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Diabetes
Diabetes Mellitus
› Sugar Diabetes or simply just diabetes
› It is a group of metabolic diseases in which there are high
blood sugar levels over a prolonged time period.
› There are three types of Diabetes
1. Type I
2. Type II
3. Gestational
Diabetes Mellitus- The Facts
› The total number of adults in Northern Ireland aged 17 and
over living with Type 1 and Type 2 diabetes is 79,072. A
further 1,092 children and young people under 17 are
now known to have Type 1 diabetes.
Diabetes Mellitus –The Facts
› Prevalence in the Northern Ireland population is now over 4%.
There are also an estimated 10,000 people who have diabetes
but have not yet been diagnosed.
› Diabetes is on the increase in Northern Ireland as it is
worldwide. The number of people living with Type 1 and Type
2 diabetes has increased by 33% in Northern Ireland during
the last five years compared to just 25% in England, 20% in
Wales and 18% in Scotland
Diabetes Mellitus- The Facts
› Many more people have blood sugar levels above the normal
range, but not high enough to be diagnosed as having
diabetes.
› This is sometimes known as pre-diabetes. If your blood sugar
level is above the normal range, your risk of developing fullblown diabetes is increased.
Diabetes Mellitus- The Facts
› It's very important for diabetes to be diagnosed as early as
possible because it will get progressively worse if left
untreated.
› You should therefore visit your GP or pharmacist as soon as possible if
you have symptoms, such as feeling thirsty, passing urine more often
than usual and feeling tired all the time.
Diabetes Mellitus- Symptoms
The main symptoms of diabetes are:
› feeling very thirsty
› urinating more frequently than usual, particularly at night
› feeling very tired
› weight loss and loss of muscle bulk
› itching around the penis or vagina, or frequent episodes
of thrush
› cuts or wounds that heal slowly
› blurred vision (caused by the lens of the eye becoming dry)
Diabetes-Symptoms
Diabetes Mellitus- The Cause
› The amount of sugar in the blood is controlled by a hormone
called insulin, which is produced by the pancreas (a gland
behind the stomach).
› When food is digested and enters your bloodstream, insulin
moves glucose out of the blood and into cells, where it's
broken down to produce energy.
› However, if you have diabetes, your body is unable to break
down glucose into energy. This is because there's either not
enough insulin to move the glucose, or the insulin produced
doesn't work properly.
Type I Diabetes
› In type 1 diabetes, the body's immune system attacks and
destroys the cells that produce insulin. As no insulin is
produced, your glucose levels increase, which can seriously
damage the body's organs.
› Type 1 diabetes is often known as insulin-dependent diabetes.
It's also sometimes known as juvenile diabetes or early-onset
diabetes because it usually develops before the age of 40,
often during the teenage years.
Type I Diabetes
› Type 1 diabetes is less common than type 2 diabetes. In the
UK, it affects about 10% of all adults with diabetes.
› If you're diagnosed with type 1 diabetes, you'll need insulin
injections for the rest of your life. You'll also need to pay close
attention to certain aspects of your lifestyle and health to
ensure your blood glucose levels stay balanced. For example,
you'll need to eat healthily, take regular exercise and carry out
regular blood tests.
Type I Diabetes
› It's important that diabetes is diagnosed as early as possible
so that treatment can be started.
› Diabetes can't be cured, but treatment aims to keep your
blood glucose levels as normal as possible, and control your
symptoms to prevent health problems developing later
Type I Diabetes
› As your body can't produce insulin, you'll need regular insulin
injections to keep your glucose levels normal. You'll be taught
how to do this and how to match the insulin you inject to the
food you eat, taking into account your blood glucose level and
how much exercise you do.
› Insulin injections comes in several different forms, with each
working slightly differently. Some last up to a whole day (longacting), some last up to eight hours (short-acting) and some
work quickly but don't last very long (rapid-acting). You'll most
likely need a combination of different insulin preparations.
Type I Diabetes
› Insulin must be injected because if it were taken as a tablet, it
would be broken down in your stomach like food and unable
to enter your bloodstream
Type I Diabetes
› There are alternatives to insulin injections but they're only
suitable for a small number of patients. They are:
› insulin pump therapy - where a small device that constantly
pumps insulin (at a rate you control) into your bloodstream
through a needle that's inserted under the skin
› islet cell transplantation - where healthy insulin-producing
cells from the pancreas of a deceased donor are implanted
into the pancreas of someone with type 1 diabetes
› a complete pancreas transplant.
Type I Diabetes
› If diabetes is left untreated it can cause a number of different
health problems. Large amounts of glucose can damage blood
vessels, nerves and organs.
› Even a mildly raised glucose level that doesn't cause any
symptoms can have damaging effects in the long term.
Type II Diabetes
› Type 2 diabetes is where the body doesn't produce enough
insulin or the body's cells don't react to insulin. This is known
as insulin resistance.
› Type 2 diabetes is far more common than type 1 diabetes.
In the UK, around 90% of all adults with diabetes have type 2
diabetes.
Type II Diabetes
› If you're diagnosed with type 2 diabetes, you may be able to
control your symptoms simply by eating a healthy diet,
exercising regularly and monitoring your blood glucose levels.
› However, as type 2 diabetes is a progressive condition, you
may eventually need medication, usually in the form of
tablets.
› Type 2 diabetes is often associated with obesity. Obesityrelated diabetes is sometimes referred to as maturity-onset
diabetes because it's more common in older people.
Type II Diabetes
The rapid rise in the number of adults developing type 2
diabetes is due to:
› increasing levels of obesity
› a lack of exercise
› increase in unhealthy diets
› an ageing population
› Even if you feel healthy, you may have a higher than normal
blood glucose level (pre-diabetes) and be at risk of getting the
condition.
Type II Diabetes
› It's therefore important to take preventative measures by
making any necessary lifestyle changes, such as eating more
healthily, losing weight (if you're overweight) and becoming
more physically active.
Risk Factors
At risk groups
Although all adults are at risk of developing type 2 diabetes, a
number of groups have a particularly high risk of developing the
condition.
Your risk of developing type 2 diabetes is increased if:
› you're over 40 years of age (over 25 if you're South Asian)
› you have a close family member with diabetes (a parent, brother or
sister)
› you're overweight or obese, with a waist size of over 80cm (31.5
inches) for women and 94cm (37 inches) for men, or 89cm (35
inches) for South Asian men
Risk Factors
› you're of South Asian, Chinese, African-Caribbean
› you've ever had a cardiovascular disease, such as a heart attack
or stroke
› you're a woman with polycystic ovary syndrome (PCOS) and also
overweight
› you're a woman and you've had gestational diabetes or given birth
to a baby of over 10 pounds
› you have a severe mental health condition, such
as depression, schizophrenia or bipolar disorder, and you're taking
medication for it
› you've been told you have impaired glucose tolerance or impaired
fasting glycaemia
Diet
Increasing the amount of fibre in your diet and reducing your fat
intake, particularly saturated fat, can help prevent type 2
diabetes, as well as manage the condition if you already have it.
You should:
› increase your consumption of high fibre foods, such as
wholegrain bread and cereals, beans and lentils, and fruit and
vegetables
› choose foods that are low in fat – replace butter, ghee and
coconut oil with low fat spreads and vegetable oil
› choose skimmed and semi-skimmed milk, and low fat
yoghurts
Diet
› eat fish and lean meat rather than fatty or processed meat,
such as sausages and burgers
› grill, bake, poach or steam food instead of frying or roasting it
› avoid high fat foods, such as mayonnaise, chips, crisps, pasties,
poppadums and samosas
› eat fruit, unsalted nuts and low fat yoghurts as snacks instead
of cakes, biscuits, or crisps
Weight
› If you're overweight or obese (you have a body mass index
(BMI) of 30 or over), you should lose weight, by gradually by
reducing your calorie intake and becoming more physically
active.
› Losing 5-10% of your overall body weight over the course of a
year is a realistic initial target. You should aim to continue to
lose weight until you've achieved and maintained a BMI within
the healthy range, which is:
› 18.5-24.9kg/m² for the general population
Physical Activity
Being physically active is very important in preventing or
managing type 2 diabetes.
For adults who are 19-64 years of age, the government
recommends a minimum of:
› 150 minutes (2 hours and 30 minutes) of"moderateintensity" aerobic activity, such as cycling or fast walking, a
week, which can be taken in sessions of 10 minutes or
more, and
› muscle-strengthening activities on two or more days a week
that work all major muscle groups (legs, hips, back, tummy
(abdomen), chest, shoulders and arms).
Physical Activity
An alternative recommendation is to do a minimum of:
› 75 minutes of "vigorous-intensity" aerobic activity, such
as running or a game of tennis every week, and
› muscle-strengthening activities on two or more days a week
that work all major muscle groups (legs, hips, back, abdomen,
chest, shoulders and arms).
› In cases where the above activity levels are unrealistic, even
small increases in physical activity will be beneficial to your
health and act as a basis for future improvements.
Type II Diabetes Medication
› You may eventually need to take medication to help control
your blood glucose levels. Initially, this will usually be in the
form of tablets, and can sometimes be a combination of more
than one type of tablet. It may also include insulin or other
medication that you inject.
Medication
Metformin
› Metformin is usually the first medicine that's used to treat
type 2 diabetes. It works by reducing the amount of glucose
that your liver releases into your bloodstream. It also makes
your body's cells more responsive to insulin.
› Metformin is recommended for adults with a high risk of
developing type 2 diabetes, whose blood glucose is still
progressing towards type 2 diabetes, despite making
necessary lifestyle changes.
Medication
› If you're overweight, it's also likely you'll be prescribed
metformin. Unlike some other medicines used to treat type 2
diabetes, metformin shouldn't cause additional weight gain.
› However, it can sometimes cause mild side effects, such as
nausea and diarrhoea, and you may not be able to take it if
you have kidney damage.
Medication
Sulphonylureas
Sulphonylureas increase the amount of insulin that's produced
by your pancreas. Examples of sulphonylureas include:
› glibenclamide
› gliclazide
› glimepiride
› glipizide
› gliquidone
Medication
› You may be prescribed one of these medicines if you can't
take metformin, or if you aren't overweight. Alternatively, you
may be prescribed sulphonylurea and metformin if metformin
doesn't control blood glucose on its own.
› Sulphonylureas can increase the risk of hypoglycaemia (low
blood sugar), because they increase the amount of insulin in
your body. They can also sometimes cause side effects
including weight gain, nausea and diarrhoea.
Medication
Glitazones (thiazolidinediones, TZDs)
› Thiazolidinedione medicines (pioglitazone) make your body’s
cells more sensitive to insulin so that more glucose is taken
from your blood.
› They're usually used in combination with metformin or
sulphonylureas, or both. They may cause weight gain andankle
swelling (oedema). You shouldn't take pioglitazone if you
have heart failure or a high risk of bone fracture
Medication
Gliptins (DPP-4 inhibitors)
› Gliptins work by preventing the breakdown of a naturally
occurring hormone called GLP-1. GLP-1 helps the body
produce insulin in response to high blood glucose levels, but is
rapidly broken down.
› By preventing this breakdown, the gliptins (linagliptin,
saxagliptin, sitagliptin and vildagliptin) prevent high blood
glucose levels, but don't result in episodes of hypoglycaemia.
› You may be prescribed a gliptin if you're unable to take
sulphonylureas or glitazones, or in combination with them.
They're not associated with weight gain.
Medication
GLP-1 agonists
› Exenatide is a GLP-1 agonist, an injectable treatment that acts
in a similar way to the natural hormone GLP-1 (see the section
on gliptins, above).
› It's injected twice a day and boosts insulin production when
there are high blood glucose levels, reducing blood glucose
without the risk of hypoglycaemia episodes ("hypos").
› It also leads to modest weight loss in many people who take it.
It's mainly used in people on metformin plus sulphonylurea,
who are obese
Medication
Acarbose
› Acarbose helps prevent your blood glucose level from
increasing too much after you eat a meal. It slows down the
rate at which your digestive system breaks carbohydrates
down into glucose.
› Acarbose isn't often used to treat type 2 diabetes because it
usually causes side effects, such as bloating and diarrhoea.
However, it may be prescribed if you can't take other types of
medicine for type 2 diabetes
Medication
Nateglinide and repaglinide
› Nateglinide and repaglinide stimulate the release of insulin by
your pancreas. They're not commonly used, but may be an
option if you have meals at irregular times. This is because
their effects don't last very long, but they're effective when
taken just before you eat.
› Nateglinide and repaglinide can cause side effects, such as
weight gain and hypoglycaemia (low blood sugar)
Medication
› If glucose-lowering tablets aren't effective in controlling your
blood glucose levels, you may need to have insulin treatment.
This can be taken instead of or alongside your tablets,
depending on the dose and the way that you take it.
› Insulin comes in several different preparations, and each
works slightly differently. For example, some last up to a whole
day (long-acting), some last up to eight hours (short-acting)
and some work quickly but don't last very long (rapid-acting).
› Your treatment may include a combination of these different
insulin preparations
Other Medications
If you have type 2 diabetes, your risk of developing heart
disease, stroke and kidney disease is increased.
› To reduce your risk of developing other serious health conditions, you
may be advised to take other medicines, including:
› anti-hypertensive medicines to control high blood pressure
› a statin, such as simvastatin or atorvastatin, to reduce high cholesterol
› low-dose aspirin to prevent a stroke
› an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril,
lisinopril or ramipril, if you have the early signs of diabetic kidney disease
› Diabetic kidney disease is identified by the presence of small amounts of
albumin (a protein) in your urine. If treated early enough, it may be
reversible.
How to Control “Hypos”
› Hypoglycaemia is where your blood glucose levels become
very low. Mild hypoglycaemia (a "hypo") can make you feel
shaky, weak and hungry, but it can usually be controlled by
eating or drinking something sugary.
› If you have a hypo, you should initially have a form of
carbohydrate that will act quickly, such as a sugary drink or
glucose tablets. This should be followed by a longer-acting
carbohydrate, such as a cereal bar, sandwich or piece of fruit.
In most cases, these measures will be enough to raise your
blood glucose level to normal, although it may take a few
hours.
How to Control “Hypos”
› If you develop severe hypoglycaemia, you may become drowsy
and confused, and you may even lose consciousness. If this
occurs, you may need to have an injection of glucagon into
your muscle or glucose into a vein. Glucagon is a hormone
that quickly increases your blood glucose levels.
Gestational Diabetes
Gestational diabetes (in pregnancy)
› During pregnancy, some women have such high levels of
blood glucose that their body is unable to produce enough
insulin to absorb it all. This is known as gestational diabetes
and affects up to 18 in 100 women during pregnancy.
› Pregnancy can also make existing type 1 diabetes worse.
Gestational diabetes can increase the risk of health problems
developing in an unborn baby, so it's important to keep your
blood glucose levels under control.
Gestational Diabetes
› In most cases, gestational diabetes develops during the
second trimester of pregnancy (weeks 14 to 26) and
disappears after the baby is born.
› However, women who have gestational diabetes are at an
increased risk (30%) of developing type 2 diabetes later in life
(compared with a 10% risk for the general population)
Care
Having the right care is essential for the wellbeing of all people with
diabetes. Some essentials:› Get your blood glucose levels measured at least once a year. An
HbA1c blood test will measure your overall blood glucose control
and help you and your diabetes
› Have your blood pressure measured and recorded at least once a
year
› Have your blood fats (such as cholesterol) measured every year
› Have your eyes screened for signs of retinopathy every year. A
special digital camera is used to take a photograph of your retina
(at the back of your eye)
Care
› Have your feet checked. The skin, circulation and nerve supply of
your feet should be examined annually. You should be told if you
have any risk of foot problems
› Have your kidney function monitored annually. You should have
two tests for your kidneys: urine test for protein (a sign of possible
kidney problems) and a blood test to measure kidney function.
› Have your weight checked and your waist measured to see if you
need to lose weight.
› Get support if you are a smoker including advice and support on
how to quit.
› Having diabetes already puts people at increased risk of heart
disease and stroke, and smoking further increases this risk.
Treatment Locally
Treatment in the Western Health and Social Care Trust
› Generally people with Type 2 diabetes will be looked after by their GP
practice team or be referred to a hospital diabetes clinic, especially if
their needs are complex, depending on local facilities. People with Type
1 diabetes will usually always be referred to the local hospital diabetes
specialist team.
Psychology Services
› Each Trust in Northern Ireland has a clinical psychologist with a specialist
interest in diabetes. If someone is experiencing significant psychological
distress which is affecting their ability to look after their diabetes a
referral can be arranged via the local hospital diabetes team or via the
community Diabetes Specialist Nurse. GPs also have access to local
mental health services and sometimes to practise based counsellors who
can help people to talk through and make sense of their feelings.
Treatment Locally
Annual eye screening
› Everyone with diabetes over the age of 12 should have their
eyes screened, for diabetic retinopathy, on an annual basis. In
Northern Ireland the screening is organised centrally by the
Diabetic Retinopathy Screening Programme.
› The Programme will obtain your details from your GP and
send you a letter asking you to come for screening in your
local area. It is very important that you attend.
Treatment Locally
Structured diabetes education
Type 1 diabetes
› CHOICE Programme is delivered in Altnagelvin, Tyrone and
Fermanagh
Type 2 diabetes (both newly diagnosed and established)
› DESMOND is delivered in Altnagelvin, Limavady, Tyrone and
Fermanagh