Diabetes

This week is Diabetes Awareness week. To help raise awareness, I have written this blog talking about the different types of diabetes and have invited a special guest writer to talk about her experiences with the condition.

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Diabetes is a life-long medical condition which causes a sufferer’s blood glucose (sugar) levels to become too high. If it is left untreated, high blood glucose levels can cause serious health complications.

There are two main types of diabetes; type 1 and type 2. There is also gestational diabetes.

The symptoms of diabetes include:

  • Excessive thirst
  • Frequent urination, particularly at night
  • Feeling very tired
  • Weight loss and loss of muscle bulk
  • Itchiness around the genital area/frequent bouts of thrush (a yeast infection)
  • Blurred vision
  • Slow wound healing
  • At a later stage, vomiting or heavy, deep breathing

Diabetes can sometimes cause the sufferer to experience either hypoglycaemia or hyperglycaemia.

Hypoglycaemia

Hypoglycaemia (or simply known as a “hypo”) is when the blood glucose levels become very low. This can often occur from taking too much insulin, skipping a meal, exercising vigorously or drinking alcohol on an empty stomach. Symptoms of a “hypo” include:

  • Feeling shaky and irritable
  • Sweating
  • Tingling lips
  • Feeling weak
  • Feeling confused
  • Hunger
  • Nausea

A “hypo” can usually be brought under control by eating or drinking something sugary. However, if it isn’t brought under control, it can result in confusion, slurred speech and possibly loss of consciousness. This would be an emergency situation and would require medical attention.

Hyperglycaemia

Hyperglycaemia is when the blood glucose levels become too high. This can often occur in type 1 diabetes because of the lack of insulin produced (explained in more detail below). Symptoms of hyperglycaemia include:

  • Extreme thirst
  • Dry mouth
  • Blurred vision
  • Drowsiness
  • A frequent need to urinate

If it is left untreated, it can lead to diabetic ketoacidosis. Diabetic ketoacidosis is when the body breaks down fat and muscle as an alternative energy source. This leads to a build-up of acids in the blood. This is a serious condition which can cause vomiting, dehydration, unconsciousness and possibly death.

Type 1 Diabetes

Type 1 diabetes is an autoimmune condition. This means that the immune system mistakenly attacks healthy body tissue. In the case of diabetes, the immune system attacks the cells in the pancreas. Therefore, the pancreas is unable to produce insulin because of the damage caused to it. Insulin is a hormone (produced in the pancreas) which works as a chemical messenger. This chemical messenger helps the body to use the glucose in the blood for energy. If the pancreas can’t produce insulin, glucose can’t be moved into the bloodstream and into the cells which means that the blood sugars will become too high. Type 1 diabetes is usually diagnosed at a young age but can develop at any age. The symptoms usually develop quickly – over a few days or weeks.

Type 2 Diabetes

While type 1 diabetes is usually developed in childhood, type 2 diabetes is usually lifestyle related. It has a strong association with obesity and tends to be diagnosed in older people. Type 2 occurs when the pancreas doesn’t produce enough insulin or the body’s cells don’t react to insulin.

Gestational Diabetes

Gestational diabetes develops during pregnancy and usually disappears after giving birth. It occurs if the body can’t produce enough insulin to meet the extra needs of pregnancy. Gestational diabetes can cause problems to mother and baby such as premature birth and pre-eclampsia but these risks can be reduced if it’s detected and managed well.

Diagnosis

It is important to get diagnosed as soon as possible. Your GP may request a blood test and urine sample. A blood test for diagnosing diabetes may require you to fast in order to test your blood glucose levels. A urine test can be used to check if there is any glucose passing from the kidneys into the urine (an indicator of diabetes).

Treatment

Diabetes is not curable. However, it can be managed. For type 1, you’ll need regular insulin treatment to make up for the lack of insulin being produced in the pancreas. This can either be done through insulin pen injections or an insulin pump. You may also be advised to monitor your blood glucose levels at home using a blood glucose monitor. When you’re diagnosed, a diabetes care team will teach you how to do all of this.

The treatment of type 2 focuses mainly on lifestyle changes. The three major areas of focus are:

  • Diet
  • Weight
  • Exercise

You may also be required to take medication to help control blood sugar levels such as Metformin which reduces the amount of glucose the liver releases into the bloodstream. Your diabetic care team will advise you on whether you require medication and what is the best type for you to take.

Gestational diabetes can be managed with the same type of lifestyle changes and treatment as type 2 diabetes.

If you have type 1, it is also important to make any necessary lifestyle changes to help with your weight and blood glucose.

Diet

For anyone with diabetes, it is important to eat a healthy and balanced diet to help control blood glucose levels and maintain a healthy weight. It is not a “diet” based on restriction, it is about making better choices and having certain foods in moderation. Even if you haven’t got diabetes, it is important to maintain a balanced diet and weight as it will help to reduce the risk of developing type 2 or gestational diabetes. Here are some tips for a healthy, balanced diet:

  • Swap refined carbohydrates such as white bread, white pasta and sugary sweets and pastries for starchy carbohydrates such as wholegrains, fruits and vegetables. These release glucose at a slower rate which will prevent blood sugar spikes.
  • Increase the amount of fibre with food sources such as wholegrains, beans and lentils, fruit and vegetables.
  • Eat protein with carbohydrates. This will slow down the release of sugars which will keep your blood sugar levels steady and will keep you fuller for longer.
  • Reduce your saturated (bad) fat intake by making simple food swaps such as switching to skimmed or semi-skimmed milk. However, make sure you check the food labels as some low-fat products such as yoghurts contain added sugar. You can reduce your intake of fatty red meat and processed meat (burgers and sausages) and choose poultry (no skin) and fish to decrease saturated fat. Choose healthier fat sources such as nuts, oily fish and avocado.
  • Cook your meals yourself rather than buy ready meals or takeaways. That way, you can control the amount of sugar, fat and salt added.
  • Limit sugary drinks. This includes fruit juices. Also limit alcohol.

Weight

You are more at risk of developing diabetes if you are overweight or obese. If you already have diabetes, reducing your weight can help to improve symptoms and overall health. This can be done through changing your eating habits and doing physical activity.

Exercise

It is important for everyone to include some exercise into their daily lives. For diabetics, exercise can be very beneficial as it can help with weight control, strengthen bones and help the body use insulin more effectively. The general recommendations for children are 60 minutes of moderate-vigorous intensity exercise each day while the recommendations for adults are 150 minutes per week (30 minutes 5 days a week) of moderate-vigorous intensity exercise. This should be a combination of cardio, strength/resistance training and flexibility training. It is also a good idea to include forms of exercise which help to calm the mind as diabetes can often cause stress for a number of reasons e.g. poor management or the strain of having to try and manage it. Examples include yoga and meditation.

Here is a story of one person’s diagnosis and life living with Type 1 Diabetes:

“My name is Sally. I am 25 years old and have type 1 diabetes. I was diagnosed with the condition when I was 10 years old on 21st January 2003 – the day my life changed forever and one that I will never forget.

My story of how I came to be diagnosed is probably like that of no other young diabetic. A month before I was diagnosed, I had been drinking a lot of water and had lost a considerable amount of weight in a very short period. My mother had noticed my excessive thirst, but couldn’t figure out why it had come about. Despite being thirsty all the time, I don’t remember ever feeling ill or weak in the slightest – pretty strange when you hear the many stories of other diabetics.

Eventually, on Tuesday 21st January 2003, my father came into my room, looking concerned, but calm at the same time, to tell me that I would not be going to school. My father had explained that we would be going to the hospital. Although he would not tell me why we were going, dad told me I had nothing to worry about. I remember going into St Mary’s hospital on that day and feeling very happy and flattered by the love and attention that was being shown to me by the staff, despite being unaware of why I was really there. During my stay, doctors and nurses were constantly doing blood tests on me and taking urine samples. We were in hospital until the evening. As a child who never paid attention, the reality of my hospital visit hadn’t hit me and I went home not grasping the full reality of what was to come.

It was not until the next day that the reality had hit home. The doctor had come round to our house with some equipment: a small blood testing machine and some reusable injection pens. I had to be injected with insulin twice a day; once in the morning and once in the evening, before dinner. I found all this very unsettling and would ask my dad why I had to have these horrible injections? He then explained that I had a condition called diabetes and told me I could never eat anything with sugar. Being a child, this thought horrified me. However, my dad would lie to me, saying the condition isn’t long-term – ‘it will be gone next week’, then it was, ‘it will be gone next month’, and so on. Eventually, I came to realise that there was no cure for diabetes and that it was here to stay.

Knowing that I was stuck with this illness for life had brought my world down. I was in constant denial and had spent most days crying; it felt as though a part of me had died and I was in mourning for a long time. From then on life was a struggle as I suffered many high (hyperglycaemic) and low (hypoglycaemic) episodes (all though my blood sugars were never too high or too low to require emergency help).

At home, my father always gave me my injections and monitored my blood glucose levels. Whenever my blood glucose levels weren’t where they needed to be, he would shout and scare me by telling me that I would die from this disease or that it was slowly killing me. As a result, I became too scared to check my blood glucose levels and the relationship with my parents strained. This led to me rebelling by eating sweets when one was watching.

As a type 1 diabetic teenager, things went from bad to worst. In school, I had no one to support me and to see that I was getting the right care whenever my blood glucose levels dropped in class. Even if I explained my condition to the teacher, they always seemed annoyed and burdened. I now know that most teachers are not trained to deal with this sort of situation and so it would come as a shock to most. From the age of 16-18 I developed depression due to the stress of not only dealing the condition itself, but also a low self-esteem, developed from being bullied, pressured and being criticised by teachers for being too quiet in class. Teachers would judge me unfairly without even talking to me; there were other kids who never contributed in class, but were never singled out for criticism just because they had extroverted personalities.

Having developed depression, I had Cognitive Behavioural Therapy for 6 months. Whenever I went to the sessions, I felt happy and positive afterwards. However, home and school were both negative environments and as a result, the positive impacts of CBT would disappear. The stress of doing my A levels further led to me neglecting my blood glucose levels and my depression and negative attitude towards the diabetes had only worsened.

However, leaving school at 18 marked a turning point for me: I had moved from paediatric to adult clinic and started self-managing my condition, without the involvement of my parents. Slowly, but surely my blood sugar levels were stabilising and I started to feel much better than I ever had before. From this I discovered the connection between poorly controlled diabetes and mental health, something which I believe many medical professionals fail to educate and prepare diabetics for. My conclusion now, which seems frustratingly obvious, is that had I maintained better control of my diabetes, my concentration at school wouldn’t have suffered and I possibly would’ve been able to handle stressful situations. From this moment on, I take a positive approach to my diabetes and do everything in my power to keep it under control, through a combination of healthy eating and regular exercise. Since adopting this approach, my blood sugar levels have improved greatly.

Since September 2013, I have been administering insulin into my body in the form of an insulin pump. Unlike with the injections, the pump gives me greater flexibility, in terms of exercise, eating times and what I can eat. Nevertheless, it has taken time for me to fully understand the features of the pump and when it is best to adjust and decrease my insulin levels. I guess you can say that type 1 diabetes isn’t as straightforward as many other conditions; you’re always learning something new about it as the years go by.

I would like to conclude this blog by telling you what I’ve learnt about being a type 1 diabetic, having lived with the condition for over 14 years now. I believe that the more educated and aware a person is about diabetes, the better control they will have over it as they will know what to do and be well prepared for what is to come. In addition, as unfair as it is that a diabetic has to work full-time to manage their condition around the clock in order live a normal life, it is worth it; when its well-controlled, you don’t feel any different to a non-diabetic.”

 

Diabetes is not an easy condition to live with but as long as you properly manage it and have the support of loved ones, support networks such as diabetes.org.uk and a medical team, you can lead a normal and happy life.

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