common in normal pregnancy.

Your baby’s organs have already developed before gestational diabetes occurs, therefore your baby will not develop diabetes due to you having the condition. The main problem is your baby will tend to be larger, which can result in early labour or Caesarean section.

GI refers to how quickly carbohydrates are digested and absorbed as glucose into your bloodstream.

Carbohydrates that release glucose quickly have a high GI, those that release more slowly have a low GI. The GI index is measured from 0 to 100, 100 being pure glucose. The purpose of a diabetic looking at the GI is to help with glucose control, eating a low GI food with meals will help maintain an even glucose level. Lots of high GI foods should be avoided.

Examples

Hypoglycaemia commonly known as a hypo means you have a blood glucose level below 4mmol/l. This happens when you have too much insulin in your system. Hypos are very common, especially in people with type 1, and can usually be dealt with easily.

The main causes are:
• Too much insulin or too many glucose lowering pills
• Not enough food
• Unexpected Exercise

You and your friends and family need to be aware of the signs of a hypo:
• Sweating
• Trembling
• Altered Vision
• Problems with movement
• Not yourself
• Emotional
• Coma/Fits (very rare)

A hypo must be treated straight away by eating glucose, keep glucose tablets or biscuits on you at all times, or by eating food. If you do not have any food mix sugar with milk.

Glucagon can be used by others if you are unable to swallow. Glucagon should be kept at your home if you are insulin treated. Glucagon is a hormone that increases the blood glucose.

ENSURE friends and family know how to treat a hypo, tell them your personal signs. If you know a person with diabetes and they are acting strange they are likely to be having a hypo – give them sugar. If they do not come round with the sugar you have given to them they may be hyper – see hyper key fact.

Hyperglycaemia commonly known as a hyper means you have a blood glucose level above 8mmol/l. If this happens occasionally you should not be overly concerned.

If your glucose levels are usually above 8mmol/l you may not have any immediate damage but you may be slowly harming your body. Levels over 19mmol/l should be dealt with straight away.

Causes include:
• Too little insulin or glucose lowering pills
• Too much food
• Too little exercise
• Monthly periods
• Pregnancy
• Infection
• Stress
• Drugs/Medication

Treatment:
• If the reading shocks you wash you hands and test again
• Take insulin
• Consult your diabetic specialist – seek advice

Symptoms will be those similar to diagnosis however in very extreme cases it can lead to diabetic ketoacidosis if untreated this can cause a diabetic coma. It is very rare that a hyper will not be treated as a diabetic should be testing their glucose levels and can give themselves more insulin or pills if required. If you suspect a friend or family member is having a severe hyper you must ring for an ambulance.

When exercising your muscles will need more glucose, in a person without diabetes the pancreas shuts off insulin production. In someone with insulin treated diabetes insulin production can not be shut off, high levels of insulin prevents the liver releasing glucose, but the muscles still want more and keeps taking glucose from the bloodstream. This can cause you to have a hypo. To stop this happening reduce your normal level of insulin with your meal prior to exercise and eat more long acting carbohydrate (low GI). Keep glucose near you when exercising in case you do become hypo.

If you are undergoing a new exercise regime you will need to check your glucose levels before and after exercise, record this data to help you prepare next time. Always consult your specialist before starting a new regime.

DO NOT exercise with high glucose levels. If you have no insulin in your system the muscles can not use the glucose produced from the liver. Fatty acids can also not be used and will break down into ketones. Glucose levels will keep rising, take insulin immediately. If untreated you will eventually develop diabetic ketoacidosis.

Having diabetes does not stop you drinking but you should keep to the recommended weekly allowance, currently 14 units for women and 21 units for men. A standard glass of wine (175 ml) is 2 units and a pint of lager is 2 units.

Alcohol prevents the liver from releasing glucose from its stores and can cause a hypo, ensure you snack when drinking. Do not drink on an empty stomach this will cause the alcohol to be absorbed too quickly into the bloodstream. Remember alcohol is high in calories and sugar.

You can have a healthy pregnancy and a healthy baby, however you will need to plan and work harder than a non-diabetic woman. Try to plan a pregnancy and use contraception until you are ready.

Before becoming pregnant ensure you have good glucose control – 4-7mmol/l two hours after meals. High glucose levels at conception can increase the risk of the development of the baby being impaired. Start to take folic acid as soon as you decide to start trying for a baby and carry on until you are 12 weeks pregnant. This vitamin helps prevent spinal cord problems (including spina bifida) from developing in your baby. Women with diabetes are advised to take 5mg of folic acid, which is only available on prescription. Discuss becoming pregnant with your specialist team.

Keep good control of your glucose levels during pregnancy if insulin treated you will need to increase the amount you give yourself, monitor regularly and ensure Glucagon is kept in the house. Due to the tight control you will be at risk of a hypo keep glucose tablets with you and be careful driving. Eat before you go to bed to ensure you do not become hypo at night.

During pregnancy you will be monitored closely by your diabetic team and you will have extra visits to the antenatal clinic. You will have extra scans to check on the baby’s growth.

Do not think that if you are diabetic your baby will have diabetes. If the mother is type 1 there is only a 2 % chance the baby will develop type 1 diabetes, if the father is type 1 there is a 10% chance. There is a higher chance, 35%, if both mother and father are type 1. If no parent has diabetes but you have a child who is type 1 there is an 8% chance that your next child will develop type 1.

If the mother or father is type 2 there is a 20 % chance the baby will develop type 2 diabetes. There is 75% chance if both mother and father are type 2.

If you control your diabetes well you will be able to drive a car or motorbike, however you will need to think about:

• How long the journey is, always take a break after 2 hours and plan for traffic
• Check your glucose levels before you start and if necessary every 2 hours to make sure your glucose levels are not too low
• Carry carbohydrate foods with you
• Make sure you have your hypo stopper in your car e.g. glucose tablets/ sugary drink
• Ensure you stop for your usual meals
• If you feel hypo stop as soon as possible

Do not drive if you feel hypo or your eyesight or health is worsening.

DVLA – www.dvla.gov.uk

You must inform the DVLA as soon as you find out you have diabetes that is treated by insulin or tablets. They will write to your doctor to ensure you are fit to drive. If you are insulin dependant the DVLA will issue you with a license that will last up to three years. Remember to apply for your license before it is up for renewal – keep them informed of any changes in address.

If you find you are having health complications due to your diabetes you must inform the DVLA as soon as possible.

INSURANCE

You must inform your insurance company if you are diagnosed with diabetes no matter how it is treated. However this should not affect your premium. Again if you start to have health complications due to your diabetes you must inform your insurance company as soon as possible.

There are lots of myths and misconceptions about diabetes and what people with diabetes can and can’t do, read the truth about some:

Eating too much sugar causes diabetes – False
Eating a high fat and sugar diet can lead you to become overweight and can increase your chances of developing type 2 diabetes.

Diabetics can not eat sugar – False
Sugar can be eaten as part of a healthy diet, remembering that it is a fast acting carbohydrate.

Diabetics should eat special food – False
You should eat a healthy diet, low in fat, salt and sugar. Diabetic food does not give you any benefits and still contain fat and calories, they can be very expensive and may have a laxative effect, so be careful.

You can not drink alcohol – False
Diabetics can drink alcohol but should be careful not to exceed the weekly allowance.

Diabetes is curable – False
Unfortunately there is no cure for the condition for both types, however leading a healthy lifestyle will help you.

You will go blind – False
Blindness is a common complication of diabetes however if you keep your glucose levels under control and keep active you can have good eye sight.

You can not eat out – False
Diabetics can eat out just read the menu and go for the healthy option.

We always need to take care of our feet but the cold weather it’s even more important – here is some advice I have been given from my healthcare team…

Footwear – Always wear well fitting shoes and have your feet measured

- Badly fitting shoes can cause blisters, corns and calluses.

- Avoid high heels and narrow fitting shoes.

- A good shoe will have a lace strap and cushioning sole to give your feet support and protection.

- Make sure socks, stockings and tights are a good fit too.

- Where ever possible wear natural fibres such as leather, cotton and wool.

Wash feet daily – use warm water and soap to keep feet clean.

- Pay particular attention to between the toes.

Dry feet carefully – use a soft towel or tissue.

- Dry carefully between toes.

- This will help to prevent infections such as ‘athlete’s foot’.

Cut and file nails – keep nails short and neat.

- Cut nails with a gentle curve rather than straight across – follow the shape of the end of the toe.

- Smooth off rough edges with file or emery board.

- Avoid cutting them too short and never dog down the sides of nails as this can cause damage.

- Always use the right equipment.

Apply cream – apply to areas of dry skin each day to keep it soft and supple.

- Use your favourite foot cream or a general moisturising cream such as E45.

- Avoid putting cream between the toes as it can make the skin too soft and soggy.

Skin and nail problems – if you have problems with hard skin or difficult nails you must get help and advice from a registered podiatrist/chiropodist.

- Do not treat yourself with knives or corn treatments containing acids as these can cause you unnecessary damage.

- Make sure private podiatrists/chiropodists are registered with the ‘Health Professionals Council’ (HPC)

Diabetes and your eyes

Diabetic eye disease (retinopathy) can affect anyone who has diabetes, whether they are being treated with insulin, tablets or diet only. Generally, people don’t notice any signs of retinopathy until it is well advanced. This is why yearly eye examinations are so important for everyone with diabetes. Early detection is the key to successful treatment.

Retinopathy affects the blood vessels supplying the retina – the inner surface of the eye, which receives the images of things you see and passes them to the brain. Blood vessels can become blocked, leak or grow haphazardly. This affects the way the retina receives images and, if left untreated, can damage your sight.

How can I protect my eyes?

You can reduce the risk of retinopathy by controlling your blood-glucose and blood-pressure levels as well as possible, and by not smoking.

In addition, everyone aged 12 years and over who has diabetes should have regular eye screening to look for any signs of retinopathy.

Remember that diabetic eye screening will carefully check your eyes for signs of retinopathy. It doesn’t detect other eye conditions, so you should continue to visit your own optometrist regularly for a sight test as well. It may be possible to have both at the same time.

What does screening involve?

Photographs of the retina are taken using a special camera. There is a flash of light when a photo is taken but this should not be uncomfortable.

The screener will put drops in your eyes. These may make your vision blurred so you should not drive for a few hours after the screening. Your eyes will be sensitive to bright light for a while, so wearing sunglasses for a few hours may help.

Very rarely, the drops can cause a sudden rise in pressure in the eye. This would happen only if you were at risk of getting this problem at some time anyway.

Following screening, if either eye becomes very painful or red or you get an unusually severe headache, possibly with cloudy vision, then you must seek help straight away. Contact the screener or go to your local hospital Accident and Emergency department.

When do I get the result?

You may get a provisional result at the time of screening. However, to reduce any risk of mistakes, a second person will often re-examine the photos. Your final result will be sent to you in writing, as well as to your GP and the screener.

What does it mean if I am called back immediately?

• An eye specialist may need to review and perhaps treat your retinopathy.

• The photos may not be clear enough so we may need to arrange a different examination.

Are my photos used in any other way?

Your photos may be used for teaching and research without identifying you. Please tell us if you don’t want them used in this way.

What happens to all the information?

• First your GP will send your name and address to the screening service office.

• The office will write to you when your screening is due and will pass your details to the screener.

• The screener will send the findings to the office, which will write to you with the final result and tell your GP, optometrist and hospital specialist.

• To double-check the findings your photos may be examined by a second optometrist from the list of screeners or by an eye specialist. Your GP or specialist may also see the photos and results.

• Your photos and the screening results will be stored on computer for at least eight years.

The screening system can only work if your information is shared and stored in this way. Computer systems are a vital part of the screening service. They keep track of when your screening is due. They also help with the sending of letters and in quality control.

You may opt out of having your eyes screened but it would put your eyesight at risk. You should think very carefully about such a choice and discuss it with your GP or the screening service office. Remember that retinopathy is still a major cause of blindness. The screening programme isn’t perfect but it can greatly reduce the risk of losing your eyesight due to diabetes.

Facts about eye screening for people with diabetes

Screening for diabetic eye disease is important – it is an effective way of finding problems at the earliest stage.

Don’t wait till you notice a change in your vision! Diabetic eye disease usually has no symptoms until it is well advanced. By then, treatment may not work. So it is very important to have your eyes screened every year.

Article from South Manchester Diabetic Retinopathy Screening Service

You often hear about ketones and if you have high sugar levels you could get ketoacidosis, but what is it?

There are many complications associated with diabetes. Sometimes, diabetics have a problem with ketones in the bloodstream. Left untreated, this turns into a condition known as ketoacidosis. A ketone is an acid that is left in the body after the body has burned its own fat. The body burns fat in diabetics when it cannot get enough glucose to use for energy. If the body has to use too much fat, ketones appear in the bloodstream.

If the level of keytones in the bloodstream becomes too high, ketoacidosis occurs. This happens in diabetics simply because when diabetes is being controlled, there may not be enough glucose left in the bloodstream. Ketoacidosis is a very serious condition, and it can lead to coma and death.

Ketoacidosis occurs in patients who suffer from Type 1 diabetes more than it occurs in Type 2 diabetes. This is not to say, however, that it won’t occur in a Type 2 diabetic. It does. The symptoms of ketoacidosis include breathlessness, nausea, vomiting, foul or fruity-smelling breath, and stomach pains.

Again, ketoacidosis is life-threatening, and if you suspect that you have it, you should contact your doctor immediately for treatment. You should also be tested for ketones. Your doctor will determine when you should be tested. Testing is very easy, and is done with urine strips. You should not eat or drink anything approximately eight hours before ketone testing.

You should absolutely be tested for ketones if your blood sugar is higher than 250 mg/dl, if you become ill, or if you are vomiting or experience diarrhea. Depression and stress are also an indication that ketone testing should be done, and diabetic women who become pregnant should also be tested regularly. Ketone testing can be done in your doctor’s office or in your home with over-the-counter test strips. When testing at home, if your ketone test is positive, you should contact your doctor right away.