THE
NEWLY DIAGNOSED DIABETIC
INFORMATION PACK
CONTENTS: Definition
of Diabetes
Understanding blood glucose
and Insulin
Possible complications of
Diabetes
Treatment Aims
Diabetes
Advice for Healthy Living
Dietary Information
Eye Care
Foot Care
Monitoring Blood Pressure
YOUR
DIABETIC NURSES: Sister Ling Westbroek
Sister
Caroline Lowe
They can always be reached at the Health Centre
(01420 84676)
What is diabetes?
Diabetes mellitus (just called
diabetes from now on) occurs when the level of glucose (sugar) in the blood
becomes higher than normal. There are two main types of diabetes - Type 1
diabetes and Type 2 diabetes.
Understanding blood glucose
and insulin
After you eat, various foods
are broken down in your gut into sugars. The main sugar is called glucose which
passes through your gut wall into your bloodstream. However, to remain healthy,
your blood glucose level should not go too high or too low.
So, when your blood glucose
level begins to rise (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. Some of the glucose is used by the cells for
energy, and some is converted into glycogen or fat (which are stores of
energy). When the blood glucose level begins to fall (between meals), the level
of insulin falls. Some glycogen or fat is then converted back into glucose
which is released from the cells into the bloodstream.
Insulin is a hormone made
by special 'islands' of cells in the pancreas. (Hormones are chemicals which
are released into the bloodstream and work on various parts of the body.)
Type 1 diabetes
In this type of diabetes
the pancreas stops making insulin. The illness and symptoms develop quickly
(over days or weeks) because the level of insulin in the bloodstream becomes
very low. Type 1 diabetes used to be known as juvenile, early onset, or Insulin
Dependent Diabetes. It usually first develops in children or in young adults.
Type 1 diabetes is treated
with insulin injections and diet.
Type 2
diabetes
With Type 2 diabetes, the
illness and symptoms tend to develop gradually (over weeks or months). This is
because in Type 2 diabetes you still make insulin (unlike Type 1 diabetes).
However, you develop diabetes because:
- you do not make enough insulin for your body's
needs, OR
- the cells in your body do not use insulin
properly. (This is called 'insulin resistance'. The cells in your body
become resistant to normal levels of insulin. So, you need more insulin
than you normally make to keep the blood glucose level down), OR
- a combination of the above two reasons.
Type 2 diabetes used to be
known as maturity onset, or Non-Insulin Dependent Diabetes. It develops mainly
in people older than 30 (but can occur in younger people). In the
What are the symptoms of Type
2 diabetes?
The four common symptoms
are:
- being thirsty a lot of the time.
- passing large amounts of urine. (The reason you
make a lot of urine and become thirsty is because glucose leaks into your
urine which 'pulls out' extra water through the kidneys.)
- tiredness.
- weight loss.
The symptoms may develop so
gradually that you can become used to your increased thirst and tiredness. You may
not recognise that you are ill for some time. Some people also develop blurred
vision and frequent infections such as recurring thrush. However, some people
with Type 2 diabetes do not have any symptoms if the blood glucose level is not
too high. (But, even if you do not have symptoms, you should still have
treatment to reduce the risk of long term complications.)
What are the possible
complications of diabetes?
Very high blood glucose
level
This is not common with Type 2 diabetes. It is more common in untreated Type 1
diabetes when a very high level of glucose can develop quickly and cause
dehydration, drowsiness, and serious illness which can be life-threatening.
However, a very high glucose level develops in some people with Type 2
diabetes.
Long term complications
if your blood glucose level is higher than normal over a long period of time,
it can gradually damage your blood vessels. This may lead to some of the
following complications (often years after you first develop diabetes).
- Atheroma ('furring or hardening of the
arteries'). This can cause problems such as angina, heart attacks, stroke,
and poor circulation.
- Eye problems which can affect vision (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 (due to poor circulation and nerve
damage).
- Impotence.
- Other rare problems.
The
type and severity of long-term complications varies from case to case. You may
not develop any at all. In general, the nearer your blood glucose level is too
normal, the less your risk of developing complications. Your risk of
complications is also reduced if you deal with any other 'risk factors' which
you may have such as high blood pressure.
Treatment complications
Too much insulin or medication can make the blood glucose level become too low
(hypoglycaemia or 'hypo'). Symptoms of hypoglycaemia include: trembling,
sweating, anxiety, blurred vision, tingling lips, paleness, mood change,
vagueness or confusion. To treat hypoglycaemia: take a sugary drink or some
sweets. Then eat a starchy snack, such as a sandwich. Some people carry a
glucagon injection (a hormone which has the opposite effect to insulin) for use
in emergencies to reverse hypoglycaemia. Note: hypoglycaemia cannot occur if
you are treated with diet alone.
What are the aims of
treatment?
If a high blood glucose
level is brought down to a near normal level, your symptoms will ease and you
are likely to feel well again. But, 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. So, the main aims of treatment are:
- To keep your blood glucose level as near normal
as possible.
- To reduce any other 'risk factors' which may
increase your risk of developing complications. In particular, to lower
your blood pressure if it is high.
- To detect any complications as early as
possible. Treatment can prevent, or delay, some complications from getting
worse.
Treatment aim 1 - keeping your
blood glucose level down
What is the level of
blood glucose to aim for?
Some people with diabetes check their blood glucose level each day. If you do,
ideally you should aim to keep your blood glucose level between 4 and 7 mmol/l before meals, and less than 10 mmol/l two hours
after meals. This 'tight' control is not realistic for everybody, and a target
level to aim for may be agreed between you and your doctor or nurse.
Not everybody checks their
blood so often. Another type of blood test is called HbA1c. This test may be
done every 2-6 months by your doctor or nurse. This test measures what your
recent average blood glucose level has been. (The test measures a part of the
red blood cells. Glucose in the blood attaches to part of the red blood cells.
This part can be measured and gives a good indication of your average blood
glucose over the last 2-3 months.) Treatment aims to lower you HbA1c to below a
target level which is usually agreed between you and your doctor. The target
level is usually somewhere between 6.5% and 7.5%. If your HbA1c is above your
target level then you may be advised to 'step up' treatment to keep your blood
glucose level down (for example, by increasing the dose of medication, etc).
In general, the nearer your
blood glucose level (or HbA1c level)is to normal:
·
the
better you are likely to feel, AND
·
the less likely you are to develop complications from diabetes such as
heart disease, eye problems, kidney problems, feet problems, etc.
Diet and exercise
You can usually reduce the level of your blood glucose
(and HbA1c) if you:
- Eat a healthy balanced
diet.
A practice nurse and/or dietician will give details on how to eat a
healthy diet. The diet is the same as recommended for everyone. (The idea
that you need special foods for diabetes is a myth.) Basically, you should
aim to eat a diet low in fat, high in fibre, and with plenty of starchy
foods, fruit and vegetables.
- Lose weight if you are
overweight. Getting to a 'perfect weight' is unrealistic for many people. But,
losing some weight will help to reduce your blood glucose level (and have
other health benefits too).
- Exercise regularly. If you are able, a
minimum of 30 minutes brisk walking at least 5 times a week is advised.
Anything more is even better. You can spread the exercise over the day.
(For example, three 10 minute spells per day of brisk walking, cycling,
dancing, etc.) Regular exercise also reduces your risk of having a heart
attack or stroke.
Many people with Type 2 diabetes
can reduce their blood glucose (and HbA1c) to a target level by the above
measures. However, if the blood glucose (or HbA1c) level remains too high after
a trial of these measures for a few months, then medication is usually advised. Medication is used ‘in addition to’ and not
instead of diet and exercise.
Medication
There are
various tablets which can reduce the blood glucose level. Different ones suit
different people. Some tablets work by helping insulin to work better on the
body's cells. Others work by boosting the amount of insulin made by the
pancreas. Another type works by slowing down the absorption of glucose from the
gut. Some people need a combination of tablets to control their blood glucose
level. Tablets do not work instead of a healthy diet - you need to eat a
healthy diet as well. See a separate leaflet called 'Treatments for Type
2 Diabetes'.
Insulin injections
Insulin is needed in some cases if diet, exercise and tablets do not work well enough.
You cannot take insulin by mouth as it is destroyed by the digestive juices in
the gut.
Treatment aim 2 - to reduce
other risk factors
You are less likely to
develop complications of diabetes if you reduce any other 'risk factors'. These
are briefly mentioned below, but are discussed more fully in another leaflet
called Preventing Heart Disease and Stroke. Everyone should aim to cut
out preventable 'risk factors', but people with diabetes have even more of a
reason to do so.
Keep your blood pressure
down
Have your blood pressure checked regularly. The combination of high blood
pressure and diabetes is a particularly high risk factor. Even mildly raised
blood pressure should be treated if you have diabetes. The aim is to keep your
blood pressure below 140/80 (lower in some cases). Medication, sometimes with
two or even three different tablets, may be needed to keep your blood pressure
down. See separate leaflet called 'Diabetes and High Blood Pressure'.
If you smoke - now is
the time to stop
Smoking is a high risk factor. See a practice nurse if you have difficulty
stopping. If necessary, medication or nicotine replacement therapy (nicotine
gum, etc) may help you to stop.
Other medication
You may be advised to take tablets to lower your
cholesterol level, and to take a daily aspirin. These help to lower the risk of
developing some complications such as heart disease and stroke.
Treatment aim 3 - to detect
early, and treat any complications
Most GP's surgeries and
hospitals have special diabetes clinics. Doctors, nurses, dieticians,
chiropodists, optometrists, and other health care workers all play a role in
giving advice, and checking on progress. Activities in diabetes clinics
include:
- Checking levels of blood glucose, HbA1c, and
blood pressure.
- Ongoing advice on diet and lifestyle.
- Checking for early signs of complications, for
example:
- eye checks - to detect
problems with the retina (a possible complication of diabetes) which can
often be prevented from getting worse. Glaucoma is also more common in
people with diabetes, and can usually be treated.
- urine tests - which
include testing for protein in the urine which may indicate early kidney
problems.
- foot checks.
- other blood tests.
It
is important to have regular checks as some complications, particularly if
detected early, can be treated or prevented from getting worse.
Immunisation
You should be immunised
against 'flu (each autumn), and against the pneumococcus bacteria (just given once).
These infections can be particularly unpleasant if you have diabetes.
Diabetes
10
Parkway
NW1 7AA
Tel (Careline): 020 7424 1030
Tel (office): 020 7424 1000
Web: www.diabetes.org.uk
Best time to telephone:
Diabetes
Its activities include the
following.
- To promote the study of the causes of diabetes.
- To provide information about all aspects of
diabetes. This includes leaflets and Diabetes
- To give advice on such things as diabetic care,
diet, family weekends and holidays, insurance and other aspects of
interest to those with diabetes and their families.
- To raise money for research.
There are many local groups
throughout the
- extract from Mentor Library copyright OUP, EMIS and Authors 1999-2002