1. What is Diabetes? Diabetes Specialist Team

2. AIMS AND OBJECTIVES Have an understanding of the physiology of Diabetes Risk factors and identifying the at risk resident Screening options

3. Diabetes is set to become one of the most costly diseases in history.

4. Statistics 2.8 million people diagnosed with diabetes in the UK An estimated 850,000 people in UK have the condition and don’t know it 3 people die from diabetes related complications every hour 100 toe, foot and lower limb amputations a week are caused by diabetes Approximately 10% of the NHS budget is spent on diabetes By 2025 it is estimated that over 4 million people will have diabetes. Most of these cases will be type 2 diabetes, because of our aging population and rapidly rising numbers of over weight and obese people

5. What is Diabetes? Diabetes is a condition where the body does not produce enough insulin Or The insulin does not work properly Diabetes cannot be cured (yet) Treatment depends on how much natural insulin is produced and how effective it is Everyone with diabetes needs to consider their lifestyle and eating habits

6. TYPES OF DIABETES Type 1 Diabetes Type 2 Diabetes Gestational Diabetes All serious conditions

7. Action of insulin Insulin is produced in the pancreas (in the beta cells) The pancreas is situated behind the stomach Insulin can only be given by injection Insulin helps to move glucose into the cells for energy

8. Who is at Risk? Android (apple) vs. gynoid (pear) obesity

9. Waist circumference Increased risk Substantial increased risk Men above = 94cm above = 102 cm 37 ins 40 ins Women above = 80cm above = 88cm 31.5 ins 35 ins

11. Type 1 Diabetes Unable to produce insulin due to autoimmune destruction of beta cells in the pancreas Without insulin free fatty acids build up producing ketones (toxins) Insulin essential for these individuals Usually affects children and people under 30 years of age

12. Signs and symptoms of type 1 Usually rapid onset of symptoms Lethargy Weight loss usually dramatic Polyuria (passing large amounts of urine) Polydipsia (excessive thirst) Presence of ketones - drowsy, pear drop smell deep breathing, may lapse in to coma if untreated Needs insulin within the first year of diagnosis Always consider the possibility of Type 1 diabetes regardless of age

13. Type 2 - Who is at Risk? Age 40 years or older First degree relative with diabetes Overweight (waist measurement) Sedentary lifestyle Heart Disease Cataracts Gestational diabetes (during pregnancy) People of South Asian or African Caribbean background have a much higher prevalence 4-6 times more likely to develop type 2 diabetes

14. Type 2 Diabetes Usually the result of or a combination of insulin resistance/beta cell failure It is a progressive condition May require insulin therapy

15. Signs and symptoms of type 2 Usually a gradual onset Tiredness Weight loss Blurred vision Polyuria Polydipsia Recurrent infections May be asymptomatic Not usually prone to ketoacidosis

16. Foods containing Carbohydrates CHO’s All Foods containing CHO’s breakdown into glucose Examples Starchy CHO’s e.g. Bread, potatoes, pasta, cereal All Fruit – contains natural sugar (fructose) Dairy - Milk, yogurt & fromage frais (not cheese) Sugary foods – cakes, biscuits, sweets etc

17. Digestion All Carbohydrates are broken down into glucose Glucose is the body’s fuel essential for energy All the body’s cells need glucose for energy CHO’s have an immediate affect on blood glucose levels

18. Glucose leaves the stomach & enters the blood stream

19. How does glucose get into the bodies cells? On ingestion of eating CHO’s the pancreas releases a hormone called insulin Insulin acts like a ‘key’. It allows glucose into the muscle cells Pancreas

20. Action of insulin Insulin allows the Glucose to leave the blood & enter the muscle cells in the body to be used as energy BLOOD VESSEL MUSCLE CELLS INSULIN

21. Digestion process Normal Blood glucose levels Before food 4 -7mmol/l 2 hours after food less than 8.5mmol/l Aim for under 10mmol/l Normally takes approx 2 hours to break down CHO’s

22. Type 1 Diabetes The pancreas stops making insulin Cells unable to access glucose Insulin therapy required to survive Approximately 5-10% of people have type 1 diabetes Often diagnosed in childhood but can occur at any time of life

23. Type 2 Diabetes The pancreas still makes insulin but the insulin doesn’t work properly, obesity can cause this – insulin resistance Or The pancreas does not produce enough insulin – beta cell failure Approximately 90% of patients will have Type 2 diabetes.

24. Management

25. AIMS OF MANAGEMENT Normalise life style Maintain long term health Relieve symptoms of hyperglycaemia Avoid hypoglycaemia Avoid long term complications

26. Possible complications of diabetes

27. What can we do? Encourage a healthy diet and lifestyle Encourage Physical Activity Encourage smoking cessation Ensure compliance with treatment as prescribed Regular diabetes review’s Be aware of at risk patients and request assessment by healthcare professional or GP

28. Identyfying the at risk patient Complete a risk assessment? Many nursing home patients may score at risk Because they are Elderly May be overweight Raised waist circumference Have other conditions such as heart disease, hypertension which increase their risk

29. Identifying the at risk patient Consider any changes Polyurea Polydipsia Frequent infections thrush, UTI More sleepy Signs of dehydration Behaviour change

31. Screening options Routine testing of urine for glucose in the home. Postive result then arrange for blood test. Blood glucose test as part of annual health check

32. Screening options Recent guidelines have said identifying or diagnosing patients can be by fasting plasma glucose or HbA1c both of which should be venous samples. HIGH RISK Fasting glucose 5.5 – 6.9 mmol/l HbA1c 42 – 47 mmols

33. Screening options Diabetes can only be diagnosed by venous blood tests. Either One positive test FPG 7 mmols or above or HbA1c 48mmols/mol or above and symptoms e.g. Thirst, polyuria etc. Or Two positive blood tests which must be the same e.g. 2 FPG or 2 HbA1c