Diabetes

Please refer to the Diabetes UK website for a comprehensive overview on all aspects of diabetes care. The following information is a mere quick summary of some of the most important points.

What is Diabetes?

Diabetes is a condition characterized by high blood sugar (glucose) levels. Glucose acts as a “fuel” for the cells in our body. The hormone insulin is produced by the pancreas and needed to transport glucose into the cells of most organs.

There are 2 main types of diabetes:

1. Type 1 diabetes
2. Type 2 diabetes

Type 1 diabetes
Type 1 diabetes develops when the body is unable to produce insulin. It develops mainly in younger people before the age of 30. At least half of all people with type1 diabetes are diagnosed before the age of 14.

Type 2 diabetes
In type 2 diabetes the body is still able to produce insulin, but it may not make enough insulin, or more often the body may have become resistant to the effects of insulin (insulin resistance). Insulin resistance is strongly associated with being overweight.
Type 2 diabetes usually occurs over the age of 40. In Afro-Caribbean and South Asian people it may present much earlier. With increasing levels of obesity in the population the incidence of type 2 diabetes has risen considerably, and it has also affected younger patients. It is estimated that there are 1 Million people in the UK alone, who already have diabetes, but have not yet been diagnosed.

Diagnosis of Diabetes
Diabetes can only be diagnosed with blood tests. In asymptomatic patients the WHO (World Health Organization) criteria require two fasting glucose levels in the diabetic range in order to confirm the diagnosis.

Some people may have higher than normal fasting glucose levels, but the actual level may not be in the diabetic range yet. These patients will be referred to the hospital for a glucose tolerance test.

Glucose tolerance tests
The patient has to attend, having fasted for 12 hours. An initial fasting glucose is taken on arrival to the hospital. The patient is then given a standard sugary drink and the blood glucose levels are measured again 2 hours later.
The glucose tolerance test may show that a person has

• Not got diabetes
• Confirmed diabetes
• Impaired glucose regulation

The WHO identifies two categories of impaired glucose regulation:

IFG (Impaired Fasting Glycaemia):
IFG is characterized by a fasting glucose above the normal, but not in the diabetic range. People with IFG then need to have a glucose tolerance test.

IGT (Impaired Glucose Tolerance):
In IGT the fasting glucose is below the diagnostic range for diabetes, and the 2 hour glucose level is above normal, but below the diagnostic level for diabetes.

Patients with impaired glucose regulation will be followed up in the practice annually.

Symptoms of Diabetes

• Being thirsty all the time
• Passing large amounts of urine
• Getting up at night to pass urine
• Tiredness
• Weight loss
• Recurrent infections, such as boils, thrush or urinary tract infections
• Other symptoms: disorientation, rapid breathing (in type 1), tingling and numbness in hands, feet and legs…

Treatment of Diabetes

The treatment of diabetes in general is aimed at

• Achieving good “glycaemic control” ( glucose control)
• Reducing associated cardiovascular risk factors such as high blood pressure, smoking and increased lipid levels
• Encourage self management through patient education
• Optimizing treatment to reduce diabetic complications, affecting the:
  Cardiovascular System
  Kidneys
  Eyes
  Neurological system

Type 1 diabetes
Type 1 diabetics all require insulin treatment in conjunction with diet and exercise.

Type 2 diabetes
The initial treatment of diabetes is centred around life style measures

• Low sugar and fat diet
• Weight loss
• Increasing exercise
• Reducing other cardiovascular risk factors (smoking cessation, good blood pressure control, reducing blood lipid levels)

Most type 2 diabetics will at some point require tablets to reduce their blood glucose levels, and a significant number may require insulin at some stage.

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