What is Diabetes?

Diabetes is a long term condition where the amount of glucose (sugar) in the blood is too high because the body cannot use it properly.

When we eat, the food is broken down into glucose. Our bodies can then use the glucose as fuel (energy) and for growth.

Glucose can’t get into the cells in our body without a substance called insulin. Insulin is a special hormone produced by an organ in our body called the pancreas.

After eating, the pancreas automatically releases a quantity of insulin to help the glucose in our blood get into the cells to be used by the body.

A person with Diabetes has too much glucose in their body (hyperglycaemia). This is because the pancreas either does not produce enough insulin, no insulin at all, or has cells that do not respond properly to the insulin the pancreas produces (insulin resistance).

This results in too much glucose building up in the body.

Types of Diabetes

There are 3 main types of Diabetes: Type 1, Type 2 and gestational

Type 1 Diabetes

Type 1 develops when the body’s immune system attacks and destroys the cells that produce insulin. The reason this happens is still not fully understood. As a result the body can’t produce insulin and this leads to too much glucose in the blood. This type of diabetes usually occurs in people before the age of 40 and often starts in childhood. It is much less common than type 2 Diabetes.

Type 2 Diabetes

Type 2 develops when the body does not produce enough insulin to maintain a normal glucose level in the blood, or when the body is unable to effectively use the insulin that is being produced.

Gestational Diabetes

Gestational Diabetes is when pregnancy hormones block insulin from doing its job. As a result glucose levels in the pregnant woman increase.

Am I at risk of developing diabetes?

There is nothing you can do to prevent Type 1 Diabetes.

You are at risk of type 2 diabetes if you have any of the following risk factors (something that increases your chances of getting a disease).

·      The Family

If a close family member has diabetes it puts you at risk. The closer the relative is, the greater the risk. So if your mum, dad, brother or sister has diabetes (rather than aunts, uncles or cousins), it’s more likely you will develop the condition too.

·      Ethnicity

African-Caribbean or South Asian people who live in the UK are at least five timesmore likely to have diabetes than the white population.

·      Your weight

Not all people who have diabetes are overweight but the statistics show that over80 per cent of people diagnosed with Type 2 diabetes are overweight. The more overweight and the more inactive you are the greater your risk. If you don’t know whether you’re overweight, ask your GP or practice nurse to measure your body mass index (a measure of body fat based on height and weight).

·      Your waist

Women – if your waist measures 31.5in (80cm) or more you’ve got an increased risk.

Men – if you’re white or black and your waist is 37in (94cm) or more you have an increased risk of developing Type 2 diabetes. If you’re an Asian man the figure is 35in (90cm) or more.

To measure your waist, the measurement needs to be taken between the top ofthe hip bone and the lowest rib (usually around your tummy button). Ensure the tape is snug, but does not squash the skin. The measurement should be taken when the person being measured has breathed out.

Other factors

  • You have been diagnosed with any problems with your circulation (the heart and blood vessels) had a heart attack or stroke, or if you’ve got high blood pressure you may be at an increased risk of diabetes.
  • Pregnant women can develop a temporary type of diabetes, gestational diabetes. Having this or giving birth to a large baby can increase the risk of a woman going on to develop diabetes in the future.
  • If you are a woman with polycystic ovary syndrome and you are overweight, you’re at an increased risk of developing diabetes.
  • You’ve been told you have impaired glucose tolerance (IGT) or impaired fasting glycaemia (IFG) it means the level of glucose in your blood is higher than normal but you don’t have diabetes at the moment.
  • Other conditions such as raised triglycerides (a type of blood fat) and severe mental health problems can also increase your risk.

The more risk factors that you have, the bigger your risk of having diabetes

Symptoms of Diabetes

There are many symptoms when someone has Diabetes; these are the main symptoms;

  • passing urine more often than usual, especially at night
  • increased thirst
  • extreme tiredness
  • unexplained weight loss
  • genital (sex organs) itching or regular episodes of thrush (a yeast infection)
  • cuts and wounds taking longer to heal
  • blurred vision

If you are concerned and think you may have Diabetes visit your practice nurse or GP for a health check.

How is Diabetes diagnosed?

Urine sample

A urine (water) sample will be tested to see if it contains glucose. Urine should not contain glucose, but if you have Diabetes some glucose can overflow through the Kidneys and into the urine.

Blood Test

If your urine contains glucose you will need to have a blood test. This can confirm if you have Diabetes. A sample of blood will be taken in the morning before you have eaten anything. This will then be tested for glucose levels.

Glucose tolerance test

If the glucose levels are not conclusive you may need to have a glucose tolerance test. You will be given a glucose drink and then blood tests are taken every half an hour for two hours to see how your body is dealing with the glucose.

Treatment

Diabetes is a long term condition and currently cannot be cured. However it can be effectively treated. Treatment aims to keep blood glucose levels as normal as possible to help lower the risk of complications that can develop over time.

There are various treatments available. Everyone with Diabetes will have their own individual treatment plan which may change over time.

Treatments include life style changes, medications and insulin injections.

Insulin

Insulin is a hormone which helps to control blood sugar. A number of different types of insulin are available, with some insulin acting for as long as a day and others acting for only a few hours.

Insulin is prescribed for people with type 1 diabetes and for people with type 2 diabetes who have tried oral medication (tablets) without success.

Biguanides (Metformin)

Biguanides help to stop the liver from making new glucose and also help to improve the body’s reaction towards insulin by making insulin carry glucose into muscle cells. Metformin is the only tablet that is in the Biguanides group. Metformin is usually used as a first line treatment for type 2 diabetes and may occasionally be prescribed, in combination with insulin, for people with type 1 diabetes.

Sulphonylureas

Sulphonylureas are a group of anti diabetic drugs for treatment of type 2 diabetes. There are lots of different tablets in this group.

Sulphonylureas work by increasing the amount of insulin the pancreas makes and help that insulin work more effectively.

The list of drugs below are all in the Sulphonylureas group of medications.

 (Brand names in brackets):

  • Glibenclamide –also known as Glyburide (Daonil)
  • Glipizide (Glucotrol)
  • Gliquidone (Glurenorm)
  • Glyclopyramide (Deamelin-S)
  • Glimepiride (Amaryl)
  • Gliclazide (Diamicron)

Meglitinides / Prandial glucose regulator / Glinides

The Glinides are a type of drug which have a similar response as Sulphonylureas but work for a shorter time. Meglitinides are prescribed for people with type 2 diabetes.

Prandial glucose regulators, like the sulphonylureas encourage the cells in the pancreas to produce more insulin. However, unlike the sulphonylureas, they work very quickly but only last for a short time.

Prandial glucose regulators are:

(Brand names in brackets)

  • Repaglinide (Prandin)
  • Nateglinide (Starlix)

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors, such as Acarbose (labelled as Precose or Glucobay) or miglitol (labelled as Glyset) are drugs for type 2 diabetes which slow down the digestion (break down of food) of carbohydrates (type of food that provides the body with energy) in the small intestine and therefore can help to reduce blood glucose levels after eating.

Thiazolidinedione / Glitazones

The only tablet in this group is pioglitazone. This tablet works by lowering insulin resistance and improving insulin responsiveness, letting the insulin that the body makes work better.

 It also helps to protect the cells in the pancreas, allowing them to carry on making insulin for longer.   They have also been found to help lower triglyceride (fatty acids) levels.

DPP-4 inhibitors / Gliptins

DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme (proteins that increase the rate of chemical reactions) which destroys the hormone incretin.

Incretins help the body produce more insulin when it is needed and reduce the amount of glucose being produced by the liver when it is not needed. These hormones are released throughout the day and levels are increased when we eat.

DPP-4 inhibitors are usually prescribed for people with type 2 diabetes who have not responded well to drugs such as metformin and sulphonylureas.

This drug class includes following medications;

 (Brand names in brackets)

  • Sitagliptin (Januvia)
  • Vildagliptin (Galvus)
  • Saxagliptin (Onglyza)

Incretin mimetics / GLP-1 analogues

Incretin mimetics, also known as GLP-1 analogues, are an injectable (a method of putting fluid/medication into the body usually with a hollow needle and syringe) treatment for type 2 diabetes.


This type of medication works by increasing the levels of hormones called ‘incretins’. These hormones help the body produce more insulin when it is needed and reduce the amount of glucose being produced by the liver when it’s not needed. They reduce the rate at which the stomach digests food and empties, and can also reduce appetite (desire to eat).

The following GLP-1 analogues are prescribed in the UK;

 (Brand names in brackets)

  • Exenatide (Byetta)
  • Liraglutide (Victoza)

Risk Factor changes

Eating Well

Even if you have Diabetes you should be able to carry on enjoying a wide range of foods as part of a healthy diet.

Your eating habits and food you choose to eat are important in helping you to manage your diabetes and long-term health.

How to eat well

Eat three meals a day

Avoid skipping meals and try to space your breakfast, lunch and dinner out over the day. This will help control your appetite (hunger) and will also help control your blood glucose levels.

Include starchy carbohydrate foods at each meal

These include bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. Try to include carbohydrates that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much.

Such as pasta, brown rice, grainy breads such as granary, pumpernickel and rye, new potatoes, sweet potato and yam, porridge oats, All-Bran and natural muesli.

Cut down on fats you eat, especially saturated fats

Our bodies need fat in order to absorb vitamins and help the brain and nervous system work properly. However a diet too high in saturated fats is bad for our health. Choose unsaturated fats or oils, (e.g. olive oil and rapeseed oil) as these types of fats are better for your heart. As fat is the greatest source of calories, eating less will help you to lose weight if you need to. To cut down on the fat you eat here are some tips:

  • Reduce saturated fat by having less butter, margarine and cheese or using the low fat options.
  • Choose lean meat (meat with no visible fat) and fish as low fat alternatives to fatty meats.
  • Choose lower fat dairy foods such as skimmed or semi-skimmed milk, low-fat or diet yogurts, reduced fat cheese and lower fat spreads.
  • Grill, steam or oven bake instead of frying or cooking with oil or other fats.
  • Watch out for creamy sauces and dressings and swap for tomato-based sauces instead.

Eat more fruit and vegetables

Aim to eat five portions of fruit and vegetables a day. This will provide you with vitamins, minerals and fibre to help you to balance your overall diet. One portion is a banana or apple, a handful of grapes, a tablespoon of dried fruit, a small glass of fruit juice or fruit smoothie, three heaped tablespoons of vegetables or a small bowl of salad.

Eat more beans and lentils

These include kidney beans, butter beans, chickpeas or red and green lentils. They have less of an effect on your blood glucose levels and may help to lower your cholesterol level (fats in the blood). You could add them to stews, casseroles and soups.

Eat at least two portions of oily fish a week

Oily fish contains a type of polyunsaturated fat called omega 3, which helps protect against heart disease. Types of oily fish include mackerel, sardines, salmon and pilchards.

Keep sugar and sugary foods as occasional treats

Diabetics don’t have to eat a completely sugar free diet. Sugar can be used in foods and in baking as part of a healthy diet. Using sugar free, no added sugar or diet fizzy drinks/juices, instead of sugary versions is a good way to lower the overall amount of sugar in your diet.

Reduce salt in your diet to 6g or less a day

Too much salt in your diet can increase your blood pressure, which can lead to stroke and heart disease. Avoid eating processed foods, as these are usually high in salt. Try adding flavour to foods with herbs and spices instead of salt, for example, pepper.

Limit alcohol intake

The current guidelines suggest drinking a maximum of two units of alcohol per day for a woman and three units per day for a man and having two days a week without alcohol.

One unit is equal to a single pub measure (25ml) of spirit or half pint of standard strength lager, ale, bitter or cider or a small glass of wine (125mls).

Over the years the amount of alcohol in most drinks has gone up, for example wine is often served in glasses that contain more than 125mls.  A drink can now contain more units than you think. A glass of wine in a restaurant or pub could contain as much as 3 units.

Don’t waste money on “diabetic” foods and drinks

“Diabetic” foods and drinks offer no benefit to people with diabetes. They will still have an effect on your blood glucose levels and they often contain just as much fat and calories as the ordinary versions. If eaten in large quantities they can have a laxative (a stimulating effect on the bowels which can cause loose stools) effect and are expensive.

It is advisable that everyone with diabetes should see a dietician for advice about their diet.

How to read a food label

Most pre-packed foods have a nutrition label on the back or side of the packaging.

These labels usually have information on energy (calories), protein, carbohydrate and fat. They may also give extra information on saturated (animal) fat, sugars, sodium, salt and fibre. Nutrition information is provided per 100 grams and sometimes per portion of the food for example per half pack.

Nutrition labels are often shown as a panel or grid on the back or side of packaging. For example the image below shows the nutrition label on a ready meal.

Nutrition

Typical values (as consumed)
Energy

per 100g
 541kJ/128kCal

per pack
2011kJ/476kCal

%GDA
24%

your GDA*
 2000kCal

Protein

4.9g

18.2g

Carbohydrates

20.8g

77.4g

of which sugars

1.5g

5.6g

6.2%

90g

Fat

2.8g

10.4g

15%

70g

Of which saturates

2.3g

8.6g

43%

20g

Fibre

2.1g

7.8g

Sodium

0.1g

0.5g

g

Salt equivalent

0.3g

1.3g

22%

6g

*Recommended guideline daily amounts for adults (GDA)

How do I know if a food is high in fat, saturated fat, sugar or salt?

These guidelines help you work out if a food is high in fat, saturated fat, salt or sugar.

Total fat
High: more than 20g of fat per 100g
Low: 5g of fat or less per 100g

Saturated fat
High: more than 5g of saturated fat per 100g
Low: 1.5g of saturated fat or less per 100g

Sugars
High: more than 15g of total sugars per 100g
Low: 5g of total sugars or less per 100g

Salt
High: more than 1.5g of salt per 100g (or 0.6g sodium)
Low: 0.3g of salt or less per 100g (or 0.1g sodium)

Blood pressure

What is blood pressure?

Blood pressure is the pressure (force) of blood in your arteries (tubes which carry blood around the body).

Blood pressure is measured in millimetres of mercury (mm Hg). Your blood pressure is recorded as two figures. For example, 120/80 mm Hg.

  • The top (first) number is the systolic pressure. This is the pressure in the arteries when the heart beats.
  • The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat.

What is high blood pressure?

There is no one reading in which high blood pressure is diagnosed. In general, the higher your blood pressure the greater the risk to your health.

Depending on various factors, the level at which blood pressure is said to be high can change from person to person.

High blood pressure actually means that your blood pressure remains above the recommended guideline each time it is taken. That is, your blood pressure is continually above the guideline level, and is not just a one-off high reading for example when you are stressed.

High blood pressure can be:

  • Just a high systolic pressure - for example, 170/70 mm Hg.
  • Just a high diastolic pressure - for example, 120/104 mm Hg.
  • Both - for example, 170/110 mm Hg.

How is high blood pressure diagnosed?

A one-off blood pressure reading which is high does not mean that you have high blood pressure (hypertension). Your blood pressure changes throughout the day. It will be lower in the morning when you first wake up and may be high for a short time if you are anxious, stressed or have just been exercising.

High blood pressure (hypertension) is diagnosed if you have several blood pressure readings which are high, and which are taken on different occasions, and when you are relaxed.

If one reading is found to be high, your doctor or nurse will want to recheck your blood pressure more regularly to build up a picture of what is happening with your blood pressure. This means checking your blood pressure at different times over a few days/weeks.

It is very important to have your blood pressure checked regularly.

Even mildly raised blood pressure should be treated if you have diabetes. Medication, sometimes with two or even three different medicines may be needed to keep your blood pressure down.

Reducing your daily salt/sodium intake can help keep blood pressure down. Also taking regular exercise can help to keep blood pressure low.

The current guidelines advise that if you have diabetes your blood pressure ideally should be 130/80 or less

Smoking

If you are a smoker you are at high risk of complications. Even smoking a small amount can have a harmful effect.

You should see your practice nurse or attend a smoking cessation clinic if you have difficulty stopping. There are treatments available to help you to stop including medications and nicotine replacement therapy (nicotine gum, etc).

Helping prevent complications of diabetes

Most GP surgeries and hospitals have special diabetes clinics.

There are many health professionals who are involved in Diabetes care including doctors, nurses, dieticians (food experts), chiropodists (foot health specialists), optometrists (eye care specialists).

They will regularly check the following:

  • Checking levels of blood glucose and a HbA1c test (a blood test that detects glucose levels over a few months)
  • Cholesterol (a blood test that detects fats in the blood)
  • Blood pressure
  • Ongoing advice on diet and lifestyle
  • Eye checks - to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse
  • Urine tests which include testing for protein in the urine, which may indicate kidney problems
  • Foot checks to help to prevent foot ulcers
  • Other blood tests, these include checks on kidney function and other general tests

It is important to have regular checks, as some complications, particularly if detected early, can be treated or prevented from getting worse.

Diabetes and sex

Sex is an important part of a close and happy relationship for most couples whether in younger or later life. A disappointing or unfulfilling sex life can often damage a relationship, leaving either partner feeling lonely and insecure.

Sexual problems are more common in people with diabetes because badly controlled diabetes can damage the blood vessels and nervous system.

In men and women, nerve damage can result in loss of sensation (feeling). Other problems connected with diabetes such as heart disease and depression can increase the chances of sexual problems in people with diabetes. Medication taken for these or other conditions can also be part of the cause.

In women

A lot of women with diabetes may suffer from recurring vaginitis (inflammation of the vagina), which is usually due to Thrush (a yeast infection). This can make sex painful. You may suffer itching or burning sensations, and a white discharge.

Women with diabetes may also get recurring cystitis (bladder infections). There is also some suggestion that women with diabetes may have problems with arousal (being turned on). The clitoris in a woman may not respond to stimulation in the normal way. If you are having any sexual problems, speak to your GP or nurse who will be able to help you.

In men

Having diabetes for a long time can cause damage to the nervous system, which is involved in the complex process of erection. This means men with diabetes may suffer from erectile dysfunction (ED) and be unable to get or maintain an erection. This is an extremely common problem for diabetic men.

ED can be treated successfully in up to 95% of all men. Don’t suffer in silence. Speak to your GP or nurse as soon as possible. The sooner you start treatment for ED the more likely it is to work!

For more information, see our ED webpage

Hypoglycaemia

‘Hypos’ are probably one of the biggest fears for people with diabetes, particularly those on insulin treatment. It is common for people with diabetes to be worried of or embarrassed about an intimate situation or sexual intercourse because they think they may have a hypo.

Your doctor or nurse will have told you that the best way to avoid hypos, generally, is to aim to keep your diabetes well under control with your medication. If your diabetes is well controlled, then there should be no reason for hypos interrupting your sex life.

Sex has the same effect on your blood sugar as mild to moderate exercise. This of course applies equally to men and women.

If you are really worried and this may stop you from relaxing, then you could check your blood sugar before exercise or having sex. This may help put your mind at rest.

It is always important to have glucose with you, and in important places such as next to the bed.  If you are still worried, speak to your GP or nurse who is there to help.

For more information about Diabetes

www.diabetes.org.uk

www.diabetes.co.uk

http:\\www.nhs.uk/pathways/diabetes

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