Diabetes is on the rise, with 4.6 million adults currently diagnosed with the condition in the UK alone, according to Diabetes UK.
Around 10% of sufferers have type 1 diabetes - an autoimmune condition in which the body stops producing insulin. However, 90% of cases are type 2 diabetes, usually caused by poor diet and lifestyle choices (although family history and ethnicity can also increase your risk).
What is Diabetes?
Diabetes mellitus occurs when the level of sugar (glucose) in the blood becomes higher than normal.
Type 1 usually develops quite quickly, over days or weeks, as the pancreas stops making insulin and usually first presents in children or in young adults. Type 2 tends to develop gradually (over weeks or months) and is more associated with being overweight. This is because people with type 2 diabetes still make insulin (unlike type 1 diabetes) but do not make enough insulin for the body's needs, or the body is not able to use insulin properly. It most often first presents in people over the age of 40 years. However, type 2 diabetes is increasingly diagnosed in children and in young adults.
Both types of diabetes can cause serious complications but these are much less common and less severe with good treatment and regular monitoring. In addition to the treatment from healthcare professionals, understanding your diabetes and being able to manage your own diabetes are very important.
As well as type 1 and type 2 diabetes, there are other types of diabetes. Pregnant women who have never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women.
Other types of diabetes
There are also a number of less common forms of diabetes, including:
- Secondary diabetes: diabetes can be caused by other diseases. Examples include diseases that affect the pancreas, such as cystic fibrosis and chronic pancreatitis. Diabetes can also be caused by other hormone (endocrine) diseases, such as Cushing's syndrome and acromegaly.
- Latent autoimmune diabetes of adults (LADA): a slow-onset form of type 1 diabetes that occurs in adults, often with a slower onset than the usual type 1 diabetes that starts in childhood.
- Maturity-onset diabetes of the young (MODY): this includes several forms of diabetes which are caused by genetic defects of the cells in the pancreas that make insulin.
- Wolfram's syndrome: another genetic cause of diabetes. It is also called DIDMOAD (because it causes diabetes insipidus, diabetes mellitus, optic atrophy and deafness).
- Other genetic diseases that can cause diabetes: these include Friedreich's ataxia and haemochromatosis.
A medical paper in 2018 suggested that adult-onset diabetes should be classified in a new way. This is because your level of resistance to diabetes can affect your risk of complications.
In the new model, those most resistant to insulin have a significantly higher risk of diabetic kidney disease than individuals with differing types who had been prescribed similar diabetes treatment. People with the greatest insulin deficiency have the highest risk of retinopathy.
However, for now this new model is purely being used for research.
Understanding glucose and insulin
After you eat, various foods are broken down in your gut (intestine) into sugars. The main sugar, glucose, passes through your gut wall into your bloodstream. However, it's important to remember it's not just sugar that increases blood glucose. Other starchy carbohydrate foods such as potato, rice or breakfast cereals digest down into surprising amounts of glucose too.
To remain healthy, your blood sugar (glucose) level should not go too high. So when your blood glucose level begins to rise - particularly after you eat - the level of a hormone called insulin should also rise. Insulin works on the cells of your body and makes them take in glucose from the bloodstream, thus lowering blood glucose again. Some of the glucose is used by the cells for energy. Any glucose not used up in this way is converted into glycogen in the liver or fat in the liver or abdomen.
When the blood glucose level begins to fall (between meals or when we have no food), the level of insulin falls. Some glycogen or fat is then converted back into glucose. This is released from the cells into the bloodstream to keep the blood glucose level normal.
Over time, if you have more glucose in your system than you need for energy, this can lead to central obesity (weight carried around your tummy) and fatty liver.
Insulin is a hormone that is made by cells called beta cells. These are part of little islands of cells (islets) within the pancreas gland. Hormones are chemicals that are released by glands into the bloodstream and work on various parts of the body.
Diabetes develops if you do not make enough insulin, or if the insulin that you do make does not work properly on the body's cells:
- In type 1 diabetes, your body does not make any insulin at all.
- In type 2 diabetes, your levels of insulin may be normal, but your body doesn't respond properly to them. This is called insulin resistance. Over time, your body's ability to produce insulin also drops if you have type 2 diabetes and your blood sugar (glucose) levels remain high.
What are the symptoms of Diabetes?
The symptoms when you first develop diabetes may include:
- Being very thirsty a lot of the time.
- Passing a lot of urine (because blood sugar (glucose) leaks into your urine, which pulls out extra water through the kidneys).
- Tiredness, weight loss and feeling generally unwell.
The symptoms tend to develop quite quickly, over a few days or weeks for people with type 1 diabetes.
Type 2 diabetes develops much more slowly and symptoms may not start until you have had type 2 diabetes for a number of years. This means that people with type 2 diabetes may already have complications of diabetes when diabetes is first diagnosed.
The symptoms of diabetes resolve when you start treatment for diabetes. However, the symptoms may come back if your blood glucose levels are poorly controlled. Without treatment, the blood glucose level becomes very high.
How is Diabetes diagnosed?
A simple dipstick test can detect sugar (glucose) in a sample of urine. This may suggest the diagnosis of diabetes. However, the only way to confirm the diagnosis is to have a blood test to look at the level of glucose in your blood. If this is high then it will confirm that you have diabetes.
Some people have to have two samples of blood taken and they may be asked to fast (this means having nothing to eat or drink, other than water, from midnight before the blood test is performed). A different blood test which measures a chemical called HbA1c is now also used to diagnose type 2 diabetes but is not suitable for the diagnosis of type 1 diabetes.
Do I have Diabetes?
Any person with diabetes needs to follow a healthy lifestyle with a healthy diet, maintaining an ideal body weight, taking regular exercise and not smoking. People with type 1 diabetes also always need treatment with insulin.
People with type 2 diabetes sometimes don't need any medicines for diabetes control when the diagnosis is first made. However, most people with diabetes need to start taking one or more medicines if a healthy lifestyle is not enough to control blood sugar (glucose) levels. However, in recent years it has become clear that by losing weight and following a low-carbohydrate diet (or, with close medical supervision, a very low-calorie diet), many people can bring their blood sugar back to normal without medication.
Some people with type 2 diabetes need to use insulin injections if the other medicines don't adequately control the blood glucose levels.
Treating diabetes is not just about blood glucose levels. It is also very important to reduce the risk of the complications of diabetes. It is therefore important to keep blood pressure and cholesterol levels in the normal range.
The treatment for diabetes also includes regular monitoring to diagnose and treat complications at an early stage.
Diabetes in pregnancy is associated with possible problems for the mother and baby. Women with diabetes who become pregnant need very close monitoring and specialist treatment to make sure that the mother and baby remain well with no problems.
When you are unwell for any reason, even just a sore throat, this may badly affect your blood glucose control. It is therefore very important to know what to do if you are unwell.
What are the aims of treatment?
Although diabetes cannot be cured, it can be treated successfully. If a high blood glucose level is brought down to a normal or near-normal level, your symptoms will ease and you are likely to feel well again.
You still have some risk of complications in the long term if your blood glucose level remains even mildly high - even if you have no symptoms in the short term. However, studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared with those people who have poorer control of their glucose level.
Therefore, the main aims of treatment are:
- To keep your blood glucose level as near normal as possible.
- To reduce any other risk factors that may increase your risk of developing complications. In particular, to stop smoking, lose weight or lower your blood pressure if needed and to keep your blood lipids (cholesterol and triglyceride) low.
- To detect any complications as early as possible. Treatment can prevent or delay some complications from becoming worse.
There is currently no known way to prevent type 1 diabetes although many studies are looking into a number of different possibilities.
Type 2 diabetes can be prevented by following a healthy lifestyle, such as a healthy diet, regular exercise and not being overweight. This is very important for everyone. However, it is particularly important for people who are at increased risk, including those who have pre-diabetes (impaired glucose tolerance).
Healthy diet and other lifestyle advice
You should eat a healthy diet. The idea that you need special foods if you have diabetes is a myth. 'Diabetic foods' still raise blood glucose levels, contain just as much fat and calories and are usually more expensive than non-diabetic foods. Basically, you should aim to eat a diet low in fat, salt and sugar and high in fibre, and with plenty of fruit and vegetables.
Click the links below for advice on following and maintaing a healthy diet:
Another high risk factor which adds complications includes smoking. You should see your practice nurse or attend a smoking cessation clinic if you have difficulty stopping smoking. If necessary, medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.
In addition, regular physical activity also reduces the risk of some complications such as heart and blood vessel disease. If you are able, a minimum of 30 minutes' brisk walking at least five times a week is advised. Anything more vigorous is even better - for example, swimming, cycling, jogging, dancing.
Depending on your age and how long you have had diabetes, you may be advised to take a medicine to lower your cholesterol level. This will help to lower the risk of developing some complications such as heart disease and stroke.
Many people with diabetes enjoy alcohol and there is no need to give up completely unless you wish to. Whether you have diabetes or not, healthy guidelines in the UK generally recommend a limit of 14 units a week for both men and women (government guidelines have recently been revised for men). However, do be aware that drinking alcohol when you have diabetes can make an episode of hypoglycaemia more likely.
Anyone with diabetes who needs treatment with insulin should monitor their blood glucose levels. This is usually not necessary for people with type 2 diabetes who do not need insulin.
It is important to have regular checks, as some complications, particularly if detected early, can be treated or prevented from becoming worse. Most GP surgeries and hospitals have special diabetes clinics. Doctors, nurses, dieticians, specialists in foot care (podiatrists), specialists in eye health (optometrists) and other healthcare workers all play a role in giving advice and checking on progress. As well as ongoing advice on diet and lifestyle, regular checks may include:
Checking levels of blood glucose, HbA1c, cholesterol and blood pressure
It is important to keep blood glucose, cholesterol and blood pressure levels as normal as possible. The HbA1c blood test helps to check your blood glucose control. Ideally, the aim is to maintain your HbA1c to less than 48 mmol/mol (6.5%). However, this may not always be possible to achieve and your target level of HbA1c should be agreed between you and your doctor.
Checking for early signs of complications
- Eye checks - to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse. Increased pressure in the eye (glaucoma) is also more common in people with diabetes and can usually be treated.
- Blood tests - these include checks on kidney function, and other general tests.
- Urine tests - these include testing for protein in the urine, which may indicate early kidney problems.
- Foot checks - to help to prevent foot ulcers.
- Tests for the sensation in your legs to detect early nerve damage.
Click the button below for more information on testing for sensitivity in your feet:
If the blood glucose level is higher than normal, over a long period of time, it can have a damaging effect on the blood vessels.
Even a mildly raised glucose level which does not cause any symptoms in the short term can affect the blood vessels in the long term. This may lead to some of the following complications:
- Furring or 'hardening' of the arteries (atheroma) which can cause problems such as angina, heart attacks, stroke and poor circulation.
- Eye problems which can affect vision. This is due to damage to the small arteries of the retina at the back of the eye.
- Kidney damage which sometimes develops into kidney failure.
- Nerve damage.
- Foot problems - these are due to poor circulation and nerve damage.
- Male sexual difficulties (such as erectile dysfunction) and female sexual difficulties (such as a dry vagina, yeast infections and loss of sensation) are common.
The type and severity of long-term complications vary from case to case. You may not develop any at all. In general, the nearer your blood glucose level is to normal, the less your risk of developing complications. Your risk of developing complications is also reduced if you deal with any other risk factors that you may have such as high blood pressure.
Diabetes Group Consultation / Session
Here at Portland Medical you can request to join a group session where you can learn more about Diabetes and discuss any questions you have regarding the condition.
What is a group consultation?
GP practices in Croydon are offering this new service to provide more support to people who have long term health conditions. All over the country people are finding group consultations very helpful. The session will last 60-90 minutes.
You will have time to learn and share information with other people who have the same condition as you. The vast majority of people who attend group consultations prefer them and we are hopeful you will feel the same.
Why do I need to attend a group consultation?
If your most recent test results show that you are not meeting the clinical targets for blood pressure, HbA1c (blood glucose) and cholesterol, then joining our Diabetes Group Consultation can help you stay on track and informed.
Research shows meeting these targets will reduce the long-term risks of your diabetes, such as having a heart attack or stroke. It is important to attend, as at the consultation we will:
- Discuss test results and what they mean,
- Explain how Diabetes can affect your body,
- Provide important advice on the management of diabetes,
- Make arrangements for any other required tests/procedures if required.
Group Consultations are well organised and respectful of privacy. All participants will be required to sign a confidentiality agreement in advance.
You can let us know in advance if there are any particular issues we are not to discuss in front of other patients. You will also be offered an opportunity to discuss personal and sensitive matters privately, away from the group, if you need to do so.
What you need to do before the consultation
- If our records show you have not had your tests undertaken within the last 3 months you will be advised to book an appointment for these to be taken prior to the Group Consultation.
- Please find below a short questionnaire to complete. This will help us tailor the session to your individual needs. Please have the completed questionnaire to hand at your group consultation appointment.
Please do call us on 020 8662 1233 if you are no longer to participate in the group session and we will book you in to an alternative.
We look forward to seeing you at the meeting. Please do not hesitate to contact us with any queries or concerns.
To request to join one of our Diabetes Group Consultations please email us at firstname.lastname@example.org.
Click on the below links to view additional content on what you can do to prevent or manage a lifestyle with diabetes:
- Low-carbohydrate diet to achieve weight loss
- The state of type 2 diabetes
- Diet advice for type 2 diabetes
- PHC sugar poster
- Bread information
- Common food information
- Cereal information
- Fruit information
- Sugar burden
- Healthy eating guidelines & weight loss advice
- Low-carb burger bun recipe
- Additional resources on type 2 diabetes
- Introductory summary video on how they did it in Southport NHS GP practice: Dr. David Unwin - 'Can we beat T2 Diabetes? HOPE on the horizon'
- The specific techniques regarding Behaviour Change with patients used in GP consultations: Dr. David Unwin & Dr. Jen Unwin - 'Behaviour Change 'In a nutshell' & Picking our low carb battles'
- A nutritional video discussing the benefits of eating fruit: Dr. Gary Fettke - 'Is Fruit Good or Bad For You?'
- Dietary advice for optimal weight and health: Dr. Stephen Phinney - 'Troubleshooting the Ketogenic Diet for Optimal Weight and Health'
- Informative video about ketosis: Dr. Stephen Phinney - 'Achieving and Maintaining Nutritional Ketosis'
- This video is about the care a patient with Type 2 diabetes will receive: Dr. David Unwin - 'The Glycaemic Index: Helping Patients in Primary care with T2D'
- A patient shares their Type 2 diabetes remission story: Shivali - 'Your Stories'
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