1. Diabetes
What do I need to know?

2. Is it a big problem?
Since 1996, the number of people diagnosed with diabetes in the UK has risen from 1.4 million to 3.5 million and is estimated to rise to 5 million by 2025.
Taking into account the number of people likely to be living with undiagnosed diabetes, the number of people living with diabetes in the UK is over 4 million.
1:16 people.

3. What's gone wrong?
Diabetes is classified as a chronic disease and primarily is characterised by high levels of sugar ( glucose) in the blood How does this happen? After eating our food it is digested and glucose drawn into the blood stream, ready to be used as fuel for the body. If the body is not ready to use this energy its needs to be able to store it in fat and liver cells. Normally the pancreas ( a gland near the stomach) releases insulin which acts like a key, unlocking the fat cells and allowing sugar to be stored . For people with diabetes either the pancreas fails to make enough insulin or the fat and liver cells fail to recognise it. The result Blood sugars stay high - long term this damages the overall health, specifically the heart, kidneys ,eyes and nerves.

4. Four types of diabetes???
The WHO (World Health Organisation) recognises four types of diabetes
Type 1 diabetes
Type 2 diabetes
Gestational diabetes
Impaired fasting glucose AKA Impaired glucose tolerance AKA prediabetes.

5. Is all diabetes the same?NO
Type one diabetes (previously called insulin dependant diabetes) . This is an autoimmune disease and the body does not make enough insulin. Affects mainly children or young adults.
Without access to insulin a type one diabetic can not survive. Onset is usually rapid.

6. Type 2 diabetes
Previously known as non insulin dependant diabetes. Affects mainly adults.
Results from the bodies ineffective use of insulin.
Onset is often slow and symptoms may be mild or non- existent
But fairly common symptoms are: Being thirsty a lot of the time.
Passing large amounts of urine.
Tiredness.
Weight loss.
Rates are rising due to obesity, lack of
exercise and unhealthy diets.

7. Gestational diabetes
This is a temporary condition affecting pregnant women and is characterised by high blood levels of sugar rather than any symptoms. Many go on to develop type 2 diabetes.

8. Impaired fasting glucose
A measurement of blood glucose which is not normal but not high enough to be classified as diabetes
Important. These patient may not be classified diabetes but may already suffer with associated diseases such as heart disease and atherosclerosis.

9. Back to type 2 diabetes
Type 2 diabetes is by far the most common worldwide.
Starts with an unhealthy lifestyle, poor diet and not enough exercise.
Other risk factors:
Having a first-degree relative with type 2 diabetes. (A first-degree relative is a parent, brother, sister, or child.)
Having a waist measuring more than 31.5 inches (80 cm) if you are a woman or more than 37 inches (94 cm) if you are a man.
A common myth-if I don’t eat sugar I wont get diabetes. whilst keeping sugar to a minimum helps , starchy foods are converted into sugar by the body.

10. Refreshments
Is it me????

11. Think big vessels -little vessels
Diabetes is a disease of 2 halves
Keep your blood pressure well controlled and reduce the chances of heart attack or stroke and other major vessel complications.
Keep your sugars well controlled and reduced the chances of Eye and kidney complications and erectile dysfunction.
Blood pressure control is just as important as sugar control.

12. Why are people with diabetes prone to foot ulcers?
Foot ulcers are more common if you have diabetes because one or both of the following complications develop in some people with diabetes:
Reduced sensation of the skin on your feet.
Narrowing of blood vessels going to the feet.

13. What has gone wrong?
Your nerves may not work as well as normal because even a slightly high blood sugar (glucose) level can, over time, damage some of your nerves (diabetic neuropathy)
Diabetes increases the risk of developing narrowing of the blood vessels (arteries), known as peripheral arterial disease. The arteries in the legs are quite commonly affected. This can cause a reduced blood supply (poor circulation) to the feet. Skin with a poor blood supply does not heal as well as normal and is more likely to be damaged.

14. What does this mean for reception?
Patients with diabetes and a new foot problem need to be seen promptly.
Left untreated a small injury or ulcer can rapidly deteriorate into infection or at worst gangrene.
In Scarborough/Ryedale there are approximately 20 major limb amputations yearly. Despite prosthesis 1 in 5 will never walk again.

15. Eye care
Free annual eye test. Any optician can perform this eye test and some have direct referral to ophthalmology if necessary Annual retinopathy test. The retina (the part of the eye that the sight comes from) is inspected by microscope and a photograph taken.
Microscopic changes can be identified and if necessary laser treatment can delay the progression of diabetic eye disease

16. Free Prescriptions
Not for all diabetics …just those of any age who are taking diabetic medications.
Patients need to complete an exemption form FP92A
All medicines are free with this exemption. Not just those used for diabetes.

17. Illness and diabetes
Any illness or other type of stress will raise blood sugar (glucose) levels, -if they test -check blood sugar (glucose) levels more regularly.
People with diabetes are unable to produce more insulin to control the glucose level. The increased glucose level can lead to dehydration. Drink plenty of water
Patients should continue eating as normally as possible, but may replace solid food with soup, milk, ice cream, fruit juice, sugar or honey.

18. When to seek advice When patients should ask for medical advice
Patients should be advised to seek medical advice if:
They are unable to eat or drink.
They have persistent vomiting or diarrhoea.
Their blood glucose is higher than 25 mmol/L despite increasing insulin.
They have very low glucose levels.
There are persistent ketones or large amounts of ketones in the urine.
They become drowsy or confused (make sure carers are aware of this).
They have any other concern.

19. Resources for people with diabetes
Everyone active
Weightwatchers/slimming world
Exercise on prescription
Diabetes UK
Patient.co.uk
NHS choices.