There are 2 types of Diabetes – 1 and 2. Type 1 diabetes is an auto-immune disease which results in your body not being able to produce insulin which you need to survive. So, a person with Type 1 diabetes must give themselves insulin injections, otherwise they would go into something called ketoacidosis and die if this was to be left untreated.
Type 2 diabetes is much more common and is usually preventable. In this type of Diabetes, the body produces insulin but the body has become “insulin resistant” which stops it from working properly, because the person is overweight, and the fat cells essentially block the insulin from working. People with Type 2 Diabetes can control their diabetes with diet and exercise alone, with help from medicines, or if the control is poor, they may go on to need insulin.
Elderly people can also get a different kind of Type 2 Diabetes where their pancreas just doesn’t provide enough insulin for the body’s requirements, and they are not necessarily overweight. Other insults to the pancreas such as alcohol mis-use, high steroid use or pancreatitis, can also cause diabetes, but overall, the main cause of Type 2 Diabetes is being overweight.
Having Diabetes is not much fun because it means that the body is unable to cope with sugar. So, you have to limit the amount of sugary things you eat and drink, if you want the Diabetes to be controlled.
If Diabetes is controlled well and you keep the sugar levels at a low level, the chances of complications are low.
If Diabetes is not controlled, the chances of complications are high, and can be terrible. These include having a heart attack, having a stroke, going blind, needing kidney dialysis, and needing amputations for poor circulation to the feet and legs. This is why it is really important to take control and look after yourself very well when you have Diabetes, and it’s why we have regular reviews with our patients who have diabetes, to make sure nothing is going wrong, and to let you know what you need to do to make the changes required to prevent things going wrong.
The key aspect to managing Type 2 Diabetes is losing weight and doing plenty of exercise. These 2 things make diabetes easier to control. Technically, it is thought to be possible to reverse Type 2 Diabetes if you lose enough weight and are careful enough with your eating habits, although you would always be called to the Diabetic clinic so that the regular monitoring would continue, just to make sure.
Being in control of your diabetes has many benefits including:
- you will feel better on a day-to-day basis
- you will have more energy
- you will reduce the risk of heart attack, stroke, long-term damage to your kidneys, eyes and feet.
Regular diabetes checks monitor your health and identify any problems at an early stage. The include checking your Blood Pressure, Blood fats (cholesterol), Blood Glucose(Hba1c), Kidney Health, Eye health, Nerve damage and Physical activity.
If you keep a record of these health checks they will allow you to see how well your diabetes is controlled over time. This will let you to recognise areas you may wish to improve. When you are deciding on changes to aim for, it is important that you choose small realistic changes that are achievable. Taking regular medication, regular exercise and adopting a healthy eating plan are the most important things that you can do to manage your diabetes.
Dr McIntyre overviews all the results of the blood and urine checks that are made, to make sure nothing is going wrong with your blood tests and kidneys. She discusses the results with Sister Everett prior to your Diabetes annual review.
Sister Everett runs the Diabetic clinics and offers help, support and advice to keep you on track. She checks your blood pressure, pulse, urine, and medications. She checks your feet for circulation and sensory problems and overviews what has been discussed regarding your results with Dr McIntyre. She will make any changes to your medications.
In addition to the Annual Diabetes clinic, Sister Everett will see you every 6 months for a Routine Diabetes review if your control is good, and every 3 months if your control is not so good.
Yvonne, in reception will contact you with appointments for these reviews, but if you notice time has passed and you haven’t had your review when you expected, please contact us and we will give you an appointment.
Retinal Screening
You should expect to be called for Retinal Screening every year at the hospital. This is to detect early signs of damage from Diabetes at the back of the eye. If detected early, it can be treated with laser to prevent the damage worsening, so these appointments are very important to keep.
Diabetic retinopathy is a leading cause of preventable sight loss in Scotland. According to recent figures, 15 per cent of people who are eligible for diabetic retinopathy screening across Scotland have not attended in the previous 15 months. We want to ensure that people understand that sight loss is a potential complication of diabetes. Also, that regular screening can pick up the early warning signs so that people can get the treatment they need to help prevent permanent damage.
Watch this 90-second film narrated by actor Brian Cox CBE.
https://www.diabetes.org.uk/in_your_area/scotland/campaigning_media/how-do-you-see-Scotland
Targets
There are “targets” for your Diabetes management and if you are able to meet these targets, it should be much less likely that you would run into the horrible complications that can go wrong with Diabetes.
Blood Glucose – There is a test called an Hba1c which measures the average of your glucose levels over the last 2-3 months. This gives go an overall picture of your Diabetes control. The target for this is under 53 (it maybe a bit higher if you are over 70). Keeping the blood glucose level under 53 will reduce the chance of damage to your kidneys, eyes and nerves, and reduce your chance of having a heart attack or stroke. If the level is persistently over 53 the chance of this damage happening is much greater. The Nurse will tell you your level when you come to the clinic, so that you can make changes to what you eat (less sugary things) to improve this level and help get it to the target.
For each 1 per cent reduction in HbA1c, there is a relative risk reduction of 21 per cent for diabetes-related deaths, 14 per cent for heart attack and 37 per cent for microvascular complications (damage to kidneys, eyes and nerves.) 1
This why it’s SO important for you to take control of your glucose level (Hba1c).
Blood Pressure – Your blood pressure is a measurement of the force at which your blood flows inside your arteries. If the blood pressure is too high it puts extra strain on your arteries and your heart, which increases your risk of having a heart attack or stroke. The target for blood pressure is usually less than 140/80. The nurse will tell you what your blood pressure is.
Things that help get the blood pressure to target :
- Remembering to take blood pressure medicine if it is prescribed.
- Stopping smoking will help reduce the blood pressure and be less damaging to your arteries.
- Reducing the amount of salt you take.
- Reducing the amount of alcohol you take
- Losing weight if you are overweight
- Learning to manage stress levels.
Blood Cholesterol (fats in the blood) – Lipids are the fats in you blood. These are made up of cholesterol and triglycerides. Most people with Diabetes should aim for a target of Total Cholesterol of less than 4.0 and Tryglycerides of less than 1.7.
To help lower your cholesterol, it is recommended that you:
- stop smoking if you smoke eat a healthy diet low in fat
- exercise regularly, which means a 1/2 hour walk every day
- lose weight if you are overweight
- eat a healthy diet low in fat, with plenty of fruit and vegetables
- take your cholesterol medication
Things you can do right now to take control of your diabetes
Look at the “Keeping healthy” Section on this website and
Watch the video in the “Health Videos” called “23 1/2 hours”
Look at the “Watching your calories” page
Look at ” How to read food labels”
Look at “Health Recipes” and “Sarah’s soups ” for some ideas for trying some new recipes
Look at “Keeping active and having a social life”
More things you can do to take control of your diabetes and take charge of your health
Increase your levels of activity and healthy eating.
Buy a pedometer and start building up how many steps you do every day
Go to somewhere indoors like Braehead and walk round and around the upper floor for half an hour, in the warm and dry (without stopping to go into shops! – you can go shopping afterwards)
If walking is a problem – do chair exercises with tins of food in each hand to use as weights, download these exercises:
Buy a set of weighing scales and start weighing yourself every few days to keep a close eye on your weight loss plan.
Buy an exercise DVD and start using it 3-4 times week. This will build up your fitness levels and help to burn the calories.
Ask the Practice Nurse to refer you for GP Exercise referral scheme and to help you to join “My Diabetes My way” to see your results and see how near you are from reaching your targets.
Join Slimming world – fabulous results but still able to eat plenty, find your nearest one : http://www.slimmingworld.co.uk/
Buy a soup pot and a hand blender and start making your own soup – it’s cheap, easy and delicious! (See Sarah’s soups in the Keeping Health Section of the Practice Website)
Sick Day Rules
If you are unwell and unable to eat, (diarrhoea and vomiting bug or something like that) or you have been told to fast for 24 hours before a hospital procedure, you should not take your Diabetes Medication. This includes Metformin, Gliclazide, Sitagliptin, Linagliptin, Pioglitasone, Dapagliflozin, Empagliflozin and Canagliflozin. Also if you take Ramipril or a tablet that ends in “pril” Enalapril, Lisinopril – you should not take these medications if you are not eating and drinking. Start them all once you are back eating again.
Check out these websites for help and advice:
http://www.mydiabetesmyway.scot.nhs.uk/
http://www.nhs.uk/conditions/diabetes/pages/diabetes.aspx
1.Stratton I M, Adler AI, Neil H A et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ 2000; 321 (7,258): 405-12.
