WHAT IS DIABETES?

Diabetes Mellitus is a common disorder that affects 2-3 people in every 100 of the population.

At Elliott Hall we have more than 250 patients with diabetes: about 4% of the practice population.

There are two types of diabetes:

· Type 1 diabetes

· Type 2 diabetes

WHAT HAPPENS IN DIABETES?

Normally, a hormone called Insulin controls the levels of sugar (Glucose) in the blood.

Glucose is produced by the digestion of sugar and starchy foods e.g. rice & potatoes.

Insulin is produced in the Pancreas, a gland that lies behind the stomach. Insulin causes glucose to move into muscles and the liver where it can be used to provide energy.

Usually there is enough insulin to keep glucose levels in the blood under control. But in diabetes glucose levels are too high.

This is due to lack of (or no) insulin (Type 1) or when the body does not respond properly to the insulin that is produced (Type 2).

WHAT IS TYPE 1 DIABETES?

Type 1 diabetes develops when the insulin-producing cells in the pancreas have been destroyed. We are not sure why this happens but the most likely cause is an abnormal reaction of the body to the cells possibly triggered by an infection.

It usually develops in people under the age of 35, often in childhood, but it can happen in any age group

It is treated with regular insulin injections combined with a healthy diet and regular exercise.

The main aim of insulin treatment is to achieve near normal blood glucose levels (between 4 and 7 before meals).

Simple blood and urine tests can be carried out at home to adjust your diet and insulin within your daily routine. The diabetes nurse or practice nurse will demonstrate how to do this.

WHAT IS TYPE 2 DIABETES?

This is due to the body no longer responding normally to its own insulin, known as insulin resistance, and/or the body not producing enough insulin.

Type 2 diabetes often develops slowly. It may be diagnosed during a routine health check on the basis of a blood or urine sample or because of symptoms.

Who is at risk?

Aged between 40-75
Asian or Afro- Caribbean origin
Overweight individuals
Family history of diabetes
Previous borderline high blood glucose test
Women who have had high blood glucose levels during pregnancy (gestational diabetes).

… and some things that do NOT cause diabetes:

eating sweets or sugar does not cause diabetes
stress does not cause diabetes although it may make the symptoms worse in diabetics
sometimes an accident or an illness may reveal diabetes if it is already there, but they do not cause it.
You cannot catch diabetes from somebody nor can you give it to them

Once you have diabetes, it will never go away. But its ill effects can be prevented by good care including maintaining a healthy diet and exercise.

Over the years diabetes tends to progress so that people may need multiple tablets or insulin injections.

WHAT ARE THE SYMPTOMS OF DIABETES?

· Thirst and a dry mouth

· Passing a large amount of urine

· Weight loss

· Tiredness

· Thrush

· Blurring of vision

However many people with diabetes are detected long before these symptoms develop.

HOW DO WE DIAGNOSE DIABETES?

Diagnosis is made after two abnormal blood glucose readings sent to a laboratory of either:

Fasting sugar of 7mmol/l or more (fast overnight)
Glucose tolerance test (GTT) of 11.1mmol/l or more. After fasting overnight you are given 350ml of Lucozade and your sugars are measured 2 hours later

WHAT TO EXPECT AS A NEWLY DIAGNOSED DIABETIC

The diabetic care team

· Yourself

· Practice nurse

· GP

· Dietician

· Optometrist/Ophthalmologist

· Pharmacist

· Diabetes specialist nurse (DSN)

· Podiatrist/chiropodist

· Consultant physician/diabetologist

What to expect

We will work with you to make a care program, including your management goals: -

· If you have no symptoms we will consider a trial of diet for 3 months

If you require treatment we will see you in 4 weeks to adjust therapy
We will do some blood tests to make sure your diabetes is coming under control
We will review you at least every 6-8 weeks until your diabetes is under control
Thereafter we will review you every six months and then a yearly review

The practice nurse will explain what diabetes is and discuss your individual treatment and the equipment you will need to use.

The dieticians advise on the importance of healthy eating & exercise on diabetes control

Discuss the effects of diabetes on your job, driving, insurance, prescription charges, and if you are a driver, whether you need to inform the DVLA and your insurance company.

WHAT HAPPENS AT OUR DIABETES CLINIC?

The aim of diabetes management is to keep blood glucose levels as near to normal as possible (4–7mmol/l before meals and up to 10 mmol/l two hours after a meal).

All patients with diabetes should have a full annual review.

At Elliot Hall diabetic clinics are held each Friday from September to July and run jointly by Dr Jenner or Dr Kelshiker and Sister Angela Bradley

LABORATORY TESTS & INVESTIGATIONS

Blood glucose control

HbA1c ( glycosylated haemoglobin) blood test measures long-term sugar control (ideal below 7)

Kidney function

Urine and blood tests to check for protein will show that your kidneys are working correctly. There should not be any protein in your urine.

Blood fats (lipids, cholesterol and triglyceride levels)

A blood test that measures your blood fat levels with an ideal being a cholesterol level below 5

PHYSICAL EXAMINATIONS

Weight/height

Ratio between height / weight (BMI) should be below 25. If not at target, you will be advised to lose weight for better control of your diabetes.

Blood pressure

Aim to have a blood pressure at or below 140/80- if it is high it should be treated.

Eye examination

Your pupils are dilated to detect any early changes at the back of the eye (retinopathy). Photographs may be taken to record the appearance at the back of your eyes.

Feet examination

Legs and feet should be examined to check your skin, circulation and nerve supply. If necessary, you may be referred to a state registered chiropodist/podiatrist.

Injection sites

If you are on insulin, your injection sites will be examined.

LIFESTYLE ISSUES

Your annual review will also include a discussion of your:

· General wellbeing

· Current treatment

· Diabetes control

· Problems- emotional/ sexual/physical

· Issues- importance of stopping smoking, healthy eating and exercise

REDUCING THE RISK OF COMPLICATIONS

People with diabetes have a higher chance of developing serious health problems including: -

· Heart disease

· Stroke

· High blood pressure

· Peripheral vascular disease

· Nerve damage (neuropathy)

· Eye disease

· Kidney disease

The following may reduce the risk of complications:-

General knowledge

Understanding your diabetes will improve your management of the condition. Ask your diabetes team what diabetes education courses there are in your area. Additionally joining Diabetes UK will provide you with continually updated information.

Regular medical check-ups

Regular check-ups will help your doctor pick up any diabetes complications at an early stage so they can be treated more successfully.

Flu vaccinations

Flu vaccinations are recommended to all people with diabetes. This is because infections interfere with diabetes control and not because you are more at risk of contracting infections.

Monitor blood glucose levels

The HBA1C gives the best indicator of diabetes control. You will be advised if urine or blood tests should be performed at home and how often. If monitoring blood sugar, you should aim for a level of 4–7mmol/l before meals and up to 10mmol/l two hours after meals. By keeping good blood glucose levels you significantly reduce the risk of developing long-term complications.

Lose weight

Losing weight by diet or exercise not only benefits overall health, it also helps reduce blood glucose levels. In diet-controlled type 2 diabetes, this is the key to control. Body mass index (BMI) should preferably be below 25. More tips on diet and exercise are covered later on in the pack.

Smoking

Giving up smoking is one of the most positive things you can do to improve your health and reduce your risks of diabetes complications. Speak to your GP or call Harrow Stop Smoking Service 020 8966 1008

Foot care

Check feet regularly. If you have nerve damage, make sure there are no stones/coins/foreign bodies in shoes before putting on and any injury should be notified even if it has not been felt.

SICK DAY RULES

If you become ill your diabetes control may be upset because your body's natural response to illness is to make more sugar (glucose). This can make your blood sugar level rise, even if you are vomiting and unable to eat or drink

Never Stop Your Diabetes Treatment

· Continue taking your insulin or your tablets

· Try to test your urine or blood at least four times a day for glucose

· Drink at least five pints of sugar free liquids, especially water, a day.

· Try to eat your normal diet. If you are unable to do this, replace your meals with fluids such as milk, fresh fruit juice, soup or Lucozade.

Contact us immediately if any of the following happens:-

· Unable to swallow or keep fluids down.

· Persistent vomiting over a week

· Persistent diarrhoea over a week

· Very high blood sugars (over 28 mmol/L) in spite of taking extra meds.

· If you develop abdominal pain, become short of breath or drowsy.

PHYSICAL ACTIVITY

As well as healthy eating and medication, physical activity is an important part of diabetes management. Even small changes in activity can help you lead a healthier lifestyle.

Physical activity helps to:

regulate blood glucose levels
make insulin work more effectively
reduce weight
improve blood cholesterol and blood pressure
prevent coronary heart disease.

How much exercise should I do?

Remember to discuss any activity plans with your doctor or diabetes team before starting
30 minutes of moderate physical activity on five or more days of the week

· If you are new to exercise then think of this as a target level and build up gradually.

Moderate means enough to make you feel warm and slightly out of breath
Physical activity can include gardening, brisk walking, cycling, swimming and dancing as well as playing sports.

· Do an activity you enjoy as you are more likely to stick to it

HEALTHY EATING AND DIABETES

This is stop gap dietary advice for you to follow until you can see the dietician who will plan your personal diet.

A healthy, well balanced diet and regular exercise will to help you to control your diabetes.

You can get off to a good start by taking these 6 steps to eating a healthy diet.

1	Eat regular meals based on starchy foods such as bread, pasta, potatoes, chapati, rice and cereals.	Try to choose high fibre varieties of these foods, such as wholemeal bread and whole grain breakfast cereals
2	Cut down on sugar.	Avoid sugary foods such as sweet biscuits, cakes, sweets, Indian sweets and chocolate. Use diet, sugar-free or low calorie squashes and fizzy drinks, as ordinary drinks can cause blood glucose levels to rise quickly. Do not add sugar or honey to food or drinks.
3	Take less fat.	Cut down on the fat you eat, particularly saturated fat as this is linked with heart disease. Aim to eat less cooking oils, butter, margarine, ghee, full-fat cheese and fatty meats. Grill, boil, poach, steam or oven bake your food rather than frying or cooking with oils or other fats.
4	Enjoy plenty of fruits and vegetables every day.	Include fruit and/or vegetables at every meal. All fruits are suitable. You could try fruit or raw vegetables as a snack between your meals.
5	Limit your alcohol intake.	The upper limit of alcohol is 2 units of alcohol a day for a woman, and 3 units a day for a man. Aim for several alcohol-free days each week. Never drink alcohol on an empty stomach - this increases the risk of hypoglycaemia (low blood sugar levels). Choose low-calorie diet mixers.
6	Use less salt.	Use less salt in your cooking and at the table.

FURTHER INFORMATION

Elliot Hall Medical Centre

http://www.ehmc.co.uk/

You will find information on diabetes under the link ‘Managing Chronic Diseases’

Diabetes UK
Diabetes UK Central Office
10 Parkway, London, NW1 7AA
Tel: 020 7424 1000
Careline: 020 7424 1030 (voice) 020 7424 1031 (text). Monday-Friday, 9am-5pm.
www.diabetes.org.uk
Diabetes UK supports 200,000 members. The aims of the charity are to:

· help and care for people with diabetes and their families;